RockyA1911

I received a decision today awarding service connection for skull loss at 30% effective 11 July 2005 with overall combined rating increased to 70%. Please recall I had gotten a combined rating of 60% in Jan of 07..... 50% - Post Concussion Residuals, Left Temporal Lobe contusion, with PTSD 10% - Post Operative Scar 10% - Tinnitus And the TIGER TEAM deffered the Skull Loss and Individual Unemployability at that time. They did not mention anything regarding my claim for clear and unmistakeable error for skull loss claimed in 1976 without adjudication until now. No mention of anything regarding claim for retro payment back to original claim dated 28 Nov 1976. They did not mention in this letter anything regarding my deferred claim for IU either. The TIGER TEAM stated that my records are being returned to my local regional office and I should contact them if I have any further questions. The date of the letter is 27 Feb 2007 with decision made on 21 Feb 2007. They made another CUE with the SC for Skull Loss by awarding me only 30% under DC 5296. It is undebateable that my Skull Loss right out of post op and is now 4.5cm x 4.5cm (20.25 sq cm) or 1.77 in x 1.77 in (3.13 sq in.) which is easily larger than 1.140 sq in or 7.355 sq in required for a 50% rating. My skull loss exceeds that by almost three times. They even listed what constituted 30% right out of the CFR DC 5296 and even listed what was required for a 50% rating. How anybody, especially the TIGER TEAM could not see that big mistake when they read all the VA and military medical records and not see I exceeded the that for the 50% rating. This is just an out and out dumb error. So I am now at least service connected for the Skull Loss as a stand alone in their letter: "Service connection of skull loss is granted with an evaluation of 30 percent effective July 11, 2005." Don't they have to give me some kind of a decision on the requested earlier effective date of Nov 1976 based on CUE claimed at the same time as the skull loss? Don't they have to render a decision on the deferred IU claim? In this letter they did not even mention the outstanding Skull Loss with earlier effective date claim nor the previously deferred claim for IU. Here is the CFR 38, DC 5296 Sec. 4.71a Schedule of ratings--musculoskeletal system. The Skull ------------------------------------------------------------------------ Rating ------------------------------------------------------------------------ 5296 Skull, loss of part of, both inner and outer tables: With brain hernia............................................. 80 Without brain hernia: Area larger than size of a 50-cent piece or 1.140 in \2\ 50 (7.355 cm \2\)............................................. (my 4.5cm x 4.5 cm verified skull loss is “3.13 in \2\ (20.25cm \2\)” Area intermediate........................................... 30 Area smaller than the size of a 25-cent piece or 0.716 in 10 \2\ (4.619 cm \2\)......................................... Note: Rate separately for intracranial complications. ------------------------------------------------------------------------ They quoted this right back to me in their decision letter, listed all the medical records, exams, and the stack of everything since 1972 until now clearly reports 4.5cm x 4.5cm skull defect. What do you make of this Vike?

I don't buy into any of that video stuff period. It was in the medial last year too. The video cannot give you the stressor event that caused your PTSD so I challenge their speculation that a video game can cure the PTSD. Unless that damn video game can more likely than not cause PTSD it cannot cure it. What a hoax!!!!!

CAVMAN!!! That is a bunch of BS period!!!!! The VA has to go out and buy NEXIUM for you and here is how you do it. "Get a letter from your private care MD that prescribed the NEXIUM for you. Have the MD state that NEXIUM is prescibed for your condition. Also, Mr. CAVMAN does not tolerate Prilosec, Prevacid, and the other listed generics listed in below thread. Mr. Cavman tolerates NEXIUM well. Have the MD address it to whom it may concern." Fax that or hand carry it to your VA Primary care Dr. and tell them you need the med immediately and how long you have gone without it. You will get your medicine and it will be NEXIUM. I had this same problem and that is what I did. I needed Aciphex because I could no longer tolerate Prevacid or Prilosec and I got tired of screwing around. My private Gastro MD put me on Aciphex and I love it with no adverse reactions such as bloating, cramps, diareahha etc. I went to my first PC visit and the VA Dr wrote the prescription for non-formulary Aciphex and the pharmacist refused to furnish the Aciphex. I went on IRIS website and complained that I had run out and had furnished the required letter from my GI doctor in order to recieve the Aciphex. Two days later real early one morning my doorbell rang and it was Federal Express with my supply of Aciphex. That was a year ago and I have been getting the Aciphex ever since. Just have your own doctor state that you only tolerate the Nexium. You should have your Nexium within a week for the prescription, but your PC VA Dr should write an immediate prescription for filling at a local area pharmacy such as a grocery store etc close to the VA clinic. I know when I got the pink eye I went to the VA clinic and they immediately prescribed some stuff and gave me some paperwork to take around the corner to the local HyVee food chain with pharmacy and I filled it there at no cost right away. Anytime you need a med that is not in the VA formulary, just get the letter from you private MD and you will get what you need. There is no smoke or mirrors just folks in the VA that don't know what they are talking about. You do not have to try other meds for evaluation first, plain BS. "The Marines have landed and the situation is well at hand"

