How can I accurately describe my symptoms to the C&P Psychologist?

Written by Dr. Deborah Miller, PhD, HSPP - Owner and Lead Psychologist at vetnexusletter.com

You've filed your claim and you've been called in for a C&P examination with a VA psychologist. To prepare for the exam, you take a look at the VA's Disability Benefits Questionnaire (DBQ) for mental health or PTSD. You notice a list of symptom checkboxes that the examiner can choose based on what you say during your mental health examination. But what the heck is "circumlocutory speech"?? What would be considered "grossly inappropriate behavior"?

Many veterans have never talked about their mental health before their C&P exams, and it's difficult to know what the examiner will ask, and what experiences will be important to share as part of your mental health exam. Below is the list of VA symptoms on the DBQ form, and a clear explanation of what the symptom means, and what that symptom might look like in daily life. If you're experiencing these symptoms or something similar, it's important to discuss them with your examiner, even if they don't ask directly.

It's also important not to fabricate symptoms for your exam just to get a higher rating, as your examiner will likely notice any inconsistencies in your daily functioning vs. the symptoms you're reporting. For instance, if you've held the same job for 10 years but you're reporting that you can't remember the names of your own children, that will probably not make much sense to the examiner and they will likely not find you a very credible examinee. So do your best not to minimize your symptoms, but also don't report symptoms that you don't actually experience.

That said - here are the list of mental health symptoms the VA examiners should assess during your C&P mental health/PTSD exam, with explanations and examples:

• Depressed mood

  What it is: Feeling low, sad, or disinterested most of the day, nearly every day.

  Example: You quit riding your motorcycle or fishing because nothing feels worth the effort.

  
  

• Anxiety

  What it is: Constant worry, overthinking, overanalyzing; nervous energy, muscle tension, racing thoughts.

  Example: You worry about small things and overanalyze simple interactions. This may cause physical restlessness, fidgeting, and feeling like you can't fully relax.

  
  

• Suspiciousness

  What it is: Distrust of others that goes beyond healthy caution.

  Example: You assume every unknown caller is a scam and every strange car on your street is casing the house. Romantic partnerships fail because you think they're cheating even if they've never given you reason to distrust them.

  
  

• Panic attacks that occur weekly or less often

  What it is: Sudden surges of intense fear/dread with physical symptoms (pounding heart, , shortness of breath, sweating).

  Example: Once or twice a month you wake from sleep sure you’re suffocating and have to step outside to breathe.

  
  

• Panic attacks more than once a week

  What it is: Same as above but happening several times a week.

  Example: You keep a change of clothes in the truck because panic sweats soak the one you’re wearing before lunch. You don't go to the grocery store anymore because you know you'll have an attack.

  
  

• Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively

  What it is: You’re overwhelmed most of the time, so day-to-day tasks collapse.

  Example: Groceries spoil because you can’t push yourself to cook or even order take-out.

  
  

• Chronic sleep impairment

  What it is: Trouble falling or staying asleep, or restless, non-restorative sleep.

  Example: You get two hours here, one hour there, and rely on energy drinks to stay awake at work.

  
  

• Mild memory loss (forgetting names, directions, recent events)

  What it is: Little everyday blanks.

  Example: You meet a neighbor, swap names, and draw a blank 30 seconds later. Your wife reminds you of an event you're attending that evening but you swear she never told you about it (she did, trust me).

  
  

• Impairment of short- and long-term memory (retention of only highly learned material, forgetting to complete tasks)

  What it is: Only the big stuff sticks; smaller tasks drop.

  Example: You remember rifle serial numbers from boot camp but forget to pay the electric bill—again.

  
  

• Memory loss for names of close relatives, own occupation, or own name

  What it is: Severe memory gaps.

  Example: For a few moments you can’t recall your kid’s name when a teacher calls.

  
  

• Flattened affect

  What it is: Limited or no emotional expression.

  Example: Your buddies tell a hilarious story; you register it with a nod—no smile, no laugh. Your dog dies and you don't feel much of anything.

  
  

• Circumstantial, circumlocutory, or stereotyped speech

  What it is: Talking circles, over-explaining, or relying on catch-phrases.

  Example: Asked how your day was, you start at breakfast and wander off into a 20-minute tangent.

