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Posttraumatic Stress Disorder In Patients With Traumatic Brain Injury And Amnesia For The Event?


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J Neuropsychiatry Clin Neurosci. 1997 Winter;9(1):18-22.

Posttraumatic stress disorder in patients with traumatic brain injury and amnesia for the event?

Warden DL, Labbate LA, Salazar AM, Nelson R, Sheley E, Staudenmeier J, Martin E.

Defense and Veterans Head Injury Program, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.

Frequency of DSM-III-R posttraumatic stress disorder (PTSD) was studied in 47 active-duty service members (46 male, 1 female; mean age 27 = 7) with moderate traumatic brain injury and neurogenic amnesia for the event. Patients had attained "oriented and cooperative" recovery level. When evaluated with a modified Present State Examination and other questions at various points from study entry to 24-month follow-up, no patients met full criteria for PTSD or met criterion B (reexperience); 6 (13%) met both C (avoidance) and D (arousal) criteria. Five of these 6 also had organic mood disorder, depressed type, and/or organic anxiety disorder. Posttraumatic amnesia following moderate head injury may protect against recurring memories and the development of PTSD. Some patients with neurogenic amnesia may develop a form of PTSD without the reexperiencing symptoms.

Publication Types:

· Clinical Trial

PMID: 9017524 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9017524

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  • HadIt.com Elder

This is BUNK science from the Defense and Veterans Head Injury Program, Walter Reed Army Medical Center. 27 patients for their study. They state "No patients met full criteria for PTSD" AND "Some patients with neurogenic amnesia may develop a form of PTSD without the reexperiencing symptoms." Blatant Contradiction. They are skewing the DSM-111 diagnosis of PTSD - in order to deny compensation for the disorder! If you read related articles, other studies independent of the DoD will state the exact opposite.

See here [israel] : One hundred twenty subjects with mild traumatic brain injury who were hospitalized for observation were assessed immediately after the trauma and followed up 1 week, 3 months, and 6 months later. All participants underwent psychiatric evaluation and self-assessment of their memory of the traumatic event. RESULTS: Overall, 17 (14%) of the participants met full criteria for PTSD at 6 months. Subjects with memory of the traumatic event were significantly more likely to develop PTSD than those without memory of the traumatic event; the difference between the groups resulted primarily from the reexperiencing cluster.

http://www.ncbi.nlm.nih.gov/entrez/query.f...3799&query_hl=2

See here [Germany]: The development of symptoms of posttraumatic stress disorder (PTSD) in patients with neurogenic amnesia for the traumatic event is recorded. With a single exception, all patients were accident victims with closed head injuries. Only about three quarters of the patients completely fulfilled DSM-III-R criteria of PTSD. Nineteen patients displayed involuntary conscious memories of aspects of the traumatic event (presenting as recurrent intrusive thoughts, images or dreams) co-existent with a complete or partial lack of voluntary conscious memories of the trauma, suggesting that different memory systems and distinct brain mechanisms subserve these phenomena.

http://www.ncbi.nlm.nih.gov/entrez/query.f...3682&query_hl=2

See here [scotland]: METHOD: Fifteen hundred case records from an Accident and Emergency Unit were screened to identify 371 individuals with traumatic brain injury who were sent questionnaires by post. The 53 subsequent valid responses yielded three groups: those with no memory (n = 14), untraumatic memories (n = 13) and traumatic memories (n = 26) of the index event. RESULTS: Groups with no memories or traumatic memories of the index event reported higher levels of psychological distress than the group with untraumatic memories. Ratings of PTSD symptoms were less severe in the no memory groups compared to those with traumatic memories. CONCLUSIONS: Psychological distress was associated with having traumatic or no memories of an index event. Amnesia for the event did not protect against PTSD; however, it does appear to protect against the severity and presence of specific intrusive symptoms.

http://www.ncbi.nlm.nih.gov/entrez/query.f...6346&query_hl=2

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  • HadIt.com Elder

There is a horrific number of TBI's (traumatic brain injuries), veterans returning from the Iraq war. The TBI is probably the signature of Iraq's combat wounded; perhaps even as high as 60%.

