Veterans with mild traumatic brain injuries to receive government help

By GREGG ZOROYA
Gannett News Service WASHINGTON — The Veterans with mild traumatic brain injuries to receive government help

By GREGG ZOROYA
Gannett News Service

WASHINGTON — The government plans to substantially increase disability benefits for veterans with mild traumatic brain injuries, acknowledging for the first time that veterans suffering from this less severe version of the Iraq war’s signature wound will struggle to make a living.

“We’re saying it’s real,” said Tom Pamperin, a deputy director for the Department of Veteran Affairs, about the significance of the change to benefits in the regulation the VA plans published Tuesday.

Up to 320,000 troops who served in Iraq and Afghanistan suffered traumatic brain injury, a RAND Corp. study estimated this year. The vast majority of the cases are mild and came from exposure to an explosion, often from a roadside bomb. Most veterans with mild cases recover, Pamperin said, but some are left with permanent problems.

Compensation could reach $600 a month, the VA said. Currently, veterans with symptoms such as headaches, dizziness, sensitivity to light, ringing in the ears and
irritability and insomnia collect $117.

After it takes effect in 30 days, the new regulation will benefit between 3,500 and 5,000 veterans a year, the department said. It estimated the changes would cost an extra $120 million through 2017.

More than 1.6 million U.S. troops have served in Iraq and Afghanistan. About half of those are now veterans, and slightly less than half of those veterans have sought health care from the VA, records show. In the past year, the department has screened 190,000 of these veterans for brain injury. About 20 percent showed signs of a brain injury, but only about 5 percent were
confirmed as suffering the wound.

The regulation modifies a 1961 rating schedule for mild brain trauma and brings compensation for this ailment into the 21st Century, said Lonnie Bristow, chairman of an Institute of Medicine committee that studied veterans’ benefits.

The old regulation failed to recognize that wounds such as brain injuries from blasts —- which do not show up on scans — are only understood by what patients say they are suffering, Bristow said.

”VA has been assessing their injuries based on outdated science,” said Sen. Daniel Akaka, D-Hawaii, chairman of the Veterans Affairs Committee.

Veterans groups, such as the Disabled American Veterans, applauded the change. However, they said the estimated numbers of traumatic brain injury cases may prove low, because the science around blast damage to the brain is still new.

Veterans who have suffered the most severe brain injuries will not receive much, if any, extra money because existing regulations provided adequate compensation in serious cases, Pamperin said. Consolidating all brain injury standards into one regulation, he said, will make it easier for veterans to get extra benefits to pay for special circumstances such as being housebound by the
injury.

, acknowledging for the first time that veterans suffering from this less severe version of the Iraq war’s signature wound will struggle to make a living.

“We’re saying it’s real,” said Tom Pamperin, a deputy director for the Department of Veteran Affairs, about the significance of the change to benefits in the regulation the VA plans published Tuesday.

Up to 320,000 troops who served in Iraq and Afghanistan suffered traumatic brain injury, a RAND Corp. study estimated this year. The vast majority of the cases are mild and came from exposure to an explosion, often from a roadside bomb. Most veterans with mild cases recover, Pamperin said, but some are left with permanent problems.

Compensation could reach $600 a month, the VA said. Currently, veterans with symptoms such as headaches, dizziness, sensitivity to light, ringing in the ears and
irritability and insomnia collect $117.

After it takes effect in 30 days, the new regulation will benefit between 3,500 and 5,000 veterans a year, the department said. It estimated the changes would cost an extra $120 million through 2017.

More than 1.6 million U.S. troops have served in Iraq and Afghanistan. About half of those are now veterans, and slightly less than half of those veterans have sought health care from the VA, records show. In the past year, the department has screened 190,000 of these veterans for brain injury. About 20 percent showed signs of a brain injury, but only about 5 percent were
confirmed as suffering the wound.

The regulation modifies a 1961 rating schedule for mild brain trauma and brings compensation for this ailment into the 21st Century, said Lonnie Bristow, chairman of an Institute of Medicine committee that studied veterans’ benefits.

The old regulation failed to recognize that wounds such as brain injuries from blasts —- which do not show up on scans — are only understood by what patients say they are suffering, Bristow said.

”VA has been assessing their injuries based on outdated science,” said Sen. Daniel Akaka, D-Hawaii, chairman of the Veterans Affairs Committee.

