ptsd Questions Relating To Tbi Claims

[dgraham82]

Hello I was recently diagnosed by a Polytrauma doc with mTBI related to a mortar blast in Iraq. I mentioned I was having memory problems, she recommended I go to neuropsych for cognitive tests. Now I did this and the Nueropsych doctor confirmed I have minor memory problems. However he said they were not related to the TBI instead he blamed them on my PTSD and occasional drinking. He also stated he believes the TBI has healed itself. I currently have a claim in for PTSD and TBI. Will this negatively affect that claim? I have read on various websites that the VA tends to downplay TBI by relating a lot of the symptoms to PTSD and Depression. Would it be a good idea from a Civilian doctor? Or jst wait for the claim process to finish it's course and see what happens?

[Berta]

Do you have copies of the neurotest results?


What is the 30% for that you get now?

This link to a hadit post will give you some idea as to what VA says caused TBI residuals.



As an OEF vet ,you will fall into the 2010 PTSD criteria ,which is here:




"Would it be a good idea from a Civilian doctor? Or jst wait for the claim process to finish it's course and see what happens?"

A civilian doctor can no longer prepare an IMO on initial PTSD diagnosis,( per the 2010 regs) as the Dx has to come from a VA professional.

I have heard of neuropsychological tests, but not of a "Neuropsyche"

What is this doctor's actual credentials?

Was this the MMPI Combat related and other tests that can separate brain trauma from PTSD?

I am trying to find out here, if this doctor was either a psychologist or psychiatrist from the VA, and if he formally had diagnosed you with PTSD.

Was this for an actual C & P exam? If so and if it was done at a VAMC you can obtain a copy of the results by writing to or going to their Records Access Office who might have a short form you need to sign to get them. Do not use FOIA for obtaining your medical records.

I have mentioned that many times here.FOIA adds LOTs of time to requests for med recs.

My husband had many neuro psyche test to separate his PTSD from his brain trauma due to a stroke,.

And the VA failed to address them in one of their decision for my accrued benefits after he died.

I went to the Dr. who had done the testing and he gave me a copy of his entire assessment on the results while I was there.

he was angry that the RO had not even considered these records and wrote a letter to them, also stating I had brought in the SSDI award my husband received for PTSD that they had ignored by then for about 2 years, and he mentioned that award in the letter he wrote to the RO.

Within weeks they reversed their denial.100& SC for PTSD P & T and sent the cash..

A FOIA request can add months to records requests of medical records that belong to you.You dotn even need to cite the Privacy Act 5, USC 552, but can if you want to.

Mauybe you should ask also for a complete copy of your C file but it would be good to get copies of the Neuro tests results first.

[USMC_VET]

Hello I was recently diagnosed by a Polytrauma doc with mTBI related to a mortar blast in Iraq. I mentioned I was having memory problems, she recommended I go to neuropsych for cognitive tests. Now I did this and the Nueropsych doctor confirmed I have minor memory problems. However he said they were not related to the TBI instead he blamed them on my PTSD and occasional drinking. He also stated he believes the TBI has healed itself. I currently have a claim in for PTSD and TBI. Will this negatively affect that claim? I have read on various websites that the VA tends to downplay TBI by relating a lot of the symptoms to PTSD and Depression. Would it be a good idea from a Civilian doctor? Or jst wait for the claim process to finish it's course and see what happens?

it will hurt your claim if thats a opinion of a specialist. however its not the end. As berta said who are they and what are their credentials, were they a intern or trainee working for the specialist, etc?

If i were you i would go to a primary care civilian doctor and ask for a consult with a neurologist OR go to www.imenet.com and seek out a neurologist there. That being a IMO for TBI and not PTSD

PTSD as Berta said has to initially be DX'd by the VA, so go and request to speak to a psyciatrist, explain your issues, etc and start the therapy and medications they offer.

I think it would be helpful if you would post again but go over in detail the chronology of events that have taken place in your claim from start to present, when you first went in for any of these issues, when you filed your claim, when this or that exam was conducted. This will help us know better what is actually going on.

