allan

TEXAS TECH UNIVERSITY LECTURE DRAFT LECTURE Most of you already know this history of denial but let’s review this section anyway VA’s distancing themselves from the problem early on and meeting behind closed doors with medical directors from Monsanto and Dow. Rewards where then handed out. VA’s chastising its own employees and telling them to cease and desist in trying figure out what was going on with our dying and disabled veterans. The many ways Vietnam Veterans were exposed and that form of exposure makes a difference as to what will and can develop. · Water in the environment in bomb craters and/or artillery craters or wherever the Veteran could find it – using a cloth over the canteen to keep out the large chucks of dioxin laden sediment · Stored food - such as potatoes in drums · Mixed with gas - creating a dioxin aerosol (Reference Fort Detrick Emergency Memo to MACV in 1969) · Boiling water in dioxin drums for drinking because of the numerous dead bodies · Using Herbicide 55 gallon drums to bath, shower, or cook food · Operation Ranch Hand target-areas were in a 4.8 mile radius · Operation Ranch Hand drift rate areas were an 11.2 mile radius · Helicopter and firebase spraying by individual tank sprayers were not recorded nor done by properly trained personnel. · B-52 arc lights in I Corps that within minutes it was hard to breathe in the dioxin laden soil sediment. (Show picture of B-52 strike on cut-off Camp Carroll taken by me) · Then we have these chemical weapons used as tactical weapons with calls from Marine HQ to have areas of ground operations saturated three days prior to commencement of ground sweeps in a particular area. The bias of Veterans Affairs was clearly demonstrated in 1985 when the director, of the Office of Environmental Medicine, Veterans Health Services and Research Administration, claimed that TCDD "presents no threat from the exposures experienced by the veterans and the public at large,” and accused scientists who find that such health effects do exist to be nothing more than witch doctors Lets not forget at the same exact time Veterans Affairs and our government was denying any and all medical impacts of our herbicide issues they bought out homes in Times Beach, Missouri and Love Canal, New York. (Slight double standard) Then lets not forget, that during the war, to reduce cost to the government and improve productivity for the needs in Vietnam and elsewhere, the government allowed the chemical companies to change the processes. Where these new chemicals that were produced studied at all or tested? Probably not! As far as analysis goes we have no idea what was sprayed by manufacturer or by lot date codes. Therefore, even the toxicity is in question. Do the scientific studies “used to deny” our disability compensations and service connection from herbicide death and disability take all of this into account when comparing Vietnam Veterans to civilian studies? Probably NOT! Do the scientists tasked with direct legal action and decisions used against we Veterans and our families even consider these facts? Probably NOT! Does Congress consider these misstated facts when they hear from Veterans Affairs officials and IOM? Probably NOT! Does Congress take an active role in this issue? The answer is no! They leave it up to the Secretary of the Veterans Affairs. This is like Adolph Hitler saying that that all the courts in Germany in 1939 should have no appointed Jewish Judges to the courts of the land. Veterans receive about that much fairness from these appointed executive branch puppets. Vietnam Veterans are unique in their form of exposures including many multiplicity forms of exposures to include both chronic and acute and many different forms of dioxins and dioxin like furan isomers, and PCB’s. In addition, a totally different form of toxic chemical was used in arsenic acid (Agent Blue) that has its own set of medical issues in both chronic and acute exposures of which many overlap what is said; to be only caused by the dioxin, TCDD by our government and Veterans Affairs. Thanks to Texas Tech and their archives, we now find that there was a physical reaction between Agent Orange and Agent Blue. What did this do in our bodies? Is anyone considering this fact that a synergy effect may be at work in our Veterans. We have testing for inclusion but no testing for exclusion, which by the even the novice investigator is paramount to the science conclusions itself. ____________________________________________________________________________ Do the studies done by our government and the comparison of other studies that were exposed to some single isomer make any sense to anyone? Other than Veterans Affairs budget control for the Executive Branch? Probably NOT! Science compares the carcinogenic severity of other dioxins, dibenzofurans, and polychlorinated biphenyls (PCB’s) to the dioxin, TCDD that “IS” quantified and qualified as the world’s worst. The key words are “carcinogenic severity of other carcinogens in this family of toxic chemicals.” Therefore, it is logical the Veteran would not only be exposed to the single toxicant of one component but many toxicants of the many components that made up the “Herbicides” (plural). Does it make any sense to only verify inclusion of the dioxin, TCDD when Veterans were exposed in many different ways to many different toxic chemical isomers? Probably NOT! What are dioxins? The term dioxin or dioxins is generic. Used as such it typically refers to a compound or group of compounds from the dibenzodioxin or dibenzofuran classifications. The classification names suggest that the basic structure is of two benzene rings connected in one class by a dioxane structure and a furan structure in the other. The basic structure is tricyclic or three-ringed. Further, the compounds generically referred to as dioxins have one or more chlorine or bromine atoms added to this basic structure. Many different numbers and configurations of these halogen atoms around the basic structure are possible. Those compounds with chlorine are referred to as polychlorinated dibenzodioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs). By chemical definition, they are broadly classified as halogenated aromatic hydrocarbons. Structurally they are tricyclic aromatic compounds that are chlorinated or brominated. One compound of the PCDD class is 2,3,7,8-tetrachlorodibenzo-p-dioxin. This compound has undergone extensive study and is sometimes called simply dioxin. The toxicity of this compound and those similar to it are of concern. To provide a way to measure the relative concern for those similar compounds this compound has been assigned a toxicity equivalence factor (TEF) of 1.0. This is based on laboratory studies, which measured its toxic effect. It has thus become the reference compound for this class of compounds. The similar compounds, which have been assigned a TEF value, are those with chorines substituted in at least the 2,3,7, and 8 positions. Additionally, the brominated dioxins and furans of the same substitution patterns and some polychlorinated biphenyls (PCB's) have been included in the definition of dioxin-like compounds. Clearly, this data indicates our governments stand and many other studies have been fraudulent in their assessments and conclusions that only the by-product dioxin, TCDD could have caused the wide spread uncompensated death and disability in our returning Veterans. Any known impacts of dioxins and furans of the same substitution patterns and some polychlorinated biphenyls (PCB's) should have been included in the Vietnam Experience and toxic chemical outcomes. Yet, because of this misguided, government directed, search for an unproven linear dose response to only the dioxin, TCDD and its relationship to medical findings in our Veterans this simply must be called a government hoax of the largest magnitude. The Herbicide with the nomenclature Agent White (2,4-D) also had other dioxin isomers as well as closely related furans, which was also used separately and as a 50/50 mixture with Agent Orange. If Agent White was used separately as a herbicide and as a 50/50 mixture with Agent Orange, then mathematically which of the toxic chemicals actually had the most wide spread usage. (2,4-D or 2,4,5-T) In 1989, scientists who reviewed Dow’s documentation stated … that there are significant concentrations of potentially carcinogenic materials present in 2,4-D, which have never been made known to the EPA, FDA, or to any other agency. Thus, in addition to the problem of the TCDD which, more likely than not, was present in the 2,4,5-T component of Agent Orange, the finding of other dioxins and closely related furans and xanthones in the 2,4-D formulation….” ____________________________________________________________________________ We have science arguing about whether these isomers can cross the brain protein blood barrier. We have photographic images of dioxins crossing this brain barrier and if the Veteran inhales these isomers through his nose does that not go directly to the brain anyway, almost like sniffing glue. Remembering that some of these Veterans were so young, their brains were not fully developed, according to science. ____________________________________________________________________________ 28-year government controlled flawed studies and flawed assessments used to deny service connection and death and disability compensations. This all started in 1979 with the VACEH that had no process or procedures for establishing what constitutes a presumptive disorder. When eventually prestigious scientists and prestigious research groups looked at or where allowed to look at their processes, they were appalled. Statements were made that nothing this committee had done should be used for anything. For 15 years, this was nothing but a government sham used to deny service connection. Many on this committee had already publicly committed that dioxins were like orange juice and good for you. After this fiasco of deciding by pure subjectivity, the courts ruled that this VACEH go back and review all its findings and decisions against the courts new rulings of “increased risk of incidence or a significant correlation.” Of course, that never happened and in stepped the NAS/IOM in 1991. In 2000, from Dr. David Butler under oath it was obvious the IOM also had no concrete measurable established fault tree or decision matrix that concludes a presumptive or even a possible presumption. Lets see a show of hands, which is not scientific. Including it must be pointed out; that any studies done in comparison must equate to the Veterans experience on the ground not what the DoD has advertised was the experience and then compare civilian studies which no way are reprehensive of the cohorts in Vietnam and what they experienced daily. In 2007 even more evidence came from the IOM they had no real transparent established and defined measurable fault tree or decision matrix as to what constitutes an increased risk of incidence or increased risk of odds ratios – p-values or the like. Once again leaving it open to subjectivity which cannot be challenged by Veterans, family, and widows. …. Do more on that one from your meeting! The DoD and Veterans Affairs working in conjunction has denied and denied until the evidence is no longer plausible in denial of the Vietnam Veteran Era exposure to such toxic chemicals. Once again, thanks to the Teas Tech Archives we know DoD lies were stated on the spraying in Cambodia and Thailand with spraying actually commencing in 1964. We now know the denials of usage in Thailand, Guam, Korean DMZ, training areas in Canada, and bases throughout CONUS were nothing but DoD government lies. Which by the way I will demonstrate they are allowed to do and our Congress does nothing to stop it. In these cases, it is all but criminal that Veterans Affairs can change the laws of chemistry of “world recognized half life issues” in various ground environments in denying those Veterans that may have served two months after the DoD said it quit the usage of such toxic chemicals. With the track record above of the DoD, whom can we really believe except science itself? Certainly not the DoD. How can Veterans Affairs deny a Veteran with two government pronounced associated cancers and when he left the Korean DMZ, he was diagnosed with a hallmark sign of exposures - pustular acne? Because congress has given them such power is how. They know there are no ramifications for such nonsensical decisions by the Veterans Affairs and/or their omnipotent raters. IMMUNE SYSTEM FINDINGS INCLUDING INTERLUKINS CREATING CANCERS AS WELL AS IMMUNE SYSTEM ISSUES THAT WOULD BE CONSIDERED HEREDITARY WHEN THERE IS NO HEREDITARY. CANCERS, AUTOIMMUNE, SMOLDERING CANCERS, ETC. (FAILURE MATRIX) RANCH HAND FLAWED ADMISSIONS AND THE IMPACTS SYSTEMIC AMYLOIDAL DEPOSITS ON PANCREAS ISLETS DNA DAMAGE FINDINGS PATERNAL BIRTH DEFECTS No fair assessment in many MEDICAL issues - list those issues. Find law that allows DoD to test Veterans as lab rats in BCW Source: http://www.2ndbattalion94thartillery.com/Chas/tt.htm

