diabetes Long Post: Please Advise.

[Border]

I need some assistance.

I was medically separated from the military in 2002 due to a non-combat parachute jump. I incurred a head injury and was dischared with post-concussive syndrome and right sural nerve damage. I received a 20% disability rating.

I presented to my current internist fatigue, difficulty with concentration and short-term memory, polyuria with 3-4 per hour voiding, and polydypsia to the point of near continuous thirst.

I have acquired paperwork from this board-certified internist (medical school at Yale, published, and 30+ plus years experience) and an endocrinologist stating that I have diabetes insipidus. I have extensive paperwork stating that I have this condition.

I was also referred to a memory disorder clinic. The clinic did an extensive neuropsychological work-up concluding that I have difficulty finishing tasks, recalling recent events, concentrating, focusing, neuropathic pain, change in behavior, masked facies, headaches, bilateral gaze-evoked nystagmus, and diabetes insipidus. My intellectual functioning was all above expectations, except for working memory. Memory was below expectations in most areas. Of particular concern was immediate and delayed recall of pictured events. Also, my performance on visual motor constructional tasks was well below expectations given my IQ (which has actually dropped almost 8 points since the military's doctor conducted the same testing). The final diagnosis was closed head injury with post concussive syndrome.

The internist also wrote a letter for my file stating that I face lifelong limitations due to this (the military accident) traumatic brain injury, including: 1) any situation in which he becomes unable to sense thirst or unable to respond by drinking, 2) the memory deficit has created a lack of confidence and profoundly effects inter-personal relationships, 3) treatment with vasopressin for one year at higher than expected doses has produced less than opitimal responses, cannot drink coffee, tea, colas, and any other diruretic beverage, restrictions within my diet that also effect my ability to socialize, 4) career choices will be limited to positions that allow frequent absence from the desk/workstation and close proximity of fluids and restrooms. She continued by stating that I have attempted to maintain functionality with exercise, no alcohol or tobacco, etc. She concludes that since the accident that created the traumatic brain injury, is likely as not that there will be a continued decline in function and working memory which will impact my way of life, potential livihood and inter-personal relationships. She including supporting attachments.

The neurologist at the memory disorder clinic recommended provigil to counter the chronic fatigue and referred me to a research study group at the local universty aimed at helping folks like me improve daily functioning. I also received documentation from that professor. Another neurologist recently placed me on depakote, though the internist took me off of it immediately because I gained almost 20 pounds within a week and half. I recently visited a psychiatrist to get documentation to support the existence of emotional problems. She thinks I have major depression with anxiety and wants me to take the MMPI-II and begin psychotherapeutic work.

Oh. I was also referred to a VA research group.

Part of my problem is that some of the paperwork is inconsistent. One doctor states this or that about me and my condition, and another doctor states something else. My internist and psychiatrist attest to serious effect on my daily life, while the memory disorder clinic's neurologist states otherwise, though notes the short-term memory, etc.

Also, while I have many symptoms with decent documentation, the results on the physical signs are negative or inconclusive (which contributed to the initial VA rating), other than the diabetes insipidus stuff and some results from a PET scan reporting decreased uptake in the cerebellum and thalmi (which I have no clue what it means). But all the doctors acknowledge that there is something going on that they cannot completely figure out. Read: I have no actual brain lesion.

I also have the real problem that I am attractive, fit, very articulate, employed (though this requires a lot of additional work - mnemonic devices, extreme difficulties with coworkers and consequential lower performance ratings), and have graduate education. I think this will potential hamper my claim despite the documentation that I have collected. And you know what, I am very fortunate compared to many folks, but my level of intellectual functioning has decreased (>99th to 91st) and most probably will continue to decrease, not to mention that my working memory is currently around the 50th percentile, which is far removed from where I should be given my intellectual functioning. So, I still function far better than the majority of healthy folks, but it is a real decline for me darnnit! and frustrates me to no end because I find that I am unable to perform or remember the way I once was.

I don't really know how to proceed in regard to completing my file for a claim. I requested and received miltary and personnel records via the Privacy Act. I am doing my best to collect more documentation for the emotional component of this claim, but am virtually clueless how to proceed.

Please help. Advice? Thoughts?

