diabetes Overcoming Military Failure To Acknowledge Tbi In 1972

[HorizontalMike]

In 1972, while serving in USN, I landed on my head from a motorcycle accident and woke up in the Naval Hospital. LOC ~45min but at time diagnosed as "mild concussion", held 24hr, dismissed after being told I would be fine and sent back to ship to be deployed to Vietnam.

Flash forward ~40yr. When my perpetual depression eventually went off the deep end I asked the VA for help. Started taking meds and asking questions about my life. Finally got directed to Poly-Trauma for full neuro-pysh and MRI. FWIW, I was wondering why I always had trouble remaining employed longer than ~2yr at-a-time over the past ~40yr. I earned three degrees including a PhD, plus three other professional certs, but just could NOT keep a job. MRI results showed past indications of "stroke" (ischemic insults in white matter where parts of brain died), but being UNRATED for TBI, the current doctors atributed this to current diabetes and age. At this point I filed for disability and 14 months later got my 50% rating for TBI. THAT is when I finaly realized my TBI was real AND just how bad I am disabled by it. The detailed list of symptoms/manifestations that the VA examiner provided read like a laundry list of my life's challenges, that until then I had never put together in conscious thought.

I have my intelligence but what I lack are the higher level executive functions that would let me put my education to use. In other words, I can't play well with others at work or at home. I could p***-off the Pope given enough time together. I have no friends at this point, but do have ONE person I taught school with (a retired LTC) that seems to understand and gives me advice from across the country.

My military performance records are bad, real bad... as in I do not understand why I wasn't kicked out, jailed, etc. They show manifestations of deprived sleep, anxiety, irratibility, lack of motivation, etc.

My post-military civilian employment performance records show the SAME manifestations over a roughly ~27yr of the 40yr since TBI. I only kept THOSE records because I thought "they" were picking on me. But they are detailed records, and they seem to show that "they" were correct, and NOT me. This took me months to come to terms with, and only by viewing these things using a 3rd person analysis. Personally, I get too upset reading/thinking about them.

My Depression Rating was denied, though the VA final rulling about depression being "secondary service connected" came through within a week of my TBI rating, so THAT will be reassessed in the appeal.

I recieved a C-PAP for my sleep apnea, that was just diagnosed in 2013. I have a 1973 diagnosis for vaso-motor rhinitus, that also states/records such things a "trouble sleeping, mouth breathing, snoring, 30lb weight gain(BMI-31 = obese), anxiety, BP of 140/100/90, non-reactivity to know allergens, etc. Sleep apnea denied due to lack of nexus.

BOTTOM LINE is that the military FAILED to do adequate testing in 1972-73 on my TBI, depression, sleep disordered breathing, etc. What is NOW considered as standard protocol following a TBI, was not even known in 1972-73. Shoot the C-PAP machine wasn't even invented until 1985, so the military would not even know what to look for.

QUESTION: Isn't THIS where the VA's "benefit of the doubt" rule should kick in? After all they finally rated my TBI (lower rating than I have records to show degree of disability) going retro-active ~41yr. (i.e. Schrödinger's cat)

CURRENT STATUS:

My TBI/Depression appeal has been filed.

My Sleep Apnea appeal is being developed AND THIS IS WHERE I COULD USE SOME HELP. I am focusing on the military's failure test me for sleep disorders when it was/is obvious that I had manifestations of sleep disordered behavior in my elisted performance records as well as in my vaso-motor rhinitus diagnosis in 1973.

Any help/advice would be appreciated.

[carlie]

Current literature connects TBi with Sleep disturbances and current VA protocol requires testing for known co-morbid injuries/diseases/manifestations of TBI. The military did NONE of that in 1972-73. Current VA TBI training program even states as much. http://www.disabledveterans.org/wp-content/uploads/2014/05/14-02938-F-Responsive-Records-2.pdf

Since the military was remiss in accurately assessing my TBI and Residuals in 1972-73, would they not have to follow a Schrödinger's cat type of analogy?

OK, I am having problems with cut and paste functions, so please bare with me...