fwd from: Gene OFFE press release FOR IMMEDIATE RELEASE December 1, 2007 CNN Snubs Veteran’s Issues During YouTube Presidential Debate If you are a veteran, or the family member of a veteran, or you are currently serving on active duty, you were probably very disappointed and even embarrassed by the content of Wednesday night’s televised debate. The CNN regulated YouTube video questions ranged from tax cuts, to illegal aliens, to gays in the military, to the New York Yankees and Red Socks baseball teams. Apparently, the news crew at CNN felt these were the most important issues of the 2008 Presidential Election. Some of the submitted video productions were very clever and featured cartoon illustrated questions. One video showcased one Mr. Jay “NRA supporter” Fox firing live rounds from an assault rifle in a reckless way and catching a loaded pump shotgun thrown to him from off camera. The only thing missing was a dog and pony. During the two hour broadcast, several candidates referred to our troops and bragged about the success of the current ‘surge’ in Iraq. But, not once did any of the candidates address the future of our troop’s healthcare, or show concern for their earned future benefits, entitlements, or services. In spite of all this, and according to CNN’s crack correspondent, Anderson Cooper “It was a fascinating debate” and “The candidates took it all on tonight!” A review of the 4927 YouTube video submissions reveals several very legitimate questions about veteran’s affairs, renewable energy, education, and national healthcare. Obviously, CNN felt no obligation to air any of these questions. Apparently, Mr. Anderson Cooper and CNN felt baseball and homosexuality was more worthy of nationwide recognition - then squeezing in a meaningless question about our disabled and retired veterans and their earned healthcare. The question I have for CNN is; if you don’t ask the Republicans the same questions as the Democrats, how in the hell are we suppose to know the differences between candidates on any particular issue? The low point of Wednesday night’s CNN debate coverage was when Retired Army, Brigadier General, Keith Kerr delivered a very lengthy comment on gays in the military - in addition to his YouTube video submission. At one point, it appeared CNN intentionally cut the General’s microphone off in an effort to get him to sit down and shut up. It was extremely obvious that everyone on the stage was very uncomfortable with the General’s disgraceful display. According to my clock, General Kerr and homosexuality were given the most time of all the CNN YouTube submissions. Evidently, General Kerr feels ‘gay rights’ in the military is the most important problem and urgent situation facing our military personnel and their families today. I’m certain our wounded troops recovering at Walter Reed and Brook Army Medical Center were glad to hear that. CNN later reported that General Kerr was a registered Democrat and political operative from the Hilary Clinton camp, and that he (General Kerr) infiltrated the CNN debate (at the invitation and expense of CNN) in an effort to embarrass the Republican candidates. Now, don’t get me wrong, I have nothing against homosexuals or generals. However, I really don’t think this issue deserved a reserved front-row seat at the Presidential debate. Over the past few months, several of the Democratic Presidential Candidates have publicly endorsed mandatory full funding for veteran’s healthcare, yet, not one Republican has been asked to address this very important issue. During past televised Democratic debates the subject of veteran’s healthcare has been openly discussed, but the very same subject has been omitted in all of the Republican debates. Democratic Presidential Candidate, Bill Richardson has even published a comprehensive veteran’s healthcare plan, including the introduction of a HERO health card which would allow eligible veterans to access local medical services outside of the VA. To view a list of OFFE Resolution endorsements, visit; http://offe2008.org/public_html/resolution.htm Now, I know some will accuse me of just being ‘jealous’ that baseball and gay rights received national coverage and a few questions I personally thought were more important weren’t asked. Well, jealous is the wrong word. I was insulted that the Yankees and Red Socks baseball teams trumped the urgent healthcare needs of all of our troops. I was incensed that several very legitimate questions were omitted from the program in order to showcase the improper and dangerous way to handle a loaded firearm. I was embarrassed that Retired Army General Kerr would put his personal sexual preference above the greater good and healthcare needs of all former military personnel. I was offended that CNN and Anderson Cooper chose the YouTube video submissions based on entertainment and shock value rather than substance. And I was disappointed to see this country’s news media cares so little about the immediate needs of our veterans. Jealousy has nothing to do with it. Thank you Mr. Anderson Cooper and CNN for dropping the ball! CNN might know about New York baseball, but they have no idea what the score is. I would love to have been a fly on the wall at that pre-debate CNN production meeting. “Well, Anderson, we have enough time for one more question, what do you suggest? How about a question about baseball, or man on man sex in the military? BRILLIANT!” Operation Firing For Effect (OFFE) is a bi-partisan grassroots leader in the battle for full mandatory funding for VA healthcare. Last year, OFFE authored a Resolution for full mandatory funding for veteran’s healthcare. As of this date, OFFE’s Resolution has been signed by a number of prominent politicians and high profile celebrities such as, Willie Nelson, Bill Cosby, Senator Hilary Clinton, and Governor Bill Richardson just to name a few. The OFFE Resolution has been endorsed by several major Labor Unions, including the AFL/CIO. Voters in several counties in Illinois (led by Cook County) will see a question on their February 5, 2008 Primary Election Ballot concerning full funding for the VA. And the necessary paperwork has been filed to put the very same question about veteran’s healthcare on the California General Election ballot. There is very little doubt that veteran’s healthcare is on the minds of many voters, and they deserve to hear from the candidates on this issue before they cast their vote, not after. Last Wednesday night’s CNN YouTube fiasco was far from informative or focused. The American public learned nothing about the candidates. No, wait! I take that back! I did learn something! I learned that the New York Yankees won 4 World Series Championships while Rudy Giuliani was Mayor. And I also learned Senator John McCain believes the U.S. never lost a battle in Vietnam. The Senator obviously wasn’t on my last patrol in Vietnam when my patrol was ambushed and we got our collective asses kicked, but I digress. The point being, nothing of any real substance was revealed during Wednesday’s CNN YouTube debate. If you are tired of the political parlor games and you are fed up with the same old canned responses from our politicians, the time has come for you to get involved. If you would like to join the OFFE Team and help us improve and protect the entitlements and services earned by our men and women in uniform, please visit; www.offe2008.org. We are also asking all former military personnel and their families and supporters to contact CNN and comment on this issue. Here is a link to just one example of a question rejected by CNN. http://www.youtube.com/watch?v=-a311ncaqlU If you are fed up with our former military personnel being treated as second-class citizens, we suggest you tune in to ‘VFVC Live on the Air’ every Tuesday night at 9PM [EST] on Stardust radio. You can listen to the program on you computer at www.stardustradio.com. The time to stand up and be counted is NOW! Operation Firing For Effect (OFFE) is a bi-partisan Veterans Advocacy group, and subsidiary of Veterans For Veteran Connection, Inc., a 501©19 non-profit corporation devoted to the protection and improvement of entitlements and services earned by our men and women in uniform. OFFE does not endorse political candidates running for office. OFFE does report on issues of importance to our former military personnel and their families and that includes ‘News’ from both sides of the aisle. OFFE will grant equal time to any candidate (regardless of political affiliation) who wishes to share and explain their position(s) on ‘Veterans’ Affairs’. Please give this article the widest possible distribution. Jere Beery National Public Relations Director Operation Firing For Effect www.offe2008.org

