TBI Appeal

landmine

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Keeping this from being long winded, I filed for PCS a while back when the VA didn't recognize it. In 2013 I had a TBI screen which I was told was negative. About a year later I filed for residuals of TBI. Was denied real fast and have an appeal currently sitting in some dark room.

Anyways I have been reading doctors notes form the VA for visits since 2010 and finally stumbled on notes entered about my TBI screen in 2013. The doctors notes say the screen was positive and consult for further eval. It also listed 7 or 8 symptoms that I was having problems with. The end of the notes concluded with...
"Positive screen. Results of TBI Screen discussed with patient.
Consult for further evaluation discussed with patient and the patient agrees. Consult order entered.
TBI Comprehensive Screening Consult."

Maybe I am reading this incorrectly but since 2013 they have clearly said my TBI screen was negative. My wife had concerns about this in 2014 when I was having a hard time with some things and I called again about scheduling an appointment for it but they said no need to since my screening was negative. For me to talk to my docs on the mental health team. I never had any sort of follow up concerning TBI.

Does anybody have a different interpretation of what these notes mean. I feel like I am going crazy sometimes and seeing things the way I want to see them. I don't even bother with asking my wife anymore about things. She has lost all patience with me.
 

scoutCC

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Yes, I agree, positive does not mean the same thing as negative. I don't know the solution, and I would think there would be some route to one given such a clear answer on the screening. I will note, however, that squeaky wheels tend to get the grease. Persistently bring up symptoms you want treatment for until satisfied is my only recommendation. It may come down to there is no good treatment for the symptoms, but that's not the same thing as letting a doc tell you a symptom doesn't exist.

I have noticed that many causes of friction with the medical word is over diagnosis. Diagnosis is for the Docs, symptoms are for the patient, they don't like you on their turf. It doesn't matter if they call it TBI, organic brain damage, or bent brain or anything else even more silly. Don't ask for treatment of your TBI. Ask for treatment of the memory problems, the ones that have been happening and getting worse since the IED exploded back in '09, or what have you. They get to tell you all day long that you don't have TBI, that's their job. They don't get to tell you that you don't have memory problems (not without proof).

That question is a little different than the one over ratings. There it may matter that they call it TBI. However if you string together the symptoms and cause/effects and get the right treatment, that will usually work itself out.
 

landmine

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Thanks scoutCC. I am actively bringing up all problems with these symptoms at every appointment now. It seems their process is to rule everything out that it could possibly be before looking into something that it is. I guess not mentioning what I think the problem might be is a good idea and different approach and stick to the problems I am having with the symptoms.

Next thing being scheduled is a sleep study according to my PCP as of last week. It seems they are determined that it is not TBI and may be associated with sleep problems or even my depression they said.

Also found a new VSO (recently moved states) in my area that I will be meeting with at the end of the month to help look over things and get somebody back in my corner that I can physically meet with and talk to.

Thanks for the reply.
 

scoutCC

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The big problem with TBI is its really fairly meaningless when it comes to treatment. TBI means your brain was knocked around. Ok, great, you know the cause, but they can't really go in with a scalpel to fix that. They really kinda have to break it down into what they can treat. Sleep problems, they got pills and machines and stuff for that. That causes memory and mood problems. If I was a doc, that'd be how I'd want to go about things. I'd want to look at the stuff I can help my patient with first and then give him the, sorry, this is just the new you, after I ruled all that out. In many ways TBI means its just the new you. They might offer you some counseling and some coping strategies and stuff to help ease the problems, but no real fixes.

That is all from the VHA perspective, the docs and hospitals. The question becomes different if you're talking TBI from the VBA perspective. Sometimes understanding and working with the VA is easier if you can distinguish between the VHA and the VBA. This can be hard, the benefits and the docs are so intertwined, and in many ways it is for the docs as well. Its quite possible the don't want you to start looking at a TBI claim and are mindful of how their write-ups may support that. They work for the government, and its part and parcel, a good government worker bee looks to save the government money, and some view hindering a claim as saving the government money. Its BS, if true, but I'd believe it.

But in reality, the timeline for symptoms presenting compared to the TBI event is probably going to be more important than the name they call it. Its also a good reason why C&P examiners are separate from people who treat you, the question of benefits and treatment really are quite separate. You can easily flip the script for your claim. Ok, so memory problems (or other symptoms) are caused by my sleep problems and depression. Well, if the sleep problems and depression started right after the TBI, why can't you say the sleep problems and the depression were caused by the TBI? Last I heard the brain controls pretty much everything, so why is that invalid? If those problems didn't start at the same time as the TBI, but the memory problems did, well that pretty neatly puts a cork in the bottle.
 

