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Blast Injury - Concussion? Tbi?


JustPLS

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Hi, everyone. I need some help with medical terminology.

I have a claim working for effects from 2 different blast injuries suffered in Vietnam (RPG, satchel charges). I think I made a mistake by referencing the injuries as TBI (I thought that was the new name for concussion), and my claim was initially denied, because there is no mention of TBI in my records. I don't know when TBI came into military medical usage, but I don't remember hearing it until about 2005.

My question now is - how do I need to re-characterize the injuries? Should I just refer to them as blast residuals, concussion, or something else? If I call it one thing, will the VA pick up on the incorrect name for the injury and rate it anyway?

My service medical records reference both injuries as due to blast, or rocket blast. Any help will be appreciated.

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I'm 17 year active duty Infantry 1SG. My docs coined my condition "Post Concussive Syndrome". Hope that helps. Need anything gimme a holla. todd.landen@us.army.mil

Hi, everyone. I need some help with medical terminology.

I have a claim working for effects from 2 different blast injuries suffered in Vietnam (RPG, satchel charges). I think I made a mistake by referencing the injuries as TBI (I thought that was the new name for concussion), and my claim was initially denied, because there is no mention of TBI in my records. I don't know when TBI came into military medical usage, but I don't remember hearing it until about 2005.

My question now is - how do I need to re-characterize the injuries? Should I just refer to them as blast residuals, concussion, or something else? If I call it one thing, will the VA pick up on the incorrect name for the injury and rate it anyway?

My service medical records reference both injuries as due to blast, or rocket blast. Any help will be appreciated.

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You are right-that the VA didnt recognize TBI until they decided it was the 'signature' injury of Iraq combat veterans.I would think thousands of Vietnam vets had TBI residuals- although there is information that reveals TBI due to modern weaponry is unlike in some ways- concussion injuries received in other wars. But

"My service medical records reference both injuries as due to blast, or rocket blast"

This is the nexus you need regardless of what VA calls it-

"If I call it one thing, will the VA pick up on the incorrect name for the injury and rate it anyway"

however-they dont have the capability to do that in most cases-

It looks like they denied specifically due to calling it TBI.

However- with the documentation in your SMRs you still need to show current ratable residuals of the injury(ies) that are being treated-in your medical records.This could be migraines, memory problems, visual problems etc-that can be directly attributed to the inservice events.

What stage is your claim at-did they deny and send you a VCAA letter telling you specifically what you need to send to them?

I feel you must clarify to them right away exactly what the injury is.

Are they waiting for a reply from you on the denial?

Do you have your complete SMRS and also copies of your copmplete VA medical records?

Did the VA itself in the denial refer to the exact post concussion terminology that the doctor stated?

Do you have a vet rep holding you POA?

The claim has to be 're characterized' as you said- but if you tell us the exact status and what they last sent to you in the mail- we can better determine what you should do.and if you have time to correct this claim or would have to re-file it.

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You are right-that the VA didnt recognize TBI until they decided it was the 'signature' injury of Iraq combat veterans.I would think thousands of Vietnam vets had TBI residuals- although there is information that reveals TBI due to modern weaponry is unlike in some ways- concussion injuries received in other wars. But

"My service medical records reference both injuries as due to blast, or rocket blast"

This is the nexus you need regardless of what VA calls it-

"If I call it one thing, will the VA pick up on the incorrect name for the injury and rate it anyway"

however-they dont have the capability to do that in most cases-

It looks like they denied specifically due to calling it TBI.

You're right, Berta. The denial just stated "your service records are negative for any complaint of or treatment for traumatic brain injury. There is no medical evidence submitted showing treatment for or a diagnosis of traumatic brain injury which incurred in or is the result of your military service". When I filed the claim, I did not have copies of my service medical records. When I requested them, the Army told me the VA had them. I finally got copies from the VA a few months ago. All the evidence related to those injuries and the treatment for them was in the medical record. Unfortunately, I guess, the only treatments shown were for hearing related problems and tinnitus. Nothing in the records about concussion that I could see, nor did it mention that I lost consciousness in both incidents.

However- with the documentation in your SMRs you still need to show current ratable residuals of the injury(ies) that are being treated-in your medical records.This could be migraines, memory problems, visual problems etc-that can be directly attributed to the inservice events.

What stage is your claim at-did they deny and send you a VCAA letter telling you specifically what you need to send to them?

My denial was dated September 11, 2008. They told me I had one year from the date of the denial to submit evidence or to appeal. I have submitted the documents from my medical records along with statement in support, but an IRIS response to a query last week said they have no information regarding my submissions of evidence supporting this (or other) claims since the denial in September.

I feel you must clarify to them right away exactly what the injury is.

Are they waiting for a reply from you on the denial?

