Developing Claim For Residuals Of Tbi

[Rockhound]

The following is a part of the write up of the discussion I had with the Individual who conducted my Neuropyschiatric testing, on the results of this testing: and a summery of those test results.

“I met with Mr.XXXX on 7/2/08 to discuss the results of neuropsychological testing. We again discussed his history of having successful performance in the military prior to the time that he was hospitalized in a military hospital and sustained an injury to his nose. With possible frontal lobe linjury. Mr. XXXX has been frustrated over the years that he has not been able to secure service connected disability. This has been based on the past diagnosis by a ratings examiner (1974) of a Personality Disorder."

"It is my opinion that if Mr. XXXX has a personality disorder, it is most likely an Organic Personality Disorder stemming from the brain injury in 1973. Neurology notes from that time document the neurologist’s opinion that EEG findings indicate some degree of frontal lobe pathology. Personality changes are frequently noted after a frontal lobe injury and they can be even more disabling and prominent than cognitive changes.”

(The examiner has a Phd. Since she is working with the psych teem, I am assuming she is a psychologist}

.

DIAGNOSTIC SUMMERY:

1. Mr. XXXX is attention and memory abilities are basically intact. Test scores show significant executive dysfunction.

2. Given the course of history, it is possible that the deficits found represent the sequelae of the brain injury he sustained during the military service. Changes in mood and personality functioning may represent an Organic Personality Disorder stemming from the brain injury. Military records show that his performance prior to the injury was satisfactory.

3. Mr. XXXX has numerous , chronic health problems that impact negatively on his physical and cognitive Functioning.

When I went to this testing, I provided the examiner with documents of my schooling and personnel evaluation during service, along with other supporting documents that showed I had no problems in service, that my problems only began after my acute psychotic episode and the minor cerebral concussion. The paper trail history supports this and the abnormal EEG test support some type of frontal lobe injury. It’s a known fact that the frontal lobe region of the brain controls ones personality.

Not that I’m going to be over joyd to find anything possiiv, but I hope my upcoming EEG test and MRI show some indication of the injury I sustained to my frontal lobe. I won’t be holding my breath, since these tests do not always show problems, when in fact there is.

Just thought I would clarify what I have been saying about my neuropsychiatric test results and the evidence that supports me reopening my claim for the TBI/Cerebral Concussion..

EEG and MRI pending, and final report from Neurologist on their findings.

I also have a statement from one of my prior treating Psychiatrists basically stating that have observed me over a period of time she can conclude that I do not have any personality disorder that meets the standards of the DSM IV. Which goes toward supporting that any personality disorder I might have, is more likely to be the results of the TBI. (still trying to locate the progress notes, since my filing process is sorely lacking in orginzation.)

Any recommendation on what other areas I should cover to support my claim would be most helpfull

[Wings]

x

x

x

http://www.reginfo.gov/public/do/eAgendaViewRule?ruleID=277782

VA

RIN: 2900-AM75

Publication ID: Fall 2008

Title: Schedule for Rating Disabilities; Evaluation of Residuals of Traumatic Brain Injury (TBI)

Abstract: This document amends the Department of Veterans Affairs (VA) Schedule for Rating Disabilities (38 CFR part 4) by revising that portion of the Schedule that addresses Neurological Conditions and Convulsive Disorders (sec. 4.124a) in order to provide detailed and updated criteria for evaluating Residuals of Traumatic Brain Injury (TBI) under

diagnostic code 8045.

Agency: Department of Veterans Affairs(VA)

Priority: Other Significant

RIN Status: Previously published in the Unified Agenda

Agenda Stage of Rulemaking: Completed Actions

Major: No

Unfunded Mandates: No

CFR Citation: 38 CFR 4.124a

Legal Authority: 38 USC 1155

Legal Deadline: None

Timetable:

ActionDateFR CiteNPRM 01/03/2008 73 FR 432 NPRM Comment Period End 02/04/2008 73 FR 432 Final Action 09/23/2008 73 FR 54693 Final Action Effective 10/23/2008

Regulatory Flexibility Analysis Required: No

Government Levels Affected: None

Small Entities Affected: No

Federalism: No

Included in the Regulatory Plan: No

Public Comment URL: www.Regulations.gov

RIN Data Printed in the FR: No

Agency Contact:

Maya Ferrandino Consultant,

Regulations Staff, C&P Service (211D) Department of Veterans Affairs

810 Vermont Avenue NW, Washington, DC 20420 Phone: 727 319-5847

Email: maya.d.ferrandino@va.gov

[timetowinarace]

Yep, I've read the new rating criteria.

