TNengland

Hot from the mailbox. One letter from my Congressman Chuck Fleischmann. When I contacted him, I went into detail about what I needed from his office. I needed to find out why the VARO was waiting until my remand was complete to pay the retro already granted to me by the VLJ order and to provide them with VA fast letter 10-02 , which I did provide the Military and Veterans Affairs Liaison. I thought this would go smoothly but the response I got was only on the status of my appeals and claims progress, no mention of retro payment. The letter also mentioned that the congressman's office would continue to inquire about this claim and will advise on any progress. So , so far not much help.

Yes , I did serve in a combat zone. Currently rated at 80%combined 70% PTSD , 10% TbI with headaches, 10% tinnitus. Thank you for your advice , I will look into the possibility of having the personality disorder ruled out.

Here is my TBI exam that was ordered in a remand from the BVA. Now I will sit and wait for the decision to be made. Review Evaluation of Residuals of Traumatic Brain Injury (R-TBI) Disability Benefits Questionnaire * Internal VA or DoD Use Only* Name of patient/Veteran: England, Larry Adam Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence review --------------- Was the Veteran's VA claims file reviewed? [ ] Yes[X] No If no, check all records reviewed: [X] Veterans Health Administration medical records (VA treatment records) [X] Other: VA rating documents as this is a review tbi SECTION I: Diagnosis and medical history ---------------------------------------- 1. Diagnosis ------------ Does the Veteran now have or has he/she ever had a traumatic brain injury (TBI) or any residuals of a TBI? [X] Yes [ ] No [X] Traumatic brain injury (TBI) ICD code: 000 Date of diagnosis: 3/2005 [X] Other diagnosed residuals attributable to TBI, specify: Other diagnosis #1: headaches ICD code: 000 Date of diagnosis: 2005 2. Medical history ------------------ Describe the history (including onset and course) of the Veteran's TBI and residuals attributable to TBI (brief summary): from neuropsych hx 2012: According to medical records intake note from 2nd Medical Group, Barksdale AFB, LA, on 5 MAR 2005, "25-year-old male hit right side of head near temple while cleaning pool on base. Patient hit side of concrete pool. + blurred vision, patient unsure if LOC, + neck and shoulder soreness, - EtOH, + headache at the moment with nausea." Subsequent evaluation that same day by physician revealed: "Mr. England was noted to be in no acute distress, laughing, smiling, alert and oriented x 3, cranial nerves grossly intact, strength 5 x 5." He was diagnosed with a minor head trauma and ordered to return on 7 March 05 for f/u eval prior to being returned to duty. A subsequent medical technician note from 7 March 2005 indicates "patient here for f/ head injury f/u Patient states he's very much better. Still has occ. HA." The subsequent physician note of that same day stated: "?not any worse than any other ou headache. RTD, f/u prn." He was discharged to follow up as needed. There are no other medical records pertaining to this injury. He reported no cognitive difficulties or other residual effects at the time. He also reported an episode of brief loss of consciousness from a MVA during the 9th grade. A CT of the head on MAR 20, 2009 revealed: Study was performed with intravenous contrast. The brain is of normal attenuation. The ventricular system is midline and symmetric. There is no edema or normal enhancement. The globes and orbits appear normal. Impression: Normal brain. rated by neuropsychologist Dr Hughes on 2/8/12 1 memory: mild c/o memory loss without objective findings on testing 2 judgment: normal 3 social interaction: routinely appropriate but with multiple firings from jobs 4 orientation: normal 5 Motor: normal 6 visual-spacial:normal 7 subjective: c/o 3 or more symptoms that mildly affect work or social interactions 8 neurobehavioral: one or more that frequently interfere with work 9 communication: normal 10 Consciousness: normal In summary, based upon this interview, history, and testing, it is clear that the veteran manifests normal organic cognitive capacities but that he has significant emotional/motivational/behavioral difficulties. He likely suffered a mild concussion when he hit his head on the side of the pool; but organic cognitive factors do NOT appear to be involved in a current clinical picture. Indeed, psychiatric factors seem to play an exacerbating role in his symptom picture and are likely responsible for the veteran's reported cognitive and functional difficulties. Diagnostic Impression: Axis I 311 Depression NOS 309.81 PTSD Axis II: 301.83 Borderline personality disorder Axis III: Please see medical record Axis IV: History of volatile interpersonal relationships,lack of coping skills, marital and family problems, unemployment, financial problems Axis V: GAF = 49 Finally, in my professional opinion, the veteran is able to manage his own financial affairs for VA purposes. Please contact me if you have questions concerning this evaluation. states hit head on empty bottom of pool while cleaning it in the service, felt nauseous and vision off, and had headaches without loss of conciousness SECTION II: Assessment of facets of TBI-related cognitive impairment and subjective symptoms of TBI ----------------------------------------------------------------------------- 1. Memory, attention, concentration, executive functions -------------------------------------------------------- [X] 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 If the Veteran has complaints of impairment of memory, attention, concentration or executive functions, describe (brief summary): see previous testing and note that this is as least likely as not related to ptsd, he recalled three things, and