TBI vet here, I think a miracle happened...

[eli]

I've been a reader here for years, rarely talk, took advice, filed my claim, was denied, appealed, you know the drill.  I'll try to give the basics of my story from hell.

During the Gulf War, stateside, I had an accident while we were loading aircraft and I was knocked unconscious.  Being the gentlemen that they were, my buddies carried me to the side and finished loading the aircraft.  Afterwards they laid me on the couch in the break room and I came to sometime later.  The accident wasn't documented,  But I did start showing up at the base hospital complaining of nausea, vomiting, headaches and sleep problems.  One doctor was so irritated at my complaints that she called my sup and told him to stop sending me to the ER and to tell me to suck it up.  I actually have a copy of her remarks in my file.  There was no way in hell I was going to admit to wetting the bed, but I was washing my bed sheets more often.  Several other odd things happened and at least one was documented thank God.  I had a seizure and wandered into a restricted area without my line badge on.  When I was addressed by the person in charge of the area I was incoherent and he told my sup to write me up for disrespecting him.  TG he did write me up, again I have a copy of this.  None of us thought, hey this is a seizure.

I finally had insurance and a great doctor.  An epileptologist, she said your MRI shoes major brain scarring, what building did you jump out of head first?  I told her about the accident in the military.  She said since you're a vet, get yourself into one of the new VA epilepsy centers of excellence.  At this point I'm averaging 55 seizures a month, can no longer work and have to file for ssdi.  Someone says why aren't you using vet benefits and why haven't you filed a claim.  "Huh?  You mean I have vet benefits?"

Fast forward...claim filed, claim denied, they say yes you have epilepsy but no record of accident.

I appeal.  Denied.

I track down one of my supervisors that was with me on the aircraft that night and he writes a witness statement re the TBI accident.  My current Epileptologist fills out the DBQ and writes a letter stating that I suffered a head trauma during the accident, that the spell I had (wandering into the restricted area) was indeed a seizure and that my epilepsy is the result of said head trauma.  Of course she didn't use the wording I tried to explain to her.  She's foreign and wrote it in medical terms.

They reopened my claim, new evidence?  This time my denial says we admit you had a head trauma accident but you haven't been diagnosed with a TBI and you don't show residuals of a TBI.  And the evidence wasn't good enough?

Me, last week when I got the denial....what???????????????????????????????????????  Although I'm not surprised.

 

Here's what  just happened, I mean ty Jesus, I just happened to see.  And please let me know if this isn't important.  Esp since these records are listed as evidence on my SOC.

VAMC Doctors notes, he's a Neurologist:

Year event type started:  1991

Frequency: 12 per month (my comment-> of the worst seizure type)

Injuries from events:  Head trauma

Traumatic Brain Injury: YES

Traumatic Brain Injury Severity/Loss of Consciousness: moderate 30 min to 24 hours

Type of TBI: closed

***If this is the diagnosis from my VA doctor then didn't VA screw up with their denials?

My last denial/SOC letter dated 11/21/17 says, quote:

Evidence:  Treatment reports VAMC Durham, for the period June 19, 2013 thru Sept 3, 2015

My 2/13/17 denial/SOC also lists the Durham records in evidence.

 

So yeah, I'd love some feedback on this situation.

I was planning on submitting 2 more IMO's stating I have a diagnosis of TBI when I submitted my form 9 from this last denial, assuming I'd be heading to BVA.

Oh dear hadit experts, whatever if anything does this mean????

Edited January 10, 2018 by eli
Clarity

[eli]

19 minutes ago, broncovet said:

Earlier you asked if you should get an attorney to represent you at the BVA.  Given your TBI, this is a no brainer:  Hire an attorney.  You could wait until the results of the Board decision, however, unless its fully favorable.  

"After the BVA decision is complete" is a "line" you dont want to cross without an attorney.  There is no reason to because the CAVC almost always awards EAja FEES to successful claimants.  In other words, the EAja PAYS your attorney fees MOST of the time at the CAVC level.  Some attorneys will even accept cases at the CAVC level "for eaja fees", and dont expect money from you.  

