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    • What diagnostic code and rating percent did they give you for the  adjustment disorder with mixed anxiety and depression? That is a ratable condition,if there was a service nexus. I will try to find your past posts. CUEs are found within decisions and rating sheets and depend on established medical evidence. It seems to me that the examiner, in 2015,  referred to established medical evidence. Have you filed a NOD yet?     "CONCLUSIONS OF LAW   1.  The criteria are not met for an effective date earlier than August 12, 2004, for the grant of service connection for adjustment disorder with mixed anxiety and depression.  38 U.S.C.A. § 5110 (West 2014); 38 C.F.R. §§ 3.1, 3.151, 3.155, 3.400 (2015).   2.  The criteria are not met for an effective date earlier than May 16, 2006, for the grant of service connection for headaches.  38 U.S.C.A. § 5110 (West 2014); 38 C.F.R. §§ 3.1, 3.105, 3.151, 3.155, 3.156, 3.400 (2015).   3.  The criteria are met for an initial rating of 100 percent for adjustment disorder with mixed anxiety and depression for the period from August 12, 2004 to January 8, 2015.  38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.340, 4.1-4.14, 4.21, 4.126, 4.130, Diagnostic Code 9411 (2015)." http://www.va.gov/vetapp16/Files3/1621642.txt   http://www.va.gov/vetapp16/Files3/1621642.txt
    • All non VA C & P  PTSD DBQ's, are Trumped by the C & P DBQ. The C & P Exam is "Forensic" in nature, Could you see your Private Dr, Psychiatrist or Psychologist, indicating that they think your over reporting your symptoms. Even with the VA, your treating MH Dr is required by VA Reg, to hand off your request for a PTSD DBQ to another MH Dr that is and has not been directly involved in your treatment. The whole Dr/Patient Trust thing comes in to play, they don't want you pissed at your treating Dr because of an unfavorable DBQ. As to your mentioned GAF Score of 53. 5 different MH Clinician's could come up with a wide ranging GAF Score, on the same day. That's why, the VA now uses the DSM V in DXing of PTSD. GAF scores are now of little or no significance. I can't recall seeing the GAF Score mentioned on any recent VA PTSD DBQ's postings here on Hadit. The old DSM-IV, used by the VA pre 2014, actually requested the GAF estimate for PTSD (other MH conditions also) be listed. Keep in mind, your PTSD C & P Exam is FORENSIC, nothing to do with treatment. Tell the Truth, be yourself, don't attempt to present yourself as any better or worse than you actually are, on a daily basis. Not unusual to have the Dr asked the same question 3 or more different ways. At the very end of the C & P exam, ask the Dr what his opinion of your condition is. If he's a VA VMC Dr, your C & P DBQ should be available from the VMC Med Records Dept and actually on your MHV Med Records in about 4- 5 days. Semper Fi
    • Armorer, I hear ya, many Vets have that same initial opinion. The VA, like most Private RX Ins Providers, has an RX Formulary, that they use. I was on Lipitor (01/2006) back in 09, when I 1st got hooked up with VA. VA's Formulary called for Simvastatin and my Private Dr didn't stipulate, Lipitor only. So I tried the Simvastatin. for about 1 yr, kept the Cholesterol #'s in check but started getting hell-latios Charley-horses late at night, in my thighs. Contacted my VA PCP, within 1 week, I started receiving the non-formulary Lipitor. The VA can and will supply you with any RX that you need, even if it's not on the VA Formulary. You can understand them, like all RX providers, preferring to use the most cost effective drug available. Just about all Rx's have some type of possible side-affect. the VA doesn't lock you into the (1) drug. As to Butcher's situation. You know, all Private Hospital ER's must treat you, right. It doesn't matter what your Insurance situation is, Private, VA or Uninsured. Hospitals, unlike Private Dr's, can not refuse a Vet using the VA Emergency Room coverage. I don't think that is Butcher's problem. VA regulations covering Non-VA Hospital ER coverage requires the Vet, Hospital ER Staff and/or the Vet's next Of-Kin, to notify the nearest VMC almost immediately, regarding the Non-VMC ER Admission.  Doing so gets the entire ER Bill covered, not doing so puts you in a real Trick Bag. Given the option, Private Hospitals will go to the fastest and most lucrative payer, Insurance Companies, private Individual and lastly the VA. If the VMC doesn't have a bed or Care required by the Vet's ER Condition, the VMC Chief can authorize continued care after the the Vet is Stabilized. Otherwise, the VMC will arrange Ambulance transfer to the VMC after the VEt is stabilized. The Rule of Thumb for Vet's, present your VA ID and request the ER Staff contact the nearest VMC. Keep your Medicare or other Medical Insurance card, hidden in your wallet (Don't mention your other Ins coverage), incase your unconscious and not accompanied by a knowledgeable family member. Both Medicare and Private Insurance companies have a sizable co-pays, 20% of $100K, would definitely FU your Day. Don't take the chance, follow the VA Rules, much easier and less stress. Semper Fi
    • VHA Directive 2013-002 Quote from the directive: "(a) A “no wrong door” philosophy must be adopted to accommodate Veterans bringing a DBQ to a VHA facility. Veterans may ask their Primary Care Providers (PCPs) and Specialists to complete a DBQ for conditions which are already diagnosed and documented and for which the PCP or Specialist is treating the Veteran. DBQs can be completed during a routine office visit when there is sufficient time and the medical information is available. DBQs can also be completed outside of an office visit, or an appointment can be scheduled for completion. A DBQ completed by a PCP or Specialist is considered by VBA as medical evidence to support the Veteran’s claim. VHA DIRECTIVE 2013-002 January 14, 2013 3 (b) If the VHA clinician is not confident completing a DBQ or finds the DBQ requires diagnostic testing not indicated in the history or current symptoms, or would otherwise be inappropriate to complete, the VHA clinician must not complete the DBQ but assist the Veteran in filing a claim for disability benefits. Depending on local processes, this may include directing the Veteran to the Veterans On-Line Application (VONAPP); to the VA benefits call center at 1-800-827-1000; to a Veterans Service Organization representative; or to other local resources. (c) VHA clinicians who are not disability examiners may complete DBQs via the CAPRI or SMART programs, when available. DBQs may also be completed through the Web site: http://www.benefits.va.gov/TRANSFORMATION/disabilityexams/. If a paper version of a DBQ is presented by a Veteran for completion, staff must copy the completed form to scan into the Computerized Patient Record System (CPRS). The original DBQ form must be returned to the Veteran so that the Veteran can submit it to VBA.

