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HorizontalMike
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Posts posted by HorizontalMike
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If you are still within the appeal period for the depression denial, a strong IMO from a shrink, might well support that depression claim
as secondary to the TBI...which is far easier than trying to prove you had the depression prior to the TBI that they SCed,unless the IMO doctor finds evidence in your SMRs of inservice depression..
I guess I am assuming the TBI was due to the fall of the ladder?
Berta,
In the TBI/Depression rating, they acknowledged that I had been treated for depression in 1973 (TBI 1972), but cited lack of continuity of care. What I now need, is to get this mistake where I purportedly said my depression "started in 2010" taken out of my record, as this mistake has now been repeated in error,... and you know how repeated lies evolve into "trooth" blah, blah...
Got the C-file request in, but HOW do I change that error in my mental health STR?
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How can I go about correcting a mistake made by the TBI assessment I had in 2011-12. They MIS-QUOTED ME when they entered into my record "...his depression started in 2010 when he fell of ladder". What I said was that "my depression worsened" after said accident and that I eventually approached VA for mental health assistance in 2011. My depression had been ongoing all of my adult life, caused by TBI manifestations that I was unaware of for +40yr. I took St. John's Wort for ~20yr, trying to feel better.
To make a long story short... When I finally got my TBI rated after 40yr (40% +10% Tinnitus), the VA denied my SC depression rating because of the ^ above ^ misinformation.
How do I get this error in my STRs corrected? A CUE? Or is there another way? FWIW, neurological depression is NOT the same as a stress induced depression, but the run of the mill general psychiatrists have just been treating me with happy pills and nothing else. They even REFUSE to look at additional evidence I have to show this. They just want me to go away.
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I think you should be made aware of this, concerning TBI and Depression:
Secondary Service Connection for Diagnosable Illnesses Associated With Traumatic Brain Injury
As best as I understand this, if it is a secondary service connection, they should be required to rate it separately. How else would it be "Secondary SC"?
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HM,
Just wanted to add that the rating decision that granted SC for your TBI with a
50% evaluation, may or may not have already rolled your symptoms of depression
into the TBI SC and compensation.
Reading thru the complete Reasons and Bases Section and the Evidence Section
of this Rating Decision should tell you whether the Depression is included in your
current TBI evaluation or not.
Carlie,
My Rating decision clearly stated "denied" as a separate line item with explanation, so no roll-over. It will be separately evaluated as secondary SC to TBI, when my appeal comes up. See the attached PDF file from the Federal Register/Vol.78. No.242/December 17, 2013/Rules and Regulations. At least THAT one (depression) is rather straight forward. The OSA not so much.
Even though I believe I have plenty enough for a nexus, I wouldn't doubt the VA tries to short-change me on the start/retro date.
Secondary Service Connection for Illnesses Associated with TBI.pdf
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HM,
The WHY's and HOW's are explained to you in the Reason's and Base's Section of your Rating Decision's.
...What I am saying is that for VBA purposes, these Diagnostic Codes in the Schedule for Rating Disabilities,
for TBI and OSA - Did Not Exist.
Thereby They Could Not have been provided SC for during 1972-73.
...Here's a link to the Schedule Of Rating Disabilities.Carlie
I am very familiar with the Schedule of Rating Disabilities and its location/relevance. But thanks for the link anyways. So they created new codes/names and "renamed" old codes to be new codes in 2008.
- Regardless... new name/code = old name/code
- And apparently the "new" disability rates are being paid for the "old" injuries. That would explain my 40% TBI rating for the injury from 1972. Please note that I was NOT rated for my injuries until 2013, so this is NOT an old claim rating that went through the 2008 upgrade. That 2013 recent rating is/was a result of my actual TBI disability (lack of awareness of disability). And THAT is why my first C&P claim for TBI lacked any specificity.
