ptsd Reconsideration For Tbi

[ironsoldier77]

I have been seeing the TBI clinic at my va hospital for a few years now. I had previously put in a claim for mild TBI. I had multiple contact with blasts in Iraq. 2 Combat tours with 1st AD Infantry. I also have a PTSD rating of 50% and Tinnitus at 10%, total 60%. I have been unemployed since 2008 and I went through voc rehab and they found me infeasable for work,untrainable,not expected to get gainful employment. I have gone through Neuropsych testing and here is the diagnosis from that testing. I am hoping this will help me get atleast 10% so I can get TDIU. I have already put in a claim for increase on my PTSD rating,mild TBI and TDIU all at the same time. Just did this on wednesday.

CONCLUSIONS AND RECOMMENDATDIONS: Mr. Anderson is a 32 year old,White,married and unemployed when the last testing session was completed. His work ihistory does not reflect stable emplyment. He was referred for a cognitive evaluation by his primary care provider after complaining of difficulty in concentrating and meory problems. He has an unremarkable academic history with a high school graduation and one semester of college. HIs family of origin was stable:however his father died just before he left for Iraq. H has a stable relationship history in his only marriage of eight years. He has three years of credible service in the the army with two combat tours to Iraq. He reports being stunned from multiple blast in juries while serving in Iraq. He has no history of substance abuse , or legal problems. His social life is limited to family due to anxiety associated with being in crowds and other symptoms of PTSD. He generally functions idependently and attends to his activities of daily living.His premorbid level of verbal intellectual functioning was estimated to be high average. Current intellectual functioning was in the average reage. All IQ scores were in the average range except for working memory which was low average. He has mild impairment in concentration and focusing on information in the auditory channel. Mild impairment in concentrating and focusing could contribute to the mild loss of intellectual functioning reflected in the drop from high average to average intelligence. Memory functioning was avearage to low average. Auditory memory, visual working memory and immediate memory were lower than expected for his intellectual functioning. Visual memory was intact despite mild difficulty in focusing and concentrating on visual channel information. He has had significant losses of memory abilities. His observed behavior, history and the test data are consistent with the following diagnoses:

Axis I-Mild Cognitive Impairment likely associated with Blast Injuries

Posttraumatic Stress Disorder

Depression (ICD-9-CM 311./300.4)

Insomnia (ICD-9-CM 780.52)

Tobacco use disorder

Axis II-NONE

Axis III-Brain diseases due to trauma (ICD-9-CM 3)

Acute pharyngitis

Low back pain

Knee: arthralgia

Tobacco use disorder

Axis IV-Exposure to combat and loss of job

Axis V- GAF=55, mild to moderate impairment

Medical problems that could contribute to cognitive impairment include brain disease and pain. PTSD, depression and insomnia could also contribute to impaired concentration. Hearing impairment could contribute to auditory memory problems and a hearing examination may be warranted. HIs past history of having tubes in his ears as a child could have contributed to a failure to develop auditory memory abilities. Medications that could contribute to cognitive impairment include clonazepam, but this is usually seen in much older patients. Mr. Anderson may benefit from medications that target concentration like those used in the treatment to attention deficit disorder,and an evaluation for a trial of one of these medications is recommended. Unfortunately the prognosis for PTSD with mild traumatic brain injury is worse than the prognosis for PTSD without brain injury. Most of the treatments for PTSD involve learning new strategies for managing the symptoms of PTSD, and when learning is impaired, progress in treatment may be slowed. Continued treatment for depression, insomnia and PTSD is recommended. He is also being seen in the speech pathology for cognitive rehabilitation and this should be continued until maximum benefit is achieved. With the recent loss of his employment, a vocational rehabilitation referral may be warranted, depending upon his progress in the PTSD outpatient treatment program.

So, thats the report from the doctor that did the psych testing. When I read this it almost sounds like a "slam dunk" and that I might get awarded a SC for mild TBI. I really hope it does, because it would make me eligable for TDIU, which is what I really need. I was also wondering if its possible that the VA could go ahead and award 100% P & T instead of just TDIU?

I am on full SSD benefits as well and that along with my VA benefits at 60% is all i have to live by. We barely have enough to keep our house. I am almost at the point to where my life just seems meaningless and I really hope I get the TDIU, mild TBI and increase for my PTSD. Im having a hard time gettng an increase for my PTSD. It seems that i have to be some deranged lunatic, murder someone or get locked up. to be even considered for an increase. I dont know what to say when I go to the C&P exams for PTSD increases.

[ironsoldier77]

Ok I just got the packet in the mail today from the VA with the VCAA response letter. It says they are working on my claim for PTSD and IU. They are not reconsidering my TBI decision, because they say I have no new evidence!!! WTF??? I sat with my VSO and gave him the TBI doctors notes which shows a clear diagnosis of mild TBI(mild cognitive impairment likely associated with blast inuries). I know it was in the packet that my VSO typed up, I saw him staple it all together. And in our packet we asked for reconsideration because I now have a clear diagnosis, and the doctors notes are in this paperwork for them to look at. This is my 3rd time apply for TBI and also my 3rd time for TDIU. Seems to me that someone over there is not doing their damn job!! How could they not look at my new evidence??? I have copies of the packet my VSO sent to them and from me looking at it, it would be really hard to miss that evidence. Which leads me to believe that the VA is just trying to screw me AGAIN! UGGGGGHHHHH!! Im so pissed off right now and frustrated because now I have to try and figure out what im supposed to do to make them look at all my evidence! This is not right and someone should be fired for not doing their job. I know they probably just do this stuff to make people give up, but Im going nowhere until I get my claim approved like it should have been almost 2 years ago.