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Transient Ischemic Attack (Micro/minni Strokes)

25 posts in this topic


I may have ask this question before but don't know for sure. I have a history of mirco strokes and would like to know how I can get it service connected. CT scan and MRI of my brain showed that I have a history of micro strokes...a surprize and scare to me. I submitted a claim but the VA denied it saying it was not service connected. What should I do next?

Best Regards


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I am very familiar with this facet of neurology- but I have never seen TIAs rated by the VA at all.

They are symptomatic of something else.

When the VA did the CT and MRI they had to prepare a full narration of the MRI findings.Have you obtained a copy of that yet?

What did VA say was the cause of these TIAs?

If you have DMII from AO or IHD from AO this would be a way to claim the TIAs.As long as there are no serious residuals then this would already be a service connected factor even if they rate at Zero SC if you ever have a major stroke.

If the VA had properly assessed my husband's TIAs (I took him to the ER every time they happened)

he might well be alive today.

There are many medical causes of TIA as well as preventive medical steps the VA can take. The VA needs to assess the cause of the TIAs and then treat the cause.

Their lack of proper diagnosis and treatment for the initial multiple presentations my husband had of this symptom (TIA) of his undiagnosed and untreated IHD and DMII was a very strong factor in my FTCA case and 1151 claim.

Cardio embolism, HBP, cerebral atherosclerosis, cerebral thrombosis – there are numerous types of TIAs as well as many causes.