Cavman, Yes, your VA primary care doctor will write your prescriptions annually. Bring your current prescriptions with you. I don't understand your question about reimbursement because to be reimbursed you must have been getting prescriptions from the VA to begin with and you would have had to have had a VA doctor prescribe them to you. Are you currently enrolled in the VA health care system? Did you fill out the VA EZ 1010 enrollemnet form and get assigned a priority number? As far as the current increase rating you just need to make a copy of the front page that says "Congratulations the VA has awarded your benefits etc., along with the date of the rating increase and either take it to or fax it to your VAMC Registration and Enrollments Office. If you are in the health care system they will update the demographic with your new rating percentage and based on the date of the increase to 50% or above, you will be reimbursed for VA co-pays that were paid after the effective date of the increased rating.

I beg to differ with rickb54 regarding Obama. Less than two years ago Obama and Durbin initiated the investigation about the disparity in the claims processes and monthly compensation and why they differed by state. We all got letters in Illinois and the other states telling us that we may have been under compensated and to file a claim if we felt we had been. Most recently and personally Senator Obama got my claim rated and me a decision ASAP.. I went to his office on the 19th of Dec (Tues), got a letter from the VA 23 Dec (Sat) stating they were expediting my claim. The decision date of the claim is 28 Dec 2006. Now considering there was a Sat, Sun, and Mon (Christmas) in the mix, that is darn fast and he DID DO SOMETHING for this VETERAN. Incidentally, the claim was chosen by the VA Secretary's Tiger Team to expedited. Obama has been for the Veteran since the day he entered public office, he's no phony, and he knows how to get results and FAST. He gets results everytime, not months, years, but days. He's a good man and works hard for us vets. Check Obama's record on supporting Vets and you will see it will shine.

They are SUPPOSED to consider them and put them in your C-File. The key word is SUPPOSED to. Make sure you also have copies and also send the new evidence to your VARO. Make sure that the VARO and the C&P examiner have the new evidence. If you don't, there are a lot of vets that gave them to the C&P examiner, were rated, and the VARO never addressed or had the new information. So send it the VARO also.

Go here to verify MOH recipients. http://en.wikipedia.org/wiki/List_of_Medal...onor_recipients It is a Federal Crime to fraudulantly claim to be a Medal of Honor recipient, it is also a crime to possess, buy, or sell if you are not a MOH recipient. If he is not a MOH recipient, have the bastard arrested, call the police on him. You're letting a POS like that dilute the prestige and crap on all of us veterans. Put the puke in jail!!!!!

FLRHC1, You should be good to go then and you have a well grounded claim for PTSD. Now just move to the WAIT list. RockyA1911 FLSTFI

Good luck with that! You DO have specific details describing the stressor event, with date, location, witnesses that you will send in with your claim in addition to just this diagnosis and just this general statement that you meet the criteria for PTSD? Just stating veteran witnesses traumatic events, death, and injury in the diagnosis,etc. is not what is called a "credible in-service stressor". You have to be more detailed and explain the stressor event. Not saying that you haven't and I realize the "stressor event" is you own personal business that you do not want to share. I'm just saying if you are using just that diagnosis, it would hard for an RO to verify the stressor event. In otherwords that diagnosis is a description that applies to any and all veterans that have been exposed to traumatic events and not specific or detailed for your specific in stressor event. Just make sure you submit your stressor letter with details of the event WITH the diagnosis. If not, that diagnosis isn't worth anything to receive VA Comp for PTSD. The RO will have the diagnosis but will ask "Where is the description of the actual in stressor event that can be corroborated?" Why don't you just state you have submitted a stressor letter describing the in stressor event, then everyone here would know that you have the diagnosis and the stressor letter, so we know you are good to go with a well grounded claim. That is not personal and we respect you privacy as far as detailing the stressor, I just believe you should have one to go with the diagnosis if you want to prevail.

