ptsd Vike17, Berta, I Got The Decision Letter From The Va

[RockyA1911]

I just received the letter from the VA in a white envelope.

Here is what they said pertaining to the skull loss, PTSD, and Unemployabiltiy claim.

Skull Loss

"The issues of service connection of skull loss and an earlier effective date for service connection of skull loss are deferred pending results of VA review examination."

Unemployability

"The issue of whether or not the veteran is entitled to Individual employability is deferred pending receipt of additional information."

PTSD

"As mentioned above, service connection of residuals of post concussion syndrome with brain trauma, left temporal contusion was previously established November 28, 1976, by Rating Decision dated April 25, 1977(rated at 10%). The evaluation of the same disability under various diagnosis is to be avoided. Disability injuries may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation; therefore, your two mental disabilities, residuals of post concussion syndrome with brain trauma/left temporal lobe contusion with post-traumatic stress disorder have been combined and are now shown as post concussion syndrome, brain trauma/left temporal lobe contusion with post-traumatic stress disorder and a 50 percent evaluation is assigned effective April 19, 2005."

I didn't think they could combine the PTSD into this because the stressor of PTSD was Vietnam service and they stated "Your DD-214 for the period of April 15, 1969 through November 27 1973, documents receipt of Combat Action Ribbon, therefore an in-service stressor is conceded."

The head injury happened in 1972 stateside while on duty and the post concussion residuals left temporal lobe contusion with brain trauma is the result of a physical injury and yes they mentioned the cognitive disorder and Memory loss in the increase due to that.

Can they do that? I have seen BVA decision making the VA separate the PTSD from head injury residuals.

So the total results are so far 60% combined:

50% - Post concussion syndrome/brain trauma, left temporal lobe contusion and post-traumatic stress disorder.

10% - Scar secondary to service- connected post concussion syndrome/brain trauma. left temporal lobe contusion (and post traumatic stress disorder).

10% - Recurrent Tinnitus

Skull loss - Deferred pending results of VA review examination.

Individual Empoyability - Deferred pending receipt of additional information.

Service connection of headaches - deferred pending results of VA review examination.

Chloracne - Denied

Barrett's Esophagus - Denied

So it looks like I they still owe me a decision for the Skull Loss and EED, and IU, and the headaches.

[Vike17]

Rock,

It looks like they aren't done with you yet. The issue of IU and skull loss will be determined at a later date, as the rating indicates, due to further exam results. However, I thought they had already administered an exam for all of this? Maybe the exam was over a year lod and they need another one, it's possible considering the time that has elapsed with this.

As far as the PTSD being combined with Post concussion syndrome, the rating schedules says the following;

§4.126 Evaluation of disability from mental disorders.

(a) When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination.

( When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment.

© Delirium, dementia, and amnestic and other cognitive disorders shall be evaluated under the general rating formula for mental disorders; neurologic deficits or other impairments stemming from the same etiology (e.g., a head injury) shall be evaluated separately and combined with the evaluation for delirium, dementia, or amnestic or other cognitive disorder (see SS4.25).

(d) When a single disability has been diagnosed both as a physical condition and as a mental disorder, the rating agency shall evaluate it using a diagnostic code which represents the dominant (more disabling) aspect of the condition (see SS4.14). (Authority: 38 U.S.C. 1155).

[53 FR 22, Jan. 4, 1988, as amended at 61 FR 52700, Oct. 8, 1996]

I think the RVSR may have read this wrong. PTSD is not a Cognitive disorder, it's an Anxiety Disorder, so I would say they should be rated seperatley. I have seen ratings in which Chronic Brain syndrom due to concussion residuals and Major Depressive disorder (MDD is a mood disorder, not a cognitive) were rated seperately, not the two rated seperately and then combined into one evaluation. I may be wrong on this, i don't know. Having said this though, the VA compensates for residulas of injuries to a particular bodly etoliogy, they can't compensate a bodily etoliogy twice under two evaluation, hence pyramiding. Remember the VA compensates for residuals of injuries, not the injury itself or diagnoses. The RVSR may have missed this because the symptoms from the two 'overlap' and wasn't able to distinguish the two seperately for an percentage evaluation. In this case I would appeal this decsion to rate the two together. I'm pretty sure a DRO will catchthis and rate them seperately. This goes with the skull loss as this is a muskuloskeletal disability and not a mental disability.

Vike 17

Edited January 17, 2007 by Vike17

[marinejay]

That is some of the biggest B.S that i ever saw in a rating. I never seen anything like this combining the concussion with PTSD. I am no MD, but i dont think the PTSD form vietnam has to do anything with your concussion. I think they should have rated them separately. I think the screwed in the you know what without lubrication (nothing personal). I would be preparing my N.O.D asap and getting a vlo. I would also send it straight to the BVA, skip all that DRO stuff.

I hope they treat you right (thats asking for alot.)

