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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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Founder AVBI

Pcs – Mtbi – Tbi – Ptsd

Question

Hi folks, I have been reading information on this forum for quite some time now and since I have a lot on my plate I haven't posted until now. First I'd like to introduce myself; I'm Cheryl the mother of a service connected disabled veteran (he suffered a severe TBI) and the founder of American Veterans with Brain Injuries. (http://avbi.org)

I figured it was about time I posted something on here in hopes to clear up some of the answers to questions that have been posed on this forum. In another words; I want to set the records straight on a few issues.

I apologize, in advance, for the length of this post; however, I hope it may help someone and might be the only time I have a chance to post on this forum. I invite any of you, that have brain injury specific questions, to visit the American Veterans with Brain Injuries forum (http://forum.avbi.org), and hopefully we can provide you additional truthful answers.

  • There has been much discussion (and confusion) about the differences between being diagnosed with a Traumatic Brain Injury (TBI), Mild Traumatic Brain Injury (MTBI) aka Post Concussive Syndrome (PCS).


    To explain the differences I'd like to give you some not medical and simplistic explanations. Please know that I am not a doctor or a medical professional and the medical community, as a whole, has not adopted this breakdown. However there are many people working very hard at getting appropriate or standardized terminology used with-in the DoD and VA. I'm providing this information in layman's terms to hopefully create a little more understanding amongst the vast confusion of terminology (verbiage).

    Post-concussion syndrome, also known PCS, and historically called shell shock, is a set of symptoms that a person may experience for weeks, months, or occasionally years after a concussion–it is a mild form of traumatic brain injury (MTBI). If a person has been exposed to blast(s), had their bell rung, banged their head, had a hard landing, etc. and possibly been knocked unconscious for a short period of time, they have most likely suffered a concussion (aka a mild brain injury). Most will recover from a concussion without any residuals, BUT if the residual effects continue for more than 3 months a post concussive syndrome (PCS) diagnosis should be assigned, and if those residual symptoms last longer than 1 year it becomes Persistent Post Concussive Syndrome (PPCS).

    Rarely does a concussion result in physical evidence, in other words; it is not uncommon for an MRI or CAT scan to not show the injury, but please understand the residual symptoms and impairments are real. The verity of symptoms include: physical (such as headache or tremors); cognitive (such as difficulty concentrating and memory loss); and emotional and behavioral (such as irritability and anxiety). There is also a host of non- descript symptoms like fatigue, syncope, or sleep difficulties.

    Many of the symptoms in PCS are common to, or exacerbated by, other disorders, and there is a high risk of misdiagnosis when that happens. Although there is no treatment for PCS itself, symptoms can be treated; medications and physical and behavioral therapy may be used, and patients can be educated about symptoms, taught ways to adapt, and advised of the usual prognosis. The majority of PCS cases disappear after a period of time, however in some cases these symptoms will continue, get worse, or reappear as the brain ages.

    It is not known what causes PCS symptoms to occur and persist, or why some people who suffer a concussion develop PCS while others do not. The nature of the syndrome and the diagnosis itself, have been the subject of intense debate, particularly in recent years with the high incidents or potential of blast injuries. However, certain risk factors have been identified; for example, co-existing medical or psychological conditions, repetitive concussions, expectations of disability, and age, all increase the chances that someone will suffer with the persistent symptoms (PPCS). Physiological and psychological factors present before, during, and after the injury are all thought to be involved in the development of PCS / PPCS.

    A moderate - severe TBI or an Acquired Brain Injury ABI can normally be associated to a single incident, illness (loss of oxygen) or a multitude of incidents (concussions); it is commonly followed by a prolonged loss of consciousness or coma. There is also commonly physical evidence of the injury, in other words the injury or damaged areas can be seen on a MRI or a CAT scan. One would think that this type of brain injury is easily or always diagnosed, but this too can be overlooked especially if the injury is compounded by other life threatening injuries that demand immediate treatment.

    The results of a moderate-severe TBI are commonly devastating (physically, cognitively and emotionally) and the physical injury to the brain is permanent, however some will rehabilitate and regain some of what was lost, due to the injury.

    • There is also a lot of confusion between TBI and PTSD.

    Let it first be understood that one can suffer from PTSD with out having a brain injury, and one can suffer a brain injury without having PTSD or one can suffer with both. But with that said; most of the confusion is because the symptoms or residual effects, of both, have many parallels. Also recent research has proven that in some cases of PTSD, the chemistry of the brain changes and therefore can create a secondary injury.