What do we need in order to get PX and Commisary privilages? Do you have to be rated 100% to get an ID card? I am 60%. Am I eligible to use the commissary and PX? A while back someone posted the forms needed to obtain a military ID card, could they post it again? I am close to a Army Arsenal that has PX and Commissary among the regular Army base activities. I already have a Department of the Army MWR ID card for gaining access to the gym etc., But I think you have to have a military type ID card to use the PX and Commisary. Right or Wrong?

OK, I read the two attachments. There is a diagnosis of PTSD and nothing else. Am I missing something? The only thing in there regarding military is "Served in the Navy, Military Police Duty". That is not what is called an in-service stressor, nothing in there identifying a in-service stressor event or occurence. "Service connection of post-traumatic stress disorder requires medical evidence diagnosing the condition, a link established by medical evidence between current symptoms and an in-service stressor and credible supporting evidence that the claimed in-service stressor occurred." You still need to furnish a credible in-service stressor in order to prevail in a PTSD claim. You can have the diagnosis of 100% and be hospitalized, but if you do not have a conceded or credible in-service stresser describing the event, witnesses, and approx date, with location the incident occured you will be SOL. By conceded I mean a combat award or combat arms MOS if the in-service stressor was from combat. If it is for a personal assault or other than combat, you must really detail the incident, witnesses, official reports, police reports, date, location, and describe the stressful event. The paragraph in quote is from an actual completed rating decision. After that paragraph they either state that your DD-214 documents the receipt of Combat Action Ribbon, etc, therefore the in service stressor is conceded. If you don't have at least that, then the next paragraph in the rating will document the in-service stressor is supported by credible evidence or the Marine Corps could not confirm that the event happened. If the Marine Corps corroborated the stressor fine, if not, you will be denied.

This is just the reg explaining what to do if there is no credible stressor provided to corroborate the veterans in-claimed stressor. The reg I also believe tell the VA not to arbitrarily send requests to the Marine Corps for verification or corroboration. It is a last resort. First you have to provide a in-service stressor, if you have combat award the in-service stressor is conceded. If you do not have a combat award, you must have written a in-service stressor and if there are no buddy statements, then the VA sends the in service stressor you provided to the Marine Corps so they can either corroborate the in-service stressor or deny that the incident happened. In the abscence of providing an in-service stressor does not mean the Marine Corps will do anything because how can they corroborate a stressor incident that you never documented your own self. Is this what you are talking about out of the M21-1MR? f. Review of Evidence (1) If a VA medical examination fails to establish a diagnosis of PTSD, the claim will be immediately denied on that basis. If no determination regarding the existence of a stressor has been made, a discussion of the alleged stressor need not be included in the rating decision. (2) If the claimant has failed to provide a minimal description of the stressor (i.e., no indication of the time or place of a stressful event), the claim may be denied on that basis. The rating should specify the previous request for information. (3) If a VA examination or other medical evidence establishes a valid diagnosis of PTSD, and development is complete in every respect but for confirmation of the in-service stressor, request additional evidence from either the Center for Unit Records Research (CURR) or Marine Corps. (See Part III, paragraph 5.14.) (4) Do not send a case to the CURR or Marine Corps unless there is a confirmed diagnosis of PTSD adequate to establish entitlement to service connection. Correspondingly, always send an inquiry in instances in which the only obstacle to service connection is confirmation of an alleged stressor. A denial solely because of an unconfirmed stressor is improper unless it has first been reviewed by the CURR or Marine Corps. (5) If the CURR or the Marine Corps requests a more specific description of the stressor in question, immediately request the veteran to provide the necessary information. If the veteran provides a reasonably responsive reply, forward it to the requesting agency. Failure by the veteran to respond substantively to the request for information will be grounds to deny the claim based on unconfirmed stressor. (See Part III, paragraph 5.14.)

Remember for PTSD, the diagnosis part is just a part of it. Without a credible in-service stressor to go along with a diagnosis they do not award PTSD. That said, if you have the credible in-service stressor along with your diagnosis of PTSD, I wouldn't think they would deny it. Remember also it is evaluated based on the severity of social and industrial impairment. I would speculate that since you already have 30% MDD and if the PTSD is determined for example 50%, Your MDD would be increased to 50% for MDD with PTSD. I think the higher of the two evaluations comes into play here. Does that answer your question? "The evaluation assigned for a service-connected disability is established by comparing the manifestations indicated in the recent medical reports with the criteria in the VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4 (1993).