- I also understand that "officially" the Schrödinger's cat analogy is NOT part of the VA's rating system. IMO, we NOW call that "nexus", though I truly believe that the Schrödinger's cat analogy plays a part in a disability rating appeal, particularly when the very disabilities being rated have symptomology such as "lack of awareness of disability" for some TBIs and sleep disorders. The inability to consciously "be aware" does not preclude the condition's existence, hence the need for Schrödinger's cat. Only by the sake of recent testing was the VA aware of the extent and existence of my moderateTBI(mis-diagnosed as mild concussion) and the ischemic insults that show where parts of my brain died as a result. In other words... what IS is what WAS, and what WAS is what IS. Thus the nexus. IMO
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The most obvious way to me would be to obtain an IMO. The military records would have to be reviewed by the physician(s)
doing it, and basically say that, in their opinion, the records show that the condition (more likely than not, etc) originated in service.
Then, the current level of the condition should be addressed. If there are post service treatment records, etc.
they should also be referred to in the IMO.
Chuck,
I will look into getting an IMO though I have many concerns/questions regarding doing this:
- How much could this cost? -- I understand that it can vary wildly, but any ideas on a range of how expensive?
- What TYPE of doctor to approach for the IMO? A psychiatrist? A neuro-psychiatrist? A neuro-psychologist? A general Physician? After all we are talking about neurological executive dysfunction, physical and/or mental (obstructive and/or central) sleep disorders, depression (most likely neurological other than psychiatric, but needs to be defined), and resulting obesity (that occurred in short order after TBI and remained a challenge).
- In other words WHO might be best at addressing all of the above in an IMO?
- Is it possible to get access to ALL of the VBMS files on me, from 1972-1975? If so HOW? FWIW, I submitted a SF-180 to the NPRC in St Louis, so will that do the trick? I delineated 7 different locations, ships, hospitals, etc. with general dated parameters.
RE current conditions:
- On daily meds for MDD -- Prescribed by a general psychiatrist, NOT a TBI specialist. I point this out because treatment(drugs) can vary for neurological(brain physically damaged) caused depression vs psychiatric(emotional) depression. These doctors literally REFUSE to look at my documented manifestations outside of the military in order to determine this, yet I have ~27yr of pertinent original data from employers that show much of what I delineated above in the OP about my military manifestations.
- OSA diagnosed and treated with nightly C-PAP
- Diabetes for past 5-6yr... treated with metformin orals only
- Hypertension treated for ~8yr. FWIW, battled obesity all of adult life after TBI.
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Again - there was no such thing (for VBA purposes) in 1972/1973, as TBI or OSA.
Perhaps I am not understanding exactly what your question actually is.
Well Carlie, I understand what you are saying. So please explain to me HOW the VA actually DID give me 40% TBI and 10% Tinnitus... IF THERE WAS NO SUCH THING AS TBI IN 1972-73? That makes no sense.
And BTW, all I can say is that my TBI/Depression/OSA manifestations/symptoms existed in 1972-73. And THAT is a documented fact. For some reason (please explain WHY/HOW to me specifically) the VA granted this when I didn't even have much of anything in the way of lay evidence since I actually was still unaware for +40yr that I actually HAD a TBI, and yes that unawareness is part of my TBI disability. Shoot, I was unemployed for SIX years, after my last job, before I even thought of approaching the VA for help and that was for my deepening depression because I was ready to check out. A malingerer I am NOT.
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A review of my medical records shows that the Navy/military doctors were remiss when they inexplicitly failed to test me for a sleep disorder in 1973. This failure to test for sleep disorders (OSA) occurred after this doctor noted several well-established indicative/diagnostic symptoms/effects of a sleep disorder in my medical record (listed below). Additionally, there was NO follow-up by military doctors after this 1973 appointment:
- November 9, 1973 – Oakland Naval Hospital Allergy Clinic – Diagnosed with Vasomotor Rhinitis with following documented symptoms of a sleep disorder:
- “…Chronic perennial nasal congestion that is the same in all locations, even out to sea.”