    Since, to date, there are no clear cut tests that can be given to distinguish between PCS or TBI and PTSD many physicians want to just slap one or two Dx codes on a person's record. Even worse, is there are many physicians who want to treat them the same. Many physicians will disagree with me, but the symptoms should not be clumped together and treatment for each is NOT the same! For example; there are some medications that will help treat the symptoms of both however there are some medications that may treat one and exacerbate the other.

    The only known way to separate some of the residual symptoms is to have full and thorough neuro-psychological testing, but even this may not give a clear cut diagnosis. This type of testing is used to distinguish and identify the areas of difficulty and there for provide appropriate treatment or therapy.

    I know this forum deals mostly with the evaluation and rating process of the VBA but I would like to extent a few more words of wisdom. The most important thing is to get a proper diagnosis and appropriate treatment. Don't think, for one minute, that if you suffer from any of the difficulties associated with PCS, TBI or PTSD, that your going to wake up one morning and be fine……

    No one knows how much recovery a person will have, but if you do nothing, chances are, you will get worse!

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5 answers to this question

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Founder,

Welcome to Hadit and thanks for the excellent post.

carlie

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This is a very good post, and I think anyone with any type of brain injury should read it. It helped me understand my condition a little better. I was diagnosed with mTBI, the symptoms are severe loss of short term memory, some balance issues, severe distemerpent either from this or the diagnosed PTSD, not sure? The last sentence makes sence, because I have had issued ever since I came back from IRAQ in 2007 Dec, and I never received any treatment and it just got worse and I am now receiving treatment for it. It is a very upsetting condition mostly frustrated with the memory loss and anger, it makes for a bad home life. Thank you for this post.

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Yes this is good information!

The VA canned one of their top TBI experts some years ago- long story -it is all at VA Watchdog archives.He blew whistle on the TBI funds situation.

But I think VA has made much headway in TBI vets these days, who also could have PTSD as well.

An IED causing a TBI is certainly a stressor as well as capable of causing residual disabilities.

I was angered beyond words a few years ago when a Iraq vet was interviewed by CNN -he had suffered TBI from IED and certainly seemed to have PTSD too but the VA deemed him to suffer instead from a personality disorder and denied his claim!

Hopefully the TV interview got him support in appealing that outrageous decision.

His wife was his greatest ally and she was determined to see VA rectify the ridiculous PD diagnosis.

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I must apologize that I don’t get to visit this forum very much, as you can figure I stay very busy with AVBI and helping our veterans with brain injuries and their families.

I thank you for your kind words and recognition of what was written, I'm pleased that it may have given more understanding to a sometimes misunderstood injury. I would also like to invite all of you to visit our forum @ AVBI.org and offer your input there also. Sadly we do not get as much participation as this wonderful forum, but we would like you all to know we available to you, if and when you need us.

Cheryl

Founder/Executive Director

American Veterans with Brain injuries (AVBI.org)

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This story recently appeared as a link from the NVLSP web site:

http://www.publicbroadcasting.net/kunc/news.newsmain/article/1/0/1731743/Regional/The.Burden.of.Proof.One.Colorado.Soldier%27s.Fight.for.Mild.Traumatic.Brain.Injury.Diagnosis.and.Treatment

It shows the difficult time many TBI/PTSD veterans are having.

I am still haunted by a news story I caught on CNN or Fox about 2 years ago-a story that hopefully brought the veteran a proper assessment of his Iraq War disabilities -from the VA.

The combat veteran, who had TBI from an IED and obviously also had PTSD-was DENIED because VA said he had a Personality Disorder!

PD my butt! It is a shame that it often takes making National news for some vets to get their proper compensation.

What gets me is that,when a C & P examiner makes an outrageous diagnosis like this, in my opinion, that is malpractice or at very least, prime evidence that the VA C & examiner was incompetent.

The very fact that so many veterans DO overcome some of these outrageous diagnoses proves the point that many C & P excaminers don't have a clue or worse yet maybe they have some internal bias against TBI/PTSD veterans.

Hopefully this vet's claim had been resolved prior to the new PTSD regs.

If not -at least he had appellate rights prior to the new Regs of July 2010.

The new PTSD regs would have given him NO appellate rights, that's right NADA, no Benefit of Doubt or anything-not even the ability to get an IMO from a real Shrink and have VA consider it.

That was main point of my article at VAWatchdogToday this past week.And the main point of the Petition filed by NOVA, PVA, VFMW,and NVLSP with the court.

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