Warrior644

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The big problem with TBI is its really fairly meaningless when it comes to treatment. TBI means your brain was knocked around. Ok, great, you know the cause, but they can't really go in with a scalpel to fix that. They really kinda have to break it down into what they can treat. Sleep problems, they got pills and machines and stuff for that. That causes memory and mood problems. If I was a doc, that'd be how I'd want to go about things. I'd want to look at the stuff I can help my patient with first and then give him the, sorry, this is just the new you, after I ruled all that out. In many ways TBI means its just the new you. They might offer you some counseling and some coping strategies and stuff to help ease the problems, but no real fixes.

That is all from the VHA perspective, the docs and hospitals. The question becomes different if you're talking TBI from the VBA perspective. Sometimes understanding and working with the VA is easier if you can distinguish between the VHA and the VBA. This can be hard, the benefits and the docs are so intertwined, and in many ways it is for the docs as well. Its quite possible the don't want you to start looking at a TBI claim and are mindful of how their write-ups may support that. They work for the government, and its part and parcel, a good government worker bee looks to save the government money, and some view hindering a claim as saving the government money. Its BS, if true, but I'd believe it.

But in reality, the timeline for symptoms presenting compared to the TBI event is probably going to be more important than the name they call it. Its also a good reason why C&P examiners are separate from people who treat you, the question of benefits and treatment really are quite separate. You can easily flip the script for your claim. Ok, so memory problems (or other symptoms) are caused by my sleep problems and depression. Well, if the sleep problems and depression started right after the TBI, why can't you say the sleep problems and the depression were caused by the TBI? Last I heard the brain controls pretty much everything, so why is that invalid? If those problems didn't start at the same time as the TBI, but the memory problems did, well that pretty neatly puts a cork in the bottle.
Indeed, you make some valid points in my opinion as I have experienced similar tactics by a VA clinician treating my TBI (which is actually a mild TBI (mTBI) and well documented while on active duty in U.S. Army military service).

Bottom line, the VA clinician ordered numerous "residual" medical appointments to try to officially "rule-out" my mTBI medical condition, but the results all "supported" evidence of a mTBI collectively. Sadly, the VA clinician still would not "connect the dots" in reference to the "residuals of a TBI" and stated that my cognitive/memory problems are more mental health related.

So, the VHA fight continues while implementing a different strategy with the VBA by using the DSM-V recognized "Post Concussion Syndrome" symptomology which is medically the same as a mTBI.

Sadly, certain individuals employed within the VHA and VBA are fully aware of their self-proclaimed "efforts" to try to potentially assist the U.S. Government with any eventual cost-saving initiatives in my opinion.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 
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landmine

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The effort put forth to prove something is not, when it clearly is seems to be a common trend. Without the advice and support of sites like pebforum.com I would have no clue about fighting back or where to even start.

Addressing the problems once they are recognized needs to be top priority. At least we have a place to gather "well-informed knowledge" and help each other out. The one place that should be on our side never seems to have any veterans best interest in mind. It is just dollar signs and how to reduce them.

I'll see my PCP next week and have a list of questions ready for her. Also got two more appointments schedule to help with the sleep problems.

Thanks for the comments guys!
 

gsfowler

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Indeed, you make some valid points in my opinion as I have experienced similar tactics by a VA clinician treating my TBI (which is actually a mild TBI (mTBI) and well documented while on active duty in U.S. Army military service).

Bottom line, the VA clinician ordered numerous "residual" medical appointments to try to officially "rule-out" my mTBI medical condition, but the results all "supported" evidence of a mTBI collectively. Sadly, the VA clinician still would not "connect the dots" in reference to the "residuals of a TBI" and stated that my cognitive/memory problems are more mental health related.

So, the VHA fight continues while implementing a different strategy with the VBA by using the DSM-V recognized "Post Concussion Syndrome" symptomology which is medically the same as a mTBI.

Sadly, certain individuals employed within the VHA and VBA are fully aware of their self-proclaimed "efforts" to try to potentially assist the U.S. Government with any eventual cost-saving initiatives in my opinion.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
I have a different take on this, the clinician is required to treat your symptoms (whether or not you have mTBI or a BH condition).

Does it really matter whether it is called mTBI or XXYZTP? Not really, what matters is that the VA provide you with solutions to your symptoms, as for residuals of mTBI there are many.

It takes a "systems" approach to dealing with the residuals of TBI.