Good post! Thanks Phillip........ Allan

fwd from: BLUE WATER NAVY VIETNAM VETERANS ASSOCIATION Thursday, November 29, 2007 A Different View Lets step back from things for a moment and take a deep breath. In reviewing the announcement of the proposed changes to the VA's Manual that hit the presses the other day, we need to make sure we understand a couple of things about the process. When Congress passes enabling legislation like the Agent Orange Act of 1991, the affected Department(s) re-write the law into the language of policy and regulation. So, Congress enacts a bill and it becomes a citation under United States Code or USC, the agency re-writes it into regulation entered into the Code of Federal Regulations or CFR. If the agency or department wishes to make a change to the CFR, it must announce that change in the daily called the Federal Register, which serves as the "public announcement" for the government. To make a change, the proposed change must undergo a period of public comment, in this case a 60 day period during which public comments will be accepted. The agency or department MUST accept all comments, but they are NOT compelled to act on them. Those that do are being responsible. Those that don't... The announcement yesterday issued by DVA Acting Secretary Gordon Mansfield announced the recission of the manual change they unilaterally and without public comment instituted in 2002 and brought us all to this situation today. The action is being announced in anticipation of a loss in the Haas case. Remember, it was the DVA that appealed. I don't believe they would have taken this action unless they were almost certain the Circuit Court's rulling will uphold the lower court's ruling in Haas against the DVA. So what is this announcement about. On the surface it is ONLY about the recission of the manual change. Because part of the Haas decision took the DVA to task for implementing the 2002 manual change without a public comment period, the DVA is dotting its I's and crossing its T's. The DVA must ask for public comments and give details on how to make those comments. For some strange reason, Mansfield chose to incude in this announcement the warning that he would be changing the CFR entry which defines "Service in the Republic of Vietnam". In order to do that, he would also have to put that out for public comment. Curiously, that note, added almost as an afterthought, was very vague. Everyone assumed that it meant he would once and for all alter that section in the CFR to exclude the Blue Water Navy Veterans. But the statement does not go that far. The change might be made to include Blue Water Navy Veterans, and accordingly,we are writing on behalf of the BWNVVA to inquire exactly what change they have in mind. So, let us cross our T's, and dot our I's as well, and slow down the attacks on the DVA. It is why I have not posted one on the Blog. I do not believe that the DVA is willing to give up that easily, but Haas DOES include other aspects, as was evidenced by the ground covered during the oral arguments. The definition of what Service in Vietnam included was very carefully crafted into the questioning by the panel. At best guess, if there is a concession by the DVA it may be only to the 12 mile limit. Or it may go back to the Vietnam Service Medal, which I think was given to anyone who served in the Combat Zone. So, let's take some time and find out whether we have been beating a dead horse for the past 24 hours, or whether we really should be celebrating. VNVets "With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan--to do all which may achieve and cherish a just and lasting peace, among ourselves, and with all nations." -- President Abraham Lincoln "Without a decisive naval force we can do nothing definitive, and with it, everything honorable and glorious." --President George Washington Copyright © 2005-2007: VNVets Blog; All Rights Reserved. Source: http://vnvets.blogspot.com/2007/11/different-view.html

