I just received my Narsum interview today. TBI and other brain injuries on it. I have already been diagnosed with TBI by army testing. Can anyone tell me how they conduct the VA tests for TBI. My last test took about 8 hrs
The VA shouldn't need to do any of the tests that diagnose the condition that you did before, that's established. They just need to determine how disabling it is. This is a bit more complex than saying there is a single test, or battery of tests, because TBI has so many different presentations. What they need to test for will depend on what your TBI looks like. My understanding is that the majority of these are controlled by the veteran based on what the complaints are. If your cognitive ability is jacked to the point where you can't assist, that usually leads to the cognitive portion being the driver for the rating, although some bring in a 3rd party to help paint a clearer picture (i.e. spouse).
Is the neuropsych exam considered objective evidence? I just received my C&P results and I don't think they reviewed my cognitive severity.
I do not believe the examiner looked at my neuropsychological evaluation/letter.
-The examiner ‘checked’ the box forMild memory, attention, concentration, executive function but without objective evidence on testing.
-On my neuropsych letter she writes that processing speed, working memory, sustained attention and concentration with mental manipulation are Severely impaired. Definitely not mild.
-My neuropsych letter findings reads almost exactly what the SOR for TBI for ‘total’ on the memory, attention, concentration, executive function section has written.
The problem with the neuro psych tests is that it is only really valid as a test to see changes. It requires a baseline test and then it measures the new impairment. Almost nobody has the baseline test. Its just as valid to say you naturally have a "mild" impairment and the TBI increased things to "severe". Without a baseline the measurement of severity is very subjective, at best it can say that the impairment is present.
Everyone has a different ability to do things like solve the puzzles and remember the phrases. Its not really an impairment to do that slower or forget more words or numbers, that's just kind of how your memory or thought organization works. Its when you can't do it the same as before that the measurement reaches objectivity.
This was brought up when the DoD got in trouble for rubber stamping post deployment health assessments. There was a need recognized that pre deployment should include a neuro psych test so they actually know how much the deployment effected things. DoD agreed but never acted on it, and really only did lip service to fix the bad post deployment health assessments.
Its worth noting that its only a factor in your evaluation that may not be controlling over your rating. They pick the worst category and that drives the TBI rating, so if one category is severe it doesn't matter that another was considered mild. A single severe category creates the whole condition as severe. Its also worth noting that lay evidence can be pretty persuasive. A co-worker or spouse isn't going to be able to diagnose TBI usually, but they can be pretty reliable and knowledgeable if they observe something like you needing to be reminded constantly, needing written notes to accomplish things, etc. when that wasn't something you did before the injury. A great deal more reliable than a doctor who never observed your function before and doesn't observe your daily impacts, but only a brief window during a high stakes evaluation.
These are really good points and thanks for replying. I'm glad to see they are doing predeployment assessments In 2006 it was not an option and in 2007 when I was hit TBI was not even a 'thing' yet. Since I did not have fluid coming from my ears and sinuses I was considered good to go. How things have changed!