ptsd Ptsd, Tbi, Obs

[Berta]

Many OIF OEF vets as well as many vets from other wars have gotten the Personality Disorder disagnosis -with no real medical basis in fact-

Hopefully they all appeal their claims.

Many OIF OEF vets as well as any other vets can have both TBI residuals, or organic brain syndrome ( which could be from DMII strokes etc)and have PTSD as well.

These are all separate disabilities and cannot be considered as pyramiding-however they can be found as one secondary to the other or completely separate from each other.

In my reply to VAF here today-I tried to explain this- and I have discussed this situation with some lawyers who rep veterans.

This BVA decision explains it better than I can:

http://www.va.gov/vetapp08/files3/0825366.txt

In part:

"In a February 2007

VA compensation examination report, a physician offered Axis

I diagnoses of PTSD and of "cognitive disorder, no other

symptoms" which clearly distinguishes the cognitive disorder

from the primary psychiatric diagnosis of PTSD. The

physician further explained, "I did not find any evidence

that the veteran's cognitive disorder was related in any way

to his posttraumatic stress disorder symptomatology."

Finally, the physician stated, "I did not see any evidence

suggesting any etiology for his cognitive difficulties other

than his exposure to heat stroke."

The February 2007 VA physician specifically noted that a

cognitive disorder had caused memory impairment, whereas PTSD

symptoms included nightmares, intrusive thoughts, startled

response, discomfort around crowds, and avoidance of war

movies.

Not only do medical professionals agree that the cognitive

disorder is a separate disability. In fact, separate ratings

(for cognitive versus mental disorders) are also mandated by

38 C.F.R. § 4.126 © (2007), which states:

Delirium, dementia, and amnestic and other

cognitive disorders shall be evaluated under the

general rating formula for mental disorders;

Neurologic deficits or other impairments [emphasis

added] stemming from the same etiology (e.g. a head

injury) shall be evaluated separately [emphasis

added] and combined with the evaluation for

delirium, dementia, or amnestic or other cognitive

disorder (see § 4.25). "

While BVA decisions are not binding in any way as sent in to support a similiar claim regarding medical evidence-or a nexus --- BVA decisions that interpret VA regs are certainly acceptable submissions of evidence as to interpretations of basic VA 101 case law and regs.

This is a great decision as it does explain how VA must differentiate between organic and psychological disabilities.

And rate them separately.

As more OIF OEF men and women find hadit, this case might become very helpful for them.

[militarynurse]

Thank you Berta. Very interesting decision. For clarification: is it accurate to state then that if an organic brain syndrome / disorder results from an already service connected TBI rated under the new guidelines, there should be two separate ratings? i.e., one for the TBI and another for the OBS?

[Berta]

As I understand it-

once a TBI has been established as having occurred-then the VA rates the residuals from it -if the residuals are disabling at a ratable and compensable level.

My husband had similiar issue OBS due to 1151 (and AO) stroke.

The stroke ,per se, wasnt rated -but the residuals of the disabling extent of the brain damage of the stroke was rated.

I

[militarynurse]

Berta, Thanks for the reply. I understand it is the residuals that are rated. What I'm confused about is the meaning from use of the word "AND" in the passage below since separate ratinga are apparently mandated by 38 C.F.R. § 4.126 © (2007). What does "evaluated separately" and then "combined with the evaluation" mean? Any further thoughts please on if the VA should split off the TBI caused OBS residuals from the TBI residuals to arrive at 2 separate ratings: one for the TBI residuals and the other for the OBS residuals? Perhaps it might help for clarification of my question if the Organic Brain Syndrome might be considered a secondary condition resulting from the TBI?

Not only do medical professionals agree that the cognitive

disorder is a separate disability. In fact, separate ratings

(for cognitive versus mental disorders) are also mandated by

38 C.F.R. § 4.126 © (2007), which states:

Delirium, dementia, and amnestic and other

cognitive disorders shall be evaluated under the

general rating formula for mental disorders;

Neurologic deficits or other impairments [emphasis

added] stemming from the same etiology (e.g. a head

injury) shall be evaluated separately [emphasis

added] AND combined with the evaluation for

delirium, dementia, or amnestic or other cognitive

disorder (see § 4.25).