The VA has to diagnosis the cause for you and then provide proper treatment.The cause could be something you potentially could have service connected.

When I get my IHD claim resolved, there might be a statement or even a rating for my husband's TIAs as I proved all of his brain trauma was due to his IHD.His CVA which VA rated but incorrectly should be 100% for 2 years in that decision.I have no guess on the IHD rating.

VA told me Friday they want to get all AO Nehmer claims resolved by end of October.

If I do receive a rating fr his TIAs I sure will post that here but I really dont expect any rating on them,nly on the Stroke that resulted from leaving them untreated.

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Their might be ratable TIA cases at the BVA web site-and this info indicates there could be a ratable residual.

My husband as a VA employee at time of his TIAs, had a definite and documented decrease in his work performance. His vision changed abruptly that fall. The year before he had the first deer kill in the county on opening day of Hunting season (and 20/20 vision without glasses)but after these TIAs, the next fall, I pushed out 7 deer to him in our woods and they all ran by him but even with a new scope on the Mossberg he didnt take a shot.He didnt trust his vision anymore and asked for a documented accomodation at the VA job because the glasses VA gave him didnt help with his damaged peripheral vision.

Your question here made me realize that I did send this info to the VA and if they dont rated the TIAs maybe I will appeal that.

Everyone needs to know symptoms of TIAs:

“The warning signs of a TIA are exactly the same as for a stroke:

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

Sudden confusion, trouble speaking or understanding

Sudden trouble seeing in one or both eyes

Sudden trouble walking, dizziness, loss of balance or coordination

Sudden, severe headache with no known cause”



“American Stroke Association meeting report:

SAN ANTONIO, Feb. 24, 2010 — Nearly four in 10 transient ischemic attack (TIA) and minor ischemic stroke patients may experience mental impairment, according to a study presented at the American Stroke Association’s International Stroke Conference 2010. “


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Greetings Berta

Sorry to hear about your husband but very glad that you are still fighting for justice.

Here is an clip of my claim for TIA and results:

Service connection for ischemic strokes and seizures as secondary to the service connected

disability of hepatitis C {also claimed as short term memory and concentration levels}.

We have considered but denied your claim for service connection for ischemic strokes

and seizures because there is no evidence of a chronic condition incurred in or as a result

of active military service; nor were strokes manifest to a compensable degree within a

presumptive period following your discharge from active military service. Additionally,

the VA examiner also noted there is no association between hepatitis C or interferon

treatment, and no seizure activity was found. Also short term memory or concentration

levels are considered symptoms only, and by themselves are not subject to compensation.

Service treatment records are negative for any complaints, diagnosis, or treatment for

strokes, seizures, or problems with memory or concentration.

VA treatment records document ongoing evaluation and management for multiple

medical conditions. There are no records of any confirmed diagnosed or treatment for

strokes or seizures. A record dated August 18, 2009, noted you had received emergent

care on May 29, 2009 in Virginia, when you had an elevated blood sugar up to 399, with

associated limb twitching. The results of subsequent diagnostic testing that included a

computed tomography (CT) scan dated June 4, 2009, showed findings compatible with

multiple small nonacute infarcts in the bilateral parietal deep white matter and is also

chronic ischemia in the white matter. There was no evidence of any brain swelling,

circumscribed tumor or hemorrhage seen. Mild frontal and temporal lobe atrophy was

also seen. An electroencephalogram study was also accomplished, which was noted as

normal. The examiner noted it was unlikely for you to have epilepsy, and the seizure you

were most likely experiencing in the emergency room was due to hyperglycemia, due to a

blood sugar of 399. The examiner attributed it to your diabetes mellitus, and noted the

best way to avoid a repeat episode was to have good control of your diabetes mellitus.

There are no records which address any problems with memory or concentration levels.