[dgraham82]

It was not a c&p eval, simply a referral from the Polytrauma doctor who diagnosed me with mTBI. I mentioned that I was having trouble in college. The Doctor I saw in Neuropsychology was a Clinical Neuropsychologist. I just read his report and the cognitive test he gave me was called RBANS my total score was in the 18th percentile. He also recommends further testing, though In the report he goes on to state Minor Cognative discrepancies believed to be related to veterans recent diagnosis with PTSD. I was diagnosed with PTSD by a different person at a different clinic.

[dgraham82]

it will hurt your claim if thats a opinion of a specialist. however its not the end. As berta said who are they and what are their credentials, were they a intern or trainee working for the specialist, etc?

If i were you i would go to a primary care civilian doctor and ask for a consult with a neurologist OR go to www.imenet.com and seek out a neurologist there. That being a IMO for TBI and not PTSD

PTSD as Berta said has to initially be DX'd by the VA, so go and request to speak to a psyciatrist, explain your issues, etc and start the therapy and medications they offer.

I think it would be helpful if you would post again but go over in detail the chronology of events that have taken place in your claim from start to present, when you first went in for any of these issues, when you filed your claim, when this or that exam was conducted. This will help us know better what is actually going on.

As for the chain of events....

June 2014 Filed intial PTSD, tinnitus and hearing loss claim

Nov 2014, Claim denied instead received SC at 30 percent for undiagnosed depressive disorder.

June 11th 2015, went in for my initial VA appointment. My Primary care doc did an initial tbi assessment. He then referred me to polytrauma for a secondary eval. Also referred me to mental Health for a PTSD assessment. The Same day Mental Health told me initial assement indicated PTSD. Referred me to a clinician for PTSD Diagnosis

Reopened PTSD claim

June 14th went in for CT Scan at doctors request, Report states I have a small arachnoid cyst on my posterior fosso. (neurology apt scheduled for July 23rd)

June 23rd Diagnosed with PTSD by a VA Mental Health Clinician.

June 25th went in for secondary TBI eval, Doc Diagnosed me with a mTBI prescribed medicine for the constant headaches I get states cyst was minor and probably not related at all to my symptoms but neurology would go over that with me in july. Then referred me to neuropsychology.

Added TBI to claim

June 30th did the Cognative testing. Also saw a psychiatrist for medicine related to PTSD diagnosis. Was prescribed Zoloft and a sleep medication

[Berta]

RBANS test means
Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)

This is good:
"June 25th went in for secondary TBI eval, Doc Diagnosed me with a mTBI prescribed medicine for the constant headaches I get states cyst was minor and probably not related at all to my symptoms but neurology would go over that with me in july. Then referred me to neuropsychology."

so far.

This is a long reply because, yes the VA has certainly downplayed TBI ,but they are getting better at not doing that.



I was alarmed at, then not surprised when I relized this appeal stems from the RO I deal with)



"Dr. Bhagwat's report is included in the Veteran's claims file. Review of Dr. Bhagwat's report reveals that the psychometrist who did the RBANS (neuropsychological status screening measure) testing July 22, 2008 to assess the Veteran's current cognitive status revealed "some variability in effort" and "fluctuating effort/interest." The psychometrist "also reported that patient would sometimes quickly finish his responses, but when prompted or cajoled, would give more information. Thus, the results of testing may underestimate his actual current functioning." Dr. Bhagwat also noted that "his performance on a narrative memory measure was impaired based on strict scoring; however, when standard administration was broken and the patient was prompted for more information, his score jumped into the average range." As such, the record reflects that the psychometrist broke the standard administration procedure for the RBANS testing by cajoling and prompting the Veteran during the examination and obtained an average range score. The failure to follow standard administration procedure during the RBANS calls into question the validity of the results, as well as the adequacy of any rationale made in reliance on these results as pertinent evidence. As such, remand is warranted. "

The veteran also a a fall froma roof that apparently the Buffalo RO blamed the TBI on.