[Rockhound]

I looked up my last claim that mentions the Cerebral Concussion. It lists it under DC # 8045, so I wonder if I should continue the claims process using this DC # or should I use a Different one that more represents my current problems or if I would be allowed to do so without a Dr. making an opinion that the old DC was wrong or inadequate to proper represent his condition?

I also noted on my Navy Medical Board, that the DC # given for the cerebral concussion was DC # 8500.

Rockhound Rider

Edited January 9, 2009 by Rockhound

[Rockhound]

Like I said, my filing system is nearly non existent, but I was finally able, by pure chance, to find the statement one of my previous Psychiatrists put in my electronic medical records concerning their opinion as to me having a personality disorder, so here is what the progress notes state.

"56 year old male with adjustment diosrder. Pt's old military records were reviewed. To clarify the prior note, the first incident with the "spiked punche" was a seperate from a few years later when he was inpatient for "acute schizophrenic episode" where he was catatonic for 2-3 days and then resolved. He also sustained a head injury when he fell in the shower while impatient. Pt has no recollection of being brought to the hospital or circumstances leading to his hospitalization. The only memory he had was being in the shower when he fell."

"One report said he thought he had a personality diosrder. Today a brief screen of borderline, dependent, antisocial, and schizotypal personality disorder were done. There was no obvious evidence that he meet criteria for theses. MMPI was done in 2005, there was no report of personality diosder during that time either."

This of course is the meat of the note she wrote. It is also of note that the medical treatment summery of 1973, also mention conducting a battery of neuropsychological test, of which the MMPI was but one of them, there to, was no mention or diagnosis of a personality diosrder given.

I had my EEG test today also and It doesn't appear on the surface that it will be of any help, but I will have to wait a week or so for the report of those results to be written up and I can request a copy of those results.

Will keep you updated as my evidence portfolio grows.

Rockhound Rider

[allan]

changes for 8045 took effect back in sept-08 i believe.............

Abstract: 4.124a Schedule of ratings—neurological conditions and convulsive disorders. With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially ps

http://www.warms.vba.va.gov/regs/38cfr/bookc/part4/s4_124a.doc - size 87,040 bytes - 12/10/2008 8:32:47 PM GMT

8045 Residuals of traumatic brain injury (TBI):

There are three main areas of dysfunction that may result from TBI and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation.

Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Evaluate cognitive impairment under the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.”

Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Evaluate subjective symptoms that are residuals of TBI, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” However, separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere’s disease, even if that diagnosis is based on subjective symptoms, rather than under the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table.

Evaluate emotional/behavioral dysfunction under §4.130 (Schedule of ratings–mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.”

Evaluate physical (including neurological) dysfunction based on the following list, under an appropriate diagnostic code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions.

The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, evaluate under the most appropriate diagnostic code. Evaluate each condition separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine under §4.25 the evaluations for each separately rated condition. The evaluation assigned based on the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations.

Consider the need for special monthly compensation for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc.

Evaluation of Cognitive Impairment and Subjective Symptoms

The table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than “total,” since any level of impaired consciousness would be totally disabling. Assign a 100-percent evaluation if “total” is the level of evaluation for one or more facets. If no facet is evaluated as “total,” assign the overall percentage evaluation based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet.

Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled “Evaluation Of Cognitive Impairment And Other Residuals Of TBI Not Otherwise Classified” with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition.

Note (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation.

Note (3): “Instrumental activities of daily living” refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one’s own medications, and using a telephone. These activities are distinguished from “Activities of daily living,” which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet.

Note (4): The terms “mild,” “moderate,” and “severe” TBI, which may appear in medical records, refer to a classification of TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under diagnostic code 8045.

Note (5): A veteran whose residuals of TBI are rated under a version of § 4.124a, diagnostic code 8045, in effect before October 23, 2008 may request review under diagnostic code 8045, irrespective of whether his or her disability has worsened since the last review. VA will review that veteran’s disability rating to determine whether the veteran may be entitled to a higher disability rating under diagnostic code 8045. A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating awarded as a result of such review, VA will apply 38 CFR 3.114, if applicable.

[ausgmblr]

Allan as a brain Injury Vet I can sympatize with you and would advise:

Since that C/P Dr. wont't ask you Executive brain dysfunctive evaluations most helpful to you, Take your wife into rating with you, Be sure you tell them and have a letter prepared and signed, dated telling them and giving expalmes of judgement decisions made to fast, shouldn't have made examples wife corrected, witnessed. Not concentrating drifting off when she or others carrying on conversation, example, how often, Any loss of speech or balance smell. Letters from friends of screw ups you've made you never would have made before your TBI. Get letters take them and send copies to your POA.

Best of Luck

Ausgmblr