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

[Berta]

"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."

This is to help you to get the definitive diagnosis and then to associate these problems with your SC TBI.

The psychiatrist has to clearly make that association at some point- for your claim-

Any family member can provide statements-no form needed-just to the VARO that your claim is held at-and they can be sent in by you as additional evidence to support the final diagnosis by the psychiatrist.

These would be statements as to how your TBI has caused you depression and distress- I would think anxiety too is a major component here-

But you might not even need these statements----

whatever tests the psychiatrist does will garner the actual diagnosis and then hopefully the psychiatrist will document how your SC TBI has caused this, as a disability secondary to your SC TBI.

A lot rests on good psychiatric testing and it is often the best way to get a good diagnostic opinion.The VA is so cheap that they fail to offer these tests to many vets who could use the results to support their claims as well as get- most importantly-better care for their disabilties.

The tests- I think Rod had 7 all in all- over 2 days at the local VAMC----

He had problems with putting the squares in the holes stuff-

that isnt the MMPI -

this showed the extent of his spatial and visual problems as well as PN from his stroke.

He took the Combat MMPI-maybe I have it here-

He didnt mind-because the worse thing he ever had to do was the stressor questionnaire-way before this testing stuff-- and apparently he didnt have to review all that in the MMPI test.

He didnt mind any of it.But it was fatiguing as he was still recovering from a major CVA.It was the first time in 5 years that he not only had a real PTSD shrink at the VA but that they were assessing him properly for both PTSD and significant brain damage and separating the two-

These tests were the most VA medical care he ever got.It took Congressional intervention.

I mean he was hosppitalized at 2 VAMCS for 2 months also- but they continually misdiagnosed him

during that period of time-so this was the only real effort VA ever made to properly assess him.

[Berta]

PS-is this a private psychiatrist?

She could certainly prepare an opinion that will conform to what the VA needs from independent physicans.

I recently posted "Getting an IMO" info here availble under search.

There are certain points that these opinions must include.

Also a psychiatrist's opinion and diagnosis outweights that of a psychologist or internist.

A psychiatrist is an MD - a psychologist isnt-they have a doctorate degree -they are not medical doctors-

An internist usually has no medical experience whatsoever to opine on any mental disorder with any rationale that VA will accept.

Whether a VA doc or not- I am glad you have a psychiatrist as their word will have weight with VA.

[Border]

Thank you, Berta!

Within your "Getting an IMO" post you reference a SMR. What is that?

Is it advised to have copies of every medical file, or does it not matter because the VA will request from the doctors anyway?

Have a good weekend.

[Josephine]

Removed by Josephine

Edited April 28, 2007 by Josephine

[Testvet]

Refusing to present yourself for a C&P exam is an automatic denial, you can refuse treatment at the VA hospitals but you HAVE to show up for C&P exams if you don't your claim will be DENIED

[Josephine]

You are absolutely correct on this one. I sure wish that I had refused though.

Josephine