"Diagnosis can be difficult even when head injury is apparent or the patient is able to describe a concussive head injury to their doctors. Even mild brain injury can cause depression, reduced cognitive functioning, nausea, sleep disturbance, erratic behavior, and violent mood swings. These disabilities are exacerbated by misdiagnosis, lack of treatment, the public¹s perceptions of brain injury and mental illness. For brain injured veterans, the lack of physical signs and the diffuse nature of symptoms is often met with skepticism, considered to be psychological, or worse, malingering." http://www.tf.org/tf/featured/01-29-04traumaticinjury.html

Although PTSD may very well be the LEAST of their organic problems, the diagnosis - more often than not - applies and deserves service-connected disability compensation.

See also: New England Journal of Medicie, Volume 352:2043-2047 May 19, 2005 Number 20. Traumatic Brain Injury in the War Zone, Susan Okie, M.D. http://content.nejm.org/cgi/content/full/352/20/2043

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"Diagnosis can be difficult even when head injury is apparent or the patient is able to describe a concussive head injury to their doctors. Even mild brain injury can cause depression, reduced cognitive functioning, nausea, sleep disturbance, erratic behavior, and violent mood swings. These disabilities are exacerbated by misdiagnosis, lack of treatment, the public¹s perceptions of brain injury and mental illness. For brain injured veterans, the lack of physical signs and the diffuse nature of symptoms is often met with skepticism, considered to be psychological, or worse, malingering." http://www.tf.org/tf/featured/01-29-04traumaticinjury.html

I am one of these from the first gulf war. I was hospitalized for several weeks for a closed head injury in '91. I returned to duty and fought in the ground assault. For 14 yrs I've been complaining of problems and even a draining feeling in my ear. I was put on anti-depressants. I told everyone I had a head injury. I was put on anti-depressants. Last Jan. at a C&P for depression secondary to SC undiagnosed fatigue (a symtom of brain injury) the examing Psych said it was my brain damage causing it all. It turns out that the draining feeling in my right ear is ceribral spinal fluid leaking from my brain. I had filed a claim in '97 for right ear disorder that was denied because there was nothing wrong with it. Oh, I better quit here. I could go on for a while. Better to just swallow a little more of my brain fluid and relax. Oh, the way they VA distiguishes between Mild Brain Trauma and PTSD for diagnostic purposes is simply avoidance of the event/stressor. Otherwize symptoms are the same.

Time

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  • HadIt.com Elder
I am one of these from the first gulf war. I was hospitalized for several weeks for a closed head injury in '91. I returned to duty and fought in the ground assault. For 14 yrs I've been complaining of problems and even a draining feeling in my ear. I was put on anti-depressants. I told everyone I had a head injury. I was put on anti-depressants. Last Jan. at a C&P for depression secondary to SC undiagnosed fatigue (a symtom of brain injury) the examing Psych said it was my brain damage causing it all. It turns out that the draining feeling in my right ear is ceribral spinal fluid leaking from my brain. I had filed a claim in '97 for right ear disorder that was denied because there was nothing wrong with it. Oh, I better quit here. I could go on for a while. Better to just swallow a little more of my brain fluid and relax. Oh, the way they VA distiguishes between Mild Brain Trauma and PTSD for diagnostic purposes is simply avoidance of the event/stressor. Otherwize symptoms are the same.

Time

Time, I am sorry for your combat injury and feel outraged with the VA's inadaquate medical attention! I hope you have since filed a proper claim for the closed head injury? Yes? Your recent C&P Examiner's report seems helpful!! Hope that you get the help you need and desrve.

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I posted a topic in the "medication" section awhile back on a similar topic - Propanolol ....It has been shown that disrupting the memory BEFORE PTSD sets in can reduce PTSD symptoms. This doesn't mean there's a cure, nor does it mean that it is guaranteed to work, but having the VA focus on helping future vets to have lesser symptomology is better then having them focus on "curing" PTSD after the fact (IE - lowering existing ratings).

