I recently met with the Audiology C&P people concerning my previous diagnosis of Vestibular Dysfunction (SC due to artillery explosion/wounds). I was subjected to several tests and spent approx two-three hours at the clinic. The techicians/doctors expalined to me that they were writing up my report as "possible Meiner's Disease" and were also refering me to the ENT clinic for diagnosis. They didn't make any distinction between Meiner's and Vistibular Dysfunction but I'm assuming that they are thinking that Vestibular Dysfunction was a mis-diagnosis.

They told me that I should expect a three month wait for the ENT appointment. My questions are: What shpold I expect from my upcoming ENT appointment and if the Vestibular Dysfunction is indeed a misdiagnosis, how will it affect my C&P award for Vistibular Dysfunction?

This recent BVA decision seems to indicate that Meniere's and the vestibular disorder are the same thing.

http://www.va.gov/vetapp09/files3/0917647.txt

Do you have any hearing loss and /or tinnitus?

What is the 40% SC you get now for?

http://www.vba.va.gov/bln/21/Benefits/exams/disexm15.htm

DEWY,

Because of my dizzyness I have had vestibular testing. It was done privetly at a university. My understanding is the testing can tell the difference between Meniers, Vestibular disfunction and central vertigo. I'm not sure what your symtoms are but Meneirs and Vestibular disfunction are inner ear dissorders(no they are not the same). My central vertigo is not an inner ear problem, though the symptoms are the same, but 'central' meaning in the brain. Rather than the vestibular system sending wrong info, the information from my eyes and ears does not get proccessed at the same time causing my dizziness.

Have you been screened for TBI? Any blast that could cause these symptoms, either Meniers or Vestibular could be sufficient to cause TBI.

Anyway, the test was called vestibular testing. I don't know what the implications could be for rating purposes.

Chief, I have never been screened for TBI. I have been told that I probably did have a TBI after the concussion from the blast but TBIs usually heal in a relative short period of time. Since this injury occured in Viet Nam some 30-40 yrs ago, I'm hesitant to press the issue. I did mention that I may have experienced a TBI during my Audiology Clinic visit (i.e., when they took my history ) but they/he didn't make a note of it as far as I could tell.

I told them that the blast threw me through the air and ruptured my ear drum causing fluid to be discharged from my ear and nose. They checked my ear drum and did note that it had scar tisssue from the rupture. I also told them that my other wounds were on the left side of my body to help support my belief that the blast I experienced was the cause of my (left) ear damage.

The hearing tests and the symptoms supported Meiner's Disease as well as the "water test" and the "cog" test (i.e., I believe that's what they called it) and some other test. [Before they injected the water into my ears they said that I would become dizzy and maybe sick to my stomach but I had no dizziness or sickness, they seemed to be suprised that I didn't].

They seemed to be confident that I had Meiner's Disease but said that they couldn't make the diagnosis, that the ENT would make a diagnosis. They also said that there were things that they could do to help reduce the intensity of the symptoms. I was relieved to hear that something can be done.

Anyway, they said it will probably take three months or more before I can get an appointment with the ENT people. I was suprised at that also. [I'm not complaining but wish it could be sooner].

I was just wondering if the ENT will subject me to more testing or just review the Audiology Clinic's findings before they make the diagnosis and provide a treatment for me.

I see. I would doubt there would be anymore testing. The testing you had is fairly definitive. I'm not a Doc but I would hazard a guess that the ENT will give you a once over and use the test results to give you a DX. As far as the rating, I would have to comb through the DXcodes to see if there is just one that they use for Meniers and vestibular disfunction. Meniers is a type of vestibular disfunction.

As far as the TBI, they actually do not heal. Post Cuncusive Syndrome symptoms can go away but for some people, residuals last a lifetime. Up untill about 2003 the general thought was that closed head injuries did not pose a significant problem but that has changed. Keep in mind that it took 12 years for my TBI to be diagnosed and I was hospitalized for it at the time of injury. I'm 100% for TBI. Also keep in mind that for the current wars, TBI is said to be the 'signature injury'. These are predominatly blast injuries, closed head, just like your situation.