oriented to day and year 2. Judgment ----------- [X] Normal 3. Social interaction --------------------- [X] Social interaction is occasionally inappropriate If the Veteran's social interaction is not routinely appropriate, describe (brief summary): he feels uncomfortable in group settings and doesn't leave house much not related to tbi 4. Orientation -------------- [X] Always oriented to person, time, place, and situation 5. Motor activity (with intact motor and sensory system) -------------------------------------------------------- [X] Motor activity is normal most of the time, but mildly slowed at times due to apraxia (inability to perform previously learned motor activities, despite normal motor function) If the Veteran has any abnormal motor activity, describe (brief summary): states baseball not as easy as was in past. However had mild tbi and is not as least as likely related to tbi 6. Visual spatial orientation ----------------------------- [X] Normal 7. Subjective symptoms ---------------------- [X] Three or more subjective symptoms that moderately interfere with work; instrumental activities of daily living; or work, family or other close relationships. Examples of findings that might be seen at this level of impairment are: marked fatigability, blurred or double vision, headaches requiring rest periods during most days If the Veteran has subjective symptoms, describe (brief summary): veteran states occ dizzy, ringing in ears for which is sc, headaches,states completely stop from working. only symptom related to tbi is headaches see headaches exam included 8. Neurobehavioral effects -------------------------- [X] One or more neurobehavioral effects that interfere with or preclude workplace interaction, social interaction, or both on most days or that occasionally require supervision for safety of self or others If the Veteran has any neurobehavioral effects, describe (brief summary): veteran states unable to work due to social interaction difficults which have precluded work for 3 years and he has ssdi for this but please see headache rating exam included 9. Communication ---------------- [X] Able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language. 10. Consciousness ----------------- [X] Normal SECTION III: Additional residuals, other findings, diagnostic testing, functional impact and remarks ----------------------------------------------------------------------------- 1. Residuals ------------ Does the Veteran have any subjective symptoms or any mental, physical or neurological conditions or residuals attributable to a TBI (such as migraine headaches or Meniere's disease)? [X] Yes [ ] No [X] Hearing loss and/or tinnitus [X] Erectile dysfunction [X] Headaches, including Migraine headaches [X] Mental disorder (including emotional, behavioral, or cognitive) [X] Other, describe: tinnitus see previous rating exam, mental heal issues see previous rating exams, erectile dysfunction not related to tbi 2. Other pertinent physical findings, scars, complications, conditions, signs and/or symptoms ----------------------------------------------------------------------------- a. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis section above? [X] Yes [ ] No b. Does the Veteran have any other pertinent physical findings, complications, conditions, signs and/or symptoms? [X] Yes [ ] No If yes, describe (brief summary): cn grossly intact, dtrs = and 2+ bilateral, sensation and movement intact, able to heel and toe stand, rhomberg neg, moves all extemities, sensation intact upper and lower extremities. no dysdiadokinisis 3. Diagnostic testing --------------------- a. Has neuropsychological testing been performed? [X] Yes [ ] No If yes, provide date: 2/8/12 Results: I. Memory, attention, concentration, executive functions The veteran has 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. II. Judgment The veteran exhibits normal organic judgment capacity but mildly impaired judgment overall as a result of emotional dysfunction. "I get impulsive without worrying about the consequences. I just react to stimuli." For some decision making, he is occasionally unwilling to identify, understand or weigh the alternatives, understand the consequences of choices, or make a reasonable decision due to emotional reasoning. Concerning his judgment, the veteran stated: "On a stable day I have good judgment but on a depressed day I don't. I get impulsive without worrying about the consequences. I just react to stimuli." III. Social interaction The veteran stated his social interaction is routinely appropriate "because I stay reserved." However, he also notes inappropriate reaction to authority resulting in multiple firings from jobs. IV. Orientation The veteran is always oriented to person, time, place, and situation. V. Motor Activity (with intact motor and sensory system) The veteran's motor activity is normal. VI. Visual-Spatial Orientation The veteran's visual-spatial orientation is normal. VII. Subjective symptoms The veteran complains of 3 or more subjective (emotional or pain related) symptoms that mildly interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment or: Intermittent dizziness, daily mild-to-moderate headaches, and frequent insomnia. VIII. Neurobehavioral effects The veteran complains of one or more emotional/behavioral symptoms that frequently interfere with work place interaction, social interaction, or both but did not preclude them. "I have had over 15 jobs since I left the military; and I lost them for arguing with coworkers and customers. I'm on Social Security disability for bipolar disorder, PTSD, and depression since May of 2010." IX. Communication The veteran is able to communicate by spoken and written language (expressive communication), and to comprehend spoken and written language. X. Consciousness The veteran's level of consciousness is