I believe it is a waste of time, unless you feel the PTSD would be evaluated with a higher rating than the mental disorder you already have. I just received my rating decision last Tues and they stated in it that both mental disorders and neurological deficits are combined because you can only have one mental disorder and neurological deficits, and when combined the highest evaluation is the one used and the one mental/neurological with the highest is the dominate disability. I had cognitive disorder, Post traumatic encephalopathy, depression, Post concussion residuals, and PTSD. They combined the PTSD and explained that I had two mental conditions, therefore they must be comined into one rating. Thus my highest rating was 50% for PTSD. If you have 50% already for one mental disorder for Major Depression, they will not give you a separate rating for PTSD even if it warranted 50%. You would stay at 50% compensation and they would just add your conditions so it would now state Major Depression with PTSD - 50%. Apparantly mental disorders are pyramiding, because a lot of the symptoms for mental disorders overlap. If you are thinking you will get a separate rating for PTSD in addition to the already service connected Major Depression......forget it or GOOD LUCK. See below: Sec. 4.126 Evaluation of disability from mental disorders. (a) When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. ( When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. (c) Delirium, dementia, and amnestic and other cognitive disorders shall be evaluated under the general rating formula for mental disorders; neurologic deficits or other impairments stemming from the same etiology (e.g., a head injury) shall be evaluated separately and combined with the evaluation for delirium, dementia, or amnestic or other cognitive disorder (see Sec. 4.25). (d) When a single disability has been diagnosed both as a physical condition and as a mental disorder, the rating agency shall evaluate it using a diagnostic code which represents the dominant (more disabling) aspect of the condition (see Sec. 4.14). (Authority: 38 U.S.C. 1155) [61 FR 52700, Oct. 8, 1996]

Vike, No, I wasn't thinking that about the scar at all, I know I did not claim it back then because when I asked the guy at the VA that helped me fill out my initial claim, he told me I wouldn't get anything for the scar, so like a dummmy I didn't. What I was thinking is since they already combined the mental disorders with neurological deficits and also rated the scar separate, the deffered skull loss should stand alone also. And the skull loss is not an inferred claim, I claimed it on 15 Nov 1976, 12 days prior to discharge from the Marines. They took 4.5cm x4.5cm both inner and outer skull during surgery and a year later replaced that 4.5cm x 4.5 cm opening with an artificial plastic materiel that is not my skull. That's what I was thinking.

Vike, Speaking of that "Swelling of the Brain" as secondary, I did have that. The C&P for skull loss, tinnitus, and skin stated: "Seen at St. Anthony's emergency hospital on date of initial assault 11 Mar 1972 and had burr hole for relief of brain swelling." X-Ray reported star shaped cluster bulge with dural tear with fragments imbedded in the brain. Then transferred to Naval Hospital Great Lakes, IL." "Had planned crainioplasty for repair of 4.5cm x 4.5cm skull defect in Nov 1972 but was delayed due to abnormal EEG." "Crainioplasty was done in July 1973 for the repair of the 4.5cm x 4.5 cm defect." It appears I had a brain hernia, or why else would they have done the burr hole immediately? They only do that to save one's life as a last resort due to brain hernia and swelling. The only other thing is that the dura required repair during surgery when the crainiotomy was done stating it was lacerated and punctured. I do no that once the dura is penetrated there is then leakage of the spinal fluid, along with damaged brain tissue (by the way is still present). All I have is the St. Anthony's emergency medical treatment reports to back up brain hernia and that is all. You still did not answer as to why they did rated the post operative scar separately then?

Vike, I would say they better not combine the skull loss with the PTSD. The skull loss is muskoskelatal and under current version DC 5296 still states (Intracranial complications are to be evaluated separately). I mean they just awarded the post operative scar separate as 10%. I that were the case they would also have combined the scar with the PTSD and PCS but they only combined the two mental disorders together. I'm sure if there was a way they could have done it, they would have. The current DC 5296 is the same one that was effective as of 10 March 1976. 3.13 sq in (20.25 sq cm) is my skull loss of 4.5 x 4.5 cm both inner and outer tables. I should at least get the 50% rating separate from the rest I would think. I think their hold up is on the skull loss is they can't fine away around it yet and if they award the 50% claim, then it was definitely a CUE and they have to pay mucho retro. They are still looking for loopholes and just haven't found or invented them yet.

