Tbi Or Not. How Do You, Or The Va, Tell?

[just a guy]

Hi everyone,

I have a question that has been bothering me for awhile.

Do I have a TBI?

I have damage to my brain. I have documented structural damage, encephalopathy, and cognitive dysfunction. That is a fact. It is evident in MRIs, EEGs and neuropsych testing (from DoD, VA and IMEs) all show it definitively.

The problem is that the definition of TBI seems...squishy, to say the least. According to CFR 38 I have all the dysfunctions of TBI. But I don't have a VA/DoD document that says TBI.

I was not in a blast. I did not hit my head. I was not punched, hit, or shaken.

I had swelling in the brain (an external force?) from excess water in there (cerebral edema). This was an acute event. Afterwards, I had seizures and was in a coma for 36 hours.

I am VA rated for many of the post TBI secondaries. I have seizures, memory loss, depression, anxiety, migraines, etc. But VA considers the seizures as primary and everything else as secondary to the seizures.

But at a C&P the doc said "you do not have TBI." My DoD medical records and even VA records definitely show damage to my brain. Dr Bash says in an IMO I had a TBI.

So what is the official definition of a TBI? Who gets to decide if it is a TBI or just damage to the brain...and what the hell is the difference?

VA says my depression anxiety and migraines come secondary to my seizures. Can I argue that everything, including the seizures, come secondary to TBI? And if I can argue that how do I make the case to VA?

Thanks,

J-A-G

[Vync]

I am not a TBI expert, but what if you had an injury to your head a long time ago and totally forgot about it? Going through your service treatment records might help shed some light on it. I did not realize that some of my doctors just flipped the page over and wrote on the back of an existing page. The note I found made a big difference. It might be similar to finding a needle in a haystack, but sometimes it is best to take your time and double-check to be sure nothing was missed.

[just a guy]

Hi Vync,

I appreciate your quick response, but I assure you that I did not miss anything. The event that precipitated everything was swelling in the brain.

There was excess water in the brain. That caused damage. Resulted in the seizures. And now all of the secondaries.

But is water in the brain considered an "external force"? It caused damage. It was not organic (i.e. I was not born with cerebral edema).

So it could meet the definition. I'm just not sure.

Thanks,

J-A-G

[Berta]

"Dr Bash says in an IMO I had a TBI."


"Definition

Traumatic brain injury (TBI) is a nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness.

The definition of TBI has not been consistent and tends to vary according to specialties and circumstances. Often, the term brain injury is used synonymously with head injury, which may not be associated with neurologic deficits. The definition also has been problematic with variations in inclusion criteria.

For excellent patient education resources, see eMedicineHealth's patient education article Concussion."
http://emedicine.medscape.com/article/326510-overview

Dr.Bash did 2 Great IMOs for me years ago. What did Dr. Bash state was the cause of the TBI?

Something caught Dr. Bash's attention.to diagnose TBI. Have you asked him about that?

But I have a question...

what do you seek to attain if the VA concedes that uyou do have a TBI?

Brain damage ,as well as TBI definitions can cover a vast amount of situations.

I had an Army husband with a brain tumor and the surgeon said the tumor removal, like any brain surgery, caused some degree of brain damage, and the tumor itself had already created damage as well.

Then again my USMC Vietnam vet husband had brain damage due to multiple transcient attacks and a major stroke ( 1151)
due to VA health care itself.


Cerebral edema almost always is due to a blow to the head or a fall on the head. But if you google cerebral edema, many potential causes will pop up.

I regret it is raining hard here and my satellite dish will fade out soon , cant post any more links from, google....

I know you would want to know the exact medical cause of your disability but my question regards what a different classification of their diagnosis could benefit you, as far as VA comp goes.

Are you employed?

If not when you hit the 70% did the VA properly consider you for TDIU?

Edited September 11, 2014 by Berta (see edit history)

[john999]

TBI means to me that your brain was damaged to some extent from an external blow to your head of some sort. If you had water on the brain then how did that happen? If you could show that some force caused the water on the brain then I think that it would be a TBI. Did you ever have heat stroke? If you had some disease that caused your brain to swell I don't think that is TBI. What is the exact definition of TBI? If you slipped and fell or were punched in the face that could result in a TBI. My wife slipped and fell and the doctors checked her for a TBI even though she just cut her lip and chin. TBI is such a knew field of medical inquiry. After WWII thousands of military were released with TBI, but they had no concept of what it was and thought that as long as you did not show gross symptoms you were fine. After Vietnam it was the same deal. Only after OIF/OEF did the military begin to really pay attention to TBI where there was not concussion from bomb blasts. The experssion shell shock is slang for TBI before it was understood a little bit. I don't think VA understands it fully now.

John

[just a guy]

Hi Berta and John,

I have neglected to say this because I am embarrassed. This is a site full of heroes and I am not. I was injured pre-war due to hyponatremia. It was in training.

I am working.

Berta, I'm not sure what exactly that I am looking. I'm 50% for depression/anxiety. I understand that due to pyramiding that TBI would most likely cancel that out. I think I am trying to increase my rating with TBI because I am not currently rated for the cognitive and psychosocial dysfunction.

I think my doctors saw it early on that I was different than I was before I got hurt. I tried for a long time to deny it, but now am so overwhelmed I do finally admit that I have changed, for the worse.

[Navy04]

I am rated for TBI, and I had to go thru a series of Brain Scans and see a Neurologist thru the VA. The whole process took a few months to diagnose. Have been rated 30% for TBI/Migraines ever since. I am sorry to hear of your troubles and truly wish you the best.

[NavyWife]

No it is not a TBI the way that VA & DOD defines it.

http://www.ncbi.nlm.nih.gov/books/NBK189784/

APPENDIX CDEFINITION OF MTBI FROM THE VA/DOD CLINICAL PRACTICE GUIDELINE FOR MANAGEMENT OF CONCUSSION/MILD TRAUMATIC BRAIN INJURY (2009)

Go to:

1.1. Definition of Traumatic Brain Injury

A traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force that is indicated by new onset or worsening of at least one of the following clinical signs, immediately following the event:

Any period of loss of or a decreased level of consciousness (LOC)

Any loss of memory for events immediately before or after the injury (post-traumatic amnesia6)

Any alteration in mental state at the time of the injury (confusion, disorientation, slowed thinking, etc.) (Alteration of consciousness/mental state5)

Neurological deficits (weakness, loss of balance, change in vision, praxis, paresis/plegia, sensory loss, aphasia, etc.) that may or may not be transient

Intracranial lesion

External forces may include any of the following events: the head being struck by an object, the head striking an object, the brain undergoing an acceleration/deceleration movement without direct external trauma to the head, a foreign body penetrating the brain, forces generated from events such as a blast or explosion, or other forces yet to be defined.

The above criteria define the event of a TBI. Not all individuals exposed to an external force will sustain a TBI, but any person who has a history of such an event with immediate manifestation of any of the above signs and symptoms can be said to have had a TBI.

The external force would have to come from outside of the body.

I don't see any benefit to you in pursuing this. It might be a better use of your time to try to get your current ratings increased if you feel they should be higher. Or pursuing TDIU if you are unable to work due to your service connected disabilities.

Sorry you have to go through this. I understand how hard it is living with seizures.