- “…Occasional snoring…”
- “…mouth breathing…”
- “…suffered some loss of smell and taste…”
- Patient: “…Combination antihistamines and decongestants have been of little relief...” Naval Doctor recommends: “…Continued symptomatic therapy with combination antihistamines and decongestants…”
- “…gained 30lb in the past year…” “…ht.5ft 9in, wt.210lb…” THIS indicates a BMI of 31 (obese, an indicator)
- “…suffers from excess worry…”
- “…some trouble sleeping…”
- “…nose disclosed no significant septal deviation...” Broken nose had already been surgically corrected from pre-navy accident
- “…patient was skin tested in our clinic and found to be essentially nonreactive to trees, weeds, grasses and environmental antigens, including dust and molds...” Non-reactivity also points toward Rhinitis and OSA
Below (from the official VA Employee Education System) is a listing of deficits that could be referenced regarding my military performance evaluations. Actually, the Executive Dysfunction list could also be tied into all of my post-Navy employment as well.
SOURCE:
Traumatic Brain Injury
Independent Study Course Released: April 2010
Sponsored By: Department of Veterans Affairs Employee Education System
This is a Veterans Health Administration System-Wide Training Program sponsored by the Veterans Affairs Employee Education System and the Office of Public Health and Environmental Hazards, Department of Veterans Affairs. It is produced by the Employee Education System.
Chapter 6: p.60
…”Executive Dysfunction
Executive functions are those capacities, most commonly linked to the frontal cortex, that guide complex behavior over time through planning, decision-making and response control. Individuals with executive dysfunction may perform well on familiar, highly structured tasks but are likely to have difficulty functioning independently. Deficits associated with frontal lobe injury often are the most handicapping as they interfere with the ability to use otherwise intact skills adaptively. Patients with executive dysfunction may present with problems including:
- Loss of initiative and drive
- Difficulty moving flexibly from task to task
- Diminished awareness of deficits
- Inability to monitor performance properly.
- Difficulty planning and organizing complex activities
- Poor reasoning, problem-solving and conceptualizing …”
Chapter 7: p.68
“…Behavioral and emotional problems may be long-lasting following moderate to severe brain injury… … In addition, they tend to lead to social problems including… [reformatted for clarity]
- over-dependency, …
- tangential or excessive talking, …
- immature behavior, …
- inappropriate use of humor,…
- inappropriate sexual behavior,…
- poorly controlled spending, …
- selfcenteredness, …
- divorce is common. This is often accompanied by a loss of social group membership for the person injured, further resulting in long-term obstacles for a successful recovery (Wood & Yardukal, 1997)…
- Resources (e.g., emotional, physical, financial, social, etc.) are much more likely to be exhausted in the recovery of someone with a more severe injury…”
The doctors at the Oakland Naval Hospital in November 1973, had my enlisted performance evaluations available to them for evaluation, yet they failed to acknowledge, act upon, the many well-known indicators of sleep disorders (OSA) exhibited in those performance evaluations. This lack of acknowledgement and action by military doctors in 1972 and 1973 has negatively affected my entire adult life regarding my TBI/Depression/OSA rehabilitation with regards to my work/career/quality-of-life over the next +42 years post-injury without treatment.
OSA induced/caused work performance indicators that were missed/overlooked by the military doctors could (and did) include the following (as well as others not listed here).
