Thank you everyone for the responses. After I made my initial post I checked VA.gov and saw that a decision had been made yesterday, so hopefully i have the decision letter soon. I do have a copy of the C&P Exam as I requested my C-File months ago and just got it in late June. I will try and figure out how to post a redacted version or cut and paste it all somehow. The C&P does service connect me for TBI, which is a start I guess. The issue is the levels of impairment listed on the C&P do not accurately reflect my neuropsych, but the examiner didn't conduct any testing or ask any questions related to myTBI symptoms and relied on the neuropsych... I don't think they actually read the neuropsych report. The highest TBI symptoms is "A complaint of mild memory loss (such as having difficulty following a conversation, recalling recent conversations, remembering names of new acquaintances, or finding words, or often misplacing items), attention, concentration, or executive functions, but without objective evidence on testing."
Here are a few findings from neuropsych which I think clearly shows objective evidence of cognitive impairments in several areas;
Attention and Working Memory:
Mr. XXXXXX basic auditory attention ability was in average range (37th percentile). When asked to repeat a 7-digit series, Mr. XXXXXX was only able to recall the series on the second trial. On a measure of visual working memory using novel visual stimuli, Mr. XXXXXX performance was measured in the low end of low average range (9th percentile ? a cognitive weakness).
Consistently impaired or weak functioning was demonstrated by Mr. XXXXXX across the majority of auditory memory tasks, however there was one exception. In the immediate memory condition, his ability to recall and learn a list of
words read aloud over 4 trials, was low average (16th percentile). Mr. XXXXXX performance on a task regarding recall of basic contextual memory was
similar (16th percentile; low average). These represent cognitive weaknesses. On a more complex contextual memory task requiring the recall of up to 25 items from a story, Mr. XXXXXX performance was significantly better, located within in the average range (37th percentile). This pattern is sometimes demonstrated by individuals with traumatic brain injury, that is, performing better on the more difficult activity, as long as it follows the easier tasks.
In the delayed recall condition, list recall was within the mildly impaired
range (3-9th cumulative percentage), while delayed list recognition was severely impaired (= 2 cumulative percentage). On this task, he was required to identify those words he recognized from the initial list. Although individuals typically
do better on the recognition as compared to the recall task, some score lower on the recognition task, as they become confused and/or uncertain when extraneous words are also presented. On the basic contextual delayed recall task, however,
his performance was severely impaired (=1 percentile). On the delayed recall of
the more complex contextual memory task, Veteran scored in the low average range (9th percentile), which is a clear weakness for him. When presented with
auditory information, Mr. XXXXXX appears to perform better when presented with a wealth of contextually based information, which can assist in recall through contextual cues. However, overall recall of immediate and delayed auditory memory appears to be a cognitive weakness for Mr. XXXXXX.
Delayed recall for visual information was within the low average range (16th percentile). On this activity, Mr. XXXXXX was able to remember a number of details of an abstract figure drawing after a short delay but displayed some errors in regard to placement of details and exclusion of other details entirely. This represents a cognitive weakness.
Visual-spatial perception/Visual-Motor Constructional Functions:
Mr. XXXXXX visual perception, as measured by a visual-spatial, line judgment
task was measured in the average range as he obtained a score of 15 out of 20 lines on this challenging task (26-50th cumulative percentage). Visual-motor construction abilities were highly variable. On a task requiring a drawing construction, Veteran's performance was severely impaired (= 1st
contrast, on a block construction activity, his performance was at the high end of average (62nd percentile). This suggests that Veteran cannot depend on his visuo-motor construction skills, as sometimes he will do well, and other times he will struggle with these activities.
On a test of fine-motor speed, Mr. XXXXXX performance varied, but both performances were below expectation. For his dominant right hand, he scored within the mildly impaired range (6th percentile), while his non-dominant left hand performance was mildly better but still weak, in the low average range (21st percentile;). That is, compared to peers similar in age, gender, and educational background, his performances were significantly lower for both sides.
Veteran's expressive language ability varied, as measured by two different confrontational naming tasks. He obtained a perfect score on a basic naming
task, placing him in the average to high average range (51st- 75th cumulative percentage). On a more challenging confrontational naming task, his performance was in the low end of the low average range (9th percentile ? a clear weakness)
in comparison to peers comparable in age, gender, race, and educational level. On a task of expressive word knowledge, Veteran scored within the average range (50th percentile).
In the verbally-mediated area, semantic fluency was in the low average range (16th percentile). This is consistent with Mr. XXXXXX self-report of difficulty with word generation. Yet, on a task of phonemic fluency and word generation, Veteran scored within the average range (55th percentile). This suggests that this Veteran can benefit from phonemic cues as compared to semantic cueing. In the visual domains, visual sequencing/scanning speed was intact (42nd percentile). On a more challenging version of this activity involving alternation of response set, a form of cognitive flexibility, his performance was also intact (66th percentile; high end of the average range).
Mr. XXXXXX demonstrated intact reasoning abilities. His verbal practical reasoning was intact, at the average level, as measured by solutions he provided
to hypothetical problem situations. Mr. XXXXXX verbal abstract reasoning was
similar within average limits (55th percentile). Veteran's visual abstract reasoning, in the form of pattern completion, was found to be intact as well (34th percentile, average range).
Processing Speed: Mr. XXXXXX demonstrated a severely impaired (1st percentile) level of processing speed on a task of visual processing where the client is required to match symbols with corresponding numbers using a key.
Mood and Neurobehavioral Functioning:
Significant levels of mood dysfunction were demonstrated on formal mood surveys completed by Mr. XXXXXX. Specifically, his responses indicated a mild to moderate level of depression, a moderate level of anxiety, a mild level of
panic, and moderate anger/frustration. In addition, a significant level of PTSD
was demonstrated, with elevated symptoms in all areas assessed, including re- experiencing, avoidance, negative self-beliefs, emotional numbing, and hyperarousal.
During the clinical interview, Mr. XXXXXX revealed a number of cognitive, physical, neurobehavioral, and mood symptoms he has been experiencing since his military-related head traumas, which are described in this report.
During objective testing, his effort and motivation were quite good, indicating
a valid assessment. Mr. XXXXXX demonstrated a pattern of cognitive impairments and weaknesses which indicate the presence of Traumatic Brain Injury at the Mild level. He exhibited several impairments which included: Delayed recall and recognition of auditory information (in the form of list recall), 1 of 2 areas of visuo-motor construction, motor functioning with his dominant hand, and processing speed. Weaknesses were shown in several areas including: Visual working memory, immediate recall of basic auditory contextually-based information and list material, delayed recall of basic and complex contextual information, delayed recall of visual information, non-dominant motor functioning, confrontational naming for challenging material, and semantic fluency. He also displayed a number of intact cognitive abilities, listed in this report. Additionally, significant levels of mood impairment, namely mild to moderate depression, a moderate level of anxiety, a mild level of panic, a moderate level of anger/frustration, and a significant level of PTSD symptomology also serves to lower cognitive functioning even further.