Honestly, I think the VA should embrace the study I linked because it refutes the fact that amnesia can stop PTSD AND can help future vets by decreasing symptoms on the battle field before it becomes a life-long problem.

Edited by Jay Johnson
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"the lack of physical signs and the diffuse nature of symptoms is often met with skepticism, considered to be psychological, or worse, malingering."

This is on point with my argument that the C&P exmination was inadiquate for adjudication purposes, that the examiner could not visualize that which took the Naval Dr's and Psycholigist special testing to detemine and having not done any of the same or similiar testing to refute the Naval Dr's and Psychologists findings, does not rise to the level of evidence to rebut the benefit of the doubt and rebut the presumption of sound condition. further that it is shown that the C&P examiner failed to concider the possible psychological effects the trauma to the brain may have had, when a personality disorder was noted six months after the event occured.

Again it brings to my mind as to why the VA can SC a Nasal Fracture, but not the accompaning Concusion, even if mild, given the difficulties in visulizing the psychological and diffuse nature of the symptoms and the fact that these may well take days, months or even years for them to develop to a degree that they may well be visualized and/or it's psychological effects could be determined as being caused by the traumatic head injury.

This furthers my idea that the VARO is not doing their job in a non adversarial manner and is doing all they can to see that Veterans receive the benefits that are rightfully theirs for their SC disabilities. The VARO should be looking at the C&P exam in the same manner as they do the information supplied by the Veteran, not using it as a tool to deny the benefits due the Veteran.

Jim S. :)

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I think the studies help prove my theory that PTSD IS a brain injury and not merely a psychological one. If a physical brain injury can produce very similar symptoms to PTSD then why can't they draw the lines between the two? In my opinion, one's brain damages itself in order to better cope with a traumatic event, but that "rewrite" of the brain has negative side effects which are expressed via PTSD symptoms. I don't think the VA wants to make that connection because it will mean that most PTSD cases would be permanent in nature and the psychiatric community won't admit it because they would be out of a job as far as the value of therapy is concerned......I think trying to talk someone into recovering from PTSD is like trying to talk someone into recovering a lost arm (it's not gonna happen).

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  • HadIt.com Elder
This is BUNK science from the Defense and Veterans Head Injury Program, Walter Reed Army Medical Center. 27 patients for their study.

Wings,

There were 47 patients in the study - there average age was 27.

There is nothing in the study to justify your categorization of "Bunk".

The other studies you cited ontradict each other, and the German one doesn't state the number of subjects evaluated.

In fact, the Scottish study, with the most subjects, would tend to support what the Walter Reed study reported. I don't think you were dispassionate when reading and analyzing this report. I can sympathize with your feelings, but not with your conclusion.

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  • HadIt.com Elder

Wings,

There were 47 patients in the study - there average age was 27.

There is nothing in the study to justify your categorization of "Bunk".

The other studies you cited ontradict each other, and the German one doesn't state the number of subjects evaluated.

In fact, the Scottish study, with the most subjects, would tend to support what the Walter Reed study reported. I don't think you were dispassionate when reading and analyzing this report. I can sympathize with your feelings, but not with your conclusion.

Walter, Thank you for correcting the numerical quotient: 27 vs 47 is an distinct variable. However, I still say BUNK. They could have done better research. They could have skewed the data to show the percentage of patients that DID meet the criterian for PTSD (in their own words, "a form of PTSD"). Instead, their study suggests that NOT ONE patient met the FULL criteria. I posted the other studies to show that TBI patients OFTEN meet the FULL criteria for a PTSD diagnosis.

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I posted this somewhere before. I think it was for Jim. Don't know if he saw it.

Differential Diagnosis

In those individuals reporting long-term PCS symptoms following MTBI,

their clinical presentation may be very similar to related disorders, including

post-traumatic stress disorder, major depression, disability seeking behavior,

or malingering. For instance, individuals may report sleep difficulties,

memory problems, irritability, and anxiety that fit any of these diagnoses.