Sources:
http://www.webmd.com/sleep-disorders/guide/central-sleep-apnea
http://www.cpaptalk.com/wiki/index.php/Symptoms
- irritability
- poor judgment, personality changes
- mood changes
- anxiety
- depression
- procrastination, difficulty acting on plans or finishing projects, diminished work performance
- social withdrawal
- neglected relationships
- high blood pressure
- weight gain
- stroke
The below quotes from my enlisted performance evaluations, were and are part of my permanent military record. Everything listed below was all available for the naval doctor’s review at the November 9, 1973 appointment, and show many of the behavioral/neuropsychological symptoms associated with TBI and OSA as listed above. I understand that many of the TBI & sleep disorder symptoms are over-lapping, but IMO they should have been tested for and ruled out. And besides, sleep disorders often present months after the original TBI:
- Oct72 –
- “…His assigned tasks are limited in scope and difficulty, but he still requires occasional supervision to complete these jobs…”
- “…his negative attitude towards the Navy and his lack of interest in doing anything.”
- “…very argumentative when dealing with his seniors.”
- 8Mar73 –
- “Petty Officer Howell has been and continues to be a significant personnel problem for E division…”
- “…He has been counselled innumerable times since reporting on board on his poor attitude, working performance, and duties.”
- “…His military behavior has been constant source of serious irritation to all petty officers senior to him…”
- “…He shows little or no interest in leadership…”
- “…Military appearance is again in borderline area in Howell’s case. Material-wise his uniforms are good,… …but his bearing is barely sat. Adaptability he is close to being a ‘misfit’…”
- “…he has uncanny ability to aggravate almost everyone senior to him in his division, including hard‐working personnel junior or of equal seniority”
- “…He is a very difficult person to understand and deal with, many have sincerely tried but have failed and been very discouraged…”
- 11Jul73 –
- “…Howell…will not take any initiative to get job done, and will not apply himself fully to any task…”
- “…Howell questions authority and antagonizes the entire crew…”
- “…Petty Officer Howell’s contribution to the ship’s morale is little if any, Howell gets along well with few people in E division and I suspect it is the same shipwide.”
- “...Part of Howell’s trouble may be his lack of confidence in himself which stands out plainly…”
- “…the unwillingness to accept either responsibility or authority is present nonetheless…”
- “…Howell’s appearance is always borderline…”
- “…Petty Officer Howell is consistently out performed by his subordinates...”
- “…Howell sometimes needs more supervision than do the non-rated men in his division.”
- 2Oct73 –
- “…Petty Officer Howell continues to be antagonistic in attitude and immature in his performance and assumption of responsibility…”
- “…Howell’s professional performance is lacking in that he is constantly surpassed by his subordinates. Military behavior is poor…”
- “…Howell’s adaptability is also borderline. He barely gets along with others in the division because of his poor attitude toward his superiors, his work, and the Navy in general…”
- “…In summary, Petty Officer Howell should not be a third class Petty Officer since his performance and lack of initiative are far below standard…”
- “…Howell needs the supervision of the division petty officers as much as would a non-rated man – and in some cases more…”
- “…Howell does not have will to get job done”
- “…Howell sets a very poor example of a petty officer in E division, and about the entire ship because of his antagonistic attitude toward authority, his obvious lack of pride in himself and the Navy, and his inability to perform his duties on the level expected of a third class petty officer…”
BOTTOM LINE:
If the military had properly conducted full testing and follow-up from my moderate-TBI on 23Oct72 and/or after my 9Nov73 doctor’s appointment (to include neuro-imaging, MRI, CT, sleep disturbance, evaluation of my then documented symptoms/manifestations, executive dysfunction, including neurobehavioral and neuropsychological symptomology exhibited post-injury and documented within my enlisted performance evaluations, etc.) then my post-military life over the past +42 years would have been dramatically different than how it ended up.
In other words, if the above (as is current standard protocol for TBI injuries) diagnostics and treatment had occurred in a timely fashion (1972-1975), then I can safely assert that it is at least as likely as not, that I would/could have been properly diagnosed and treated at that time, for my then and still ongoing injuries:
- Sleep Apnea
- Moderate-TBI
- Major Depression
- Obesity that has now led to my diabetes and hypertension
QUESTION: So how do/can I best present this to the VA upon appeal some +42yr later? ...for TBI, Depression, OSA, and possibly diabetes?
