ptsd Organic Brain Syndrome Due To Head Trama

[qmcorps]

everyone,

I need some help on this.

I am attempting to assist a vet who in 1968 (age 19) received severe head trama after being struck by a section of anchor chain that fell three levels before striking him. He is currently receiving 50% for Loss of part of skull and 10% for organic brain syndrome. he has been experiencing ptsd type complaints and depression from this incident. He was medically discharged from the Navy in 1968, and has been seeing a VA psycharist. I am attempting to connect the dots between the incident and ptsd, and / or, the organic brain syndrome with the depression, and / or, the ptsd and depression.

Thanks,

Mike

[vaf]

This involves a BVA decision that discusses head trauma:

http://www.va.gov/vetapp/files3/9420714.txt

The relevant section follows:

III. Residuals of head trauma

The veteran has reported that he experiences migraine headaches

due to his head injury two to three times a week, fatigue, and

dizzy spells almost daily. He also has maintained that he

experiences daily headaches that have worsened, and intermittent

dizziness, stating that he sometimes feels faint.

Diagnostic Code 8045 for brain disease due to trauma provides

different rating criteria depending on whether the veteran's

condition is a purely neurological disability, or is manifested

by purely subjective complaints. The veteran has neither

evidenced nor reported having seizures, facial nerve palsy, or

other neurological symptoms attributable to brain trauma. His

complaints, which have varied as to frequency and severity, have

consistently been purely subjective, and medical examiners have

associated his reported headaches and dizziness with residuals of

his head trauma. Diagnostic Code 8045 provides that on the basis

of such complaints, a 10 percent evaluation is to be assigned.

That code specifies that where only purely subjective complaints

are evidenced, a rating in excess of 10 percent for brain disease

due to trauma is not assignable under Diagnostic Code 9304,

pertaining to dementia associated with brain trauma, absent a

diagnosis of the same. As the veteran has not manifested any

neurological symptoms and is not diagnosed with dementia

associated with brain trauma, he is not entitled to an evaluation

in excess of the 10 percent currently assigned.

The veteran's representative averred at the hearing that it was

"conceivable" that the veteran's somatic complaints would fall

under the category of "petit seizures," also suggesting that the

veteran suffered from organic brain syndrome. It is noted that

no medical support for these averments has been submitted, and no

diagnoses or findings relative to the suggested conditions are of

record. The veteran is competent to testify as to the his own

somatic complaints, if any. Gowen v. Derwinski, 3 Vet.App. 286,

288-289 (1992). However, as the diagnosis and evaluation of a

neurological or brain condition is within the medical realm, and

is not a matter of common knowledge, Id., the Board finds the

opinions of the veteran and his representative are not competent

evidence as to the diagnosis and assessment of a neurological or

brain condition. See also Espiritu, 2 Vet.App. at 494.

[Berta]

Mike I think all he would need is a strong medical opinion from his psychiatrist that states that his depression and PTSD like (anxiety) symptoms are more than likely due to the severe brain trauma.

He certainly can ask the VA doctor if he would do this and if not, I feel he should get a good outside IMO- because even if there is a cost for the IMO-this would certainly support what appears to be a valid claim for PTSD and/or depression due to the inservice trauma.

Is he working-? If not he should file for SSA and also TDIU.

I bet the 10% is way too low-if that much skull damage was done it certainly could show more brain damage.

Hard to say though-if he has been able to work and function well with this-maybe it is right but a good IMO would sure help.

Any neurological residuals would have to be assessed too as the BVA case shows.

I knew a vet with "hole in his head" as he described himself.His name was Fred so easy to find him-around the VAMC-Fred with a hole in his head-

He had a clear hole in his forehead and you could look into it- it was some sort of brain stint or something and he was unemployed because he tried to work with the public and he was not too easy to look at-but maintained a part time volunteer job with the VA because know one cared about his hole in his head at the VAMC.

I forget if he was SC or NSC- he seemed to have no residual damage as far as intellect ,sight, or motor skills and had a great sense of humor.I liked him a lot- you talk to the guy for a few minutes and forget that you can see into his brain.

My long point is that not only does your vet have a valid claim for PTSD but the 10% sounds very low and he could have residuals that the VA has never assessed yet- only an MRI could reveal that trauma or obvious signs like poor eyesight after the accident, loss of balance, etc -things like that- if he is claiming depression or PTSD due to this traumatic event he might want to ask for higher comp on the organic brain syndrome too.

Any type of brain syndrome or trauma can certainly affect numerous other body parts and even the emotions and thought process.Maybe he is like Fred with a severe picture of brain trauma -due to the hole- but no apparent residuals-and maybe not-Something to think about on that 10%.

Edited September 16, 2006 by Berta

[timetowinarace]

Berta,

Not to correct you but residuals for head injury CANNOT be rated any more than 10%. It does not matter how severe they are.

The ONLY way to be rated any more than 10% for head injury is with a diagnoses of multi-infarct dementia. All othe complaints are subjective and as such are not ratable over the 10% cap.

Now, there are two ways to prove multi-infarct dementia associated with head injury. The first one is undisputable but not very common. CT or MRI must show multiple infarcts in various parts of the brain. However, CT and MRI most often does not have the ability to detect the microscopic infarcts and are useless. The second is the #1 method of detecting multi-infarct dementia (brain damage). Neuro-psychological testing is undisputable, cannot be cheated, and is far more accurate at determining mult-infarct dementia.

My suggestion is always to have the neuro-psych testing done. Preferably privately. This is the only way to get more than 10%. Unless there is obvious paralisis, and that speaks for itself.

