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TBI Screening

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USMC_VET

Question

Didnt want to hijack someone elses thread.

I have written about this before but here is the backstory and updates, chronologically.

I had posted about this before here

Incident:

IED attack

1) in slow motion sort of, seeing the dust lift off my cammies a few inches and thinking "thats so cool looking"

2) After I dont know how long starting to hear "GO GO GO GO" since i was driving and we didnt want to lolly gag in the area. I had apparently slowed down to an idle (when above was happening). so i was being yelled at and finally clicked in my head what was going on and we went

3) the sound of the firefight as it was a ambush in conjunction with the ied.

i dont remember anything after that just starting to drive, that is it.

I dont remember if i passed out, i dont think i did, but i was "out of it" for a few seconds maybe longer, i just dont really know. may have been longer havent talked to any of the guys who were with me for years and never asked.  The thing is i dont know if i was unconscious or not, and i told them that.  I dont remember the rest of that day or week for that matter.

 

After Seperation 2006:

When I first got out (6 months after separation give or take) i didnt want to have anything to do with the VA, compensation etc. I only went because A buddy made me go in and jsut get in the system.

Because i was OIF, they had me screened (what they call level II?) for TBI.

What the couple guys (didnt look like doctors, were in jeans and polo) told me was I didnt have TBI because I didnt actually go unconscious after the blast.

 

I am working right now on getting the records for this screening since it was not in my Blue Button.  the Level II "cleared me" based on the the fact that 'you werent unconscious for that long'

I dont know how long is was, if i was, i dont remember....

 

5 years after seperation 2011:

5 years later i was diagnosed with PTSD and all that really fun stuff, and the counselor i was seeing indicated in my records that she thought some of my issues especially with memory may come from TBI.  however her DX isnt valid because she was a LSW, social worker type.

 

9 years after separation 2015:

So i moved to a new state and with that came a new PCP and a new initial screening.

In my TBI Screen with the PCP this is what it showed for TBI

-------------------------------------------------------------------------

"TRAUMATIC BRAIN INJURY SCREENING
Has the veteran already been diagnosed as having TBI during OIF/OEF
deployment?
No
Section 1: The veteran experienced the following events during OIF/OEF
deployment:
Blast or Explosion IED (improvised explosive device), RPG (rocket
propelled grenade), Land Mine, Grenade, etc.
Fall
Blow to head (head hit by falling/flying object, head hit by another
person, head hit against something, etc.)
Section 2: The veteran had the following symptoms immediately
afterwards:
Being dazed, confused or "seeing stars"
Not remembering the event
Section 3: The veteran states the following problems began or got
worse afterwards:
Sensitivity to bright light
Headaches
Sleep problems
about:blank
47 of 170 7/29/2015 9:36 AM
Section 4: The veteran relates he/she is currently having or has had
the following symptoms within the past week:
Memory problems or lapses
Sensitivity to bright light
Headaches
Sleep problems
Positive screen. Results of TBI Screen discussed with patient.
Consult for further evaluation discussed with the patient and the
patient agrees. Consult order entered."

-------------------------------------------------------------------------

A neurology consult was ordered above. Below is the response....

-------------------------------------------------------------------------

LOCAL TITLE: NEUROLOGY CONSULT REPLY
STANDARD TITLE: NEUROLOGY CONSULT
DATE OF NOTE: XXX
AUTHOR: XXX COSIGNER:
URGENCY: STATUS: COMPLETED
CC: Headache
HPI: This is a XXX year old MALE referred by XXX for electronic
consultation. The patient was deployed to Iraq in 2003 and 2005. During one of
his deployments he had a single close proximity blast exposure associated with a
very brief period (<1min.) of disorientation but no loss of consciousness. He
underwent level II TBI evaluation in January of 2012. At that time he was
determined to have no sequelae from blast injury, but his main issues were in
the behavioral health realm, including PTSD and depression. The patient was seen
in primary care on multiple occasions in 2012 and 2013. Headache was not even
listed on his problem list, and he mainly complained of back pain. He was given
naproxen, and ibuprofen and Robaxin, and also utilized physical therapy and a
TENS unit. The patient initially sought care in this area on February 2 of this
year. At that time he reported 3 headaches per week to his PCP. He was seen
today in the sleep clinic for potential sleep apnea, and a polysomnogram has
been ordered. His last vitamin D level was low at 23.9. A TSH was normal. There
is no brain imaging available. Neurology input is requested.