Mittenberg and Strauman (2000) suggest the following considerations in

differential diagnosis:

• Post-concussion Syndrome versus Post-Traumatic

Stress Disorder. PCS is not associated with persistent reexperiencing

of the accident or numbing of general

responsiveness, whereas PTSD is. In contrast, PTSD is not

characterized by headaches, dizziness, generalized memory

problems, or subjective intellectual impairment, while PCS is.

• Post-concussion Syndrome versus Major Depression. PCS is

not associated with changes in appetite or weight, psychomotor

agitation or retardation, suicidal ideation, or a history of

depressive disorder.

• Post-concussion Syndrome versus Disability Seeking or Overt

Malingering. While a malingerer may convincingly report many

symptoms of PCS, level and pattern of performance on formal

neuropsychological testing can be used to differentiate between

the two presentations, at least in cases where the medical record

clearly indicates that the head injury was mild. However, it is

certainly possible that individuals with legitimate post-injury

symptoms may also amplify or exaggerate their problems. These

cases are the most difficult to tease apart contributing etiologies,

although a careful history, collateral interviews, and formal

neuropsychological assessment are often useful.

Veterans health initiative-links to training manuals

Wings,

Combat injury, no. A sledge hammer fell through the gun hatch and landed on my head. I had filed a claim in '03 and was denied for lack of records. Could not find records nor had diagnoses, just knew I was messed up. It went no where. Appeal in for depression and reopened head injury claim after hunting down records. Have testing and diagnoses. Just waiting.

Time

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  • HadIt.com Elder

Time, Differential Diagnosis information was useful; most notably is the use of neuropsychological testing for cognative impairments. Did the VA give you a battery of tests or did you need to get those independently? Combat or no combat, service related injury nonetheless. How much does a sledgehammer weigh anyhow?! Ouch!! BTW, how did you go about "hunting down" your SMR''s (service medical records)? This is a tricky subject, one that comes up time and again with many vets - and your success might prove helpful to others . . . Hang in there!! ~Wings

Edited by Wings
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10# sledge. Fell 4 feet. Yep, ouch. I didn't see it. Didn't know what hit me.

The C&P psych said I needed neuropsych testing and to see a neurologist. He took me out front and ordered the referals. it never happened. I didn't think it would so I tried to find as much info as I could myself. This area is too small and no brain injury experts. I did find a good psychologist that was up to date and got the neuropsych testing done. I'm very cognitively impaired. Uh, slow. She says I do not have the mental ability to work. (I thought I was too tired and sore)

The internet found my hospital records. Well, as stated, I'm slow, so I thought about it for a month. Then I ran google search after google search after google search. I hadn't found hadit then. I finally came across a DoD press release about a data base of gulf war hospital records. It had a 1-800 # and there you go. I believe the information is on hadit. The problem was, the VA had my SMR's. But hospital records from the gulf were never put in the SMR's. Hospital records from that time have to be requested from a different records place in St Louis. The VA did not request them. When I requested my records from the DoD I was told that the VA allready had ALL of my records. I was never informed that there were two places that medical records are kept for Gulf war soldiers. My SO did not know. Nobody at the Vet center knew. LOL. Anyway, that's the story as my brain understands it. :) I'm pretty sure the information is on hadit. If not I'll find the # for the data base and post it. It is still messed up though. I was in two hospitals. The data base showed records for one. When I requested those records I included the other hospital records just in case. Well, I got the ones that weren't supposed to be there and not the ones that were. Go figure.

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  • HadIt.com Elder
10# sledge. Fell 4 feet. Yep, ouch. I didn't see it. Didn't know what hit me.

