PTSD (70) and TBI combined into one.

[lancesay]

i need some help with my tbi...

 

i was awarded the ptsd since 2012 and have gotten 3rd evaluations, this last one in may was my 4th. two weeks later i went for my tbi c&p.

a letter from the va arrived 2 weeks ago, my ptsd is still at 70 and they award me not zero for tbi. the crazy part is they combined my tbi to my ptsd. instead by it's own.

here is how hey added to my eBenefits:

"PTSD (claimed also as insomnia, memory, psychological, sleep problems, and nightmares) with Traumatic Brain Injury (from 05/28/2014)"

i'm reaching out to see if the va can do this by combining two different claims into one. has anyone has the same experience and what did to win your case on the appeal under which regulation code you used. thank you.

[Buck52]

It maybe they are trying to Differentiate  the PTSD/TBI with all these other C&P YOU GOT COMING UP?

You can be rated for both PTSD/TBI,  TBI is more hard for them to make decisions on because he has so many other symptoms and problems that can occur later on.

   JUST HANG IN THERE AND SEE WHAT THEY DO?

[lancesay]

@Buck52 how would i go about doing appeal? any feedback, suggestion, or guidance you or anyone could give me would greatly appreciate it.

[Buck52]

File your  NOD (NOTICE OF DISAGREEMENT) on the new form 20- 0995   not the old form 21 -0958 you will be automatically placed in the New System  (AMA) choose the Supplemental Lane Review)

Remember you can't use New & Relevant evidence if you elect the HLR

If your denied ?After your denial,  then file this new form (20-0995) and submit any new evidence you have that would render you a service connection and rating, if for increase  then you need to show medical evidence that your condition as worsen and this needs to come from a qualified  Dr that has read your medical records and examine you, the Dr needs to go into detail about your condition and show that it has got worse since the last time you were evaluated .

To start off your NOD  just say to whom this may concern  I respectable disagree with the decision on date**-**-**** I have new & Relevant evidence to show my condition has worsen,(Please see Dr Smiths report) who has examine me and read my medical records and the symptoms I have are that of the 100% criteria in the mental health rating criteria and I meet that criteria  ect,,,ect,,, or simply show the rating criteria that fit your symptoms,   Remember PTSD is rated on the symptoms and the severity of them.

   Remember you need medical proof and that proof has to come from a qualified Dr in the field of medicine that your claiming.(Mental Health)

so you may need to get a Private evaluation from a qualified Dr  if the VA Dr's ARE OF NO HELP this is called a IMO (Independent Medical Opinion)

The Dr needs to use phrases in his opinion  like '' is likely as not'' or as least likely as not '' ''most likely as not''   or ''caused by''  or related to that your condition is worse ''ect,,ect,,,what ever the case may be.

The VA likes this type of wording . it also helps the Dr from being liable meaning that the is right and he maybe wrong  but its basically for legality purposes 

[SameOldSong]

I'm going to add a bit to Buck's excellent advice.

Your PTSD and TBI will be combined if the VA feels that the symptoms are identical and cannot be teased out to "this set of symptoms for PTSD" and "this other different set of symptoms for TBI".  They are similar ailments, but they can be teased out.

Buck's absolutely right about the nexus letter --that's the letter from the private doc who examines you and states that:

1. He's seen your military service medical records and says so in the nexus letter.
2. He describes that the conditions that have resulted are "at least as likely as not" or "is likely as not" that the conditions were caused by the military service injury/disease.  It is also helpful if the doctor discusses the condition and why the doc feels that the military service injury/disease caused it.  The "likely as not" wordings of the two choices above is specific because these phrases do not have the legal weight of "caused by" or "most likely as not" so the doc won't put himself in some sort of legal stranglehold.
3. He evaluates your condition on the DBQ and also USES THE PROPER ICD CODE.  The ICD code is the military code for an injury or illness and is completely different from the Medicare codes that are used by every doctor.  You've got to have the right ICD codes on that form, or the VA questions that the private doc is familiar with VA rating.  So, look up the ICD code for PTSD and TBI.  And anything else you are being evaluated for.  If you don't know them, this site may help you:  http://www.militarydisabilitymadeeasy.com

Other things to know about the Byzantine way that PTSD and TBI are diagnosed:

1. PTSD must first be diagnosed and rated by the military docs. You can't have a private doc diagnose it first. But you have that diagnosis now.  Now a second private doc can sort out the details. ( TBI also may have to be diagnosed first by the military.  I'm not sure because the DBQ is no longer on the VA site.)
2. PTSD has only specific types of docs that can diagnose and write these letters. For PTSD, look at the top of the DBQ for the listing of health provider types that can Review your military diagnosis. https://www.vba.va.gov/pubs/forms/VBA-21-0960P-3-ARE.pdf
3. TBI also has only a set group of physician types that can diagnose or Review your military diagnosis. However, the DBQ for TBI has been missing on the VA site for at least a year.  I can't find it.  I did find the Coast Guard's version, which is very similar to what used to be printed up on the VA site.  https://www.dcms.uscg.mil/Portals/10/CG-1/PSC/PSD/docs/VBA - Initial evaluation of TBI residuals.pdf?ver=2017-03-28-105323-973
4. I think a private doc can diagnose a TBI, but pick a specialist. I'd try to find a Neurologist or Psychiatrist to do it.

Now the fun.  You must separate the symptoms to get them rated separately.  Well, not you, but someone trained that can evaluate you.  If you have a TBI, it can cause a lot of the issues that PTSD have.  Look at the DBQ for PTSD. TBI can also have physical symptoms like headaches, vertigo, tinnitus. If you can get it done, talk to companies that do SPECT MRIs (Warning:  they are expensive).  SPECT MRI can actually pinpoint the difference between TBI and PTSD in the brain.  The VA was all over backing that analysis method until they realized that it would cost a fortune to analyze every soldier and would provide solid evidence about the physical injury. Places that offer SPECT scans also usually have neurological testing and usually will write nexus letters from the appropriate healthcare providers.

They rated you at 70% for both.  But it's going to hard to get to 100% from that point. The VA always low-balls your rating. Fight to raise the rating. There are now a lot of residuals that will eventually pop up and you will need to file on those. Use part of the lump sum payment they give you to arrange for private evaluation.

The good news is that they should rate it as Permanent & Total because TBI has no expectation of getting better.  If they did not do that on your rating, ask on this site and see if someone can instruct you on the letter to write about it and where to send it.  PTSD is now viewed as treatable, so the VA likes to mix those because then they can harass you every 2-3 years until they take your rating away.  It's never settled until you reach P&T.