Yes, the VA EEG and abscence of any objective findings in 1977 were flat out wrong. The conclusion that it had to have been misinterpreted was by my current VA NP and the Neurologist. They came to that conclusion and explained to me that there was no way that the EEG in 1977 could have interpreted it as EEG essentially normal. Because immediately post-operative a Navy Medical Board reported finding of Abnormal EEG with a new evaluation in 6 months which again another Medical Board finding was Abnormal EEG and directed another 6 months of which the 3rd and final Medical Board finding reported again Abnormal EEG with clear focal slowing in the left parietal area. So they are saying the 1977 had to be error by whoever interpreted it at the VA because the abnormality and clear focal slowing was present in 1973. The VA did an EEG in 1977 and found no evidence and that the EEG was essentially normal. Here it is in 2006 the VA EEG reports the same abnormality with clear focal slowing. They are saying this condition doesn't come, go, and then come back and that I clearly have always had it since post operative. Like I said previously they didn't even have such a thing as a Neuropsychologist it was a new specialty since then, back then I don't think even MRI to detect the encephalopathy. Yes I should have appealed, your're right. At the time I was young, scared of the VA, and didn't even know what or why I should appeal anything in the rating decision. I did call them about why they didn't give me anything for the skull loss and they guy on the phone tried telling me he would mail me a return bus ticket to go to the VA hospital where they would have to do some exploratory surgery etc. I had two brain operations already each 6 months apart, the craniotomy, and then 6 months later a crainioplasty. Anyway, I hung up and never wanted anything to do with the VA at all, I wanted to be as far from them as possible. Glad you explained these things to me. I understand what you have provided but thought I'd answer your question as to whether 1977 was flat out wrong or not? And no these are not complications that have progressed since the rating in 1977. According to the recent VA reports and consultations I was told they existed immediatley post operative in Mar 1972. It's to bad that vets can't contact their RSVR via email like this and sort the whole thing out. The way I read your explanations I think back on the 1977 Rating they flat out let the skull loss slip through the crack and there reason for the misinterpreted EEG presented the statement "abscence of any objective findings" so 10%. Now that I have recent reports that represent "objective findings" that is still 10%, so what's the diff. Am I correct? I can live with that.

Vike17, Something has got to be fishy then. My previous rating of Rating Decision dated April 1977 has both of the DCs and hyphenated since effective date of Nov 1976 was assigned both as 8045-9304. It was not "or", it was just like this "DC 8045-9304. There are no DCs in the recent decision at all. So what DC would the give to the PCS with PTSD? In May of 06 I had submitted as an "Additional claim" for organic post-traumatic Encephalopathy secondary to service-connected head injury. As support of claim I submitted that: Exhibit A: Merriam-Webster Medical Dictionary definition of Encephalopathy is "a disease of the brain; escpecially one involving alterations of brain structure." Exhibit B: Merriam-Webster Medical Dictionary definition of Encephalomalacia is "softening of the brain due to degenerative changes in nervous tissue (as in crazy chick disease). Exhibit C: Follow-up VA Neurology consult in May of 06 EEG and MRI findings: "At the left tempoaral lobe predominately in the middle gyrus and partially in the superior gyrus posteriorly is abnormal signal with some susceptability artifact consistant with old blood, likely related to patient's known prior history of trauma. IMPRESSION: Old encephalomalacia and post traumatic changes in the left temporal lobe as described above. Mildly abnormal EEG for the awake and drowsy state showing occasional theta slowing in the left mid-temporal area. A breach rhythm is also in the same area. These findings show focal cerebral dysfunction. No epileptiform activitiy was noted." DIAGNOSIS: 1) Post-Traumatic Encephalopathy, this is (more probable than not) as a result of the head injury in 1972 (chronic encephalomalacia seen on MRI). 2) "Spells", cannot r/o simple partial seizures, but treatment with PHT in past was ineffective and description is vague." Exhibit D: Proof of cognitive impairments from VA Neuropsychological Evaluation Jan 06. "Clear evidence of cognitive impairments are present, particularly in situations requiring problem solving, attention, and some visual motor skills. In social and employment settings, he is expected to be severely comprimised. Exhibit E: Pyschiatrist Dr. XXXXXX diagnosis letter dated April 05 states: "Mr XXXXX is disabled and unemployable as a result of his condition." Exhibit F: Proof of entitlement to service connection for post traumatic encephalopathy as separate condition related to already service connected head injury. USCOVA NO 98-934, 10 Feb 2000 and BVA citation Nr. 9930148, Docket NO 94-41 060 29 Oct 1999. The April 1977 10% under DCs 8045-9304 rating decision was based on "absence of any objective findings." Both the psychiatrist, Neuropsychologist, and Neurologist have all told me that there IS NOW objective findings and that Neuropsychologist did not exist back in 1977 and that the EEG in 1977 HAD TO HAVE BEEN MISINTERPRETED. So Vike, it appears to me they picked and choosed which sentences in the medical reports and ignored the above one. They had to have read it because they used them as references and quoted some of the sentences to suit their needs, but as you can see there is nothing in the decision addressing Encephalopathy or even the EEGs and MRIs and nowhere in these reports does it say my current EEG is essentially normal, I posted what the report said above. That is from the 1977 EEG. So, should I not have been awarded a separate rating for the Encephalopathy which is an organic brain disease, not a mental condition, but contributes to the mental conditions such as Cognitive Disorder and Memory loss. They all tied the memory loss and cognitive disorder to the Head Injury. 5 consults and tests with the neuropsychologist stated it was due to the head injury and the only mention of PTSD in her report is "Symptoms of PTSD are present" and that is all, the VA C&P Examiner stated the same thing in her report. How could they not have addressed this and awarded a separate rating then? I would assume this to be at least 20%. It seems they put more weight on a C&P exam dated 11 July 2005 even though it stated "I also believe that it is more likely than not that the veteran has problems with his memory and his interaction with other secondary to his service connected brain trauma and left temporal lobe contusion. However, the brief evaluation I was able to do today showed very inconsitent results. To get a full picture of how much this impacts his daily life, I believe he would need full neuropsychiatric testing, which I have recommended he pursue." She requested full NP testing. The NP testing appointment wasn't until Dec 05 and lasted thru middle of Jan 2006 with report end of January 06. The NP request an appointment for Neurology exam and consult that didn't happen until Feb and Mar 06 with report of EEG, MRI, and X-RAYs and diagnosis furnished in April of 06. It is evident the C&P examiner in July 05 knew there was a cognitive disorder due to brain trauma but did not know the extent or severity at that time. Neither did she have in her possession the NP evaluation report, nor recent EEG, MRI, X-Ray results, nor the neurologists diagnosis.

