TBI review and Polytrauma eval

[drago]

Hi All,

Me again... another few questions that hopefully someone can shed some insight on.

Over the last few months, as I've gotten deeper into the VA medical side, they have talked about a polytrauma referral, basically saying it could be helpful in me getting to a better place. I was involved in an incident and sustained a significant concussion. I agreed to the referral, and had an MRI that did not show any abnormalities other than something with sinuses. I'm now scheduled for a neuropsych exam. I'm not sure what all that entails, and I can't seem to find much "meat" of what polytrauma is about, other than kind of marketing info that it's "good".

So the questions:

1. Does anyone have any experience with poly-trauma, what it is, is it helpful etc? It is worth following up on and if not, are there any consequences to cancelling it out?
2. Has anyone had any experience with poly-trauma evals affecting ratings? This may just be in my head (and probably is), but it's starting to feel like things with VA medical are just data collection for VA rating side, to look to show why a veteran is over-rated (rating is too high). I'm just not feeling good about how it seems the rating side of VA can access my medical records whenever they want.

Thoughts from the group?

*BTW... I am very thankful for everyone putting up with me, and continuing to hang in there with me.

[drago]

Separate question then:

For higher rating purposes, would it be better to have them find a decision of no TBI, and then submit hypersomnia as a stand alone item?

Or maybe for conversation to say that TBI had originally been denied, and then submit hypersomnia as a stand alone?

Hope that makes sense...

[El Train]

2 hours ago, drago said:

I know it is dangerous to ascribe motive to looks and statements, but I think that format at the very least caught the evaluator off guard, and perhaps had a hint of "unethical" in the look and questions. Could be my own paranoia though.

No, I think this is good.  Too many times an examiner skips questions and categories only to check the box as 'NO'.  If they know that isn't going to work in this case, they are more likely to ask the question.  If you answer 'YES', that's the box they should mark.  Hell, I've walked in with the DBQ in hand.  Guess what?  The DBQ was asked and answered in full.  Got  100% PTSD for that one.  My initial TBI DBQ took 2 hours.  Very thorough, and very good outcome.  In fact this was used against a C&P examiner (an inept one at that) who spent all of 20 minutes and gave me an unfavorable opinion.

2 hours ago, drago said:

Separate question then:

For higher rating purposes, would it be better to have them find a decision of no TBI, and then submit hypersomnia as a stand alone item?

Or maybe for conversation to say that TBI had originally been denied, and then submit hypersomnia as a stand alone?

Hope that makes sense...

Hell no.  You have a mental rating already.  Mental ratings (PTSD in your case) include insomnia/hypersomnia.  It would be pyramiding.  You can't file a stand alone on hypersomnia.  If you think your mental rating should be increased to 100% (pretty high hurdle) due to increased hypersomnia, then go for it.  I'd look for a Psyc. Dr. that can write you a DBQ and Nexus that put's you in the 100% range before doing that.  Just wait for the outcome of your current claim.  Who knows, you might get the 100% PTSD/TBI.  PM me if you have any questions.  I battled these two claims for over two years.

[drago]

Thanks EI Train, I appreciate the information and the offer to pm. It will be really interesting to see how it turns out. My $.02 would be that the 70% for PTSDby itself is appropriate, as I really do struggle with that... a LOT. At the time, based on the initial report, I can see why the actual VA rater assigned TBI as present, but bundled it with PTSD as they are similar. I'm HOPING that now when considering the hypersomnia which is a new civilian diagnosis and is now being treated, as well as the new info if it gets included (the notes really were notes, I was going to fill in a lot verbally) the rater (not QTC evaluator) will consider that as "more". The hypersomnia has been a problem since the actual incident itself and has been a lifelong thing. Just be kind of nice to have some sort of acknowledgement, even if it doesn't move the needle toward 100.

My apologies to the group as well because I think I'm perhaps a little more talkative in my posts than necessary, but its really kind of cathartic and helpful to just get this "stuff" out there. Thank you for listening and the support.

[drago]

Just got the paperwork for the poly trauma eval which is scheduled for Monday. I believe the appointment is for a “neuropsychological evaluation”, and paperwork says the appointment will be 3 hours long. The MOCA I just took lasted about four minutes… I called the office where eval will be to ask what all is entailed in the test, but had to leave a message, and I’m guessing the office may be closed on Fridays.

Soooo… any insight from anyone as to what all may be involved?

[drago]

I know this has been a while, but thought I'd follow-up to maybe help someone else.

It seems "Polytrauma" is a pretty wide ranging support that is basically a service coordination support. The "team" decided based on several data points that i should probably have a neuropsych. It seems in my case it was due to having some early dementia symptoms (memory trouble, language trouble, frequently getting lost, etc). The neuropsych was done by a private provider as a community partner. She was nice, and did a battery of memory and visual spatial tests. Generated a report that actually showed that my actual memory was ok, and did not indicate early dementia, but i did have several subtests of concern. That report has now led to the polytrauma team/dr. referring me to actual neurology for a consult. That appointment is scheduled for about four months from now due to a backlog.

So thus far, it seems to be fairly benign...

[pwrslm]

A neurologist will be concerned with the operation of the brain and peripheral nerves. A Psych is dealing with mental health. A lot of the time, the two are intertwined. In cases of TBI, the neuro will be employed to figure out the actual physical damage to the brain. Physical damage to the brain can be expressed through physical and mental conditions. The residuals of such injuries could affect the behavior of the patient for the most part in a myriad of ways.