Assessment/Plan:
This is an electronic consultation performed to aid in the care of the patient.
It is based upon a review of the chart. The following observations and
recommendations are offered:
This 30-year-old patient has a history of a single remote blast related mild
traumatic brain injury around a decade ago. The single event would not be
expected to produce any cognitive or headache sequelae. The patient reported no
headaches to his primary care providers in 2012 or 2013, but this month reported
3 headaches per week to his new PCP.
Given the new subjective report of frequent headaches, would recommend brain
imaging. Brain MR would be suitable. Treatment of depression and PTSD would be
important as well. The patient is being evaluated for sleep apnea, which is a
potential cause of headache. The patient has a low vitamin D level, and agree
with treating this, as low vitamin D levels can be associated w/ headache.
Prophylactic therapy for headaches could include Elavil or Pamelor at bedtime,
as well as other mood elevators such as SSRI's or SNRI's. Behavioral health is a
resource for this. Other considerations for prophylaxis would be Topamax or
Depakote, if the headaches exhibit migraine features. Would utilize low doses of
any of these agents. Regular aerobic exercise, relaxation techniques and
biofeedback, physical therapy and acupuncture may all be helpful for chronic
pain issues such as low back pain and headache.
/es/XXX
MD,PhD NEUROLOGY
Signed: XXX

-------------------------------------------------------------------------

A few comments, this <1 min comment never goes away no matter how many times i tell them, i THINK it MIGHT have been less than a minute, i dont know, i dont remember, i remember a few bits and pieces i mentioned above, thats it.  It very well may have been but they have used that one comment i made without the full context of the events and what i said after and before and ran with it.  I also love the comment of "subjective" reports by myself.  i had mentioned headaches but i thought they were more due to my drinking right after i got out, i drank all the time so i was hungover a lot.  I also didnt go to the VA for long periods of time and this latest "subjective" report by myself is the first time i have really come to the VA since i quit drinking (or i should say i have stopped drinking to get drunk all the time, i still have a drink on occassion) after i got married.

 

Next I was finally able to get an MRI, no abnormalities were found thank god, on one hand i wish there was so i could see it an name it as the issue, but i also know that having something there could also mean much worse to come, etc.

 

Next after talking to my PCP about new medications and a "what do we do now?" sort of talk i got this letter

-------------------------------------------------------------------------

Per recommendations of XXX(neurologist) and XXXl, if you would
like a non-medication approach to treating your headaches, you may benefit from
regular aerobic exercise, low doses of biofeedback, physical therapy, relaxation
techniques and acupuncture. If you would like to try any of these methods,
please call our office.
Please don't hesitate to contact us at XXX with any questions.
Thank you for allowing us to participate in your healthcare.
Respectfully,
XXX, Community Based Outpatient Clinic
(Letter mailed to patient's current address in VA computer system on this
date).

-------------------------------------------------------------------------

Problem is that they want me to go to the hospital that is 2 hours away from me for these non medication techniques.  truth is i dont like meds and if something can do the trick that doesnt poison my body, lets go for it.  but i dont have the time or ability to travel 4 hours round trip constantly through the month.
 

I had started going to a private clinic and not the VA and have been given a few medications, and after a switch or two found one that kindof helps reduce amounts of headaches (verapamil) and one that helps take the edge of the real bad ones (sumatriptan). 

I went to the VA again and they now prescribe me these meds as well and i discontinued the prescription from the private clinic.

 

So i am looking for opinions on this.

It seems to me that im sor tof stuck between he said she said.

The Level II cleared me, but they were not qualified to make a diagnosis or not, my social worker counselor said i did have it but she is not qualified either. my PCP gave me a positive screening but he is not qualified either.  the neurologist who IS qualified, has taken no position at all other than to insinuate im maybe lying about it? I was given 0% for headaches, but am appealing it and have a DRO hearing regarding it.  its interesting to note the neurologist said that i never mentioned headaches before but the VA gave me a retro date (for the 0% headaches SC) back to 2012 based on "continuous prosecution" meaning that i had claimed it before, back to 2012 but they had never made a decision until recently. 

I had an appointment with a civilian neurologist, board certified etc earlier but the appointment was canceled and wont happen now until next month.  Im going to present all my evidence to him and hopefully he would be willing to make the TBI diagnosis and fill out the DBQ for residuals, etc.

 

what is your opinion on this?

 

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