The C&P psych said I needed neuropsych testing and to see a neurologist. He took me out front and ordered the referals. it never happened. I didn't think it would so I tried to find as much info as I could myself. This area is too small and no brain injury experts. I did find a good psychologist that was up to date and got the neuropsych testing done. I'm very cognitively impaired. Uh, slow. She says I do not have the mental ability to work. (I thought I was too tired and sore)

The internet found my hospital records. Well, as stated, I'm slow, so I thought about it for a month. Then I ran google search after google search after google search. I hadn't found hadit then. I finally came across a DoD press release about a data base of gulf war hospital records. It had a 1-800 # and there you go. I believe the information is on hadit. The problem was, the VA had my SMR's. But hospital records from the gulf were never put in the SMR's. Hospital records from that time have to be requested from a different records place in St Louis. The VA did not request them. When I requested my records from the DoD I was told that the VA allready had ALL of my records. I was never informed that there were two places that medical records are kept for Gulf war soldiers. My SO did not know. Nobody at the Vet center knew. LOL. Anyway, that's the story as my brain understands it. :) I'm pretty sure the information is on hadit. If not I'll find the # for the data base and post it. It is still messed up though. I was in two hospitals. The data base showed records for one. When I requested those records I included the other hospital records just in case. Well, I got the ones that weren't supposed to be there and not the ones that were. Go figure.

An Independent Medical Examination is often the critical factor to winning a case. Good on you. Tbird's data base is huge. I'll go to the home page and see if I can find the information. I've known for some time that in-patient records are stored in a separate location at St. Louis, but I do not know the most direct route. If either one of us finds that information today - let's post it again under Claims/Research. You might want to think about how you are going to associate the current cognative impairment with the traumatic injury. Prior to active duty were your test scores higher? School work grades normal, etc. Just thinking out loud. Stay confident. It seems you have some hard evidence now in support of your claim. I totally sux that the DoD and VA, both ignored the in-patient records. I'm sure they still do it routinely! ~Wings

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Here is the #. 1-800-497-6261

The link: Gulf War Hospital Records

The article:

DoD Database Helps Locate Gulf War Hospital Records

WASHINGTON, August 4, 1998 (GulfLINK) - The Office of the Special Assistant for Gulf War Illnesses announced today that it is offering assistance to those Gulf War veterans who have had difficulty in obtaining copies of their inpatient hospital records from the Gulf War. Collaborating with the Department of Veterans Affairs, the National Personnel Record Center and the Department of the Army, the office is creating a consolidated database to retrieve hospital records for all patients treated in Army, Navy and Air Force Gulf War hospitals. Veterans who are interested in securing information from these records are encouraged to contact the office to request a data search.

"Our goal is to inventory any known surviving hospital record from the Gulf War and create a database with names of all U.S. military and coalition forces and civilians," said Dr. Bernard Rostker, the special assistant for Gulf War illnesses.

In the military, the disposition and storage of records is governed by each service, DoD regulations and statute. Medical records fall into two categories: individual health records and inpatient hospital treatment records.

Individual health records include clinic visits, diagnostic tests, immunizations, dental care, and, in some cases, discharge summaries of inpatient care. These records represent a history of a service member’s medical care and accompany them throughout their military career. Upon a member’s separation or retirement, the individual health record is retired to the Department of Veteran’s Affairs Record Management Center in St. Louis, Mo., Rostker said.

Inpatient hospital treatment records are created each time a service member is admitted to a military medical treatment facility for care. These records document all treatment and procedures performed while the member is hospitalized. If the patient is evacuated to another facility, a copy of the treatment record accompanies the patient and the original record is retained with the hospital’s files. Defense Department guidelines call for hospital in-patient treatment records to be retired within a span of four to 10 years, depending upon the facility’s record disposition policy to the National Personnel Records Center where they are archived under the name of the hospital transferring the records.

War often skews even the best policy, explained Rostker. In a fast-paced, chaotic battle environment a service member’s individual health record may be maintained by his unit and never reach the hospital administering care or the individual may receive treatment in a number of facilities. The in-theater hospitals did not have transcriptionists, so discharge summaries were not done in most cases. Also, the in-theater hospital generally did not have copy machines, so when a patient was transferred to a hospital, the original record was sent with the patient.

After the war, veterans seeking their medical records had to know the name of the facility that treated them during the war in order to obtain the record from the hospital or the National Personnel Records Center.