normal. In summary, based upon this interview, history, and testing, it is clear that the veteran manifests normal organic cognitive capacities but that he has significant emotional/motivational/behavioral difficulties. He likely suffered a mild concussion when he hit his head on the side of the pool; but organic cognitive factors do NOT appear to be involved in a current clinical picture. Indeed, psychiatric factors seem to play an exacerbating role in his symptom picture and are likely responsible for the veteran's reported cognitive and functional difficulties. Diagnostic Impression: Axis I 311 Depression NOS 309.81 PTSD Axis II: 301.83 Borderline personality disorder Axis III: Please see medical record Axis IV: History of volatile interpersonal relationships,lack of coping skills, marital and family problems, unemployment, financial problems Axis V: GAF = 49 Finally, in my professional opinion, the veteran is able to manage his own financial affairs for VA purposes. Please contact me if you have questions concerning this evaluation. b. Have diagnostic imaging studies or other diagnostic procedures been performed? [X] Yes [ ] No If yes, check all that apply: [X] Computed tomography (CT) Date: 3/20/2009 Results: normal c. Has laboratory testing been performed? [ ] Yes [X] No d. Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No 4. Functional impact -------------------- Do any of the Veteran's residual conditions attributable to a traumatic brain injury impact his or her ability to work? [X] Yes [ ] No If yes, describe impact of each of the Veteran's residual conditions attributable to a traumatic brain injury, providing one or more examples: see included headache exam 5. Remarks, if any: ------------------- none **************************************************************************** Headaches (including Migraine Headaches) Disability Benefits Questionnaire Name of patient/Veteran: Indicate method used to obtain medical information to complete this document: [ ] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. [ ] Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence. [ ] Examination via approved video telehealth [X] In-person examination Evidence review --------------- Was the Veteran's VA claims file reviewed? [ ] Yes [X] No If yes, list any records that were reviewed but were not included in the If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [X] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [X] Other: VA rating documents as this is a review tbi 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a headache condition? [X] Yes [ ] No [X] Other (specify type of headache): unknown type ICD code: 000 Date of diagnosis: 2005 2. Medical History ------------------ a. Describe the history (including onset and course) of the Veteran's headache conditions (brief summary): developed headaches at time of tbi in 2005. Had neurologic consult 3/2009 and diagnosed with headaches of unknown type inially treated with ibuprofen b. Does the Veteran's treatment plan include taking medication for the diagnosed condition? [X] Yes [ ] No If yes, describe treatment (list only those medications used for the diagnosed condition): ibuprofen 3. Symptoms ----------- a. Does the Veteran experience headache pain? [X] Yes [ ] No [X] Pulsating or throbbing head pain [X] Pain on both sides of the head [X] Pain worsens with physical activity [X] Other, describe: stress worsens and tinitis increases during headache b. Does the Veteran experience non-headache symptoms associated with headaches? (including symptoms associated with an aura prior to headache pain) [X] Yes [ ] No [X] Nausea [X] Vomiting [X] Sensitivity to light [X] Sensitivity to sound [X] Changes in vision (such as scotoma, flashes of light, tunnel vision) [X] Sensory changes (such as feeling of pins and needles in extremities) [X] Other, describe: headaches vary intensity, frontal headaches on 1-10 7-8 and severe posterior headache 8-9 c. Indicate duration of typical head pain [X] Less than 1 day d. Indicate location of typical head pain [X] Both sides of head [X] Other, describe: both sides of head and back of head 4. Prostrating attacks of headache pain --------------------------------------- a. Migraine / Non-Migraine- Does the Veteran have characteristic prostrating attacks of migraine / non-migraine headache pain? [X] Yes [ ] No If yes, indicate frequency, on average, of prostrating attacks over the last several months: [X] Once every month b. Does the veteran have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadatability? [X] Yes [ ] No 5. Other pertinent physical findings, complications, conditions, signs and/or symptoms ----------------------------------------------------------------------------- a. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis section above? [ ] Yes [X] No b. Does the Veteran have any other pertinent physical findings, complications, conditions, signs and/or symptoms related to any ENGLAND, LARRY ADAM CONFIDENTIAL Page 16 of 17conditions listed in the Diagnosis section above? [X] Yes [ ] No If yes, describe (brief summary): see included tbi physical 6. Diagnostic testing --------------------- Are there any other significant diagnostic test findings and/or results? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): ct normal see attached tbi exam 7. Functional impact -------------------- Does the Veteran's headache condition impact his or her ability to work? [X] Yes [ ] No If yes, describe the impact of the Veteran's headache condition, providing one or more examples: veteran states headaches cause him to be unable to function in a job seting due to need for no sensory input during headaches. He states that he has up 5 severe headaches a week lasting up to 2 hours that would prevent him from having full or part time work. 8. Remarks, if any: ------------------- none