Paul, I gave the AMC's Director's office a call Monday and heard nothing in "5" days. Said he would get someone to give me a call of why it remains in "Ready to wait" status after 17 months. He said that it is a claims issue and nothing he could do but turn it over to someone that will get back to me. ************************************************************** >Tank here been at the appel management center about three years.Call last week was told my case that was with rating specialist .I was told that last year .I really think the AMC is joke but what do I know.Can someone tell is there any other way or information that can help to get this people to do their job. Tank, the operators at the AMC will throw out in their conversation, that your claim has been turned over to a rater or rating specialist. Ask these operators, do you mean the claim is in "ready to rate status"? being assigned to a rating officer that is reviewing your claim, does not mean "ready to rate status". Ready to rate status: is the time your claim sits without being reviewed or receiving any type of evaluation. Many AMC operators will try to give the impression it is under review, but thats not the truth. It's waiting for someone to review it. *********************************************************** Keep it at the RO level to fix? The same level of review the BVA keeps remanding to fix, only to have the rating specialists refuse to fix? These intentional "due process"errors under VARO, AMC and Contract rating specialists control. Are designed to prevent the claim from being finalized. According to todays data, it happens to nearly 60% of us. I'm hear to tell ever one, Legal review of Primary Evidence, (IMO's, favorable SMR's, private treatment records/medical diagnoses/medical opinions, etc), seldom happens during VARO claims review. But thats only based on 30 years of RO claims assistance. I don't receive assistance from the BVA by their issuance of a (expedited)remand back to RO level of review and I don't receive due process or assistance under RO level of review. The "errors" that need fixing start with the VARO(VA Regional Office) review and the same errors continue with the VARO raters anytime it comes under their review. My claim has been under Regional Office review since "1977". In 1997, they finally granted service connection for some issues that were on my separation physical in 1971, and that I filed for in 1977. The RO raters in 1978, denied the claim with one sentence. " The veterans records do not support the claim". That was all they said on one piece of paper. The RO also immediately requested from the National Records Archives, that all of my original service records be sent to them. My service officers have requested copies of SMR's from 1975 to 1997 with out ever receiving a response from the RO raters. When I sent requests to the RO raters for my naval service records, they would only reply that I had to request them through the National Archives in St Louis. Regional Office rating specialists requested an additional C&P to the "general" that did not include lab, xrays, MRI's, opinions, SMR's etc in 1996 or 97. Their instructions to the next VAMC C&P examiner a month or so later, was to include a physical examination, examination of current medical records and opinion as to whether or not the claimed issues were "on a more probable than not bases". The VARO C&P examiner opined, that on a more probable than not bases, the veteran is service connected for all claimed issues, since his symptoms and periods of incapacitation have been consistent over the years. The VARO and the VAMC rating dept, refused to send a copy of this C&P's results and concealed it from me for nearly two years. I found out a few years later, the RO raters claimed they never received this examiners opinion and physical examination results. Two months after the VARO raters received what they requested to finalize the claim, they scribble on a note to a staff, contract consultant at another VAMC to opine, without examination. They ordered an IMO in other words. Three days later, they get the response they looked for when the consultant states, not service connected since veteran had no health complaints until the 1990's. They immediately denied the claim. they never informed my NSO, or myself they had the first favorable opinion or that they were ordering an IMO or that they recieved it and denied the claim based on it alone. They denied the claim stating the "only" medical opinion of record was unfavorable. This is what put me in appeals. Ask yourself this. Can the Regional office level of review rating specialists, provide "you" with "due process" of law or the Court of Veterans Appeals? In my case, with what i've had pulled on me over the last thirty years by rating specialists at the Regional Office review level, I would say its near impossible to receive an honest evaluation of evidence. Currently, I do not posses the right to legal council by an attorney. One day I hope all Veterans will earn the right of someone that hopped the fence this morning. Until then, I do not have the right to hire an attorney to represent me until I get to the court level of review and nothing i've experienced tells me due process will take place until then. Sorry Josephine. I completely disagree with leaving it at the RO level to process, when the RO level of review is not to review it properly in the first place. Allan

Hello hurryupnwait, I've been on appeal for over ten years. Five years through the AMC.. Been in ready to wait status since the last BVA remand for seventeen months now. Remand is for RO rating specialist refusal to acknolledge three IMO's from Dr Bash, list them as evidence and provide a basis for excepting or rejecting evidence in the last two or three SOC's. Allan

3.328 lndependent medical opinions. (a) General. When warranted by the medical complexity or controversy involved in a pending claim, an advisory medical opinion may be obtained from one or more medical experts who are not employees of VA. Opinions shall be obtained from recognized medical schools, universities, clinics or medical institutions with which arrangements for such opinions have been made, and an appropriate official of the institution shall select the individual expert(s) to render an opinion. (b) Requests. A request for an independent medical opinion in conjunction with a claim pending at the regional office level may be initiated by the office having jurisdiction over the claim, by the claimant, or by his or her duly appointed representative. The request must be submitted in writing and must set forth in detail the reasons why the opinion is necessary. All such requests shall be submitted through the Adjudication Officer of the office having jurisdiction over the claim, and those requests which in the judgment of the Adjudication Officer merit consideration shall be referred to the Compensation and Pension Service for approval. © Approval. Approval shall be granted only upon a determination by the Compensation and Pension Service that the issue under consideration poses a medical problem of such obscurity or complexity, or has generated such controversy in the medical community at large, as to justify solicitation of an independent medical opinion. When approval has been granted, the Compensation and Pension Service shall obtain the opinion. A determination that an independent medical opinion is not warranted may be contested only as part of an appeal on the merits of the decision rendered on the primary issue by the agency of original jurisdiction. (d) Notification. The Compensation and Pension Service shall notify the claimant when the request for an independent medical opinion has been approved with regard to his or her claim and shall furnish the claimant with a copy of the opinion when it is received. If, in the judgment of the Secretary, disclosure of the independent medical opinion would be harmful to the physical or mental health of the claimant, disclosure shall be subject to the special procedures set forth in 1.577 of this chapter. (Authority: 38 U.S.C. 5109, 5701(b)(1); 5 U.S.C. 552a(f)(3)) [55 FR 18602, May 3, 1990] 3.329 [Reserved]

Topic Index: A-Z U.S. Preventive Services Task Force -------------------------------------------------------------------------------- The U.S. Preventive Services Task Force (USPSTF) was convened by the Public Health Service to rigorously evaluate clinical research in order to assess the merits of preventive measures, including screening tests, counseling, immunizations, and preventive medications. This list includes all recommendations: active, inactive, and in progress. http://www.ahrq.gov/clinic/uspstf/uspstopics.htm