The need for a database grew out of the concerns veterans expressed to Rostker’s team about locating their records. Many veterans thought that their records were lost or destroyed.

"The records were never lost or destroyed," explained Mike Boyle, an investigator on Roskter’s medical issues team. "If veterans didn’t know the name of the hospital that treated them, there was no way of finding their records."

To come up with a solution for veterans, Rostker’s staff built on the work accomplished by the Department of the Army. The Army created an electronic database which cross referenced the patient’s name and social security number with the name of the admitting hospital and dates of care for 10,500 in-patient treatment records before sending the records to the records center in St. Louis. This accounted for approximately 70 percent of the Army Gulf War inpatient records.

The Special Assistant’s staff members flew to the records center in St. Louis to examine more than 2,000 boxes identified as Air Force and Navy hospital records from the Gulf War. The hands-on effort, augmented by Army reservists, resulted in the identification of 7,000 additional Air Force and Navy in-patient hospital records. Rostker’s team added this list of individuals by name, social security number and hospital facility name to the Army’s electronic database.

"We literally examined and reviewed every record," said Boyle, explaining how the team provided the bridge to unlock the information.

Rostker and his staff hope that this effort will assist veterans who require records to establish a claim with the Department of Veterans Affairs due to service-related illness, as well as those who wish to keep track of their medical conditions.

To obtain copies of in-patient hospital records from hospitals deployed to the Gulf, the veteran should call the Special Assistant’s office at 1-800-497-6261 to request a database search. The office will complete a request form and forward it to the veteran for signature and mailing to the record center.

Individual health records of former service members are archived in two locations, Boyle said. The VA maintains records for Army veterans discharged after 1992; and Air Force, Marine and Navy veterans discharged after 1994. To obtain copies, veterans may call the VA at 1-800-827-1000. For all other records, veterans should write to the National Personnel Records Center, 9700 Page Ave., St. Louis, Mo. 63132.

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I'll put this in a new post.

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I don't think a nexus between injury and current cognative impairment is going to be the big issue. My entrance exam (asvab) scores were fairly high. (above average) While in service I recieved exemptions for time in service and time in grade for early promotions in rank, twice. Four Army Achievement Medals. Also, I never would have been on the Special (nuclear) Weapons Team with severe cognitive difficulty. From what I understand, I would have been in special education and unable to complete school in my current condition. I know I failed at Voc Rehab recently.

The problem I face is that though I have the concrete evidence of tests, I do not have the full diagnoses of multi-infarct dementia required to get more than a 10% rating. The psychologist that did the testing will say that I cannot work due to cognative difficulty and that it was caused by the head injury I recieved in service. And she will say that my depression and anxiaty are from brain trauma. But without a MD diagnoses of multi-infarct dementia, wich I fit, it will get me no where. There is no one in this area with knowledge of brain injury other than her. I've looked allot. I have to rely on the VA for it. And for the neurological symptoms, most of wich I had been denied for in the past, pre-diagnoses.

I gave a complete account of what happened with my injury when I first filed specifically for it in '03. Dates, hospitals, everything. When I get a rating, if it does not go back to then I'll CUE it. They had the info. Their error.

Time

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I don't think a nexus between injury and current cognative impairment is going to be the big issue. My entrance exam (asvab) scores were fairly high. (above average) While in service I recieved exemptions for time in service and time in grade for early promotions in rank, twice. Four Army Achievement Medals. Also, I never would have been on the Special (nuclear) Weapons Team with severe cognitive difficulty. From what I understand, I would have been in special education and unable to complete school in my current condition. I know I failed at Voc Rehab recently.

The problem I face is that though I have the concrete evidence of tests, I do not have the full diagnoses of multi-infarct dementia required to get more than a 10% rating. The psychologist that did the testing will say that I cannot work due to cognative difficulty and that it was caused by the head injury I recieved in service. And she will say that my depression and anxiaty are from brain trauma. But without a MD diagnoses of multi-infarct dementia, wich I fit, it will get me no where. There is no one in this area with knowledge of brain injury other than her. I've looked allot. I have to rely on the VA for it. And for the neurological symptoms, most of wich I had been denied for in the past, pre-diagnoses.

