Cognitive Disorder Nos W/ Tbi Residual Rating Without C&p Exam

[signalsix]

So I applied for TBI Rating after failing the memory testing, etc, during the TBI screening and sebsequent testing. I had a C&P Exam scheduled in Aug but had to cancel it because my step-Father passed away. Then yesterday I received a letter from the DAV telling me the VA has awarded me 40% rating for Cognitive Disorder with residual TBI. DAV said I should recieve the offical paperwork from the VA soon. I am very surprised the VA settled my claim without a C&P Exam. The only thing I can think of, maybe they used the results from previous C&P exams for other ratings and combined them with the results of the TBI testing.

I am appreicative of the 40% rating, but after reading the rating schedule I believe I may be eligible for 70%. The difference is evidence of mild (40%) or moderate (70%) memory impairment from testing ..... with mild (40%) or moderate (70%) functional impairment. Does anyone have any idea how they quantify mild versus moderate on the test results and functional impairment? I might except this rating since I am able to keep my job.

Thanks

[timetowinarace]

Um, I think you need to know what DX code you were rated under. It will be listed when you get your paperwork.

Two things here that stand out, the DX code and the rating without a C&P.

While it may be easier for a rater to apply a rating to DC9304-Dementia due to trauma it is more benificial to the veteran to have the proper DC8045. There are many reasons for this of wich I won't get into here. I suspect you will have gotten the 8045 rating, otherwise you would need two ratings. One for 9304 for cognative dissorder and one 8045 for residuals because 9304 does not address other tbi residuals(one of the reasons to apply the proper dx code).

The reason a C&P is important is mostly because TBI claims are complicated. Especially the cognative issues. For one, a severity must be assigned to each facet of the regs, I believe there are ten of them. Each facet covers certain possible residuals. I beleive a medical profesionals opinion is needed on each of these facets for a proper rating. The biggest problem is the cognative facet. If full neuro_cognative testing has been performed, the results of that testing are complicated as well. While an area or two may report mild or moderate functional impairment, the whole picture may be quite different. If a rater assigns a rating based on the test results, of wich a rater is not qualified to interpret them, the whole picture of the full test results is not likely to be seen. I can only give my own example. My memory tested normal, other portions were measured at moderate such as executive functioning. Though my memory tested as normal, I can't remember chit. I was found 'not competent' from VA because the examiner stated "he might forget to pay his bills". My memory is bad because some information is never stored to begin with. The point is, if a rater had tried to interpret these results my memory would likely have gotten a 0% as the tests say "normal". I might have gotten 40% for my 'moderate' impairment in some areas. Since I was evaluated by a psychiatrist that read the full test scores and understands the relationship between all the aspects, not only is my memory not 'normal' his opinion is my memory is too poor to handle my own money.

Okay, now that I said all that, I agree with James. Get a C&P. LOL.

A note for James: I think if a proper TBI C&P is done it makes it considerably easier on the rater. The examiner must(should) give a level of impairment for each facet. Then the rater need only use the highest level facet, assign the rating that equals the level and the rest of the facets are ignored. Complications may arise when psycholigical or other residuals(such as migraine) require a seperate evaluation and rating. A rater should not have to read the test results and is not likely to understand the full implications of the scores for each area.

Edited October 19, 2009 by timetowinarace

[signalsix]

I received the official VA letter and it says cognitive disorder NOS with residual of TBI, but does not list a specific code. However, in the explanation they go over the different areas under the TBI rating so i am pretty sure that is what the rating is for.

But, I noticed in their explanation they quote the VA tesing and Doctors explanation as clinically significant decline in memory. But then go on to say that is a only mild impairment. Does anyone think the clinically significant decline in memory should be "moderate"

[timetowinarace]

Without reading the tests I couldn't give an answer.

The main consideration is that a rater is not qualified to understand the meaning of the test results. You need a doctors opinion based on the test results as to yourr functional impairment due to cognative problems.

I would file a NOD and request a C&P. I can't see how it could hurt as I doubt a C&P examiner will find you 'less' than mildly impaired. In other words, it can only go up.

[Rockhound]

I haven't worked since 2004, at which time I was granted TDIU for NSC Sarcoidosis, a auto-immune disease and for an Adjustment Disorder combined with Chronic Major Depression with Anxiety Disorder.

Just this past winter while waiting for a decision on my current claim for secondary issues related to my SC nasal bone fracture and devieted septum, I was able to, after many years, get a referal for neuropsychological testing, which led to a diagnosis of a personality disorder due to a medical problem or as the testing Psychologist, called a cognitive personality disorder due to trauma.

With this said, I need to add, that I was denied SC for the personality, because at the time it was ruled a personality disorder not due to a medical problem, but due to a developmental disorder and not compensatable under VA Law and Regulation.

Now with this new diagnosis that can be used as a correction, what would I, like the original post recommend, would I need to further support the diagnosis to lesson the wiggle room the VA's ability to deny such a claim?

Rockhound Rider :D

[askmeimarater]

I'm not understanding your reply. You keep making statements referring to raters as "not qualified to interpret." Well who do you think "interprets" the TBI and Neuropsych examinations? Do you think the examiner provides the Rating decision, or do you think the Rater does? I'm confused? Raters are quite well versed in TBI, as well as a myriad of other diagnostic codes, believe it or not.

Um, I think you need to know what DX code you were rated under. It will be listed when you get your paperwork.

Two things here that stand out, the DX code and the rating without a C&P.

While it may be easier for a rater to apply a rating to DC9304-Dementia due to trauma it is more benificial to the veteran to have the proper DC8045. There are many reasons for this of wich I won't get into here. I suspect you will have gotten the 8045 rating, otherwise you would need two ratings. One for 9304 for cognative dissorder and one 8045 for residuals because 9304 does not address other tbi residuals(one of the reasons to apply the proper dx code).

The reason a C&P is important is mostly because TBI claims are complicated. Especially the cognative issues. For one, a severity must be assigned to each facet of the regs, I believe there are ten of them. Each facet covers certain possible residuals. I beleive a medical profesionals opinion is needed on each of these facets for a proper rating. The biggest problem is the cognative facet. If full neuro_cognative testing has been performed, the results of that testing are complicated as well. While an area or two may report mild or moderate functional impairment, the whole picture may be quite different. If a rater assigns a rating based on the test results, of wich a rater is not qualified to interpret them, the whole picture of the full test results is not likely to be seen. I can only give my own example. My memory tested normal, other portions were measured at moderate such as executive functioning. Though my memory tested as normal, I can't remember chit. I was found 'not competent' from VA because the examiner stated "he might forget to pay his bills". My memory is bad because some information is never stored to begin with. The point is, if a rater had tried to interpret these results my memory would likely have gotten a 0% as the tests say "normal". I might have gotten 40% for my 'moderate' impairment in some areas. Since I was evaluated by a psychiatrist that read the full test scores and understands the relationship between all the aspects, not only is my memory not 'normal' his opinion is my memory is too poor to handle my own money.

Okay, now that I said all that, I agree with James. Get a C&P. LOL.

A note for James: I think if a proper TBI C&P is done it makes it considerably easier on the rater. The examiner must(should) give a level of impairment for each facet. Then the rater need only use the highest level facet, assign the rating that equals the level and the rest of the facets are ignored. Complications may arise when psycholigical or other residuals(such as migraine) require a seperate evaluation and rating. A rater should not have to read the test results and is not likely to understand the full implications of the scores for each area.