To all of you who say the VA tries to be fair this is a perfect example that its a lie plain and clear. I dont think this is an honest mistake, this is the va screwing the vet big time and a perfect of why vets have to fight the va to get what they deserve. If they are treating older vets like this, i can't imagine what the vets returning from iraqi freedom will have to go through

just venting

marinejay

[Vike17]

Marinejay,

If the VA was out to screw Rocky purposely, then don't you think they would have just flat out denied his skull loss and IU without deffering it for further evidence? Just becuase you think they should be rated seperately doesn't equate to what is suppose to be done.

You tell me, if you were a RVSR and read the regulation that I posted, would you have seperarted the two? Well, that probaly was a dumb question on my part because from the looks of things, you would rate all 26million veterans out there with 100% regardless of their disbility and evidence.

Vike 17

[RockyA1911]

It says in the letter "We are pleased to inform you that the Secretary's Tiger Team has granted your claim for benefits." "Your records are being retained at our local Regional Office, You should contact this office if you have any questions at 1-888-556-0933 ext. xxxx" "VA uses a schedule for evaluating disabilities that is published as Title 38 Code of Federal Regulations, Part 4." "If you have any information or evidence that you have previously told us about or given to us, and that information or evidence concerns the level of your disability or when it began, please tell us or give us that evidence now. You have a full year to submit additional evidence in support of your claim."

Maybe I can just call the number and ext of the Tiger Team and straighten some of these things out.

There are several Typo errors such as previously established service connection Nov 28, 1978 (it is not 1978, it is 1976) They did that one twice.

Also back in July of 05 I received a copy of my C-File. In it was a medical record of Emergency Treatment records from Methodist Medical Center of Peoria, IL dated May 28, 2005. I had never been to the Medical Center in Peoria, IL and when I looked at it twice it wasn't even my name. Reading it further it was a 14 year old boy (dependent of veteran I assume) detailing emergency treatment for shortness of breath and forehead hematoma. This kid even had an entirely different name. I called the 800# and informed them I had another vets records and he told me to throw it away and they would remove it from my file. In good conscience I couldn't do that to another vet, so I mailed the medical report to the home address in listed in the report since the incident was only a couple of months old with a note that it was erroneously in my C-File.

Guess what? They have listed it as evidence in the decision for the increase for residuals, post concussion syndrome/brain trauma, left temporal lobe contusion and post-traumatic stress disorder, (claimed as post traumatic-stress disorder, memory loss) currently evaluated as 10 percent disabling.

Also, under DC 5296 for skull loss it specifically has a note at the bottom of the schedule stating "Rated separately from intracranial complications:

Sec. 4.71a Schedule of ratings--musculoskeletal system.

The Skull

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

Rating

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

5296 Skull, loss of part of, both inner and outer tables:

With brain hernia............................................. 80

Without brain hernia:

Area larger than size of a 50-cent piece or 1.140 in \2\ 50

(7.355 cm \2\).............................................

(my 4.5cm x 4.5 cm verified skull loss is “3.13 in \2\ (20.25cm \2\)”

Area intermediate........................................... 30

Area smaller than the size of a 25-cent piece or 0.716 in 10

\2\ (4.619 cm \2\).........................................

Note: Rate separately for intracranial complications.

http://www.va.gov/vetapp98/files1/9809718.txt BVA decision to rate skull loss separately and stated RO was in violation of anti-pyramiding provisions and remanded.

http://www.va.gov/vetapp96/files2/9618053.txt BVA decision entitlement to skull loss separate from cranioplasty. Ordered service connection for skull loss.

http://www.va.gov/vetapp06/files3/0610575.txt BVA decision ordered skull loss as separate evaluation and earlier effective date to 28 December 1968. Skull loss in this case was 3.3cm x 3.3cm.

PTSD must be rated separately from post concussion syndrome according to this BVA case:

BVA9414656

DOCKET NO. 92-22 251

Entitlement to a separate rating for post-traumatic stress

disorder (PTSD) with post-traumatic encephalopathy and concussion

residuals, now rated 30 percent disabling.

Upon review of the evidence, the Board finds that the veteran

should receive separate disability ratings for service-connected

PTSD and his service-connected residuals of concussion,

identified as encephalopathy and dementia. While the PTSD and

the concussion (physical trauma to the brain) may have resulted

from the same incident, i.e., a mortar explosion, each is a

distinct entity which warrants a separate disability rating under

different Diagnostic Codes in the VA schedule for rating

disabilities. See 38 C.F.R. Part 4 (1993). In this regard, the

Board notes that PTSD is rated under Diagnostic Code 9411, while

the residuals of physical trauma to the brain, in this case, may

properly be rated under Diagnostic Codes 8045 or 9304.

Vike17, I did do another exam for skull loss back in April of 06 along with a VA neuroligists consult along with more X-Rays, EEG, and MRI. The MRI x-rays measure it to be approx. 4.8cm x 4.8cm. C&P reported 4.5cm x 4.5cm again. There is no more examinations required regardless how old they are. It is as simple as this: The in service crainiotomy resulted in complete removal of skull area diameter of 4.5cm x 4.5cm. A in service crainoplasty (plastic plate) was done to close the open skull. The in service operative and post operative reports will never change and the skull loss is permanent. There a 3 Naval Medical Boards alone with tons of test reports and images over the years.