Maybe you will get a successful resolution of this before CAVC, but you are paddling "upstream".  The problem is that GS11's really dont have the authority to authorize six figure retro checks, thus they deny, and to get paid you have to hire an attorney and have a CAVC judge decide it.  With your TBI, you are paddling "up a waterfall".  

My advice:  Wait for a board decision, but, in the interim, be "making a list" of attorneys to send your BVA decision to.  Start here:

https://vetadvocates.org/welcome/find-an-attorney/

The likeliness of this being resolved at the Board level or below, with the correct effective date is not good, but good luck to you anyway.  

You just might get your 100 percent with TBI, but you probably wont get the effective date you should get.  

I'll be mailing my form 9 out today.  I wouldn't even know where to begin to find an attorney, so thank you for the link.  :)

I'm wondering how tacky it would be to call the white house hotline again.  I'm really curious if the "ready to review" status means it's at step 4, review of evidence or if it's at step 6 where the rater is reviewing it.  Something major happened between Dec 12 when WI intake rec'd my CUE because they were saying I didn't have a TBI diagnosis and now they admit that I do, based on the VA guy saying my filed is "flagged" as TBI.  Given they claimed I was lacking a TBI diagnosis I would guess this is a major step forward. 

[eli]

Broncovet,

"Maybe you will get a successful resolution of this before CAVC, but you are paddling "upstream".  The problem is that GS11's really dont have the authority to authorize six figure retro checks, thus they deny, and to get paid you have to hire an attorney and have a CAVC judge decide it.  With your TBI, you are paddling "up a waterfall"."

Just so I make sure I am understanding you correctly...If your retro goes into 6 figures then all of we vets with old claims are denied simply because of the amount of the retro?  And where are the GS11's located?  At the RO's?

Thanks for your input.  :)  

[Berta]

Eli-

" Something major happened between Dec 12 when WI intake rec'd my CUE because they were saying I didn't have a TBI diagnosis and now they admit that I do, based on the VA guy saying my filed is "flagged" as TBI.  Given they claimed I was lacking a TBI diagnosis I would guess this is a major step forward. "

Indeed it is- in my opinion.

I recall thinking I posted here  somewhere that you had a "beauty" of a CUE within the appellate period ( ( My favorite  GCY tactic Go CUE yourself VA..... he he)

But I also had spent considerable time at church things in December and wasn't here much.

Thanks for filing that CUE!!!!! 

They clearly violated 38 CFR 4.6  from what has been posted here .

Yippeeeeeeeeeeeeeeeeeee!

Then again maybe best to wait for the decision as I hope they dont screw up your claim AGAIN!

We have 3 "GCY" cuerino vets here so far with success and you would be # 4.( And me too # 5)

 

 

[Buck52]

I don't think broncovet means if you have a 6 figure  retro payment they deny on that bases , I think he means before that during the adjudication of the claim  they find ways to deny  not because of the large retro  that would be an error for sure. CUE

[eli]

 

Quote

Berta - Indeed it is.

Thank you  Berta, I used your CUE template so I owe you tons.  If I ever see you or Tbird in real life you are both getting huge hugs!

The gentlemen I spoke to at the VA was so nice.  After I explained the case situation, he said, I'm a TBI vet and I completely understand, but your file is now flagged TBI.  I said what's that mean????  He said they don't do that to a file without a TBI diagnosis.

The one thing they claimed they were lacking.

He said, I'm reading from the computer, quote claim, "ready for review."

I couldn't help but cry, I'm worn out.

I would hope that given they have my mountain of medical evidence that that means the rater is final reviewing.  Who knows.

Thanks to everyone here that gave input also!

[eli]

7 minutes ago, Buck52 said:

I don't think broncovet means if you have a 6 figure  retro payment they deny on that bases , I think he means before that during the adjudication of the claim  they find ways to deny  not because of the large retro  that would be an error for sure. CUE

Thanks for the clarification.  I was a little confused about some of it.