>Personally, I don't think a Lawyer is going to sit-down with a Vet and fill-out claim forms properly, refer them for IMOs, track and interpret C&Ps, etc, etc. If they're incapable of doing what a brain injuried veteran is required to do with their claim, than I would agree with you. Somehow SSA attorneys are able to figure out how to get r done. I would love to see some sharp young minds with a passion for justice and a law degree work at it for a while. Ending illegal and unethical rating practices would take care of a good deal of those 407,000 still pending. Allan

Good idea, Thanks Pete....... Allan

I posted this before getting a good look at the date. I can't figure out how to delete it now. Does someone else need to do it or is the board on hold for this type of editing? Thanks..........Allan

fwd from: Gene STARDUSTRADIO PRESENTS! Welcome to VFVC on the air Live! LISTEN ON YOUR COMPUTER AT: WWW.STARDUSTRADIO.COM ASpecial Broadcast! Hosted by; Gene Simes & Jere Beery November 27, 2007 - 9:00 PM [EST] [All times Eastern Standard Time] The call-in number is; 877 213-4329 Special Guest National Commander of the Jewish War Veterans of the United States of America National Commander Larry Schulman Walter Silverman Mort Stine Lee Kauffmann

[Joe Violante, national legislative director of the Disabled American Veterans, which represents 1.3 million veterans, says trained volunteers from the service organizations are far more experienced at representing veterans' claims than the newly recruited lawyers. "If the veteran is under the impression that an attorney is going to get their claim through faster, there's no proof of that," he says.] Hello Pete, Due process is where an attorney would make a difference I think. That alone could resolve the backlogs in just a short time. I hope our returning troops are able to finally avoid the years of seeing each other pass away without the decency of due process. It would be great to see this STOP with this generation of Veterans.

>there for it depends on the VA hospital you assign to? Hello RC, I'm trying to figure out what VA MD's prescribe to patients that are intolerant to methadone and morphine, if their guideline recomends oxycodone cr and management says no to prescribing it? Or is it simply, "we can make you sick, take it or leave it" as a treatment plan? Oh how humain! Does that come with their license from the AMA these days? I know vets that get it out of the same facilities that preach it's been banned by some MD's. I hear you can get it prescribed at one VAMC, but not the other, or one MD but not the other, or one part of the country but not the other. It's a Dr choice and a facilities choice I think. And I understand everyone has their reasoning. But it seems to me that if your going to set guidelines to releave chronic pain from veterans (system wide), including those that are "intolerant" to the other medications available, than it should be a nation wide benefit for "all" patients that are intolerant to methadone and morphine, like the guidelines say. One select group of vets, at one select VAMC somewhere can get it proscribed, no problem, while the rest are told it's banned across the country, it's way to expensive to just hand that out to anyone and so on. My last MD's way of resolving the issue, was to write in the VAMC records that I no longer have a need for pain medication, and removing diagnoses i've had in my medical records. No health issues, no need for health care. Problem solved as far as he was concerned. There is a good number of us that become very sick from taking morphine or methadone that don't seem to rate an alternative, wether there is one or not. This is one major difference I see between Private scetor health care and DVA health care. "If someone gave me the secret handshake, I forgot it long ago."

Our Vietnam Vets were exposed to many toxins. Look at the fight for Agent Orange and it's still not settled. Those honey pots must have been nasty to deal with. Allan