Whew! Good and I agree with most of that and now that you understand the case too we're on the same page. You basically said the same thing I did about the 10% post concussion residuals and since it was already 10%, I filed for an increase in DC 8045-9304 that already existed as a separate complication which it had been since 1976. And that was the only compensation received 10%, one disability. I had filed for PTSD as a separate issue also in March 05. Since you do agree the PTSD should be 50% and they left the PCS the same at 10% why isn't the higher of the two evaluations (PTSD at 50%) considered the main disability and listed as PTSD and PCS with DC 9411 coming first? Second question is how does my complications differ from these BVA decisions ordering that these be separate disabilities? I ask this because these cases just about mirror mine identically with the exception of the cause of injury: 1) PTSD and PCS: Upon review of the evidence, the Board finds that the veteran should receive separate disability ratings for service-connected PTSD and his service-connected residuals of concussion, identified as encephalopathy and dementia. While the PTSD and the concussion (physical trauma to the brain) may have resulted from the same incident, i.e., a mortar explosion, each is a distinct entity which warrants a separate disability rating under different Diagnostic Codes in the VA schedule for rating disabilities. See 38 C.F.R. Part 4 (1993). In this regard, the Board notes that PTSD is rated under Diagnostic Code 9411, while the residuals of physical trauma to the brain, in this case, may properly be rated under Diagnostic Codes 8045 or 9304. 2) PTSD and ENCEPHALOPATHY: Same as above. The recent VA exams MRI, EEG, and X-Ray furnished with claim reported Post Operative Post Traumatic Encephalopathy due to service-connected traumatic head injury. 3) Skull Loss separate (and mine is a lot larger than this vets): Entitlement to an earlier effective date than November 5, 1999, for a 50 percent rating for residual skull loss from a shell fragment wound, to include on the basis of clear and unmistakable error (CUE). Given the evidence cited above in light of the testimony presented to the undersigned, and considering the unlikelihood of any increase in the size of the area affected in the many years since the in-service injury, the Board finds that is was "undebatable" that the evidence at the time of the January 1969 rating decision demonstrated that the service connected skull wound affected an area of at least 3 cm. As such, the Board finds that reasonable minds could only conclude that the evidence of record at time of the January 1969 rating decision compelled a conclusion that a 50 percent rating for the veteran's skull wound was warranted under 38 C.F.R. § 4.71a, DC 5296 (1969). Thus, the January 1969 rating action may be viewed for the purposes of this adjudication was flawed at the time it was made, and was the product of CUE. As such, the criteria for a 50 percent rating for residual skull loss from a shell fragment wound effective from December 21, 1968, are met. 38 C.F.R. § 3.400(k) (The effective date to be assigned for an award based on CUE is that date from which benefits would have been payable if the correct decision had been made on the date of the decision found to have been the product of CUE). ORDER A 50 percent rating for residual skull loss from a shell fragment wound is granted effective from December 21, 1968, subject to the regulations governing the award of monetary benefits. How does my claim for EED and service connection for skull loss and combined PCS with PTSD differ? I'm just trying to get to what is good for the goose is good for the gander and the differences from my claim versus these decisions.