It may be that you do not have residuals but you should look into it. Below is a questionaire from the TBI guide. It will help you decide if you want to pursue it.

COMMON INDICATORS OF A HEAD INJURY
This questionnaire is not meant to be a formal "test" to see if you have a head injury. If you have multiple "YES" answers, bring this questionnaire to your doctor. Additional tests (medical and neuropsychological) maybe ordered.

HEADACHES

Yes No Do you have more headaches since the injury or accident?
Yes No Do you have pain in the temples or forehead?
Yes No Do you have pain in the back of the head (sometimes the pain will start at the back of the head and extend to the front of the head)?
Yes No Do you have episodes of very sharp pain (like being stabbed) in the head which lasts from several seconds to several minutes?

MEMORY

Yes No Does your memory seem worse following the accident or injury?
Yes No Do you seem to forget what people have told you 15 to 30 minutes ago?
Yes No Do family members or friends say that you have asked the same question over and over?
Yes No Do you have difficulty remembering what you have just read?

WORD-FINDING

Yes No Do you have difficulty coming up with the right word (you know the word that you want to say but can’t seem to "spit it out")?

FATIGUE

Yes No Do you get tired more easily (mentally and/or physically)?
Yes No Does the fatigue get worse the more you think or in very emotional situations?

CHANGES IN EMOTION

Yes No Are you more easily irritated or angered (seems to come on quickly)?
Yes No Since the injury, do you cry or become depressed more easily?

CHANGES IN SLEEP

Yes No Do you keep waking up throughout the night and early morning?
Yes No Do you wake up early in the morning (4 or 5 a.m.) and can’t get back to sleep?

ENVIRONMENTAL OVERLOAD

Yes No Do you find yourself easily overwhelmed in noisy or crowded places (feeling overwhelmed in a busy store or around noisy children)?

IMPULSIVENESS

Yes No Do you find yourself making poor or impulsive decisions (saying things "without thinking" that may hurt others feelings; increase in impulse buying?)

CONCENTRATION

Yes No Do you have difficulty concentrating (can’t seem to stay focused on what you are doing)?

DISTRACTION

Yes No Are you easily distracted (someone interrupts you while you are doing a task and you lose your place)?

ORGANIZATION

Yes No Do you have difficulty getting organized or completing a task (leave out a step in a recipe or started multiple projects but don’t complete them)?

__________ Total Number of Yes Answers

If you have 5 or more Yes answers,
discuss the results of this questionnaire with your doctor

Chief, thanks for the questionaire. I have easily over five. The one question that I can identify with the most are the stabbing pains in the head that seem to go into the brain and , in my case, completetly immobilized me for a matter of seconds.

I will discuss this with my doctor during my next appointment.

Was there any treatment noted in your SMRS for this injury in Vietnam?

If not does your Unit history out you at scene of this blast?

Has VA asked you to obtain 'buddy statements"?

Would this have any relationship to the 40% you get now?

I don't know what an SMRS is. There were others killed in the blast and I received (among other wounds) a head wound that left a huge scar. I was in the hospital and bed rest for several weeks before I rejoined my unit. At first they denied that I was wounded but it turned out that the rater never bothered to obtain my medical records and just wanted the case closed. To their credit, they found the mistake themselves and called me a couple of years later...I've never been asked for buddy statements, my 40% is a cummulative of vistibular dysfunction (10) tinnitus (10) and the balance PTSD. All they said about my unit was that it was involved in alot of action in VN while I was there.

Ask for a TBI screening/evaluation.

I reccomend that you have neuro-pycholigical testing. The VA is loath to do this for older vets so if it is possible, seek private cognative evaluation.