fwd from: Colonel Dan [Federal Register: November 27, 2007 (Volume 72, Number 227)] [Notices] [Page 66218-66219] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr27no07-132] ======================================================================= DEPARTMENT OF VETERANS AFFAIRS VA Adjudications Manual, M21-1; Rescission of Manual M21-1 Provisions Related To Exposure to Herbicides Based on Receipt of the Vietnam Service Medal AGENCY: Department of Veterans Affairs. ACTION: Notice, with request for comments. ----------------------------------------------------------------------- SUMMARY: The Department of Veterans Affairs (VA) proposes to rescind provisions of its Adjudication Procedures Manual, M21-1 (M21-1) that were found by the U.S. Court of Appeals for Veterans Claims (CAVC) not to have been properly rescinded. DATES: Comments must be received by VA on or before January 28, 2008. ADDRESSES: Written comments may be submitted through http://www.Regulations.gov; by mail or hand-delivery to the Director, Regulations Management (00REG), Department of Veterans Affairs, 810 Vermont Ave., NW., Room 1068, Washington, DC 20420; or by fax to (202) 273-9026. Comments should indicate that they are submitted in response to ``Rescission of Manual M21-1 Provisions Related to Exposure to Herbicides Based On Receipt of the Vietnam Service Medal.'' Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management, Room 1063B, between the hours of 8 a.m. and 4:30 p.m. Monday through Friday (except holidays). Please call (202) 273-9515 for an appointment. In addition, during the comment period, comments may be viewed online through the Federal Docket Management System (FDMS) at http://www.Regulations.gov. FOR FURTHER INFORMATION CONTACT: Rhonda F. Ford, Chief, Regulations Staff (211D), Compensation and Pension Service, Veterans Benefits Administration, Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, (202) 273-7210. SUPPLEMENTARY INFORMATION: This rulemaking is necessitated by the opinion rendered by the CAVC in Haas v. Nicholson, 20 Vet. App. 257 (2006), notice of appeal filed, No. 07-7037 (Oct. 26, 2006). In that opinion, the CAVC concluded that certain provisions of VA's Adjudication Procedures Manual M21-1 (M21-1) were substantive provisions that had not been properly rescinded. Id. at 276-78. We have appealed Haas, and if we are successful on appeal, this rulemaking will be withdrawn. However, in the event that we do not prevail on appeal, we now take action to properly rescind the provisions. In Haas, the CAVC held that a 1991 M21-1 provision required VA to concede that Mr. Haas had served in Vietnam, and was presumed to have been exposed to herbicides during service, because he had received the Vietnam Service Medal (VSM). Haas, 20 Vet. App. at 270-72 (quoting in full and discussing M21-1, part III, para. 4.08(k)(1)-(2) (1991)). In 2002, VA had issued a new M21-1 provision that more clearly restated the 1991 provision, advising that receipt of the VSM could indicate service on land in Vietnam but, by itself, was not proof of such service. M21-1, pt. III, para. 4.24(e)(1)-(2), change 88 (Feb. 27, 2002). However, the CAVC held that VA's 2002 revision of the M21-1 was ineffective because VA had not followed the notice and comment procedures of the Administrative Procedure Act, 5 U.S.C. Sec. 553(a). Haas, 270 Vet. App. at 275-78. As interpreted by the CAVC, the 1991 M21-1 provision requires VA, in at least some circumstances, to concede service in Vietnam, and thus herbicide exposure, based merely on the receipt of the VSM, even if all other evidence indicates that the veteran did not serve on land or on inland waterways in Vietnam and therefore was exceedingly unlikely to have been exposed to herbicides as a result of Vietnam service. VA revised the M21-1 in 2002 because, although receipt of the VSM is an indication of possible service in Vietnam, it is not definitive or conclusive evidence of such service. It is inappropriate to include receipt of the VSM as a sole criterion for the presumption of exposure to herbicide agents due to service in Vietnam because a veteran may have received this medal for service in locations other than Vietnam. (The VSM was awarded to all members of the Armed Forces who served between July 3, 1965, and March 28, 1973, either: (1) In Vietnam and contiguous waters and airspace thereover; or (2) in Thailand, Laos, or Cambodia, or airspace thereover, in direct support of operations in Vietnam. See Army Reg. 600-8-22, para. 2-13.) The 2002 revision was intended to clarify VA's view that receipt of the VSM does not require or permit VA to ignore other evidence indicating that a veteran did not serve in the Republic of Vietnam. Because the CAVC's interpretation of the 1991 M21-1 provision does not accord with VA's intent in issuing that provision, we propose to rescind it. The M21-1 is an internal manual used to convey guidance to VA adjudicators. It is not intended to establish substantive rules beyond those contained in statute and regulation. Neither the 1991 nor the 2002 M21-1 provision, nor any intervening revision to such provisions, was intended to establish a substantive rule. Further, the 1991 provision was not intended to convey the rule the CAVC imputed to that provision, treating the VSM as conclusive evidence of service in Vietnam even if other evidence would support a finding that the veteran did not serve in Vietnam. However, because the CAVC held that the 1991 M21-1 provision established a substantive rule, and because that rule, as interpreted by the CAVC, is inconsistent with VA's intent, we are proposing to rescind the M21-1 provision. we note as well that we will soon be revising Sec. 3.307(a)(6)(iii) to clarify VA's interpretation of the statutory authority governing service in Vietnam for purposes of the presumption of herbicide exposure. In view of the confusion created by the M21-1 provisions in the Haas case, we believe it is preferable to rescind the M21-1 provisions relating to proof of service in Vietnam, including the 1991 provision at issue in Haas, the 2002 clarifying revision to that provision, and intervening revisions. This will enable VA to clarify and ensure that its interpretation of the governing statutory provisions set forth in its regulation and to minimize the possibility of a perceived or unintended inconsistency based on VA's internal manual. Hence, VA proposes to rescind the following manual provisions describing service in Vietnam for the purposes of the presumption of exposure to herbicides: M21-1, pt. III, para. 4.08(k)(1)-(2) (November 8, 1991); M21-1, pt. III, para. 4.24(g)(1)-(2), change 23 (October 6, 1993); M21-1, pt. III, para. 4.24(g)(1)-(2), change 41 (July 12, 1995); M21-1, pt. III, para. 4.24(g)(1)-(2), change 76 (June 1, 1999); M21-1, pt. III, para. 4.24(e)(1)-(2), change 88 February 27, 2002). Approved: November 19, 2007. Gordon H. Mansfield, Acting Secretary of Veterans Affairs. [FR Doc. E7-22983 Filed 11-26-07; 8:45 am] BILLING CODE 8320-01-P -----Original Message----- From: Ney, Gerald A CIV [mailto:gerald.ney@navy.mil] Sent: Tuesday, November 27, 2007 9:41 AM To: Ney, Gerald A CIV Subject: FW: Federal Register Notice M21-1 Provisions -----Original Message----- From: Paul Sutton [mailto:ssgtusmc6169@yahoo.com] Sent: Tuesday, November 27, 2007 10:30 Subject: Federal Register Notice M21-1 Provisions This appeared in this morning's Federal Register. Interesting turn of events. "Keep on, Keepin' on" Dan Cedusky, Champaign IL "Colonel Dan" See my web site at: http://www.angelfire.com/il2/VeteranIssues/

FWD from: Colonel Dan More than half of the disability cases decided by the 57 regional offices of the Department of Veterans Afairs are reversed or returned for reconsideration upon appeal www.nvlsp.org http://www.usatoday.com/news/nation/2007-1...valawyers_N.htm Lawyers step up to help veterans gratis By Laura Parker, USA TODAY WASHINGTON — The scene resembled Hollywood's version of how a multibillion-dollar legal deal might be negotiated. Big-name corporate law firm. Posh conference room, with a conference table so large 70 attorneys fit easily around it. Video technicians, hovering nearby, beam the meeting to other big law firms from Boston to Seattle. Yet there was no deal to cut. Instead, the high-powered lawyers were getting a tutorial in the arcane vagaries of veterans law. "This could be the VA's worst nightmare," Bart Stichman, one of the organizers, enthused from the podium. "Hundreds of attorneys from around the country providing legal service to veterans for free." The recent gathering at Sidley Austin, a firm with 1,700 lawyers around the globe, is part of a growing effort to provide free legal help to thousands of veterans returning from Iraq and Afghanistan who are trying to win disability benefits from the Department of Veterans Affairs (VA). "There are 100,000 veterans seeking benefits, and too many of them are waiting too long to get them," says Ron Abrams, who, with Stichman, directs the National Veterans Legal Services Program, a non-profit group in Washington spearheading the effort. "These lawyers are going to treat these veterans the way they would treat their corporate clients." The approach marks the first time since the Civil War that attorneys have been recruited in large numbers to represent veterans. The lawyers hope their legal expertise will speed consideration of claims and result in better benefits for veterans, Stichman says. More than 50 of the largest law firms in the USA and more than 400 attorneys have signed up. Stichman and Abrams hope to start assigning veterans to the attorneys early next month. Law schools join cause Amanda Smith, an attorney with the Philadelphia-based firm Morgan Lewis, says many of the participating lawyers are Vietnam veterans and "are appalled at the circumstances that they find veterans in today." Besides the push by big law firms, law schools in states such as the Carolinas, Virginia, Delaware, Michigan and Illinois also are offering free services to veterans. Craig Kabatchnick, who worked as a VA appellate attorney from 1990 until 1995, launched a clinic last January for veterans at North Carolina Central University's law school, where he now teaches. "We had all kinds of veterans who were very disabled, litigating against trained attorneys like myself who were defending the VA," Kabatchnick says. The VA would "win" if the claim was denied, Kabatchnick says. "Did we litigate to win? Absolutely. In cases where the veteran was representing himself, the win ratio was very high." Paul Hutter, the VA's general counsel, says its attorneys have "an ethical obligation to fairly and justly" review claims and settle "meritorious cases quickly." "Our job is to ensure that veterans get the benefits allowed them by law," he says in an e-mail. Disability claims have increased from 578,773 in fiscal 2000 to 838,141 this year, according to VA figures. There are about 407,000 pending. The average processing time is 177 days, the VA says. Change in law lifted restrictions Traditionally, veterans have represented themselves or sought assistance from a service organization, such as the American Legion or the Veterans of Foreign Wars. But many of the caseworkers in those groups are overloaded with cases, Stichman says, and sometimes one volunteer oversees 1,000 veterans' claims. The approach has not led to quick compensation for veterans. Evidence supporting a veteran's claim — medical records or letters from colleagues — is not always submitted with the original claim. When that evidence is added later, it can lead to reversals or requests for reconsideration. That can add more than a year to the appeals process, the VA says. The Board of Veterans Appeals either reverses or orders reconsideration of decisions made by VA regional offices 56% of the time, according to an analysis of VA figures by Stichman's group. Congress has long kept attorneys at arms-length from the veterans' disability process. Until last June, when federal law changed, paid attorneys could not work on cases until after a final decision by the Board of Veterans' Appeals. The VA is now considering regulations that would require all attorneys to pass a test in order to qualify to handle veterans' claims, according to Phil Budahn, a department spokesman. Service organizations, including the Disabled American Veterans and Veterans of Foreign Wars, vigorously fought the change in law. They are now pushing to repeal the law and support requiring a test, arguing that lawyers could turn what is supposed to be a non-adversarial process into a litigious one. "The fear was lawyers will dominate, and they'll ruin everything," says Thomas Reed, a law professor at Widener University in Wilmington, Del., who began offering free legal services to veterans in 1997. Lawyers not the cure-all Joe Violante, national legislative director of the Disabled American Veterans, which represents 1.3 million veterans, says trained volunteers from the service organizations are far more experienced at representing veterans' claims than the newly recruited lawyers. "If the veteran is under the impression that an attorney is going to get their claim through faster, there's no proof of that," he says. Ron Flagg, a Sidley attorney involved in the pro bono veterans' project, says there are so many claims that the system is overwhelmed. "Lawyers are not the cure to all ills," he says. "But this is a problem where lawyers can be helpful." ************ APPEALS GET SECOND LOOK More than half of the disability cases decided by the 57 regional offices of the Department of Veterans Afairs are reversed or returned for reconsideration upon appeal. In fiscal 2007, the Board of Veterans' Appeals heard 40,401 cases. Of those, 22,817 or 56% were overturned or sent back to regional offices. Status of appealed cases at the 10 largest regional VA offices: City Reversed{+1} Sent back{+2} Total{+3} Atlanta 23% 40% 63% St. Petersburg, Fla. 26% 37% 63% Little Rock 22% 39% 61% New York 22% 38% 60% Nashville 23% 37% 60% Montgomery, Ala. 20% 38% 58% Winston-Salem, N.C. 23% 34% 57% Houston 18% 36% 54% Waco, Texas 19% 33% 52% St. Louis 18% 33% 51% National average 21% 35% 56% 1 - Claim granted by the Board of Veterans' Appeals after being rejected by the regional office. 2 - Claim sent back to the regional office for further review. 3 - Total percentage of claims reversed or sent back. Source: National Veterans Legal Services Program analysis of Board of Veterans' Appeals figures for fiscal year 2007 "Keep on, Keepin' on" Dan Cedusky, Champaign IL "Colonel Dan" See my web site at: http://www.angelfire.com/il2/VeteranIssues/