Thanks Vike, I realize the skull loss is an entirely separate issue and that it should and more than likely receive a separate evaluation. The only thing the decision mentioned as far as combining was only the PCS and PTSD at 50% stating - Post concussion residuals, left temporal lobe contusion chronic WITH post-traumatic stress disorder. The head injury occurred in 1972 while in service on active duty and was determined line of duty. Both the IMO psychiatrist diagnoses and the VA C&P examination report both stated problems with focus, memory loss, cognitive disorder due to service connected brain trauma, however, Mr. XXXXX has more problems with his PTSD symptoms than with his memory and they both stated "Flattened Effect" in their PTSD diagnosis. The IMO psychiatrist stated that Mr XXXXX stating diagnosis of PTSD with GAF of 52 and that this is impacted by his traumatic brain injury. The PTSD onset occurred due to my experiences in Vietnam from Apr 1968 to May 1969. I understand that they can combine the mental and neurological deficits, but don't understand then why under appeal to the BVA, the BVA separates the two i.e. PCS and PTSD and PTSD and Encephalopathy and clearly rebutts the combination of the two and orders the two are separate distinct Diagnostic Codes PTSD is 9411, where PCS is proper under DC 8045-9304. Skull loss is evaluated separately and correctly under DC 5296. With this recent decision they did award 10% for the post operative scar secondary to the PCS and listed it as a separate rating. I don't think the skull loss defferrance at this point has any impact on the already combined PCS and PTSD rating of 50% as it is to be evlauated separate. So the question still remains why is it the CFR is correct in combining the mental by a separate evaluation for neurological deficits and then combined with mental evaluation? BUT, the BVA always determines they are separate and distinct even if it is the same etiology, and orders they receive separate evaluations and rating, but still reference the same CFR reg as above. I guess the question is the CFR is correct as far as the RO following the rules. But yet the BVA says the ROs always broke the rules when combining the PCS and PTSD are separate even if it is the same injury and etiology. That is where my confusion lays, not with the pending skull loss as it will not be combined with other intracranial complications. My previous PCS awarded 10% in 1976 was under 8045-9304 and since PTSD is DC 9411. What DC codes would the hyphenated together when I had before and still have the 8045 -9304. How do they add the DC 9411 when the BVA determines that is a violation? I'm just trying to understand why if the biggest problem according to the doctors is PTSD, and not the mere 10% PCS residuals under 8045-9411? Since "Flattened Effect" was in the reported symptoms of PTSD that warrants a rating of 50%, I would thing since PTSD being the highest rated condition that PTSD would come first with PCS residuals being second. Am I wrong? I actually only claimed one new mental (PTSD) condition, and an increase in current 10%PCS residuals (memory loss, cognitive disorder) under 8045-9304, and PTSD was a new claim. The skull loss had been claimed in 1976 and I claimed it with retro back to 1976 because the skull loss remained unadjudicated.