In your statements you related having an undiagnosed and untreated stroke condition

which was manifested by the treatment used for your Hepatitis C, and you related the

types of associated symptoms you experienced. You further detailed your history of the

emergent care you received in May 2009, as well as the associated symptoms you

experienced leading up to this emergent episode of care. You also provided copies of

printed web based documents regarding Hepatitis C, as well as the treatments and side

effects thereof. Also provided were multiple copies of prior treatment records which are

duplicate of records already received, and included an emergency record from the Reston

Hospital Center dated May 29, 2009, which noted treatment for a diagnosis of poorly

controlled type II diabetes mellitus with associated peripheral neuropathy. The statement

provided by your spouse relates her observations of your symptoms leading up to your

emergent care at Reston Hospital Center. She also discussed the advice you had been provided

by your primary care provider.

On VA examination, you related the history of your transient ischemic attacks which you

related to have begun in 1996. You reported symptoms of light headedness, with sudden

numbness, weakness, and blurred vision during these attacks. Your current treatment for

this condition consists of use of Aspirin. You continue to have moderate attacks of

dizziness every 2 to 3 weeks, that radiates into the arms, legs and right side of the body.

You are not able to walk during attacks, your tongue swells, and you have been

hospitalized four times for these attacks in 1996, 2003, 2009, and 2010. You also noted

you do not have seizures, but have transient ischemic attacks.

The VA examiner noted coordination, speech, memory, cranial nerve function were all

normal. Romberg's and Babinski's testing was normal. You were oriented to person,

place, and time, and are competent to manage your financial affairs, and the examiner

noted you have no cognitive impairments. The final diagnosis was recurrent transient

ischemic attacks, with associated symptoms of dizziness, numbness, weakness, blurred

vision, tremors, and swollen tongue during attacks. Based on a review of your active

military service records and history pre and post military service, the VA examiner

opined it is not at least as likely that your recurrent ischemic attacks are secondary to

your hepatitis C or the treatment provided in conjunction with that condition, as there is

no association between hepatitis C and ischemic attacks. Additionally, the examiner

noted no seizure activity was found or claimed.

Although there is a diagnosis of transient ischemic attacks found on VA examination, the

examiner did not relate it to your hepatitis C or the treatment thereof, nor is there no

objective evidence of a chronic condition incurred in or as a result of active military

service. Additionally, it does not establish this condition to a compensable degree

(severe enough to be evaluated at least 10 percent disabling) within one year following

your discharge from active military service. In the absence of a diagnosed transient

ischemic attacks that can be attributed to active military service or in relation to your

hepatitis C or the treatment thereof, your claim for service connection cannot be


Best Regards


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I agree with VA that the TIAs have no association to the Hep C.

Poorly controlled or undiagnosed and untreated diabetes mellitus can cause TIAS.

And then it can cause a major cerebral vascular event.

Are you service connected for the Diabetes?

"The examiner noted it was unlikely for you to have epilepsy, and the seizure you

were most likely experiencing in the emergency room was due to hyperglycemia, due to a

blood sugar of 399. The examiner attributed it to your diabetes mellitus, and noted the

best way to avoid a repeat episode was to have good control of your diabetes mellitus."

That could have caused a TIA.

"and noted the

best way to avoid a repeat episode was to have good control of your diabetes mellitus."

"She also discussed the advice you had been provided

by your primary care provider."

These statements alarm me.

They indicate either VA is trying to blame you for these TIAs or you are not following the VA's advise as to the treatment program.

The claim-in my opinion- was written wrong if you are service connected for diabetes.

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Have you had any head trauma or other medication that might be connected to the conditions that are rated? If not, you may have a losing fight on your hands. Not that your condition isn't severe, but because the nexus (in VA eyes) is weak. By what you've posted, that's what I read.

My experience: head injury due to auto accident while on active duty. Started having migraines that lasted weeks (wouldn't wish this on anyone). I was rated for migraines - not TIA. A few years ago, I was having a migraine when I dropped to my knees in excruciating pain and facial numbness. This has happened twice since then. My neurologist said that they would become more frequent and severe over time, and potentially more destructive. I take aspirin for other reasons, but was told it may help. I also take several other drugs for other reasons that have secondary benefits for migraine prevention/reduction. I haven't had a TIA in a year or so; I feel lucky.

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