Veterans groups, such as the Disabled American Veterans, applauded the change. However, they said the estimated numbers of traumatic brain injury cases may prove low, because the science around blast damage to the brain is still new.

Veterans who have suffered the most severe brain injuries will not receive much, if any, extra money because existing regulations provided adequate compensation in serious cases, Pamperin said. Consolidating all brain injury standards into one regulation, he said, will make it easier for veterans to get extra benefits to pay for special circumstances such as being housebound by the
injury.

If they can't work they should get 100%

I'm wondering how this will effect those of us who had minor TBI's due to trauma, from say a fall or auto accident, or being hit by something, or for that matter, as in my case, happened 35 plus years ago and have been suffering it's effect and just now being able to show some evidence from tests that demonstrate the problems I have. Will I qualify under this new program or what ever it is?

Rockhound Rider

I've read the new regs and am not impressed. While as stated in the article, many will get an increased rating, most will still be seriously lowballed. As an example, if I was re-rated under the new rating criteria, I'm not sure my rating would reach the 100% I am currently rated. I beleive it would not. Why? Because residuals will be averaged together to determine a rating. Meaning if an individual has residuals that are 70%, 50% and 30% disabling each, it is quite certian the combination of conditions would leave that person in very poor overall health. Yet the rating will be 50% even though the most disabling condition is 70% on it's own and the total added together is 150%. My experience with my brain injury is that, using the percentages given(if they applied to me), is that I would be 150% disabled and not 50% disabled.

The reason many will get an increase with the new rating scheduall is not because the scheduall is more accurate in determining the disabling effects of brain injury. It is simply because the residuals are now recognized as being real. Averaging rather than adding the accumulation of these residuals assures that ratings will remain low. I'm sorry but someone losing 50% of one arm and 30% of the other does not add up to a 40% loss of both arms.

Even VA math, where 50% and 50% add up to 75%(then round) is better than 50% and 50% adding up to 50%.

Just my thoughts.

Will the new regs apply to disabled vet of years past or only
OIF/OEF vets and newer ?
carlie

Vet's already rated under the old rules will retain their ratings under those rules unless the Vet requests re-evaluation under the new Code. A Veteran may request re-evaluation under the new reg's no matter of the date of injury or prior rating. If a re-evaluation under the new reg's produces a lower rating, the Veteran will retain the higher rating obtained under the old regs.(I would be carefull not to rely on that too much)

This is how I understand it. Hope it answers your question.

TBI & PTSD link...


http://www.braininjurylawblog.com/brain-in...s-disorder.html

time,
Since I currently get only 10 % perhaps I should request
to be re-evaluated under the new ratings.
carlie

The VA will do to TBI Vets as they continue to do to PTSD Vets. The game is the same only the players change.

I think it would be a good idea, depending on your residuals.

Have you been evaluated for cognative disfunction? An actuall neuropsych test? This is still the best way to get a decent rating because the residuals are still subjective complaints and subject to lowballing.

Anyway, I don't see a 10% TBI rating being reduced due to re-evaluation under the new laws. By Law, the original rating under the old laws cannot be reduced.

[quote name='timetowinarace' date='Nov 4 2008, 03:26 PM' post='112505']
I've read the new regs and am not impressed.

Time,
Do you have a link to the new regs and/or TBU rating criteria ?
Thanks,
carlie

Time,
I found the new info. - but what I found does not list any percentages.
Is there another link anyone knows of that has the percentages listed ?
Thanks,
carlie

http://ecfr.gpoaccess.gov/cgi/t/text/text-....67&idno=38


8045 Residuals of traumatic brain injury (TBI):

There are three main areas of dysfunction that may result from TBI and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), emotional/behavioral, and physical.
Each of these areas of dysfunction may require evaluation.Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain.

Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive.

Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day.

Evaluate cognitive impairment under the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified."Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction.

Evaluate subjective symptoms that are residuals of TBI, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified."

However, separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere's disease, even if that diagnosis is based on subjective symptoms, rather than under the
"Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" table.Evaluate emotional/behavioral dysfunction under §4.130 (Schedule of ratings—mental disorders) when there is a diagnosis of a mental disorder.