Border

Edited April 26, 2007 by Border

[Pete53]

Border:

Welcome to Hadit. There is help here. You need to file your claim as soon as you can. It can be as simple as a short letter sent to the VA Regional Office that handles where you live.

Since it is 2 years since you seperated you are going to have a lot to do. After 1 year it gets a lot harder but it is not unsurmountable.

It appears that you had undiagnosed Diabetes Meletius Type 1 while you served. Although you have a diagnosis now you will need a Doc to spell it out that you had it while you served and it is worse now.

The Depression can probably be linked to your head injury or maybe the diabetes. Either one will do but as of now the head injury will service connect the Depression and the Diabetes will not.

You might consider going to your nearest VA Hospital and finding a Service Officer to help you start your claim. Be aware that anything they tell you needs to be double checked.

Hang in and don't give up. One last thing if you are not able to work y7ou need to file for TDIU and consider filing for Social Security DIsability.

'

We are at the end of the month and it will probably be May before you can get paid by VA for your claim.

Pete

[Berta]

Welcome aboard Border- the military and the VA are doing more work regarding the TBI issue-

TBI happens too often these days and needs to be fully understood-

I am familiar with many terms regarding your issue- my Army husband -not the Vietnam Vet husband -(I had a few husbands ) had TBI- from Brain surgery-

itself which is in fact TBI-and diabetes insipidus-a chronic problem and difficult for many hospitals to treat. He never came home after the brain surgery-was hospitalized for 2 years.

The Insipidus in my opinion is Definitely medically related and caused by the inservice TBI.I would be shocked if a doctor did not agree with my opinion.

"mnemonic devices, extreme difficulties with coworkers and consequential lower performance ratings)"all of these if medically associated with the TBI will help your claim-

"I have acquired paperwork from this board-certified internist (medical school at Yale, published, and 30+ plus years experience) and an endocrinologist stating that I have diabetes insipidus. I have extensive paperwork stating that I have this condition"

Did they state that the insipidus is more than likely due to your TBI?

I suggest that you file for direct service connection for the TBI and all residuals to include the insipidus.

(I am surprised that vasopressin is still the med of choice for insipidus)

I also suggest that you ask for them to service connect your emotional status ( dont put that -I mean put the exact emotional diagnosis- such as depression-I assume that would be it ??)and state that this is also due to your TBI and the limitatiions it has caused to you as to memory, emotional liability, social interactions,etc and this is reflected in documentation from your employer (the performance appraisals and anything else that would prove this point)and you can attach copies of them and refer to the attachments in the claim itself (Copies only- VA loves to lose the good stuff)

Actually all of the reports you have are excellent-

they can all be copied and sent as evidence for your claim---

dont leave out anything that the TBI could possibly have caused and tell VA of the side affects of any meds you take.

OK -I re-read -major anxiety with depression- a diagnosis -that should be claimed as secondary to the TBI. The docs report on that is great!

What you present is a physical disability with mental and emotional components-

In my ither husbands case the VA (after Congressional intervention because I raised Hell) gave Rod a series of tests that could reveal extent of his PTSD and then separate that from his cognitive problems due to a VA caused-stroke.

One thing ran through all of his med recs- he was above average intelligence and so the VA appeared to try to use this against him even in spite of severe brain trauma due to major stroke (100% disabling)and the PTSD (100% disabling)which interfered with his normal thought processes and his vision and his employability.

In your case there is obvious relationship between emotional and ophysical disability -it just takes people at VA who clearly read your evidence and comprehend it.

Most important thing to do- I suggest you talk to a vet rep from DAV, AL, VVA-etc and give them your POA and the 21-526 to fill out unless you have done that already-for formal application of the claim.

Others will chime in here as how best to shape this claim-

although I think I covered it all-TBI direct SC with residuals and depression with anxiety as secondary claim to the direct SC for TBI.

Hope others offer suggestions.

You deal with PLENTY and you work.It is best to set this claim up well now for any foreseeable potential that you cannot work anymore due to SC- a long way down the road I am sure- but still- it helps to think ahead.

[Berta]

I think I said it wrong- was it major depression with anxiety?

That can be secondarily SCed to the TBI as well as the residuals from the insipidus-either way the doc put it is OK.

The nystagmus- does that cause you inability to drive? or problems on the job? If so tell them that too.That is definitely from the diabetes insipidus.

In my opinion-

[Border]

Thank you for the responses.

