Tbi-- Personality/behavior Changes

[ArmyWife07]

Hello,

My husband is currently undergoing his MEB process and I had some questions for some of the veterans out there who suffer from a TBI. My husband suffered several head traumas during his 7 tours and changed dramatically after his 6th tour where he went into a coma after an IED blast. After his tour, his personality changed and he became very self-centered and aggressive. Sometimes he'll become very aggressive and narcisistic whereas at other times he remains calm and laid-back. His switch or 'trigger' is unknown, but he can switch into aggressive behavior in an instant and it doesn't take much to make him angry. In addition he has memory trouble, disorientation, impulse problems, a lack of empathy, difficulty with abstract thinking, problem-solving difficulties, and other associated trouble.

Has anyone else suffered from this 'personality change?' Have you found a way to overcome this trouble or something that helped in some way? I'm willing to change anything and everything I do to help my husband. If you're someone who suffered this injury 20+ years ago, has your behavior imporved at all? If anyone has any helpful information or any resources that can help; please, please share them.

[Pete53]

Its called PTSD and it can be treated and better but untreated and it could become a nightmare.

Believe it or not but these symptoms you see are actually defense mechanisms mostly unknown to your husband to cope with PTSD. That is not anything but my opinion. Thank you for helping your Veteran

[carlie]

Armywife07,

Welcome to Hadit.

This link will give you some rating information.

This is the new way Diagnostic Code 8045 - TBI is to be rated.

This new criteria went into effect Oct 2008.

Right now the server is down - post me a reminder tomorrow

and I will send you a link for this.

Since your husband is not discharged yet, if I were you

I would be sure DOD knows what's going on concerning your feelings

and how your husband has changed.

Hang in there,

carlie

[ArmyWife07]

Carlie,

Any links you can provide would be great, thanks so much!

[carlie]

Armywife,

This is the new rating criteria for Diagnostic Code 8045 - Post Oct 2008.

You can find it in 38 CFR Part 4 - Schedule for Rating Disabilities (Neurological).

I am not at my own computer right now and can't pull up the link, but I have

copied all of the new 8045 for you here.

It's a long read and a bit difficult to understand how the rating is applied and the

evaluation percentage reached, but do believe me it is now more adventageous to the

veteran than DC 8045 was prior to Oct 2008.

Also with a TBI injury your husband may have additional claims such as cervical,

thoracic or lumbar injuries - be sure everything is properly addressed.

Hope this helps a vet.

carlie

8045 Residuals of traumatic brain injury (TBI):

There are three main areas of dysfunction that may result from TBI and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation.

Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Evaluate cognitive impairment under the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.”

Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Evaluate subjective symptoms that are residuals of TBI, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” However, separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere's disease, even if that diagnosis is based on subjective symptoms, rather than under the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table.

Evaluate emotional/behavioral dysfunction under §4.130 (Schedule of ratings—mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.”

Evaluate physical (including neurological) dysfunction based on the following list, under an appropriate diagnostic code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions.

The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, evaluate under the most appropriate diagnostic code. Evaluate each condition separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine under §4.25 the evaluations for each separately rated condition. The evaluation assigned based on the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations.

Consider the need for special monthly compensation for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc.

Evaluation of Cognitive Impairment and Subjective Symptoms

The table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” contains 10 important facets of TBI related to cognitive impairment and subjective symptoms.

It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than “total,” since any level of impaired consciousness would be totally disabling.

Assign a 100-percent evaluation if “total” is the level of evaluation for one or more facets.

If no facet is evaluated as “total,” assign the overall percentage evaluation based on the level of the highest facet as follows:

0 = 0 percent; 1 = 10 percent;

2 = 40 percent; and 3 = 70 percent.

For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet.

Note (1):There may be an overlap of manifestations of conditions evaluated under the table titled “Evaluation Of Cognitive Impairment And Other Residuals Of TBI Not Otherwise Classified” with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code.

In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions.

However, if the manifestations are clearly separable, assign a separate evaluation for each condition.

Note (2):Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation.

Note (3):“Instrumental activities of daily living” refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one's own medications, and using a telephone. These activities are distinguished from “Activities of daily living,” which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet.

Note (4):The terms “mild,” “moderate,” and “severe” TBI, which may appear in medical records, refer to a classification of TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under diagnostic code 8045.

Note (5):A veteran whose residuals of TBI are rated under a version of §4.124a, diagnostic code 8045, in effect before October 23, 2008 may request review under diagnostic code 8045, irrespective of whether his or her disability has worsened since the last review.

VA will review that veteran's disability rating to determine whether the veteran may be entitled to a higher disability rating under diagnostic code 8045.

A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating awarded as a result of such review, VA will apply 38 CFR 3.114, if applicable.

Edited May 31, 2009 by carlie
it all ran together