I don't think they mean a VA examination, they are saying just the opposite (VA review examination) for the skull loss.

They actually say pending VA examination for the deferred headaches that I never claimed. What's up with that.....?the headaches must be that 14 yr old kids that was treated for shortness of breath and frontal hematoma that was mistakenly in my file.

So should I call the Tiger Team number and inform them of all this, prepare statements in support of claim for separate rating for PTSD and Skull Loss separate rating to send as additional information and also demand they remove that 14 yr old kid's emergency medical treatment records from my C-File and expunge from all correspondence, evidence, and decision documents that pertain to my claims.

Really need help right now on how to handle this. They are saying in the letter this is not an appeal or NOD, that I can just contact them.

Funny thing though, they said they are retaining my file at the Cleveland RO but to send any additional information to my local RO (Chicago). I know I have brain damage but I'm trying to figure out why they wouldn't want it to go directly to where my claim and C-File is being retained.

Thanks all!

[Vike17]

Rocky,

First of all, You do not need to addres anything with the skull loss yet, they haven't made a rating determination on it according to your rating decision.

As far as the medical records from the 14 year old boy being listed as evidence, it probably had little weight to as the actual outcome of your claim. Probably no harm, no foul. I wouldn't worry about it!

It looks like the VA has inferred a claim of headaches as secondary to your one of your other claims. Or they are just waiting for other evidence concerning headaches in conjuctions with one of your claims. This may be the case if the headaches associated with your other claims allows for a higher rating. By this I mean headaches may be a symptom of your post concission syndrome and any evidence that shows severe headaches may warrant a higher rating. I'm almost positive that to be awarded service-connection for headaches would be indeed pyramiding.

All the BVA cases that you might have read about veterans receiving seperate ratings for your two claimed disabilities are more than likely correct, but you have to remember that BVA cases are based on that individual case and, therefore, do not set precedence. Only decisions from the Court does this.

Like I said before in my prevoius post, I'm guessing that the two, PTSD and post cuncussion syndrome, warrant seperate ratings, but I'm not 100% sure. I have seen ratings for Chronic Brain syndrome associated with brain trauma rated seperately to Major Depressive disorder secondary to the veterans claimed disabilities. However, like I said before, MDD is a Mood disorder and your PTSD is an Anxiety Disorder, and I'm not sure how they would corolate with a cognitive disorder as stated in §4.126. Do you see what I mean. Maybe the RVSR made a mistake in favor of the veteran I'm referring to with the two seperate ratings? I don't know, it could have happened and sometimes does!

If I were you I would hang tight until you get your rating decisions back from the deferred actions, but also making sure you keep the one year appeals deadline in your sights as far as this recent rating. I say this because, if for some unseen reason the deferred rating aren't addressed by the time your appeals time runs out on this decision, you'll need to submitt a NOD about the PTSD and post cuncussion syndrome to preserve the effecitve date. Does this make sense?

Vike 17

Edited January 17, 2007 by Vike17

[Berta]

This is a new one for me-I have never seen the VA before attempt to combine PTSD from a combat stressor with a physical disabilty-

The reason for your skull loss and the concussion syndrome-in many cases-could give a veteran PTSD-as secondary to an inservice stressful unjury-

however they are combining this? It makes no sense as I recall your stressors were from combat-

I will re-read and try to figure out their logic-

Rocky- as you know- and your citations are correct-the VA can assess PTSD as separate from brain trauma-

they did this in my husband's case-

In the BVA case you cited:

"While the PTSD and

the concussion (physical trauma to the brain) may have resulted

from the same incident, i.e., a mortar explosion, each is a

distinct entity which warrants a separate disability rating under

different Diagnostic Codes in the VA schedule for rating

disabilities. See 38 C.F.R. Part 4 (1993). In this regard, the

Board notes that PTSD is rated under Diagnostic Code 9411, while

the residuals of physical trauma to the brain, in this case, may

properly be rated under Diagnostic Codes 8045 or 9304."

This reg has not changed in last 13 years that I know of-

Maybe it is best to wait for the deferred decision but then again- whoever wrote up this rating has erred-in my opinion-so what would stop them for erring in the deffered part?

Does the AMC have fax machine that you could send them a Reconsideration request on this?

I never dealt with the AMC and have no idea if calling them can straighten stuff like this out.

They acknowledged the PTSD but did not use the 9411 code to rate it-

In my opinion only- I would ask the VA to CUE themselves on this-

or reconsider the decision-

when I made a fuss in 2005 and asked them to do this on a sameo sameo de novo review-to CUE it- I did get another review-but the DRO still didnt know how to read-

The VA can CUE itself-

I received $40,000 when they did this for me 2 years ago in another situation-

I would certainly try to get this decision right as - it would impact on what they deferred anyhow -wouldn't it?

Edited January 17, 2007 by Berta