A lot has changed about how head injuries are now viewed. I was told I didn't have a brain injury, even with medical records of my hospitalization in service. I went to a neuro-psychologist and asked her if a head injury could cause the problems I was having. After testing, she reccomended I go on disability. I hadn't told her I was considering that.

SMR's are service medical records.
Hadit Home page has a list of acronyms that are often used. We like to say we speak a different language.

J

In reference to TBI:

I've been coming across more information about VN era veterans that have probably received an TBI but were probably not treated for it. I've heard that the VA now has a policy in place where they are trying to identify these soliders and have them properly evaluated followed by treatment if deemed necessary.

I have always believed that my concussion/head injury resulted in some type of damage but I have never been properly evaluated for it. If this is true (i.e., the VA is now concerned) how does one request an evaluation for TBI? I answered the evaluation that the good Chief sent me and the results do leave me with the opinion that some of my problems are the result of an TBI. Should I file a claim through my service representative for TBI?

I suppose there are a couple different routes you could take.

You can tell your concerns to your PCP and request a TBI evaluation. They will probably send you to a neurologist. Also, and maybe even better, if you suffer from PTSD and see a mental health PCP, tell them your concerns also. I personally don't have much faith in neurololgists for TBI. Try to see a neuro-psychologist.

Since you have service records supporting possible TBI, I don't see how it could hurt to file a claim for it. As long as you have records of a concusion they will do a C&P. However, this is a poor way to get a DX and if you get a bad examiner, it could cause long claims delays to fight a bad C&P. Better to get a DX first. If you need the effective date, you could file now.

I personally prefer private sector DX. If you can swing it, find a neuro-psychologist, preferably one that is familuar with TBI. Explain all your symptoms and say you want to know if the blast injury is causing these problems. They will do lots of testing. This testing is irrefutable. No VA C&P examiner can dispute the results.

The VA is getting better, but for several reasons can still drop the ball with DX'ing older vets with TBI.

Dewey, I would go for the Meiner's disease it is rated at 100 % for sure so let me know okay-
Bill

Dewey,

what happened at your c&p eam and what did they do my roomate is going through the same thing, and wants to get his 100% he deserves it he falls at home all the time they did the ear exam with water, and the hearing test and now he is waiting to see the ENT dr. again.

Thanks,
Bill

LLB, I'm still waiting for my ENT appointment. They told me to expect a three month wait and it's been almost two months to the day. I'm assuming they will contact me concerning the appointment (i..e, the audiology technician said I had to do nothing but wait, that they would contact me). I'm a little confused with what my audiology appointment was, that is, was it a C&P exam? The clinic building was labeled Audiology /C&P so I'm assuming that it was an C&P exam. No one ever said that was what it was. I was referred to them by my PCP but she never said anything about it being an C&P exam, she said she was concerned about my dizziness/vertigo and falling.

In addition to my possible Menieirs Disease/ENT appointment, I have a concern with my shoulder. I was shot through the shoulder in VN and received what I preceive as nerve damage (i.e., burning sensation at the site of the wound, pain in my bicep and numbness in my fingers (i.e, excluding the thumb). I expalined this before on this forum but still am unsure how to proceed. As I explained before, I was denied consideration due to an rater's error (i.e., I guess) and eventually received a C&P two years after the filing. They finally acknowledge that I was wounded but rated me at 0 %. I appealed since I felt that they ignored my compalint of pain/numbness and I have recently have read comments on this forum that the VA typically "low balls" awards on the first claim. The appeal is now over one and a half years old. I voiced my concerns with my PCP concerning my shoulder pain/numbness. She said that there was nothing that could be done to counter the pain/numbness and offered no more. Should I just wait for the appeal or contact my DAV rep and ask for a re-evaluation?

Also, I have been reading about new standards for TBI (i..e, that is, I 've been reading about new standards but have never actually read them, I only know that they exist).
Is it possible that a person could have Meiner's Disease and a TBI?

Yes it is possible to have meniers and a TBI.