This is not really a question but just a summary of the exam I was given today for a remanded appeal. Mountain Home VAMC was the location of the exam. Dr. Belanger was the examiner, he was nice and easy to speak with. He also wanted very short and to the point answers and never let me talk freely. I assume he was only asking the questions that the VLJ wanted addressed for the remand. The exam was not at all what I thought it would be, they never are. It lasted roughly 30 minutes and at the end his stated his opinion, in which I was unable to work full or part time due to my headaches from my TBI. He then said that he signed the report and submitted it and that I could sign for a copy of the exam the next day. He thanked me for my service and sent me on my way. Now the wait begins for the appeal to fall before the VLJ again to make his final decision. Hoping for a favorable outcome. I guess the Nashville VARO will make the decision not the VLJ who ordered the remand. Sorry for the mix up.

My VSO with the DAV acted as if the FL 10-02 had no weight in getting my retro payment processed any quicker and advised me to be more patient. When I felt, that since I have been at this claim since 2005, and the VARO told my VSO they were waiting to pay me, that is when I had my Congressman forward the letter to the VARO. Maybe that letter will carry a heavier load.

I turned in my information release form for a congressional inquiry just this past week.The VLJ ordered a partial grant and also a remand on 02/03/2014 . I made contact with my VSO about retro payment status on 03/24/2014, he then contacted the Nashville RO and there response about the retro is they are withholding payment until the remand was complete. I feel this goes against the VA Fast Letter 10-02 and I feel the only way I can have any influential contact with that Regional Office is by a congressional inquiry. Retro pay is over 20k, so I am determined. I will keep you updated on my situation in case of success or failure.

Congratulations ! And well deserved.