There are many of the body's systems that are affected, you can have memory and cognition issues, motor skills issues, sensory depravation issues, pulmonary depravation issues, and of course issues with your psyche.

There is no one solution for everyone, everything differs.
 

Warrior644

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I have a different take on this, the clinician is required to treat your symptoms (whether or not you have mTBI or a BH condition).

Does it really matter whether it is called mTBI or XXYZTP? Not really, what matters is that the VA provide you with solutions to your symptoms, as for residuals of mTBI there are many.

It takes a "systems" approach to dealing with the residuals of TBI.

There are many of the body's systems that are affected, you can have memory and cognition issues, motor skills issues, sensory depravation issues, pulmonary depravation issues, and of course issues with your psyche.

There is no one solution for everyone, everything differs.
Indeed, I would concur albeit the TBI Clinic's VA clinician seems to be utilizing the "systems" approach to keep her job (in my opinion), but won't "connect-the-dots" with all of the other TBI referral appointment results to make an official "residual of TBI" diagnosis for VHA purposes.

As such, that's her opinion, but I don't accept it at this point in time because my symptomology via all medical evidence and medical documentation "collectively" states otherwise!

And so, the fight shall continue until officially resolved either via VHA channels (e.g., a "residual of TBI" official diagnosis) and/or VBA channels (e.g., military service-connection via "Post Concussion Syndrome" under DSM-V criteria). ;) Appreciate your additional feedback; thanks! :)

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 
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gsfowler

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I understand your frustration, it is very similar to what I faced from the DoD side, since they turned a blind eye (pun intended) to my mTBI diagosis during my med board and would not find the condition as unfitting even though residual diagnosis were unfitting.

DoD wanted to call my symptoms post-concussion syndrome (and went as far as to claim malingering) and would not accept a diagnosis of homonymous hemianopsia an unfitting condition (visual field defect) from the VA, they documented it as retinal hemaginoma (because I had a retinal hommorhage as well as homonymous hemianopsia) my heart tells me that the MEB physician did a typo on purpose just to keep the true diagnosis off of my records.

The MEB physician then stated that the condtion of retinal hemaginoma was EPTS and not rateable (it fell under the 8 year rule) .more than likely he was trying to keep the VA from service connecting it

I was rated at 70% from the VA for TBI (post-concussion syndrome) which I felt should have been rated as unfitting since my vision was unfitting (residual of mTBI).

When it was all said and done, because my injuries were not combat related, I decided to give up the fight since there was no financial gain to be had. I was never in the MEB for the financial aspect, I was submitted because I was injured. My heart told me that I should fight for the Army to perform to standards.

I went as far as to create a flow chart of my medical conditions, to show the MEB physician how the systems worked (to explain the TBI diagnosis), and how two signifigant traumative events in my life which were LOD yes, affected my health forever.
 

Tinybutcher

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I understand your frustration, it is very similar to what I faced from the DoD side, since they turned a blind eye (pun intended) to my mTBI diagosis during my med board and would not find the condition as unfitting even though residual diagnosis were unfitting.

DoD wanted to call my symptoms post-concussion syndrome (and went as far as to claim malingering) and would not accept a diagnosis of homonymous hemianopsia an unfitting condition (visual field defect) from the VA, they documented it as retinal hemaginoma (because I had a retinal hommorhage as well as homonymous hemianopsia) my heart tells me that the MEB physician did a typo on purpose just to keep the true diagnosis off of my records.

The MEB physician then stated that the condtion of retinal hemaginoma was EPTS and not rateable (it fell under the 8 year rule) .more than likely he was trying to keep the VA from service connecting it

I was rated at 70% from the VA for TBI (post-concussion syndrome) which I felt should have been rated as unfitting since my vision was unfitting (residual of mTBI).

When it was all said and done, because my injuries were not combat related, I decided to give up the fight since there was no financial gain to be had. I was never in the MEB for the financial aspect, I was submitted because I was injured. My heart told me that I should fight for the Army to perform to standards.

I went as far as to create a flow chart of my medical conditions, to show the MEB physician how the systems worked (to explain the TBI diagnosis), and how two signifigant traumative events in my life which were LOD yes, affected my health forever.
I had some testing done and they said there was no way to prove my cognitive dysfunction at my level was from TBI, yet I had 4 TBIs in 2 years. I was diagnosed with post concussion syndrome, but are telling me I'm Malingering. I have an LOD for one of the injuries, which screwed up my life completely. Some people I know even think I've developed PTSD from so many injuries recurring in such a short span of time. Thank God my MEN is finally going through, but it's not for TBI even though it was the TBI that caused it.
 
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