  
  

• Speech intermittently illogical, obscure, or irrelevant

  What it is: Sentences don’t connect; listeners can’t follow you.

  Example: In a meeting you reply to “What’s the timeline?” with “The timeline has purple edges, just like steam.”

  
  

• Difficulty in understanding complex commands

  What it is: Multi-step directions get scrambled.

  Example: The foreman rattles off a three-step safety check; you catch step one and lose the rest.

  
  

• Impaired judgment

  What it is: Trouble weighing pros and cons or seeing consequences.

  Example: You blow a paycheck on a motorcycle part before rent is paid.

  
  

• Impaired abstract thinking

  What it is: Struggling with ideas that aren’t concrete.

  Example: You can’t grasp a metaphor in a simple conversation and take everything literally.

  
  

• Gross impairment in thought processes or communication

  What it is: Thoughts are disorganized; speech is incoherent.

  Example: You start a story about fixing the lawn mower and end up describing colors you smell.

  
  

• Disturbances of motivation and mood

  What it is: Low drive, unpredictable mood swings.

  Example: You’re fired up to start a home project, then crash on the couch for days without picking up a tool.

  
  

• Difficulty in establishing and maintaining effective work and social relationships

  What it is: You can land a job or friendship but can’t keep it steady.

  Example: First three months go well, then arguments blow up with co-workers and you quit or get fired.

  
  

• Difficulty adapting to stressful circumstances (including work or a work-like setting)

  What it is: Stress derails performance fast.

  Example: A schedule change sends you into a tailspin; you call off sick for a week. You lock yourself in your office every day because interacting with coworkers sets you off.

  
  

• Inability to establish and maintain effective relationships

  What it is: Connections fizzle or never form.

  Example: Family calls go unanswered; you ghost friends until they stop asking.

  
  

• Suicidal ideation

  What it is: Thoughts of killing yourself, with or without a plan.

  Example: Catching yourself thinking, “Everyone would be better off if I weren’t here,” more days than not.

  
  

• Obsessional rituals which interfere with routine activities

  What it is: Repetitive behaviors you feel driven to perform.

  Example: You lock and unlock the front door 20 times before leaving, making you late to appointments.

  
  

• Impaired impulse control (such as unprovoked irritability with periods of violence)

  What it is: Sudden actions without thinking, often angry.

  Example: Someone cuts you off in traffic; you chase them for miles, fists clenched. Being irritated with your boss at work and blowing up on him instead of approaching it in a calm manner.

  
  

• Spatial disorientation

  What it is: Losing sense of where you are.

  Example: You walk out of a familiar store and can’t remember which way the parking lot is. This can also happen during a PTSD flashback when you feel for a moment like you're physically back in a traumatic experience.

  
  

• Persistent delusions or hallucinations

  What it is: Fixed false beliefs or sensing things that aren’t there.

  Example: Hearing voices in a quiet room telling you you’re under surveillance.

  
  

• Grossly inappropriate behavior

  What it is: Actions wildly out of social norms.

  Example: Stripping off your shirt and yelling at strangers in the grocery aisle.

  
  

• Persistent danger of hurting self or others

  What it is: Ongoing risk because of actions or intents.

  Example: Keeping a loaded gun on your lap “just in case” every time someone knocks. Recurring suicidal behavior. Getting into frequent physical fights or road rage incidents.

  
  

• Neglect of personal appearance and hygiene

  What it is: Skipping showers, laundry, grooming.

  Example: Wearing the same stained clothes for a week and not noticing the odor. Neglecting to shower or brush teeth for days at a time, not just on the weekend.

  
  

• Intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene)

  What it is: Some days you just can’t manage basics.

  Example: You can't manage to get out of bed except to use the bathroom; neglecting work, personal care, making food - unless someone forces you or helps you.

  
  

• Disorientation to time or place

  What it is: Not knowing where you are or what day/time it is.

  Example: Waking up in your own bed and needing several minutes to figure out the year.

If any of these sound similar to something you've experienced, discuss it with your C&P examiner. If you've been denied for a claim because you couldn't fully communicate your symptoms to a VA examiner, an independent mental health exam and DBQ with Dr. Miller could help, as she does her best to give you time and encouragement to detail your experiences. Contact Dr. Miller by filling out this form.