VA/DoD Clinical Practice Guidelines http://www.oqp.med.va.gov/cpg/cpg.htm

Here are the Opiod Guidelines for care providers I don't know what these guielines are for, if a care provider has the choice to ignore them. Allan

Hello Bob, Personal Care Providers(PCP's)such as RN's, PA's etc. need to get what they recomend, signed off on by the MD that oversees their work. The Pain Clinic is "NOT" the only way to recieve the proper medication you need. An MD is licensed to prescribe pain medication such as Oxycodone. If your facility does not provide it, that is an administive issue. According to the DOD/DVA guidlines doctors must follow, they are athorized to prescribe it.

Hello Nam Vet, When your listing "enviromental exposures", such as Agent Orange, make sure you include exposure to fuel oils. Explain in detail, what it was you were exposed to, how you were exposed and if it was repeated exposure. As far as causing lasting mental disorders, according to what iv'e read, yes. Since it can alter DNA, fuels can cause alot of problems. Todays VA will require that you prove without a shadow of doubt, that you were exposed, when, where and how, backed up by scientifc data and medical opinions/diagnoses stating how it harmed you. Once you do that, you will likely spend years apealing. Allan

J Head Trauma Rehabil. 2004 Mar-Apr;19(2):109-18. Related Articles, Links Evaluation and management of spastic gait in patients with traumatic brain injury. Esquenazi A. Department of Physical Medicine and Rehabilitation, MossRehab, Albert Einstein Medical Center, 1200 W. Tabor Road, Philadelphia, PA 19141, USA. aesquena@einstein.edu Damage to the corticospinal system after brain injury interferes with activities of daily living, mobility, and communication. The chief cause of this interference has to do with impairment to produce and regulate voluntary movement accompanied by the presence of spasticity. This review advocates that the evaluation of "spasticity" should focus on 3 issues: (1) identifying the clinical pattern of motor dysfunction and its source; (2) identifying the patient's ability to control muscles involved in the clinical pattern; and (3) the differential role of muscle stiffness and contracture as it relates to the functional problem. We have identified and described 6 clinical patterns of motor dysfunction affecting the lower limbs during gait, found in patients with traumatic brain injury and residual from upper motor neuron lesions. We have presented the use of dynamic electromyography to identify the voluntary and spastic characteristics of individual muscles in gait and the use of anesthetic nerve blocks to identify properties of stiffness and contracture in particular muscle groups. Treatment algorithms for these problems include identification of the muscles that contribute to the deformity across a joint; the stage of patient recovery; and most important, the clinical goals applicable to the patient. The treatment strategies based on the algorithm included in this article were focused on the use of chemodenervation of targeted muscles, neuro-orthopedic surgery, and other therapeutic strategies. PMID: 15247822 [PubMed - in process] http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=15247822