Sleep disturbance is one of the most common yet least studied of the post-TBI sequelae. Recent research suggests that 30% to 70% of patients experience sleep problems following TBI and that these sleep disturbance often exacerbate other symptoms and impede the rehabilitation process and the ability to return to work. - See more at: http://www.nursingcenter.com/lnc/journalarticle?Article_ID=863002#sthash.DvenCkhI.dpuf

Sleep disturbance is one of the most common yet least studied of the post-TBI sequelae. Recent research suggests that 30% to 70% of patients experience sleep problems following TBI and that these sleep disturbance often exacerbate other symptoms and impede the rehabilitation process and the ability to return to work. - See more at: http://www.nursingcenter.com/lnc/journalarticle?Article_ID=863002#sthash.DvenCkhI.dpuf

Sleep disturbance is one of the most common yet least studied of the post-TBI sequelae. Recent research suggests that 30% to 70% of patients experience sleep problems following TBI and that these sleep disturbance often exacerbate other symptoms and impede the rehabilitation process and the ability to return to work. - See more at: http://www.nursingcenter.com/lnc/journalarticle?Article_ID=863002#sthash.DvenCkhI.dpuf

TBI Symptoms

... There is no single TBI symptom or pattern of symptoms that characterize mild TBI. Symptoms may resolve quickly, within minutes to hours after the injury event, or they may persist longer. Some TBI sequelae may be permanent. Most signs and symptoms will manifest immediately following the event. However, other signs and symptoms may be delayed from days to months. ...

TBI symptoms generally fall into one or more of the three following categories:

• Physical: headache, nausea, vomiting, dizziness, blurred vision, sleep disturbance, weakness, paresis/plegia, sensory loss, spasticity, aphasia, dysphagia, dysarthria, apraxia, balance disorders, disorders of coordination, or seizure disorder.
• Cognitive: problems with attention, concentration, memory, speed of processing, new learning, planning, reasoning, judgment, executive control, self-awareness, language, or abstract thinking.
• Behavioral/emotional: depression, anxiety, agitation, irritability, impulsivity, or aggression.

- See more at: http://www.asha.org/aud/articles/CurrentTBI/#sthash.jj5oIRwg.dpuf

HM,

It is my understanding that current literature and recent studies, would in no way

pertain to issues dating back to 1972 / 1973.

The military could in no way be negligent in assessing your TBI at that time, because there

was no criteria for TBI at that time.

Prior to October 2008, the only criteria available for brain injury due to trauma, was

(VBA Schedule for Rating)- Brain Disease Due to Trauma - Diagnostic Code 8045.

This DC limited the evaluation to 10 %.

A DC that could go hand in hand with 8045 was 9304, for dementia associated to the

SC'd Brain Trauma.

Here is a portion of and a link to a BVA case that explains the criteria that existed in those days.

http://www.va.gov/vetapp92/files2/9212975.txt

"Post Concussion Syndrome

Disability ratings are based on schedular requirements which

reflect the average impairment of earning capacity

occasioned by the current state of a disorder. 38 U.S.C.

§ 1155. Here, the RO has rated the veteran for post

concussion syndrome under Diagnostic Codes (DC) 8045-9304 of

the Department of Veterans Affairs (VA) Schedule for Rating

Disabilities, 38 C.F.R. Part 4.

DC 8045 provides that purely subjective complaints (such as

headache, dizziness, insomnia, etc.) recognized as

symptomatic of brain trauma will be evaluated as 10 percent

disabling and no more under 38 C.F.R. Part 4, Code 9304.

This 10 percent evaluation may not be combined with any

other evaluation for a disability due to brain trauma.

Ratings in excess of 10 percent for brain disease due to

trauma under 38 C.F.R. Part 4, Code 9304, are only

assignable where, as here, there is a diagnosis of dementia

associated with brain trauma (nonpsychotic organic brain

syndrome with brain trauma). 38 C.F.R. Part 4, Code 8045.

A 50 percent evaluation is warranted for dementia associated

with brain trauma with considerable impairment of social and

industrial adaptability. A 70 percent evaluation requires

symptomatology which is less than that required for a

100 percent evaluation, but which nevertheless produces

severe impairment of social and industrial adaptability. A

100 percent evaluation requires impairment of intellectual

functions, orientation, memory and judgment together with

lability and shallowness of affect of such extent, severity,

depth and persistence as to produce total social and

industrial inadaptability. 38 C.F.R. Part 4, Code 9304."