The Remand is more detailed:

"f. If it is not clear that the Veteran had a head injury prior to his service enlistment in June 1980, did any currently manifested head injury: (1) have its onset during service; (2) manifest within the first post-service year after the Veteran's discharge from service in June 1984; OR, (3) is such a head injury otherwise etiologically related to service or any incident therein?

g. Is it clear and unmistakable that the Veteran had a head injury (please specifically identify such by diagnosis/manifestations) prior to his service enlistment in December 2003?

h. If the Veteran did have a head injury prior to his service enlistment in December 2003, is it clear and unmistakable that such a condition was not aggravated (permanently worsened) during, or as a result of, the Veteran's period of military service from December 2003to March 2005?

i. If there was an aggravation (permanent worsening) of a preexisting head injury during, or as a result of, the Veteran's period of military service from December 2003to March 2005, is it clear and unmistakable that the aggravation was not due to the natural progress of that condition? "

There was no question that this veteran had suffered TBI in service:
"IAW AR 40-501, Chapter 3-30j (Traumatic Brain Injury) where his condition was found to be "medical unacceptable" and a referral for administrative action was included; a memorandum dated February 26, 2010 that discussed the Veteran's medical record versus his duty description; and a March 4, 2010 discharge letter from the United States Army Reserve effective March 20, 2010."

http://www.va.gov/vetapp13/Files5/1342015.txt

I am glad you re opened the PTSD claim.

Why did they deny in the first place?

A TBI incident is a stressor. VA can separate the affects of both and they must rate them separately.


We also had a similar claim here some time ago.


In this BVA TBI case, they stated:

"A February 2009 MRI of the Veteran's brain did reveal a very small subarachnoid cyst on the left side next to the cerebellum.

At a January 2008 VA TBI screening, the Veteran conveyed symptoms including memory issues, balance or dizziness issues, sensitivity to bright light, irritability, headaches, and sleep problems. The report of an April 2008 VA TBI evaluation noted additional symptoms including headaches (for which he is currently service connected), poor coordination and concentration, nausea, and fatigue. The examiner opined that the findings were consistent with a diagnosis of TBI. At a February 2009 VA neuropsychology consultation, the Veteran was diagnosed with cognitive disorder NOS and concussion, with symptoms including pain, headaches, impaired attention, and slowed motor speed. The examiner opined that the Veteran sustained a mild closed head injury from blast exposure. In July 2010, the Veteran received a VA neurological examination for compensation purposes. He reported suffering from headaches three times per week. The examiner diagnosed the Veteran with "closed head trauma without traumatic brain injury." As the evidence is in relative equipoise, the Board will resolve reasonable doubt in the Veteran's favor to find that he currently suffers from head injury residuals. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102."

Apparentently this RO doctor blamed the cyst for the closed head injury and not to TBI.


"The April 2008 VA TBI examiner found that the Veteran's TBI was caused by the turret hatch accident in Iraq. Similarly, the July 2010 VA neurological examiner found that the Veteran's closed head trauma was caused by the same accident. The February 2009 VA neurological examiner opined that the Veteran's closed head trauma was the result of blast exposure in Iraq. Resolving reasonable doubt in favor of the Veteran, as the Veteran sustained a combat related head injury and no alternative explanation for his head injury residuals has been advanced, the Board finds that the medical evidence sufficiently indicates that his head injury residuals are as likely as not related to his in-service combat experiences. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. "

It is another absurd decision by a VARO,runnng with the lest favorable opinion they had that they never weighed properly with the other positive C & P findinfgs.

. ORDER

Service connection for head injury residuals, including TBI residuals and a concussive disorder, is granted.

http://www.va.gov/vetapp13/Files4/1338701.txt
My long point is that the cyst could have an association to the TBI. But the VA could blame the cyst for the problems you have and say it is congenital or some other BS.

You do have documentation (I hope) that the recent examiner says the cyst is not the cause of your brain trauma.

As long as you have proof of the mortar blast and that your SMRs or MOS put you into the same time/place of the blast, I do think think VA will grant SC for both:
any TBI residuals and the PTSD.

I am just seeing the possible 'landmines' here ,if you pardon the expression, that many claims hold...meaning how VA can try to deny them.

It might not be the time for you to seek an independent opinion...the results of the additional tests etc and C & Ps will reveal whether you need one. Try to get copies of any further tests or C & Ps as soon as they occur.

And hopefully you can scan and attach them here (cover C file number, name, address prior to scanning)

[dgraham82]

I cannot remember the exact reason the PTSD was denied, however my c&p exam was done by a civilian psychologist outside the VA. luckily both my primary Doc and the PolyTrauma doc put in their reports the head trauma relates directly to a close range mortar blast in Iraq. So far the only hiccup I have had is neuropsych.