http://www.dissvcs.uga.edu/whatabi.html Acquired Brain Injury, Defined Acquired brain injury (ABI) is the leading killer and cause of disability in children and young adults. More than two million head injuries occur each year. Statistics show that the highest rate of injury occurs in young men between the ages of 15 and 24. As a result, there is an emerging population of students with ABI on the college campus today. Due to the symptoms associated with their brain injuries, the Disability Services (DS) provides academic and support services to these students. ABI is an impairment of brain functioning that is physically or psychologically verifiable. Common causes of ABI are brain lesions caused by traumas such as motor vehicle accidents, falls, assaults and violence or sports injuries. Other brain lesions can be due to internal events such as focal brain lesions, tumors, cerebral vascular accidents, aneurysm or infections of the brain. Another cause of ABI is ingestion of toxic substances due to either alcohol or drug abuse or exposure to toxic chemicals. Students who have experienced a brain injury often enter or return to college with cognitive, psychological and/or sensorimotor disorders. Problems in the cognitive area usually pose the greatest challenge in the classroom. Although students may experience cognitive problems in such areas as memory, attention, and organization, they may still possess the abilities to succeed in an academic environment. Differences between Acquired Brain Injuries and Learning Disabilities: Students with Acquired Brain Injuries (ABI) and Learning Disabilities (LD) may, on the surface, exhibit similar cognitive deficits. However, the National Head Injury Foundation (BIA) cautions us to be aware of each population's unique needs. The BIA states, ". the cognitive profiles of students with traumatic brain injuries differ in important ways from profiles of [students] with congenital learning disabilities or developmental delays. It is also suggested that a neuropsychological assessment be performed by a professional trained in such assessments. According to the BIA, "it is most important that assessment and evaluation procedures be comprehensive and that those specialists administering such tests be acquainted with the unique needs of this population." (1988) Service providers should be aware of the differences between students who have ABI and LD. Students with LD have usually lived with the disability all their lives. However, students with ABI have experienced a trauma and must reorient their lives accordingly. Differences between ABI and LD: 1. ABI can have an academic profile which changes frequently as recovery occurs over time necessitating ongoing program changes. This invalidates a rigidly sequential curricula for most ABI. 2. There is unpredictable progress for months and years after the injury, based on the neurologic recovery. Therefore, the pattern of academic functioning over time may be quite different than most LD. 3. Assuming there was pre-traumatic mastery of a process or concept, ABI often reacquire some material rapidly despite significant processing and learning problems acquired after the injury. The curricular emphasis for LD is thus inappropriate for ABI. 4. In the early months following ABI, there is more confusion, disorientation and lack of control than LD. Further, ABI might be more impulsive, hyperactive, distractible, verbally intrusive and socially inappropriate than LD. 5. Students with ABI may have to change a thoroughly habituated learning style that is no longer useful after the injury. 6. There are different emotional stresses in that ABI have to deal with a loss of capacity along with ongoing experiences of failure and frustration. 7. There are more extreme discrepancies in ability levels for ABI. 8. ABI may have more problems generalizing and integrating information. ABI may need more individualized teaching, reteaching and monitoring. 9. ABI may need ongoing monitoring of tasks requiring independent thinking and judgment. 10. ABI may have difficulty processing information because their comprehension is decreased with more complex material. 11. ABI may need more compensatory strategies because of impaired memory, problems with word retrieval, information processing and communication. 12. ABI may have more difficulty with organization of thoughts, cause- effect relationships and problem-solving. 13. ABI may be resistant to new, easier techniques and learning strategies because they want to use their pre-trauma techniques and strategies. Students who have ABI may have problems in the following areas: Cognitive: communication and language memory comprehension (especially learning new information) perception short attention span concentration distractibility expressive language skills organization, planning, and decision making judgment and reasoning flexibility (adjusting to change) studying and academic skills Physical: vision, hearing, and speech coordination balance, strength, and equilibrium limited movement/motor function - walking, writing eye-hand coordination spatial orientation seizures fatigue (sleep disturbances) weight Emotional: denial depression anger fear self-esteem self-control awareness of self and others interest in activities and social involvement family relationships age-appropriate behavior post-traumatic stress disorder social isolation Environmental: noise temperature visual distraction unexpected change (class location moved, class canceled, etc.) inadequate support/information/transportation misunderstanding by others/rejection

1: J Head Trauma Rehabil. 2004 Mar-Apr;19(2):143-54. Related Articles, Links Neuro-orthopedic management of shoulder deformity and dysfunction in brain-injured patients: a novel approach. Keenan MA, Mehta S. Neuro-Orthopaedics Program, Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street, 2 Silverstein, Philadelphia, PA 19104, USA. maryann.keenan@uphs.upenn.edu Shoulder problems are common in patients with traumatic brain injury. Very little has been written about the evaluation and neuro-orthopedic management of these problems. This is largely because there have not been surgical treatments available other than release of contracted, nonfunctional shoulders. Shoulder problems can be classified and evaluated using several different strategies: bony versus soft tissue restrictions; static versus dynamic deformities; traumatic injuries versus impairments secondary to weakness and spasticity; or problems of active function versus problems of passive function. Regardless of the classification system employed a systematic approach to evaluation and treatment is essential. Shoulder impairments can be corrected leading to significant improvement in functional outcomes. In this paper we report on the novel evaluation and surgical management options developed in our program for the most common shoulder problems encountered in patients with traumatic brain injury. PMID: 15247824 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=15247824

Psychological Effect of Motor Vehicle Accidents This study reviewed the literature that deals with the psychological complaints of whiplash and traffic accident patients, in particular, PTSD. 1 The author focused on the characteristics of PTSD and a victim’s phobic anxiety to both the traumatic event, and driving a car, in general. Overall, he concluded that although psychological morbidity decreases with time, in the long term, victims will have higher than average psychological complaints over the long-term. The most important predicative risk factor for PTSD is the psychological impact of the stressor: studies show that when patients are tested for intrusion and avoidance reactions immediately following a traumatic event, high scores indicate the onset of PTSD at a later stage. Other predictive factors include a previous PTSD episode, premorbid psychological state, and questionable coping strategies. Severity of physical pain and possible financial compensation has not been shown as predictive risk factors in other studies. The author dedicates attention to the psychology of coping. She cites a Radanov3 study that found: “The authors concluded that it was not so much the subject’s premorbid psychological functioning that determined the course of whiplash, but more the psychological problems (including the cognitive ones) that affected the subject’s ability to cope with the somatic problems, particularly pain.” Avoidance behavior seems to a common pitfall/coping strategy for most car accident victims—avoiding thoughts or emotional reactions to the accident, or just avoiding driving altogether. Mayou2 found that even 4-6 years after the accident, one out of three victims still had anxiety or avoidance behavior towards road travel. Due to the trend of avoidance behavior, a major aspect of treatment is exposure. Exposing the client to their trauma-related emotions and memories relieves the victim of the emotional weight of the stressful event, and anxiety and other symptoms may very well disappear. For other aspects of treatment the author recommends combining biological, psychological, and psychosocial disciplines. And, treatment should focus on the patient’s response to trauma, not just the physical whiplash symptoms: “Overall it can be assumed that psychological problems resulting from an accident are underestimated for traffic accident victims in general and for whiplash patients in particular. PTSD is especially common, but usually goes untreated. Instead of focusing most attention on the chronic whiplash complaints, it is recommended that priority be given to coping with the trauma. Afterwards it can be decided whether other complaints require treatment. “ Other studies have demonstrated, on the other hand, that the psychological symptoms disappear after the physical pain has been alleviated. Thus, waiting to decide whether the physical symptoms warrant attention may lead to chronic pain and dissatisfied patients. Very few patients would be willing to wait to deal with the physical pain. Jaspers JPC. Whiplash and post-traumatic stress disorder. Disability and Rehabilitation, 1998;20(11),197-404. Radanov BP, Di Stefano G, Schnidrig A. Common whiplash: psychosomatic or somatopsychic? Journal of Neurology, Neurosurgery, and Psychiatry 1997;57:486-490. Mayou RA, Simkin S, Threlfall J. The effects of road traffic accidents on driving behavior. Injury 1994;24: 457-460.