The following relates to the change to the Rating Schedule

I believe the following BVA case will help explain this a bit better.

http://www.va.gov/vetapp12/Files2/1211691.txt

"TBI

Schedular Criteria

During the course of the appeal, the regulations for the evaluation of brain disease due to trauma or TBI under Diagnostic Code 8045 were amended, effective October 23, 2008. See 73 Fed. Reg. 54,693 - 54,708 (Sept. 23, 2008). The effective date for these revisions is October 23, 2008. See 38 C.F.R. § 4.124, Note (5).

If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C.A. § 5110(g) ; VAOPGCPREC 3-2000. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003); VAOPGCPREC 7-2003. Therefore, in this case, prior to October 23, 2008, the Board may apply only the previous version of the rating criteria. As of October 23, 2008, the Board must apply whichever version of the rating criteria is more favorable to the Veteran.

Stated differently, in this case a staged rating is based on a liberalizing change in rating criteria. In accordance with 38 U.S.C.A. § 5110(g), the effective date may be no earlier than the effective date of the liberalizing act or administrative issue.

Under the previous regulation, Diagnostic Code 8045 provides for the evaluation of brain disease due to trauma. 38 C.F.R. § 4.124a (2008). This diagnostic code specifies that purely neurological disabilities are rated under the applicable diagnostic code. Purely subjective complaints, such as headache, dizziness, or insomnia, which are recognized as symptomatic of brain trauma, are rated at 10 percent and no more under Diagnostic Code 9304 (dementia due to head trauma) and may not be combined with any other rating for a disability due to brain trauma. A rating in excess of 10 percent for brain disease due to trauma under Diagnostic Code 9304 may not be assigned in the absence of a diagnosis of multi-infarct dementia associated with brain trauma."

I also second and completely agree with Berta's reply,

"The Schrödinger's cat paradox has no meaning within either the military or the VA,regarding claims.."

jmho

[carlie]

HM,

Just one more thing I think is of utmost importance to post is that,

there can be many medical treaties, medical studies, research papers, etc. . .

that relate Y to Z - - - - but it is also necessary that a doctor relate all of this

directly to, the claimant themselves as an individual.

[john999]

Did you set foot on Vietnamese soil at any port in Vietnam even for an hour? TBI is different from depression, so I would pursue the depression as secondary to the TBi or any other emotional difficulties you have since your TBI. I would also get a private shrink to write a report saying that your TBI has caused secondary depression, anxiety, inability to work etc. If you can get 30% for one of those conditions you will have enough for TDIU. If you have to prove sleep apnea 40 years after discharge it is going to be harder.

I got a 10% rating for a "nervous condition" in 1973. It took almost 30 years to get to 70%. Then it took only about 18 months to get TDIU P&T. You are really lucky you got 50% for the TBI 40 years later. That being said I think you have a great chance of depression, anxiety, mood swings etc. being SC as secondary if you just get some new evidence to make the nexus between them and the TBI. I also got college degrees and could not hold a job until 1985 fifteen years after I got out of the army. Then in 2001 after a long decline I got fired and got SSD and TDIU. If you can't work file for SSD. If you win that will help with a TDIU claim. Go after low hanging fruit. If I had not filed in 1972 within one year of discharge I would have gotten nothing. I know guys who were blown up and got nothing because they never filed for the headaches, ringing in the ears and inability to settle down and work steady. You are lucky something showed up on the brain scan.

John

[HorizontalMike]

A review of my medical records shows that the Navy/military doctors were remiss when they inexplicitly failed to test me for a sleep disorder in 1973. This failure to test for sleep disorders (OSA) occurred after this doctor noted several well-established indicative/diagnostic symptoms/effects of a sleep disorder in my medical record (listed below). Additionally, there was NO follow-up by military doctors after this 1973 appointment:

• November 9, 1973 – Oakland Naval Hospital Allergy Clinic – Diagnosed with Vasomotor Rhinitis with following documented symptoms of a sleep disorder:
  • “…Chronic perennial nasal congestion that is the same in all locations, even out to sea.”
  • “…Occasional snoring…”
  • “…mouth breathing…”
  • “…suffered some loss of smell and taste…”
  • Patient: “…Combination antihistamines and decongestants have been of little relief...” Naval Doctor recommends: “…Continued symptomatic therapy with combination antihistamines and decongestants…”
  • “…gained 30lb in the past year…” “…ht.5ft 9in, wt.210lb…” THIS indicates a BMI of 31 (obese, an indicator)
  • “…suffers from excess worry…”
  • “…some trouble sleeping…”
  • “…nose disclosed no significant septal deviation...” Broken nose had already been surgically corrected from pre-navy accident
  • “…patient was skin tested in our clinic and found to be essentially nonreactive to trees, weeds, grasses and environmental antigens, including dust and molds...” Non-reactivity also points toward Rhinitis and OSA

Below (from the official VA Employee Education System) is a listing of deficits that could be referenced regarding my military performance evaluations. Actually, the Executive Dysfunction list could also be tied into all of my post-Navy employment as well.

SOURCE:

Traumatic Brain Injury

Independent Study Course Released: April 2010

Sponsored By: Department of Veterans Affairs Employee Education System

This is a Veterans Health Administration System-Wide Training Program sponsored by the Veterans Affairs Employee Education System and the Office of Public Health and Environmental Hazards, Department of Veterans Affairs. It is produced by the Employee Education System.

Chapter 6: p.60

…”Executive Dysfunction

Executive functions are those capacities, most commonly linked to the frontal cortex, that guide complex behavior over time through planning, decision-making and response control. Individuals with executive dysfunction may perform well on familiar, highly structured tasks but are likely to have difficulty functioning independently. Deficits associated with frontal lobe injury often are the most handicapping as they interfere with the ability to use otherwise intact skills adaptively. Patients with executive dysfunction may present with problems including:

• Loss of initiative and drive
• Difficulty moving flexibly from task to task
• Diminished awareness of deficits
• Inability to monitor performance properly.
• Difficulty planning and organizing complex activities
• Poor reasoning, problem-solving and conceptualizing …”

Chapter 7: p.68

“…Behavioral and emotional problems may be long-lasting following moderate to severe brain injury… … In addition, they tend to lead to social problems including… [reformatted for clarity]

• over-dependency, …
• tangential or excessive talking, …
• immature behavior, …
• inappropriate use of humor,…
• inappropriate sexual behavior,…
• poorly controlled spending, …
• selfcenteredness, …
• divorce is common. This is often accompanied by a loss of social group membership for the person injured, further resulting in long-term obstacles for a successful recovery (Wood & Yardukal, 1997)…
• Resources (e.g., emotional, physical, financial, social, etc.) are much more likely to be exhausted in the recovery of someone with a more severe injury…”

The doctors at the Oakland Naval Hospital in November 1973, had my enlisted performance evaluations available to them for evaluation, yet they failed to acknowledge, act upon, the many well-known indicators of sleep disorders (OSA) exhibited in those performance evaluations. This lack of acknowledgement and action by military doctors in 1972 and 1973 has negatively affected my entire adult life regarding my TBI/Depression/OSA rehabilitation with regards to my work/career/quality-of-life over the next +42 years post-injury without treatment.

OSA induced/caused work performance indicators that were missed/overlooked by the military doctors could (and did) include the following (as well as others not listed here).

Sources:

http://www.webmd.com/sleep-disorders/guide/central-sleep-apnea

http://www.cpaptalk.com/wiki/index.php/Symptoms

• irritability
• poor judgment, personality changes
• mood changes
• anxiety
• depression
• procrastination, difficulty acting on plans or finishing projects, diminished work performance
• social withdrawal
• neglected relationships
• high blood pressure
• weight gain
• stroke

The below quotes from my enlisted performance evaluations, were and are part of my permanent military record. Everything listed below was all available for the naval doctor’s review at the November 9, 1973 appointment, and show many of the behavioral/neuropsychological symptoms associated with TBI and OSA as listed above. I understand that many of the TBI & sleep disorder symptoms are over-lapping, but IMO they should have been tested for and ruled out. And besides, sleep disorders often present months after the original TBI:

• Oct72 –
  • “…His assigned tasks are limited in scope and difficulty, but he still requires occasional supervision to complete these jobs…”
  • “…his negative attitude towards the Navy and his lack of interest in doing anything.”
  • “…very argumentative when dealing with his seniors.”
• 8Mar73 –
  • “Petty Officer Howell has been and continues to be a significant personnel problem for E division…”
  • “…He has been counselled innumerable times since reporting on board on his poor attitude, working performance, and duties.”
  • “…His military behavior has been constant source of serious irritation to all petty officers senior to him…”
  • “…He shows little or no interest in leadership…”
  • “…Military appearance is again in borderline area in Howell’s case. Material-wise his uniforms are good,… …but his bearing is barely sat. Adaptability he is close to being a ‘misfit’…”
  • “…he has uncanny ability to aggravate almost everyone senior to him in his division, including hard‐working personnel junior or of equal seniority”
  • “…He is a very difficult person to understand and deal with, many have sincerely tried but have failed and been very discouraged…”
• 11Jul73 –
  • “…Howell…will not take any initiative to get job done, and will not apply himself fully to any task…”
  • “…Howell questions authority and antagonizes the entire crew…”
  • “…Petty Officer Howell’s contribution to the ship’s morale is little if any, Howell gets along well with few people in E division and I suspect it is the same shipwide.”
  • “...Part of Howell’s trouble may be his lack of confidence in himself which stands out plainly…”
  • “…the unwillingness to accept either responsibility or authority is present nonetheless…”
  • “…Howell’s appearance is always borderline…”
  • “…Petty Officer Howell is consistently out performed by his subordinates...”
  • “…Howell sometimes needs more supervision than do the non-rated men in his division.”
• 2Oct73 –
  • “…Petty Officer Howell continues to be antagonistic in attitude and immature in his performance and assumption of responsibility…”
  • “…Howell’s professional performance is lacking in that he is constantly surpassed by his subordinates. Military behavior is poor…”
  • “…Howell’s adaptability is also borderline. He barely gets along with others in the division because of his poor attitude toward his superiors, his work, and the Navy in general…”
  • “…In summary, Petty Officer Howell should not be a third class Petty Officer since his performance and lack of initiative are far below standard…”
  • “…Howell needs the supervision of the division petty officers as much as would a non-rated man – and in some cases more…”
  • “…Howell does not have will to get job done”
  • “…Howell sets a very poor example of a petty officer in E division, and about the entire ship because of his antagonistic attitude toward authority, his obvious lack of pride in himself and the Navy, and his inability to perform his duties on the level expected of a third class petty officer…”

BOTTOM LINE:

If the military had properly conducted full testing and follow-up from my moderate-TBI on 23Oct72 and/or after my 9Nov73 doctor’s appointment (to include neuro-imaging, MRI, CT, sleep disturbance, evaluation of my then documented symptoms/manifestations, executive dysfunction, including neurobehavioral and neuropsychological symptomology exhibited post-injury and documented within my enlisted performance evaluations, etc.) then my post-military life over the past +42 years would have been dramatically different than how it ended up.

In other words, if the above (as is current standard protocol for TBI injuries) diagnostics and treatment had occurred in a timely fashion (1972-1975), then I can safely assert that it is at least as likely as not, that I would/could have been properly diagnosed and treated at that time, for my then and still ongoing injuries:

• Sleep Apnea
• Moderate-TBI
• Major Depression
• Obesity that has now led to my diabetes and hypertension

QUESTION: So how do/can I best present this to the VA upon appeal some +42yr later? ...for TBI, Depression, OSA, and possibly diabetes?

FWIW, I am truly interested in the HOW and not the can't.