Again, headache, dizziness, fatigue and the like are all subjective complaint and cannot be seen or felt by anyone but the injured. You must have some sort of proof that can be seen (imaging, test scores) to succeed with a head injury claim.

Time

[timetowinarace]

As a side note.

PTSD is often a misdiagnoses of brain injury.

I have been diagnosed with PTSD. But I don't have it. I have brain damage. The symptoms are axcactly the same without the stressor.

Time

[Berta]

Time- you are certainly correct-however with residuals that would boost the rating-?

I mean such as :

http://www.va.gov/vetapp00/files3/0020292.txt

Rod had multi infarct dementia -but due to a stroke-and evident on MRI- you are correct also when you state that MRI often cannot detect all of this type of damage and Rod was given numerous Neuro tests to assess and separate his PTSD from his brain trauma.Put block into the square thing and about 6-7 tests of this nature to include the MMPI.

His shrink stated that the PTSD Rod had prior to stroke could affect the affects of the brain trauma and vice versa-

You are correct .

The above BVA case is very interesting-

"After consideration of all the evidence, the Board concludes

that the veteran did not submit a timely substantive appeal

with the denial of service connection for residuals of a head

injury in the August 1991 RO rating decision"

BUT then

"The veteran's representative stated

the veteran's disagreement with this determination in a VA

Form 1-646 dated in March 1995, noting that the veteran had

residuals of a head injury, including a psychiatric

disability. This statement from the representative satisfies

the requirements for a timely notice of disagreement with the

December 1994 RO rating decision. 38 C.F.R. §§ 20.201,

20.300, 20.302(a) (1999). This issue should now be made the

subject of a statement of the case. Manlincon V West."

Another point in this case is:

"The veteran also testified to the effect that he is

incompetent because of his psychiatric disability and that

this condition constitutes good cause for not submitting a

timely substantive appeal with the denial of service

connection for residuals of a head injury in the August 1991

RO rating decision. " His claim was remanded.

Edited September 16, 2006 by Berta

[timetowinarace]

Yes, but even if this remanded case does become SC, It is not assignable at greater that 10%. In other words, even when he wins, he can only get 10%.

This seems to be a little known loophole for VA. That guy spent quite some time fighting for a maximum 10%. When he gets it, he'll learn to file for dementia due to trauma, wich is rated under the general rating scale for mental disorders. Not the rating scale for neurological disorders that head injury is under. The Code is quite clear. A rating higher than 10% is not assignable for residuals of brain trauma WITHOUT a diagnoses of multi-infarct dementia. It is not to be combined with any other rating. It's WRONG, but clear.

DSM-IV Symptom Criteria for Determination of PCS

1. History of a head injury with concussion

2. Following the head injury evidence of attention or memory difficulties on formal testing

3. Following the head injury presence of three or more of the following symptoms:

a. Becoming fatigued easily

b. Disordered Sleep

c. Headache

d. Dizziness or vertigo

e. Irritability or aggression with little provocation

f. Anxiety, depression, or affective lability

g. Changes in personality (e.g., social or sexual inappropriateness)

h. Apathy or lack of spontaneity

4. The PCS problems cause a significant disturbance of social or

occupational functioning

Table 2

Figure 1

Figure 1 is a schematic representation of the stages of recovery from closed head.

Differential Diagnosis

In those individuals reporting long-term PCS symptoms following MTBI,

their clinical presentation may be very similar to related disorders, including

post-traumatic stress disorder, major depression, disability seeking behavior,

or malingering. For instance, individuals may report sleep difficulties,

memory problems, irritability, and anxiety that fit any of these diagnoses.

Mittenberg and Strauman (2000) suggest the following considerations in

differential diagnosis:

• Post-concussion Syndrome versus Post-Traumatic

Stress Disorder. PCS is not associated with persistent reexperiencing

of the accident or numbing of general

responsiveness, whereas PTSD is. In contrast, PTSD is not

characterized by headaches, dizziness, generalized memory

problems, or subjective intellectual impairment, while PCS is.

• Post-concussion Syndrome versus Major Depression. PCS is

not associated with changes in appetite or weight, psychomotor

agitation or retardation, suicidal ideation, or a history of

depressive disorder.

• Post-concussion Syndrome versus Disability Seeking or Overt

Malingering. While a malingerer may convincingly report many

symptoms of PCS, level and pattern of performance on formal

neuropsychological testing can be used to differentiate between

the two presentations, at least in cases where the medical record

clearly indicates that the head injury was mild. However, it is

certainly possible that individuals with legitimate post-injury

symptoms may also amplify or exaggerate their problems. These

cases are the most difficult to tease apart contributing etiologies,

although a careful history, collateral interviews, and formal

neuropsychological assessment are often useful.

Appropriate referrals of patients with MTBI

Although a thorough physical examination and history are the initial

elements of a post-concussion clinical workup, a variety of other tools are

available to clarify examination findings. Individuals who continue to

describe difficulties with concentration, attention, and memory may be

referred for more comprehensive evaluation including cognitive assessment

by neuropsychological testing. Magnetic Resonance Imaging (MRI) may be

indicated at follow-up in patients who are experiencing persistent

Points to Remember

• Correct diagnosis of posconcussion syndrome is complicated

by its overlapping symptom pattern with other conditions

•

This is from veterans health initiative-Traumatic Brain Injury. I wish I could post the whole thing but its 177pgs long.

Time

Edited September 16, 2006 by timetowinarace