I don't know what they are waiting for now....looks to me like they have either lost or not yet filed anything I have sent in since September.

Do you have your complete SMRS and also copies of your copmplete VA medical records?

I have only what they sent me from the VA. Both my requests to the Army said the VA had my records checked out, and they had nothing to send.

Did the VA itself in the denial refer to the exact post concussion terminology that the doctor stated?

No. They didn't mention anything at all about the information in the medical records, they just said there was no mention of TBI.

Do you have a vet rep holding you POA?

Yes, unfortunately. I am trying to figure out how to fire them since the rep won't even return my emails, and has done absolutely nothing for me so far.

The claim has to be 're characterized' as you said- but if you tell us the exact status and what they last sent to you in the mail- we can better determine what you should do.and if you have time to correct this claim or would have to re-file it.

The claim appears to be in a denied status, pending receipt of evidence - evidence which I have sent in but they say they didn't get (which was in the medical record already). I have recently written a letter to them requesting re-consideration under the lost records special claim handling procedures they announced last November, since I believe some of my stuff hasn't been looked at.

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Oops! I'm still new at this, so I don't know all I need to know about making replies. I wanted to add thanks to Berta and Todd for their help.

Pat

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You should receive a computer generated letter with 30 days of filing a claim. Call the 800 number and make sure you have a claim pending.

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You should receive a computer generated letter with 30 days of filing a claim. Call the 800 number and make sure you have a claim pending.

I didn't call the 800 number, but I did make an IRIS contact through the website. They told me there was nothing active in regards to this claim since it was denied last September. Thanks for the suggestion, though. I may give that a try tomorrow.

Pat

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I didn't call the 800 number, but I did make an IRIS contact through the website. They told me there was nothing active in regards to this claim since it was denied last September. Thanks for the suggestion, though. I may give that a try tomorrow.

Pat

JustPLS,

If you were denied in Sept. you need to file a NOD.

carlie

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JustPLS,

If you were denied in Sept. you need to file a NOD.

carlie

Thanks, Carlie

I have been sort of planning to do the NOD in August. Right now I have requested re-consideration under the VA procedure for "Special Claims Handling Procedures for Missing Documents" since I believe all my documents didn't get to the files for one reason or another. I am working on the NOD now, and may send it earlier if I don't hear anything about my request earlier.

Pat

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Thanks, Carlie

I have been sort of planning to do the NOD in August. Right now I have requested re-consideration under the VA procedure for "Special Claims Handling Procedures for Missing Documents" since I believe all my documents didn't get to the files for one reason or another. I am working on the NOD now, and may send it earlier if I don't hear anything about my request earlier.

Pat

JustPLS,

Keep in mind that even tho you have submitted a request for reconsideration

your NOD clock is still ticking, do not let your year pass by.

If that happens then about the only way to re-open is with new and material evidence.

carlie

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JustPLS,

Keep in mind that even tho you have submitted a request for reconsideration

your NOD clock is still ticking, do not let your year pass by.

If that happens then about the only way to re-open is with new and material evidence.

carlie

I have it in my calendar...I won't let them off the hook that easily! Thanks for your concern..

Pat

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JustPLS,

These regs became effective Ost 2008 for TBI.

FYI - for research:

http://ecfr.gpoaccess.gov/cgi/t/text/text-....67&idno=38

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.

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That's great information, Carlie. Thanks!

I'm sure it will come in handy with my claim or appeal.

Pat

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File a NOD with a Form 9 attached.

Thanks, Pete. So I don't have to wait for the SOC to file the form 9?

Pat

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  • HadIt.com Elder

The Form 9 is on a time limit. Ask for a SOC on the Form 9. The form 9 should include a brief statement of what you are asking for and if you are not able to work ask for TDIU.The Form 9 will guarantee your effective date without it many problems can develop. Besides the initial claim probably the most important document in you C File.

Good Luck

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The Form 9 is on a time limit. Ask for a SOC on the Form 9. The form 9 should include a brief statement of what you are asking for and if you are not able to work ask for TDIU.The Form 9 will guarantee your effective date without it many problems can develop. Besides the initial claim probably the most important document in you C File.

Good Luck

Thanks, Pete. Sounds like good advice.

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I sure hope you have proof of mailing them the evidence.

When I testified at the hearing on VA's shredding scandal I mentioned I had 53 USPS tracking slips for submissions of evidence over a six year period that VA ignored.

I also sent the Sub COmmittee a copy in living color of the 53 green and white USP tracking slips all fanned out- they all didnt fit on the page.

Funny thing is the missing stuff suddenly appeared when the BVA got the case a few months later.

You have to make sure you retain copies of everything you send them as well as proof of mailing it to them.

"Nothing in the records about concussion that I could see, nor did it mention that I lost consciousness in both incidents."