I gave a complete account of what happened with my injury when I first filed specifically for it in '03. Dates, hospitals, everything. When I get a rating, if it does not go back to then I'll CUE it. They had the info. Their error.

Time

Tests, like the asvab, are not a sign of one's IQ; rather, they are nothing more then one's ability to memorize facts (IE - knowledge). From a neurological standpoint they are going to want to test your IQ and unless you've had IQ tests prior to the military it will be hard to prove that it has dropped. You can probably get by with a historical review of all your tests going back to grade school *IF* you can prove you were average to above average then, but are now sharply below average in IQ....it sounds like you may be able to make that case given your history in the military, but you cannot use a given test or tests to determine your cognitive ability in general.

Good luck.

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  • HadIt.com Elder
I don't think a nexus between injury and current cognative impairment is going to be the big issue. My entrance exam (asvab) scores were fairly high. (above average) While in service I recieved exemptions for time in service and time in grade for early promotions in rank, twice. Four Army Achievement Medals. Also, I never would have been on the Special (nuclear) Weapons Team with severe cognitive difficulty. From what I understand, I would have been in special education and unable to complete school in my current condition. I know I failed at Voc Rehab recently.

The problem I face is that though I have the concrete evidence of tests, I do not have the full diagnoses of multi-infarct dementia required to get more than a 10% rating. The psychologist that did the testing will say that I cannot work due to cognative difficulty and that it was caused by the head injury I recieved in service. And she will say that my depression and anxiaty are from brain trauma. But without a MD diagnoses of multi-infarct dementia, wich I fit, it will get me no where. There is no one in this area with knowledge of brain injury other than her. I've looked allot. I have to rely on the VA for it. And for the neurological symptoms, most of wich I had been denied for in the past, pre-diagnoses.

I gave a complete account of what happened with my injury when I first filed specifically for it in '03. Dates, hospitals, everything. When I get a rating, if it does not go back to then I'll CUE it. They had the info. Their error.

Time

Be careful diagnosing yourself: Multi-infarct dementia is typically associated with a vascular dicturbance (multiple strokes), whereas a blunt head injury with dementia is more aligned with Chronic subdural haematomas, etc. I think it would be in your best interest to see a Psychiatrist with some forensic knowledge. Have you ever had an MRI or Cat Scan?

Check out this page http://www.emedicine.com/med/topic3152.htm

Regarding pathophysiology, specifically of dementia after head injury, the pattern of symptoms reflects the nature of the injury and the location of tissue damage. Symptoms related to particular brain areas include the following:

Prefrontal cortex - Disinhibition, apathy, personality change (coarsening, flattening), decreased fluency of speech, obsessions, hypochondria, delusions

Basal ganglia - Depression, mania, tremor, cogwheeling, bradykinesia, obsessions, compulsions

Thalamus - Apathy, irritability, pathological crying, paresthesias, pain, hypersomnia

White matter - Apathy, lability, loss of spontaneity, transient hemiparesis or hemiplegia, bradykinesia, bradyphrenia

Cerebellum/pons - Mild avolition, disinhibition, cerebellar signs, loss of ability to execute motor routines automatically

P.S. I worked as a Psychiatric Technition, USAF 80-86, but I am certainly not current on my studies!

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Jay,

The Defence and Veterans Brain Injury Program are allowed to readminister the ASVAB to patients within 6 months of service. No one else is allowed to retake it. They are trying to protect the integrity of the test. The ASVAB is is almost the only commonly taken test not accepted by MENSA. The reason? The Gov. has speciffically asked them not to. Though it is claimed that the ASVAB is not an IQ test, it has the uncanny abillity to detect the g facter. General Intelligence.

Reaseach article, Dept. of Psych.