I think I have both. I'll wait for my ENT appointment and see what they do or say.
My fear is that I'll make this too confusing and they will not want to help... I hate it when they say there is nothing they can do (e.g., my shoulder problem) and send me out the door. At least with the Meiner's the audio tech gave me some hope when he told me that the ENT people will be able to help with decreasing the occurence of the symtoms.

So, I'm expecting the ENT staff to make a dx at my upcoming appt. Do they then send their findings to the Judication Officer and he/she makes the changes and applies the appropriate rating and then notifies me by mail? How long does this process take?

Hi Dewey,

I probably have more experience with MN than I like to. I am currently %100 Meniere's and %70 other. This disorder is one of the hardest to diagnose because it is a differencial diagnoses, meaning that it can only arrived at after EVERYTHING else has been ruled out. A few of the things they will look for is Syphilis, Benign positional vertigo, and vestibular disorder. It took me close to two years for my diagnoses and 3 surgeries. I had to go through Steroid injections through the ear drums, endolymphatic shunt surgeries, (really not fun) and a list of different meds as long as my arm. At the time I was more interested in relieving the symptoms than the award. Meniere's is one of the most destructive diseases there is. Depression, anxiety, hearing loss, isolation. On and on. Not trying to be a downer but if you have the diseaese than my heart goes out to you. it has all but stolen my life from me. So for now I stay on my anxiety and depression meds and stay close to bed when the symptoms are bad. The worst of it is after every attack you lose a little more hearing and my hearing aids are not really working any more. Oh yeah, the ENT will be testing you hearing to look for the tell tale signs of menieres as it progresses. My hearing tests over the two years showed a marked decline and the ENT could see on the tests when I went Bi-lateral.

Good luck and God bless.

Diz

Thanks for the comments, Diz. I have an appointment with my PCP on 9 February. I was hoping to have my ENT appointment before then so I would have something to tell her but that doesn't look like it's going to happen. Could you explain how you are 100% for Menier's and 70% for other? I thought you could only be 100% combined-just curious, I'm still trying to understand the system.

I waited almost four months to be notified for my ENT appointment and did not recieve a call or letter. I called the VA to inquire about the delay. They informed me that the referral doctor did not notify my PCP so no consult request was ever entered. It's very frustrating to deal with the lack of accountability that the VA allows to it's staff.
I'm now awaiting another call or letter for an appointment...tipically it's a three month wait. I'm hoping that they take into consideration that I have already waited four months and will therefore expidite the scheduling of it.

I called the DAV and asked for guidance on how to proceed. They are going to represent me and will file for an increase based on what's already in my record. I'm am very thankful to the DAV for being an advocate of the veteran. They are true professionals. In the interim, I'll continue to wait and will update those interested when the appointment happens.

REHABILITATION OF MODERATE TO SEVERE TBI: SENSORY-PERCEPTUAL AND BALANCE DISORDERS IN TBI: BALANCE AND VESTIBULAR DYSFUNCTION



BALANCE AND VESTIBULAR DYSFUNCTION - An inability to control the body's center of mass relative to specified limits. Balance and gait testing in patients with complaints of instability is warranted (Basford, et al 2003). Two years following acute rehabilitation, more than one-third of subjects continue to display a neuromotor abnormality on basic neurological examination. Persistence of tandem gait abnormality is particularly common. (Walker and Pickett, 2007).

Causes - Persisting vestibular deficits after moderate and severe TBI are due to peripheral and central nervous system lesions and associated injuries, such as fractures, which can cause:

Muscle weakness and paralysis, which result in:
An inability to prevent movement and/or an inability to quickly initiate postural responses necessary to maintain balance, and
Biomechanical constraints, such as limited ROM and weight bearing activities, necessary to maintain postural balance and for compensation by the intact components
Poor motor coordination of the trunk and leg muscles into movement strategies with postural control
Dysfunction in the vestibular, visual, or somatosensory systems, or in the central integration of the 3 systems