FWIW, I am truly interested in the HOW and not the can't.
- November 9, 1973 – Oakland Naval Hospital Allergy Clinic – Diagnosed with Vasomotor Rhinitis with following documented symptoms of a sleep disorder:
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"Since the military was remiss in accurately assessing my TBI and Residuals in 1972-73, would they not have to follow a Schrödinger's cat type of analogy?"
The Schrödinger's cat paradox has no meaning within either the military or the VA,regarding claims..
Then, for clarity's sake, please explain how the/a VA examiner rated my TBI/Tinnitus at 40%+10% some +40yr after the fact WITHOUT A NEXUS? In other words RE my OSA, I had documented manifestations of OSA in 1972-73, just as I have those same manifestations of OSA TODAY (other than I now have a diagnosis), no difference than when comparing my TBI and Tinnitus without a nexus.
I apologize in advance Berta. Please understand that part of my TBI is my to-the-point bluntness without tact. I have had much job turn-over from this point alone so please do not take it personal.
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Current literature connects TBi with Sleep disturbances and current VA protocol requires testing for known co-morbid injuries/diseases/manifestations of TBI. The military did NONE of that in 1972-73. Current VA TBI training program even states as much. http://www.disabledveterans.org/wp-content/uploads/2014/05/14-02938-F-Responsive-Records-2.pdf
Since the military was remiss in accurately assessing my TBI and Residuals in 1972-73, would they not have to follow a Schrödinger's cat type of analogy?
OK, I am having problems with cut and paste functions, so please bare with me...
Sleep disturbance is one of the most common yet least studied of the post-TBI sequelae. Recent research suggests that 30% to 70% of patients experience sleep problems following TBI and that these sleep disturbance often exacerbate other symptoms and impede the rehabilitation process and the ability to return to work. - See more at: http://www.nursingcenter.com/lnc/journalarticle?Article_ID=863002#sthash.DvenCkhI.dpuf
Sleep disturbance is one of the most common yet least studied of the post-TBI sequelae. Recent research suggests that 30% to 70% of patients experience sleep problems following TBI and that these sleep disturbance often exacerbate other symptoms and impede the rehabilitation process and the ability to return to work. - See more at: http://www.nursingcenter.com/lnc/journalarticle?Article_ID=863002#sthash.DvenCkhI.dpufSleep disturbance is one of the most common yet least studied of the post-TBI sequelae. Recent research suggests that 30% to 70% of patients experience sleep problems following TBI and that these sleep disturbance often exacerbate other symptoms and impede the rehabilitation process and the ability to return to work. - See more at: http://www.nursingcenter.com/lnc/journalarticle?Article_ID=863002#sthash.DvenCkhI.dpufTBI Symptoms
... There is no single TBI symptom or pattern of symptoms that characterize mild TBI. Symptoms may resolve quickly, within minutes to hours after the injury event, or they may persist longer. Some TBI sequelae may be permanent. Most signs and symptoms will manifest immediately following the event. However, other signs and symptoms may be delayed from days to months. ...
TBI symptoms generally fall into one or more of the three following categories:
- Physical: headache, nausea, vomiting, dizziness, blurred vision, sleep disturbance, weakness, paresis/plegia, sensory loss, spasticity, aphasia, dysphagia, dysarthria, apraxia, balance disorders, disorders of coordination, or seizure disorder.
- Cognitive: problems with attention, concentration, memory, speed of processing, new learning, planning, reasoning, judgment, executive control, self-awareness, language, or abstract thinking.
- Behavioral/emotional: depression, anxiety, agitation, irritability, impulsivity, or aggression.
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In 1972, while serving in USN, I landed on my head from a motorcycle accident and woke up in the Naval Hospital. LOC ~45min but at time diagnosed as "mild concussion", held 24hr, dismissed after being told I would be fine and sent back to ship to be deployed to Vietnam.
