PEBLO sent me this narsum for review..YES Another "Whats my Rating?!"

A

at_a_canter

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This is only the psych side of things. I have used my NSA/CIA skills to redact any PII. Other than that its not censored, try not to judge me. I am pretty frustrated at this thing because:

a) I wasnt aware you could quote someone using paraphrasing.

b) On page 2 it says: "Occupational and social impairment with reduced reliability and productivity" which If im correct is aiming for a 50% rating. I have highlighted the criteria i personally interpret to fit into the 70% rating, but what do I know. I would be grateful if someone with any amount of knowledge would throw in their opinion.

c) On page 12 is something that is both funny and angering. Again, I hope yall don't judge me.
"IS THERE PRESENCE OF SUICIDAL THOUGHTS? denied; "I have been
having some suicidal thoughts; not really any plans or anything, but I've
been dealing with that for over a year now." SM has one prior attempt in
2013 while in Korea. At that time he attempted to hang himself, "but the
anchor point on the belt broke. I had also told my wife I was going to and
she called my lSG and Commander and they showed up."

Wait, what?

d) Page 4 e - Is that indicating possible PDRL?

Looking for any opinions. I 100% understand that nothing said will be fact. I would be so appreciative.

EDIT: I REMOVED LINK AT REQUEST OF POSTER (my file is too big, i had to upload it on to my personal server)
 
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It should all be in the PDF file, is it not?
 
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Quite a bit of it align with 50%, however the statements about obsessive rituals, impaired impulse control and inability to establish and maintain effective relationships are consistent with 70%.

The statement on page 4e basically states that you do not meet retention standards.

I think it will be rated at 70% TDRL. If they diagnosed you with Chronic Adjustment Disorder, I would then say PDRL.

By any chance can you post up the results from your TBI evaluation? In particular the 10 facets?
 
SECTION II: Assessment of facets of TBI-related cognitive impairment and
subjective symptoms of TBI
1. Memory, attention, concentration, executive functions
[X] A complaint of mild memory loss (such as having difficulty following a
conversation, recalling recent conversations, remembering names of new
acquaintances, or finding words, or often misplacing items), attention,
concentration, or executive functions, but without objective evidence on
testing
2. Judgment
[X] Normal
3. Social interaction
[X] Social interaction is routinely appropriate
4. Orientation
[X] Always oriented to person, time, place, and situation
5. Motor activity (with intact motor and sensory system)
[X] Motor activity normal
6. Visual spatial orientation
[X] Normal
7. Subjective symptoms
[X] Subjective symptoms that do not interfere with work; instrumental
activities of daily living; or work, family or other close relationships.
Examples are: mild or occasional headaches, mild anxiety
8. Neurobehavioral effects
[X] No neurobehavioral effects
9. Communication
[X] Able to communicate by spoken and written language (expressive
communication) and to comprehend spoken and written language.
10. Consciousness
[X] Normal
SECTION III: Additional residuals, other findings, diagnostic testing,
functional impact and remarks
1. Residuals
Does the Veteran have any subjective symptoms or any mental, physical or
neurological conditions or residuals attributable to a TBI (such as migraine
headaches or Meniere's disease)?
[X] Yes [ ] No
If yes, check all that apply:
[X] Headaches, including Migraine headaches
2. Other pertinent physical findings, scars, complications, conditions, signs
and/or symptoms
a. Does the Veteran have any scars (surgical or otherwise) related to any
conditions or to the treatment of any conditions listed in the Diagnosis
section above?
[ J Yes [X] No
b. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs and/or symptoms?
[ J Yes [X] No
3. Diagnostic testing
a. Has neuropsychological testing been performed?
[X] Yes [ ] No
If yes, provide date: 21 April 2014
Results:
Summary of results: Current evaluation finds mildly erratic memory
functioning, ranging from normal range to mildly impaired performance.
This is almost certainly due to to occasional lapses in
attention/engagement, as indicated by erratic effort testing and
invalidated PAI(inconsistent responding). Previously diagnosed PTSD and
(possibly) residual ADHD are the most likely explanations for memory
problems. Postconcussive syndrome/TBI is NOT likely to be a significant
cause of memory problems, as indicated by above average processing speed
and robust executive functioning-two areas most strongly affected by TBI.
b. Are there any other significant diagnostic test findings and/or results?
[ ] Yes [X] No
4. Functional impact
Do any of the Veteran's residual conditions attributable to a traumatic brain
injury impact his or her ability to work?
[ ] Yes [X] No
5. Remarks, if any:
His headaches are at least as likely as not a residual of his TBI.
Subjective complaints of memory loss are not likely a residual of TBI. Per
the neuropsychologist and TBI physician, these subjective symptoms of memory
loss are secondary to his previous psychiatric diagnosis


in your opinion, could this warrant a rating?
 
Facet 1 warrants a 10% rating, it does overlap with your BH rating and may not be rated.

However there is conflicting language (Postconcussive syndrome/TBI is NOT likely to be a significant cause of memory problems, as indicated by above average processing speed and robust executive functioning-two areas most strongly affected by TBI.) but then in the remarks it states (His headaches are at least as likely as not a residual of his TBI. Subjective complaints of memory loss are not likely a residual of TBI.)

I think they may grant 10% on the headaches.
 
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I think you are right that as written, you are tracking for a 50% rating. (It is possible to get a PDRL finding; however, it is likely that the VA will rate you based on 38 C.F.R. Sec. 4.129, which mandates at least a 50% Temp rating with re-evaluation in 6 months....that would result in TDRL). However, (understand, that in the context of IDES, this issue has not been litigated, and it is unclear how this would pan out, especially if you challenge the rating through VA channels post retirement, in regards to the 4.129 issue) as gsflowler suggested, I see a basis for a 70% schedular rating.
 
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