Hey Vike, Berta, and all, Below is the evaluation procedures for mental disorders. Note it states mental disorders and neurological deficits will be evaluated separately and then combined with the evaluation for mental disorders. It looks like the CFR standing alone means the VA can combine the rating for Post Concussion Residuals (Cognitive disorder, memory loss, etc, encephalopathy) with the mental disorder evaluation such as PTSD. But the BVA decisions quote the same CFR and state they are distinct and separate and require separate rating evaluations: It appears there is constant conflict in that the RO evaluation conforming to the CFR, but upon an appeal to BVA the mental and neurological deficits are then ordered separate evaluations. Which is correct? The BVA decisions are the CFR as it is currently? TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS PART 4_SCHEDULE FOR RATING DISABILITIES--Table of Contents Subpart B_Disability Ratings Sec. 4.126 Evaluation of disability from mental disorders. (a) When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. ( When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. © Delirium, dementia, and amnestic and other cognitive disorders shall be evaluated under the general rating formula for mental disorders; neurologic deficits or other impairments stemming from the same etiology (e.g., a head injury) shall be evaluated separately and combined with the evaluation for delirium, dementia, or amnestic or other cognitive disorder (see Sec. 4.25). The evaluation assigned for a service-connected disability is established by comparing the manifestations indicated in the recent medical reports with the criteria in the VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4 (1993). When there is a question as to which of two evaluations should be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1993). Is the below in conflict with the CFR or is the CFR in conflict with this? The Board will consider all applicable provisions of the VA's Schedule for Rating Disabilities. Diagnostic Code 8045 provides that for brain disease due to trauma, purely neurological disabilities, such as hemiplegia, epileptiform seizures, facial nerve paralysis, etc., following trauma to the brain, will be rated under the diagnostic codes specifically dealing with such disabilities, with citation of a hyphenated diagnostic code. Alternatively, purely subjective complaints such as headaches, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more under diagnostic code 9304. This 10 percent rating will not be combined with any other rating for a disability due to brain trauma. Ratings in excess of 10 percent for brain disease due to trauma under 9304 are not assignable in the absence of a diagnosis of multi-infarct dementia associated with brain trauma. 38 C.F.R. Diagnostic Code 8045 (1993) PTSD and Encephalopathy separately, according to the BVA but not the CFR but yet the BVA quotes the same CFR that says mental and neurological complications will be evaluated separately and then combined. Upon review of the evidence, the Board finds that the veteran should receive separate disability ratings for service-connected PTSD and his service-connected residuals of concussion, identified as encephalopathy and dementia. While the PTSD and the concussion (physical trauma to the brain) may have resulted from the same incident, i.e., a mortar explosion, each is a distinct entity which warrants a separate disability rating under different Diagnostic Codes in the VA schedule for rating disabilities. See 38 C.F.R. Part 4 (1993). In this regard, the Board notes that PTSD is rated under Diagnostic Code 9411, while the residuals of physical trauma to the brain, in this case, may properly be rated under Diagnostic Codes 8045 or 9304. http://www.va.gov/vetapp94/files2/9414656.txt Again the BVA quotes the same CFR that states they can combine them, but rules they cannot be combined: Upon review of the evidence, the Board finds that the veteran should receive separate disability ratings for service-connected PTSD and his service-connected residuals of concussion, identified as encephalopathy and dementia. While the PTSD and the concussion (physical trauma to the brain) may have resulted from the same incident, i.e., a mortar explosion, each is a distinct entity which warrants a separate disability rating under different Diagnostic Codes in the VA schedule for rating disabilities. See 38 C.F.R. Part 4 (1993). In this regard, the Board notes that PTSD is rated under Diagnostic Code 9411, while the residuals of physical trauma to the brain, in this case, may properly be rated under Diagnostic Codes 8045 or 9304.

I submitted my claim in March of 05. It went to the rating board in June of 06. I just received a partial rating decision dated 28 Dec 2006 with decision letter dated 9 Jan 2007. They deferred two of the conditions for further VA review examination on one and pending additional information on the other. At least they finally gave me something instead of continuing to hold the whole thing up until all the issues have been rated. So it was almost 6 months at the rating board, before a decision. 22 months is how long it took before I received a partial decision with 21 months of retro for the claims that were approved.

Goofycow, You can also go on line and submit a complaint via IRIS system. You will get an answer as to the resolution in 5 days. Go to http://www.va.gov . In the upper menu tabs select "CONTACT VA" or it might be CONTACT US. The next screen will have FAQs and the next one after that says "ASK A QUESTION", click on that one. The IRIS screen will come up and there will be some drop down menu boxes, select the one that says Veterans Health Benefits and the other block select Complaint. There will be a drop down box also that lists the VAMCs and select the one you desire that you have the complaint with. Then there is a text block where you can detail your complaint. Make sure you only click once to send, do not click again.....it will process and you will receive an email immediately acknowledging receipt.

Shoot said: Since they only performed one Mental Status portion of the examination that was not considered valid data they are telling you they cannot do a rating because they cannot do it based on GAF score alone, it also requires the diagnosis, along with the results of a VALID Mental Status portion of the C&P exam. Like I said before, when the mental status portion does not coincide with a low GAF score, I was told by a VA neuropsychologist that it is evidence of faking them. She also said they do not take the invalid data just by itself, they do second one to either confirm faking, or confirm the vet is not faking. They should have given you a second mental status portion exam to confirm whether the data was right or wrong based on your GAF. She said the first one is considered inconclusive when the data is not valid. Since the VA was missing the valid data of your mental status portion, I would think they errored in not ASSISTING in the rescheduling of another C&P for mental status examination and I would think that claim is still open. Or ask for reconsideration due to invalid data of the mental status being declared invalid.