[carlie]

iron,

Was any of what you are referring to as "new evidence", actually cumulative evidence

just restated by an additional medical provider ?

[ironsoldier77]

iron,

Was any of what you are referring to as "new evidence", actually cumulative evidence

just restated by an additional medical provider ?

The new evidence is from the VA TBI clinic doctor. The same guy I've been seeing since I got out of the army and started receiving treatment from the VA. He wanted to do the Neuropsych testing so we did. It took a couple months to do it because he had to break it up into different appointments. After we did the testing, I went to the ROI and got a copy of his notes on the results from the testing. Under axis I it says "Mild cognitive impairment likely associated with blast injuries", he gave me a GAF of 55. So i guess the answer would be no to your question. Its from the VA and its the same doctor I've been seeing for TBI.

[carlie]

Let me re state my point -

whether the "new evidence" comes from the same medical provider or another medical provider,

if it is merely a re-iteration of the evidence already of record - then the VA will consider it as

cumulative evidence and state it is not "new evidence".

The only reason I'm posting this is because you asked about it in the original topic thread post.

You had posted,

" They are not reconsidering my TBI decision, because they say I have no new evidence!!! WTF??? I sat with my VSO and gave him the TBI doctors notes which shows a clear diagnosis of mild TBI(mild cognitive impairment likely associated with blast inuries). I know it was in the packet that my VSO typed up, I saw him staple it all together. And in our packet we asked for reconsideration because I now have a clear diagnosis, and the doctors notes are in this paperwork for them to look at. This is my 3rd time apply for TBI and also my 3rd time for TDIU. Seems to me that someone over there is not doing their damn job!! How could they not look at my new evidence???

Also:You SHOULD already be eligible to IU under 38 CFR - 4.16 (b)

BUT unfortunately the VA rarely grants under it part (b).

38 CFR 4.16

(b) It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Therefore, rating boards should submit to the Director, Compensation and Pension Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in paragraph (a) of this section. The rating board will include a full statement as to the veteran's service-connected disabilities, employment history, educational and vocational attainment and all other factors having a bearing on the issue.[40 FR 42535, Sept. 15, 1975, as amended at 54 FR 4281, Jan. 30, 1989; 55 FR 31580, Aug. 3, 1990; 58 FR 39664, July 26, 1993; 61 FR 52700, Oct. 8, 1996]

[ironsoldier77]

Ok so what exactly do they consider new evidence? If the doctors diagnosis says mild tbi , I would think that would be NEW evidence.Its not a re-iteration. Hes never stated a diagnosis before until now. Thats why he wanted to do the testing. The VA is crazy! Cumulative evidence! Seriously??? Maybe I just dont understand what your saying. Now im even more confused and angry.

Let me re state my point -

whether the "new evidence" comes from the same medical provider or another medical provider,

if it is merely a re-iteration of the evidence already of record - then the VA will consider it as

cumulative evidence and state it is not "new evidence".

The only reason I'm posting this is because you asked about it in the original topic thread post.

You had posted,

" They are not reconsidering my TBI decision, because they say I have no new evidence!!! WTF??? I sat with my VSO and gave him the TBI doctors notes which shows a clear diagnosis of mild TBI(mild cognitive impairment likely associated with blast inuries). I know it was in the packet that my VSO typed up, I saw him staple it all together. And in our packet we asked for reconsideration because I now have a clear diagnosis, and the doctors notes are in this paperwork for them to look at. This is my 3rd time apply for TBI and also my 3rd time for TDIU. Seems to me that someone over there is not doing their damn job!! How could they not look at my new evidence???

Also:You SHOULD already be eligible to IU under 38 CFR - 4.16 (b)

BUT unfortunately the VA rarely grants under it part (b).

38 CFR 4.16

(b) It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Therefore, rating boards should submit to the Director, Compensation and Pension Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in paragraph (a) of this section. The rating board will include a full statement as to the veteran's service-connected disabilities, employment history, educational and vocational attainment and all other factors having a bearing on the issue.[40 FR 42535, Sept. 15, 1975, as amended at 54 FR 4281, Jan. 30, 1989; 55 FR 31580, Aug. 3, 1990; 58 FR 39664, July 26, 1993; 61 FR 52700, Oct. 8, 1996]

[carlie]

Ok so what exactly do they consider new evidence? If the doctors diagnosis says mild tbi , I would think that would be NEW evidence.Its not a re-iteration. Hes never stated a diagnosis before until now. Thats why he wanted to do the testing. The VA is crazy! Cumulative evidence! Seriously??? Maybe I just dont understand what your saying. Now im even more confused and angry.

iron,

Of course "Seriously".

I will try to be more clear.

Did you file a claim for the issue of TBI - (that's DC 8045) ?

If yes, was the issue of TBI denied.

If yes, when was it denied and what was stated in the Reasons and Bases Section

regarding the denial of SC for TBI.

If it was denied - did you file a NOD for denial of TBI within one year ?

If not - then you have to re-open the issue of TBI with New & Material evidence.

If a denial for TBI was adjudicated and it has not become final yet - and if your NOD timeframe

isn't too narrow,then you can submit this additional TBI evidence from the TBI clinic for a reconsideration.

From M21-1MR

Definition: Evidence

Evidence is any means by which an alleged matter of fact is established or disproved.

Examples: Examples of evidence include the following:

testimony, to include

statements

contentions, and

arguments

documentary proof

medical examinations or reports, and

other material not previously considered.

d. Definitions: New Evidence and Material Evidence:

New evidence is evidence not previously of record.

Material evidence is relevant and relates to an unestablished fact necessary to substantiate the claim, and

has a legitimate influence or bearing on the decision in the case.

From BVA:New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a).

Below is a link for a good read that allan posted from M21-1MR on Evaluation of Evidence.