When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified."Evaluate physical (including neurological) dysfunction based on the following list, under an appropriate diagnostic code:

Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions.

The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, evaluate under the most appropriate diagnostic code.

Evaluate each condition separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine under §4.25 the evaluations for each separately rated condition. The evaluation assigned based on the "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations.

Consider the need for special monthly compensation for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc.

Evaluation of Cognitive Impairment and Subjective SymptomsThe table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" contains 10 important facets of TBI related to cognitive impairment and subjective symptoms.

It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled "total." However, not every facet has every level of severity.

The Consciousness facet, for example, does not provide for an impairment level other than "total," since any level of impaired consciousness would be totally disabling. Assign a 100-percent evaluation if "total" is the level of evaluation for one or more facets.

If no facet is evaluated as "total," assign the overall percentage evaluation based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet.

Note (1):There may be an overlap of manifestations of conditions evaluated under the table titled "Evaluation Of Cognitive Impairment And Other Residuals Of TBI Not Otherwise Classified" with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code.

In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions.
However, if the manifestations are clearly separable, assign a separate evaluation for each condition.

Note (2):Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation.

Note (3):"Instrumental activities of daily living" refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one's own medications, and using a telephone.
These activities are distinguished from "Activities of daily living," which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet.

Note (4):The terms "mild," "moderate," and "severe" TBI, which may appear in medical records, refer to a classification of TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under diagnostic code 8045.

Note (5):A veteran whose residuals of TBI are rated under a version of §4.124a, diagnostic code 8045, in effect before October 23, 2008 may request review under diagnostic code 8045, irrespective of whether his or her disability has worsened since the last review. VA will review that veteran's disability rating to determine whether the veteran may be entitled to a higher disability rating under diagnostic code 8045.

A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating awarded as a result of such review, VA will apply 38 CFR 3.114, if applicable.

carlie,

You found it. The regs are very complicated. the first part you posted is more of an explaination of how it works.

Evaluation of Cognitive Impairment and Subjective Symptoms
The table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than “total,” since any level of impaired consciousness would be totally disabling. Assign a 100-percent evaluation if “total” is the level of evaluation for one or more facets. If no facet is evaluated as “total,” assign the overall percentage evaluation based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet.

The table is farther down but on the same page:

Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified

Facets of cognitive
impairment and other
residuals of TBI not
otherwise classified Level of
impairment Criteria
Memory, attention, concentration, executive functions 0 No complaints of impairment of memory, attention, concentration, or executive functions.
1 A complaint of mild loss of memory (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 Objective evidence on testing of mild impairment of memory, attention, concentration, or executive functions resulting in mild functional impairment.
3 Objective evidence on testing of moderate impairment of memory, attention, concentration, or executive functions resulting in moderate functional impairment.
Total Objective evidence on testing of severe impairment of memory, attention, concentration, or executive functions resulting in severe functional impairment.
Judgment 0 Normal.
1 Mildly impaired judgment. For complex or unfamiliar decisions, occasionally unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision.
2 Moderately impaired judgment. For complex or unfamiliar decisions, usually unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision, although has little difficulty with simple decisions.
3 Moderately severely impaired judgment. For even routine and familiar decisions, occasionally unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision.
Total Severely impaired judgment. For even routine and familiar decisions, usually unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision. For example, unable to determine appropriate clothing for current weather conditions or judge when to avoid dangerous situations or activities.
Social interaction 0 Social interaction is routinely appropriate.
1 Social interaction is occasionally inappropriate.
2 Social interaction is frequently inappropriate.
3 Social interaction is inappropriate most or all of the time.
Orientation 0 Always oriented to person, time, place, and situation.
1 Occasionally disoriented to one of the four aspects (person, time, place, situation) of orientation.
2 Occasionally disoriented to two of the four aspects (person, time, place, situation) of orientation or often disoriented to one aspect of orientation.
3 Often disoriented to two or more of the four aspects (person, time, place, situation) of orientation.
Total Consistently disoriented to two or more of the four aspects (person, time, place, situation) of orientation.
Motor activity (with intact motor and sensory system) 0 Motor activity normal.
1 Motor activity normal most of the time, but mildly slowed at times due to apraxia (inability to perform previously learned motor activities, despite normal motor function).
2 Motor activity mildly decreased or with moderate slowing due to apraxia.
3 Motor activity moderately decreased due to apraxia.
Total Motor activity severely decreased due to apraxia.
Visual spatial orientation 0 Normal.
1 Mildly impaired. Occasionally gets lost in unfamiliar surroundings, has difficulty reading maps or following directions. Is able to use assistive devices such as GPS (global positioning system).
2 Moderately impaired. Usually gets lost in unfamiliar surroundings, has difficulty reading maps, following directions, and judging distance. Has difficulty using assistive devices such as GPS (global positioning system).
3 Moderately severely impaired. Gets lost even in familiar surroundings, unable to use assistive devices such as GPS (global positioning system).
Total Severely impaired. May be unable to touch or name own body parts when asked by the examiner, identify the relative position in space of two different objects, or find the way from one room to another in a familiar environment.
Subjective symptoms 0 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.
1 Three or more subjective symptoms that mildly interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment are: intermittent dizziness, daily mild to moderate headaches, tinnitus, frequent insomnia, hypersensitivity to sound, hypersensitivity to light.
2 Three or more subjective symptoms that moderately interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment are: marked fatigability, blurred or double vision, headaches requiring rest periods during most days.
Neurobehavioral effects 0 One or more neurobehavioral effects that do not interfere with workplace interaction or social interaction. Examples of neurobehavioral effects are: Irritability, impulsivity, unpredictability, lack of motivation, verbal aggression, physical aggression, belligerence, apathy, lack of empathy, moodiness, lack of cooperation, inflexibility, and impaired awareness of disability. Any of these effects may range from slight to severe, although verbal and physical aggression are likely to have a more serious impact on workplace interaction and social interaction than some of the other effects.
1 One or more neurobehavioral effects that occasionally interfere with workplace interaction, social interaction, or both but do not preclude them.
2 One or more neurobehavioral effects that frequently interfere with workplace interaction, social interaction, or both but do not preclude them.
3 One or more neurobehavioral effects that interfere with or preclude workplace interaction, social interaction, or both on most days or that occasionally require supervision for safety of self or others.
Communication 0 Able to communicate by spoken and written language (expressive communication), and to comprehend spoken and written language.
1 Comprehension or expression, or both, of either spoken language or written language is only occasionally impaired. Can communicate complex ideas.
2 Inability to communicate either by spoken language, written language, or both, more than occasionally but less than half of the time, or to comprehend spoken language, written language, or both, more than occasionally but less than half of the time. Can generally communicate complex ideas.
3 Inability to communicate either by spoken language, written language, or both, at least half of the time but not all of the time, or to comprehend spoken language, written language, or both, at least half of the time but not all of the time. May rely on gestures or other alternative modes of communication. Able to communicate basic needs.
Total Complete inability to communicate either by spoken language, written language, or both, or to comprehend spoken language, written language, or both. Unable to communicate basic needs.
Consciousness Total Persistently altered state of consciousness, such as vegetative state, minimally responsive state, coma.

Wow, this info is great. Can you have both PTSD and TBI listed seperately? Or do they still require that TBI be listed under mental? Also....I could not figure out how to adjust a percentage if it was not toal in one catagory.....



Matt

You can have seperate ratings for tbi and ptsd now. There is a section for cognative impairment under DC8045 so it no longer has to be rated under the DC9304 (mental) code. My rating under the old code is under 9304.

The catagories use a number system 0 through 4. 0 is 0. 1=10%. 2=40%. 3=70%. 4=total.

Let's use the Visual spatial orientation catagory as an example. We'll say a person meets the conditions for a 2: "Moderately impaired. Usually gets lost in unfamiliar surroundings, has difficulty reading maps, following directions, and judging distance. Has difficulty using assistive devices such as GPS (global positioning system)." That warrent a SC rating of 40%.

The highest number of all the catigories will be the percentage awarded. So, if a person meets the criteria for a 2 (40%) in most of the catagories and get's a 3 (70%) in one catagory the rating will be a 70% rating.

I don't like it being done this way because as a tbi sufferer I know that I am more disabled due to the culmination of my symptoms. Having problems in these multiple catagories means I have 'multiple problems' and only being rated based on one of them, even if it is the most disabling, ignores my other conditions that add to my functional inability. But, it is much better than the old way.