[carlie]

A review of my medical records shows that the Navy/military doctors were remiss when they inexplicitly failed to test me for a sleep disorder in 1973. This failure to test for sleep disorders (OSA) occurred after this doctor noted several well-established indicative/diagnostic symptoms/effects of a sleep disorder in my medical record (listed below). Additionally, there was NO follow-up by military doctors after this 1973 appointment:

• November 9, 1973 – Oakland Naval Hospital Allergy Clinic – Diagnosed with Vasomotor Rhinitis with following documented symptoms of a sleep disorder:
  • “…Chronic perennial nasal congestion that is the same in all locations, even out to sea.”
  • “…Occasional snoring…”
  • “…mouth breathing…”
  • “…suffered some loss of smell and taste…”
  • Patient: “…Combination antihistamines and decongestants have been of little relief...” Naval Doctor recommends: “…Continued symptomatic therapy with combination antihistamines and decongestants…”
  • “…gained 30lb in the past year…” “…ht.5ft 9in, wt.210lb…” THIS indicates a BMI of 31 (obese, an indicator)
  • “…suffers from excess worry…”
  • “…some trouble sleeping…”
  • “…nose disclosed no significant septal deviation...” Broken nose had already been surgically corrected from pre-navy accident
  • “…patient was skin tested in our clinic and found to be essentially nonreactive to trees, weeds, grasses and environmental antigens, including dust and molds...” Non-reactivity also points toward Rhinitis and OSA

Below (from the official VA Employee Education System) is a listing of deficits that could be referenced regarding my military performance evaluations. Actually, the Executive Dysfunction list could also be tied into all of my post-Navy employment as well.

SOURCE:

Traumatic Brain Injury

Independent Study Course Released: April 2010

Sponsored By: Department of Veterans Affairs Employee Education System

This is a Veterans Health Administration System-Wide Training Program sponsored by the Veterans Affairs Employee Education System and the Office of Public Health and Environmental Hazards, Department of Veterans Affairs. It is produced by the Employee Education System.

Chapter 6: p.60

…”Executive Dysfunction

Executive functions are those capacities, most commonly linked to the frontal cortex, that guide complex behavior over time through planning, decision-making and response control. Individuals with executive dysfunction may perform well on familiar, highly structured tasks but are likely to have difficulty functioning independently. Deficits associated with frontal lobe injury often are the most handicapping as they interfere with the ability to use otherwise intact skills adaptively. Patients with executive dysfunction may present with problems including:

• Loss of initiative and drive
• Difficulty moving flexibly from task to task
• Diminished awareness of deficits
• Inability to monitor performance properly.
• Difficulty planning and organizing complex activities
• Poor reasoning, problem-solving and conceptualizing …”

Chapter 7: p.68

“…Behavioral and emotional problems may be long-lasting following moderate to severe brain injury… … In addition, they tend to lead to social problems including… [reformatted for clarity]

• over-dependency, …
• tangential or excessive talking, …
• immature behavior, …
• inappropriate use of humor,…
• inappropriate sexual behavior,…
• poorly controlled spending, …
• selfcenteredness, …
• divorce is common. This is often accompanied by a loss of social group membership for the person injured, further resulting in long-term obstacles for a successful recovery (Wood & Yardukal, 1997)…
• Resources (e.g., emotional, physical, financial, social, etc.) are much more likely to be exhausted in the recovery of someone with a more severe injury…”

The doctors at the Oakland Naval Hospital in November 1973, had my enlisted performance evaluations available to them for evaluation, yet they failed to acknowledge, act upon, the many well-known indicators of sleep disorders (OSA) exhibited in those performance evaluations. This lack of acknowledgement and action by military doctors in 1972 and 1973 has negatively affected my entire adult life regarding my TBI/Depression/OSA rehabilitation with regards to my work/career/quality-of-life over the next +42 years post-injury without treatment.

OSA induced/caused work performance indicators that were missed/overlooked by the military doctors could (and did) include the following (as well as others not listed here).

Sources:

http://www.webmd.com/sleep-disorders/guide/central-sleep-apnea

http://www.cpaptalk.com/wiki/index.php/Symptoms

• irritability
• poor judgment, personality changes
• mood changes
• anxiety
• depression
• procrastination, difficulty acting on plans or finishing projects, diminished work performance
• social withdrawal
• neglected relationships
• high blood pressure
• weight gain
• stroke

The below quotes from my enlisted performance evaluations, were and are part of my permanent military record. Everything listed below was all available for the naval doctor’s review at the November 9, 1973 appointment, and show many of the behavioral/neuropsychological symptoms associated with TBI and OSA as listed above. I understand that many of the TBI & sleep disorder symptoms are over-lapping, but IMO they should have been tested for and ruled out. And besides, sleep disorders often present months after the original TBI:

• Oct72 –
  • “…His assigned tasks are limited in scope and difficulty, but he still requires occasional supervision to complete these jobs…”
  • “…his negative attitude towards the Navy and his lack of interest in doing anything.”
  • “…very argumentative when dealing with his seniors.”
• 8Mar73 –
  • “Petty Officer Howell has been and continues to be a significant personnel problem for E division…”
  • “…He has been counselled innumerable times since reporting on board on his poor attitude, working performance, and duties.”
  • “…His military behavior has been constant source of serious irritation to all petty officers senior to him…”
  • “…He shows little or no interest in leadership…”
  • “…Military appearance is again in borderline area in Howell’s case. Material-wise his uniforms are good,… …but his bearing is barely sat. Adaptability he is close to being a ‘misfit’…”
  • “…he has uncanny ability to aggravate almost everyone senior to him in his division, including hard‐working personnel junior or of equal seniority”
  • “…He is a very difficult person to understand and deal with, many have sincerely tried but have failed and been very discouraged…”
• 11Jul73 –
  • “…Howell…will not take any initiative to get job done, and will not apply himself fully to any task…”
  • “…Howell questions authority and antagonizes the entire crew…”
  • “…Petty Officer Howell’s contribution to the ship’s morale is little if any, Howell gets along well with few people in E division and I suspect it is the same shipwide.”
  • “...Part of Howell’s trouble may be his lack of confidence in himself which stands out plainly…”
  • “…the unwillingness to accept either responsibility or authority is present nonetheless…”
  • “…Howell’s appearance is always borderline…”
  • “…Petty Officer Howell is consistently out performed by his subordinates...”
  • “…Howell sometimes needs more supervision than do the non-rated men in his division.”
• 2Oct73 –
  • “…Petty Officer Howell continues to be antagonistic in attitude and immature in his performance and assumption of responsibility…”
  • “…Howell’s professional performance is lacking in that he is constantly surpassed by his subordinates. Military behavior is poor…”
  • “…Howell’s adaptability is also borderline. He barely gets along with others in the division because of his poor attitude toward his superiors, his work, and the Navy in general…”
  • “…In summary, Petty Officer Howell should not be a third class Petty Officer since his performance and lack of initiative are far below standard…”
  • “…Howell needs the supervision of the division petty officers as much as would a non-rated man – and in some cases more…”
  • “…Howell does not have will to get job done”
  • “…Howell sets a very poor example of a petty officer in E division, and about the entire ship because of his antagonistic attitude toward authority, his obvious lack of pride in himself and the Navy, and his inability to perform his duties on the level expected of a third class petty officer…”

BOTTOM LINE:

If the military had properly conducted full testing and follow-up from my moderate-TBI on 23Oct72 and/or after my 9Nov73 doctor’s appointment (to include neuro-imaging, MRI, CT, sleep disturbance, evaluation of my then documented symptoms/manifestations, executive dysfunction, including neurobehavioral and neuropsychological symptomology exhibited post-injury and documented within my enlisted performance evaluations, etc.) then my post-military life over the past +42 years would have been dramatically different than how it ended up.

In other words, if the above (as is current standard protocol for TBI injuries) diagnostics and treatment had occurred in a timely fashion (1972-1975), then I can safely assert that it is at least as likely as not, that I would/could have been properly diagnosed and treated at that time, for my then and still ongoing injuries:

• Sleep Apnea
• Moderate-TBI
• Major Depression
• Obesity that has now led to my diabetes and hypertension

QUESTION: So how do/can I best present this to the VA upon appeal some +42yr later? ...for TBI, Depression, OSA, and possibly diabetes?

FWIW, I am truly interested in the HOW and not the can't.

Again - there was no such thing (for VBA purposes) in 1972/1973, as TBI or OSA.

Perhaps I am not understanding exactly what your question actually is.

[Chuck75]

The most obvious way to me would be to obtain an IMO. The military records would have to be reviewed by the physician(s)

doing it, and basically say that, in their opinion, the records show that the condition (more likely than not, etc) originated in service.

Then, the current level of the condition should be addressed. If there are post service treatment records, etc.

they should also be referred to in the IMO.