So I called my VSO to find out why my retro has not been paid out yet. He then called the appeal center and was told that they are holding out to paying the retro until the TDIU exam was complete because they think my percentage will increase. When I mentioned to my VSO about the VA fast letter 10-02, he stated that when DRO thinks that the percentage will increase they typically don't pay the retro until the final decision. I guess I should be happy about this but I am having mixed feeling due to the fact that the DRO is not the one making the final decision. So, unless he can see the future how does he know that my percentage will go up? The TDIU exam is on the first of April so maybe this will be done sooner than I think and just a little more patience is all I need.

Victory !

Thank you for the encouraging words and thank you for your service. Yes, I am registered with Ebenefits and with a premium account.

Your victory is deserved and your story is inspiring. Congratulations on your success!

Still have not received the official letter from the Nashville Regional Office about the appeal decision made February 3, 2014. I have been notified by the Mountain Home VA Medical Center of my ratings exam on April 1 for the remanded issues. A person from Mountain Home called me and also said that the appointment will last all day long and be very extensive. (no anxieties about that) Still no retro pay as of yet. The VLJ granted an increase from 50% to 70% for my PTSD effective June 2008 to November 2011. So I wait, patiently anxious, as to when my RO will officially notify me on these updates from the BVA.

http://www.veteranscalculator.com/ You have to register to use the calculator but it works very well when you have everything put in right. Each time you make a change to your rating make sure and recalculate your payment chart.

Congrats Jfarr!

I agree with the above comment about that if you are currently working it will hurt your chances for the VA to rate you at 100%. Have you applied for SSDI? if you haven't you should.

Thank you !

TBI and TDIU remanded, PTSD granted at 70% for entire duration of appeal dating back to June 2008. Was initially rated at 50% for PTSD, so I will get back pay for the other 20% for the past 69 - 70 months. A victory, but the battle rages on. Never give up!

Spoke with my VSO and from what he could see is that my appeal for PTSD was granted and my appeal for TBI and IU were both remanded. He could not see the % but I am rated at 70% now for PTSD. Now I need to sit by mailbox and wait.

If it is being sent to the AMC I am guessing remand. Never give up!

My decision was mailed out today. I am thinking about calling my VSO and asking if he can see the decision. Now that I know a decision has been made my anxiety has went through the roof to and my OCD has kicked in full gear to try and find out the outcome. Hoping for a victory!

As of today 05/14/2014 I have not received notification from Nashville VARO about decision made on April 24, 2014. DAV representative assured me on two different phone calls about the decision of granted 100% IU P&T. DAV mailed their notification on April 30,2014 but still has not showed up in my mail box. I was also told by my Congressman Chuck Fleischmann that my appeals file at his local office will be forwarded, along with several other that he has hand selected, to a hearing in Washington about the VA claims and appeals backlog. I just want complete resolution and see the big brown envelope in my mail box. Timeline of Your Appeal Date of Progress 08/11/2009 Local VA Office Decision RO 11/04/2009 Notice of Disagreement (NOD) RO 11/05/2009 Appeal Pending RO 06/16/2010 Statement of the Case (SOC) RO 06/30/2010 Substantive Appeal (Form 9) RO 07/07/2011 Supplemental Statement(s) of the Case (SSOC) RO 01/24/2013 Certification of Appeal RO 05/29/2013 Received by BVA BVA 05/29/2013 Administrative Case Processing BVA 05/29/2013 With VLJ BVA 01/07/2014 With VLJ BVA 01/07/2014 With VLJ BVA 01/23/2014 With VLJ BVA 1/30/2014 With VLJ BVA 02/01/2014 Pending Dispatch BVA

I found out today that I was approved for SSDI . My question is if I have been found totally disabled by the Social Security Administration what are my chances of getting a 100% disability rating from the VA. I have a 50% rating already and have appealed the last rating decision and requested a review by DRO. Any help with this question would be greatly appreciated. Adam UPDATE ! June 6, 2010 Denied by the VA for TDIU even after being approved by Social Security for disability for the same disability. I am not sure on what to do next except to send a notice of denial and go through the entire process again.