From the NLSY79 data set, we extracted measures of performance on the Armed

Services Vocational Aptitude Battery (ASVAB) and the SAT (known as the Scholastic Aptitude Test at that time), as well as a number of intelligence tests that did not have scores available for as many subjects ("small-N" tests).A principal-axis factor analysis was performed on the 10 subtests of the ASVAB in order to derive a measure of g. This analysis included 11,878 of the 11,914 subjects who had taken the ASVAB. The remaining 36 subjects were excluded because they were missing scores for 1 or

more subtests. ASVAB scores were chosen in place of scores on some of the more traditional intelligence tests because ASVAB scores were available for nearly all of the NLSY79participants (11,878 of 12,686). Furthermore, prior analysis of the ASVAB confirmed a hierarchical g model in which 64% of the variance in the ASVAB was due to a general factor (Ree & Carretta, 1994; see Roberts et al., 2000, for an alternative model). Results of the factor analysis of the ASVAB are shown in Table 1. They indicate a substantial loading of all subtests of the ASVAB on a first factor, g. ASVAB first-factor scores were transformed to an IQ scale using the following equation:IQ = (z * 15) + 100.Finally, the IQ scores derived from the ASVAB were correlated with SAT scores for the 917 respondents who had scores on both measures. Simple correlations between both SAT scores and ASVAB IQ scores and scores on the small-N intelligence tests were also analyzed.

Can post the whole thing if interested. Regardless it can't be used.

Wings,

Title 38 Chapter I Part 4 Subpart B Sec 4.124a

Purely subjective complaints such as headache, 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

diagnostic code 9304 are not assignable in the absence of a

diagnosis of multi-infarct dementia associated with brain

trauma.

I have done extensive research on brain trauma. The only place I have seen the words "multi-infarct dementia associated with brain trauma" are in this reg. Multi-infarct dementia is diagnoses given to the elderly. However, I have found definition of multi-infarct dementia as being multiple random cognitive impairments with no mention of stroke. Let me explain. My testing shows I have above average language skills in the 70% range. But I have verbal skills in the 3% range. A contradiction. My overall memory functions are fully intact. My working memory is allmost nonexistant. A contradiction. And my memory in general is poor despite the functions being there. A contradiction. This is how the neuropsychologist determines if my deficits are due to brain trauma. Not just one area is affected, and some are not effected at all. This is allso why they use this testing to rule out malingering. You can't fake multiple areas of deficts consistantly on multiple tests because they use different methods to find them. So you see, if you leave the infarct part out, (the word is there to imply organic damage) I fit. Not every person with brain trauma is going to show tiny strokes throughout their brain. Not even if severely injured. They do not show on imaging for the elderly in most cases. Neuropsych testing is now the most relied on method of detecting brain damage due to trauma. This has to be the definition meant, otherwise very few seriously injured could quallify for comp.

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Edited by timetowinarace
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  • HadIt.com Elder

Brother Vet, Your psychologist has stated your cognative impairments are secondary to in-service head trauma to the brain. Your neuropsychological testing shows organic impairment. This is GREAT evidence to have in support of your claim. Leave off the words "multi-infarct", re-read Sec 4.124a and then combine 4.126 (et all) -- see here:

§ 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.

(b) 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 §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 §4.14).

(Authority: 38 U.S.C. 1155)

*You seem to fall into numerous schedules for rating disabilities. You have been diagnosed with depression too!

Hey, I'm only suggesting your evidence be evauluated by a Psychiatrist of your own choosing 'cause the VA is going to hand it over to an M.D. eventually. I wouldn't worry about the specific terminology just now, not unless you get a very clear neuro diagnosis from a specialist. You are facing organic brain damage with cognative impairment and seconday mental disorders. I think you should pay to see a psychiatrist who can put it all together for you. What do you think? I did work in a Neuropsyche testing lab at Wilford Hall medical center for 3 years: head wounds, gunshot wounds to the head, strokes, etc. It sounds like you are suffering short term memory problems as well as some aphasia ... yes? Hang in there, stay confident, I think you are hot on the trail! ~Wings

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