Flash forward ~40yr. When my perpetual depression eventually went off the deep end I asked the VA for help. Started taking meds and asking questions about my life. Finally got directed to Poly-Trauma for full neuro-pysh and MRI. FWIW, I was wondering why I always had trouble remaining employed longer than ~2yr at-a-time over the past ~40yr. I earned three degrees including a PhD, plus three other professional certs, but just could NOT keep a job. MRI results showed past indications of "stroke" (ischemic insults in white matter where parts of brain died), but being UNRATED for TBI, the current doctors atributed this to current diabetes and age. At this point I filed for disability and 14 months later got my 50% rating for TBI. THAT is when I finaly realized my TBI was real AND just how bad I am disabled by it. The detailed list of symptoms/manifestations that the VA examiner provided read like a laundry list of my life's challenges, that until then I had never put together in conscious thought.
I have my intelligence but what I lack are the higher level executive functions that would let me put my education to use. In other words, I can't play well with others at work or at home. I could p***-off the Pope given enough time together. I have no friends at this point, but do have ONE person I taught school with (a retired LTC) that seems to understand and gives me advice from across the country.
My military performance records are bad, real bad... as in I do not understand why I wasn't kicked out, jailed, etc. They show manifestations of deprived sleep, anxiety, irratibility, lack of motivation, etc.
My post-military civilian employment performance records show the SAME manifestations over a roughly ~27yr of the 40yr since TBI. I only kept THOSE records because I thought "they" were picking on me. But they are detailed records, and they seem to show that "they" were correct, and NOT me. This took me months to come to terms with, and only by viewing these things using a 3rd person analysis. Personally, I get too upset reading/thinking about them.
My Depression Rating was denied, though the VA final rulling about depression being "secondary service connected" came through within a week of my TBI rating, so THAT will be reassessed in the appeal.
I recieved a C-PAP for my sleep apnea, that was just diagnosed in 2013. I have a 1973 diagnosis for vaso-motor rhinitus, that also states/records such things a "trouble sleeping, mouth breathing, snoring, 30lb weight gain(BMI-31 = obese), anxiety, BP of 140/100/90, non-reactivity to know allergens, etc. Sleep apnea denied due to lack of nexus.
BOTTOM LINE is that the military FAILED to do adequate testing in 1972-73 on my TBI, depression, sleep disordered breathing, etc. What is NOW considered as standard protocol following a TBI, was not even known in 1972-73. Shoot the C-PAP machine wasn't even invented until 1985, so the military would not even know what to look for.
QUESTION: Isn't THIS where the VA's "benefit of the doubt" rule should kick in? After all they finally rated my TBI (lower rating than I have records to show degree of disability) going retro-active ~41yr. (i.e. Schrödinger's cat)
CURRENT STATUS:
My TBI/Depression appeal has been filed.
My Sleep Apnea appeal is being developed AND THIS IS WHERE I COULD USE SOME HELP. I am focusing on the military's failure test me for sleep disorders when it was/is obvious that I had manifestations of sleep disordered behavior in my elisted performance records as well as in my vaso-motor rhinitus diagnosis in 1973.
Any help/advice would be appreciated.
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Vbms is the varos next greatest thing since slice bread. Here to stay. Too much money pissed away on it to turn back.
QUESTION: Can I, the veteran, access the VBMS? If so... Where? How? When?
Making A Correction To Mental Health Record
in VA Disability Claims Research
Posted · Edited by HorizontalMike
Berta,
I'm afraid I didn't explain (above) very well. Let me try again...
BOTTOM LINE to all of this is that that PCP referral to mental health, fully explains WHY I was seeking mental health services (failing self-treatment), more than a year before the TBI folks and the C&P shrink made the error in my record. I NEVER stated that my depression started in 2010, but that didn't stop the VA from denying my SC Depression.
So how do I go about getting this kind of error corrected in my files?