You might need to obtain a buddy statement if the records are silent on having been in a blast or rocket blast-

do the hearing problems in the SMRs document that this was due to a blast?

Did you claim hearing problems and tinnitus due to this blast?

Have you attempted to find any morning reports or have you attempted to find out if your unit has a web site?

Was any soldier killed or any other soldier injured in this blast?

What was your unit and MOS- and the approximate date and place of this blast?

Was it regular incoming or due to offensive tactics?

Was USA equipment or materiale damaged by this enough that there would have been a report prepared?

Unfortunately although Corpmen are well trained to document everything even in the heat of battle or right after it but often they couldnt- and that is when a buddy statement can be critical to proving a claim.

Your unit might have a public reunion list and maybe someone's name would strike a bell- it takes a lot of googling etc to find a buddy but it can be done.

Did your unit retaliate against this strike in a way that would have generated a morning report written soon after the rocket blast?

A buddy statement could give an eyewitness account which is what you need. Of course it would have to come from someone in your unit at the same time who recalls this event and who's MOS would be compatible with that.

And then this event would have to be found as directly causing or contributing to documented disabilities you have now-that are disabling at a ratable level.

You can revoke your POA by sending the POA a letter (certified) as well as same letter to the VARO where your claim is stating that you have decided to revoke their POA.

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I sure hope you have proof of mailing them the evidence.

When I testified at the hearing on VA's shredding scandal I mentioned I had 53 USPS tracking slips for submissions of evidence over a six year period that VA ignored.

I also sent the Sub COmmittee a copy in living color of the 53 green and white USP tracking slips all fanned out- they all didnt fit on the page.

Funny thing is the missing stuff suddenly appeared when the BVA got the case a few months later.

You have to make sure you retain copies of everything you send them as well as proof of mailing it to them. I do have copies and proof of mailing if I need it.

"Nothing in the records about concussion that I could see, nor did it mention that I lost consciousness in both incidents."

You might need to obtain a buddy statement if the records are silent on having been in a blast or rocket blast-

do the hearing problems in the SMRs document that this was due to a blast?

Yes, the first one ('68) says due to rocket blast, the second ('70) just says injury due to blast, I think.

Did you claim hearing problems and tinnitus due to this blast? Yes, and am service connected for both...10% for tinnitus only

Have you attempted to find any morning reports or have you attempted to find out if your unit has a web site? No, I haven't tried morning reports, and I haven't found a web site for the unit I was with during the first incident. There is a website for the unit I was with in the second incident, and I communicate with a few of those guys from time to time.

Was any soldier killed or any other soldier injured in this blast? Yes, unfortunately

What was your unit and MOS- and the approximate date and place of this blast? A/1/8th Cav, 1st CAV Div,mos 1542, March 25, 1968, Quang Tri province, RVN; D/1/506th Inf, 101st ABN Div, mos 71542, April 7, 1970, Thua Thien Province, RVN

Was it regular incoming or due to offensive tactics? 3/25/68 due to firefight; 4/7/70 due to attack in our night position

Was USA equipment or materiale damaged by this enough that there would have been a report prepared? I'm sure some weapons were destroyed, but that was pretty commonplace - don't know if any reports prepared or not

Unfortunately although Corpmen are well trained to document everything even in the heat of battle or right after it but often they couldnt- and that is when a buddy statement can be critical to proving a claim.

Your unit might have a public reunion list and maybe someone's name would strike a bell- it takes a lot of googling etc to find a buddy but it can be done.

Did your unit retaliate against this strike in a way that would have generated a morning report written soon after the rocket blast? Well, we were in a fight all day in '68, so yes....in '70 we shot artillery, small arms, helicopter gunships...

A buddy statement could give an eyewitness account which is what you need. Of course it would have to come from someone in your unit at the same time who recalls this event and who's MOS would be compatible with that. In documenting my hearing loss and tinnitus, the VA included in the rating decision that I was injured by a rocket blast (RPG), so I don't think I need a buddy statement to corroborate that...I think I just need to find a way to make them read the file and put the blast injuries together with possible TBI/concussion. If I need buddy statements to say I was unconscious, I might be able to get them. So far, they won't even correspond with me about what I need. They just said it was denied because there is no mention of TBI in my medical records.

And then this event would have to be found as directly causing or contributing to documented disabilities you have now-that are disabling at a ratable level. Yes, I agree....but unfortunately, some of the symptoms are similar to those of PTSD, and I'm already compensated for tinnitus. I know there can be no pyramiding, but I think as far as service connection goes, I should be given the benefit of the doubt whether or not they compensate me.

You can revoke your POA by sending the POA a letter (certified) as well as same letter to the VARO where your claim is stating that you have decided to revoke their POA. I revoked the POA today.

Thanks for your interest, Berta. I appreciate your questions, as they make me think throught the process again.

Pat

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