Berta, I am sorry for the suffering associated with the death of your husband. Thankfully, you have channelled some of that energy into helping others. I hope to be so lucky one day.

Yes. They clearly linked the DI to my parachute accident. The internist clearly stated that the causes of DI are: 1) familial, which appears in childhoos as failure to thrive, 2) primary tutors, metastatic carcinomas, lymphomas, and 3) head trauma. She then proceeds to rule out tumor based upon MRI results and that the onset was adult. She provided definitions for this stuff as she proceeds. She states that based upon the documentation, and that a known head trauma within the military is known to have occurred, that the cause is clear.

I did speak with a DAV rep. He encouraged me to gather paperwork for the emotional components, and that is really where I am seeking more advice. I literally JUST started with this doctor. I don't have nearly enough documentation... Actually, I don't know what she needs to write or how. Are there specific points she should be addressing? My internist has a good bit of savvy to her. I am unclear about the psychiatrist, yet. And yes, she is working from the position of major depression with anxiety, though the testing might change that. She told me about the MMPI-II. Not sure what to think about it or how to approach it. She is also talking about medications... Gosh. I'm on vassopressin and provigil, with history of heavy neurontin and depakote. Pretty mixed about that, too.

The DAV rep also suggested to take a long-view approach given probable cognitive deterioration. He thinks that if the DI doesn't rate to 60% immediately, it will in time, and then I file for unemployability. While that thought stinks, I cannot speak for what I will or will not be able to do in the future, nor if I will be able to provide for my loved ones. It really scares me.

I've had a difficult time adjusting to all of this since 2002. Much of that time was without the validation that something was actually going on with me. But family and girlfriend kept insisting, and then I stumbled upon this internist, who also serves as my primary. Anyhow, how does the time since my service-connected discharge effect my chances of an increased rating? Also, I am currently a category 2 within the VA system. Obviously, I am interested in moving to a category 1, and also having these medications and treatments paid for. Currently, much of it is out of pocket.

Also, is my concern for some inconsistency between the doctors something to worry about?

I really don't know much about nystagmus other than that both the internist and neurologist seem to think I have it. I am able to drive. I have lots of problems at work. Unfortunately, my manager misunderstands much of what is going on with me, though I think she would write a letter in support. What does she need to address?

What else can I do? This is an exhausting and confusing process.

Edited April 26, 2007 by Border

[Berta]

Your DAV rep is right- to focus on the emotional component-

that letter would help if the employer understands you are not sueing them under the ADA-

then again it sounds to me like the shrink you have is going to be able to support your claim for depressionand/or anxiety as secondary based on the test results as well as other factors.

The MMPI is a test that can rule out many things like personality disorder and malingering or false statements- NOT your case at all-and can highlight and define areas of emotional distress, anxiety, depression and its levels thast you experience.

Rod had the MMPI for combat veterans-and many other shrink tests-

he had no idea what it would all reveal- these tests revealed his PTSD as catastrophic and his congitive functive levels after the major stroke he had as well as deficits in memory etc.

Nothing to worry about veteran - these test results should help you.

The girl friend could write a statement too in support of your claim.

Did she know you before the TBI?

[Border]

Good advice. Thank you.

No. The girlfriend did not know me before the accident. But we have known each other for 18 months now. Actually, the VA research group I briefly referenced has requested to speak with her, too. What and on what form does she need to make a statement? Would it help to have family members submit statement about the changes they have noticed? Or would they be considered too biased? I also have my current roommates who could write statements. Why is this sort of step advisable?

Oh... The MMPI just intimidates me some. Not the questions, but the answers. While I want and need the validation, it is difficult to hear this sort of stuff about oneself. How did Rod handle this? It must have been difficult, and I do worry about the secondary stress it creates for my loved ones. And since I am placing so much effort into collecting documentation, I do worry that the psychiatrist might try to do too much or too little with it.

In your opinion, what other opinions/documentation should I be collecting?

How does my claim for an increased rating unfold (generically)? Does the VA review my material, and then send off for their own copies from all of the doctors, and then have me do the CP. Geez. If so, that could take a long time.

**Just discovered that my original psychoneurological examination by the military includes a diagnosis for OCD. However, I was never rated on this. I also did not enter Service with it. What do I do with this, if anything?

Edited April 26, 2007 by Border