Documenting Concussions and Concussive Injury

22 Jun 2017

One of the strange things about an injury to the head and brain is that the cumulative effect of even a small or minor injury matters. Medical science has not yet determined how to measure and evaluate the extent of an individual injury, nor how to evaluate a new injury in light of a series of old ones. Current methods of assessing thinking and memory are inaccurate, at best. But the science is growing, and it is important for the emerging understanding of traumatic brain injury that you are able to document a history of both diagnosed concussions and concussive injury to the head.

Documentation of an injury does not involve producing medical records or any sort of proof as such. This documentation involves writing a detailed list of incidents, with all of the information you can remember or get from others, such as family members, about the injury: how it happened and the effects on you after.

An older definition of significant head injury was an injury that resulted in unconsciousness. Doctors carefully documented how long a person was unconscious and any symptoms after, such as dizziness and headache. What we know now, through advances in science and brain imaging, is that any injury that involves a blast or blow of any degree can affect the brain, and a series of injuries over time can produce an effect long after the initial injury.

Many kids have an injury as infants and children due to accidents at home. Falling off the couch or bed as an infant, any injury needing stitches to the face or chin, falling off a top bunk bed, bike accidents, and similar accidental injury to young children may be significant and should be documented.

During the school years, any sports participation should be noted. Even sports such as track and field can produce head injury, as anyone who has even tripped over a hurdle can describe. Any significant sports injuries should be noted, particularly ones in which a student athlete was evaluated for a concussion. Any history of hunting as a child can be estimated as the number of times weapons were shot in the course of a season, and then the number of seasons. Any violent attacks on a child's face or head can produce head injury, and should also be documented. Boxing and tackle football should be carefully noted.

As adolescents, the type of injuries noted above should be documented, in addition to any car accidents or vehicle whiplash-type injury while riding motorcycles and ATVs. Riskier sports, such as paragliding and bungee jumping, should be documented. During boot camp and other military training, hours of weapons training and types should be carefully noted, as well as activities such as parachute training. Any fighting or boxing that involved blows to the face or head are significant and should be noted.

While in the service, both weapons training and exposure to weapons and concussive or blast injury should be noted. It is understood that in the chaos of combat, not every incident can be carefully evaluated and documented in a medical record. Your recollections and accounts are important and are taken as valid sources of information.

As we get older, balance can be affected, making it easier to have an accidental injury. Falls on the ice, or while walking the dog, can cause significant head injury. Motor vehicle accidents are significant. Any head injury sustained during an interaction with law enforcement or while under the influence of substances should also be noted.

This type of documentation can be important for your doctor and for the VA while assessing a claim. As science into the brain and methods of injury grows, the more information we can gather can help researchers who are trying to puzzle out the strange relationship of repeated concussive injury to traumatic brain injury and chronic traumatic encephalopathy.

For more information on Traumatic Brain Injury - Veterans, please contact us.


NPR Looks at Veteran Suicides and Gun Availability

15 Jun 2017

A recent NPR story examines the connection between veteran suicides and access to guns. Recent trends dramatize the urgency of the issue, but taking any action is controversial.

Suicide rates have been rising in the US, and veterans now have a higher rate than civilians for the first time in history. The situation is especially alarming for women. Female veterans have a suicide rate between two and five times higher than women who never served, based on figures from the Department of Veterans Affairs.

While numerous studies show that limiting access to guns dramatically decreases the risk of suicide, it can be difficult to balance the right to gun ownership with the need to prevent suicides. Recent events in Congress highlight the dilemma. Currently, the VA makes veterans who have been declared mentally incompetent unable to buy a new gun by flagging their names in the FBI National Instant Criminal Background Check System. A bill sponsored by Republican Rep. Phil Roe of Tennessee, chairman of the House Veterans Affairs Committee, would add a provision requiring a judge or magistrate to put veterans on the NICS. Roe believes that strengthens due process while opponents worry that it could weaken suicide prevention efforts.

While reliable data is difficult to come by, the Harvard School of Public Health has conducted many of the key studies in this area. Work such as theirs suggests some initial steps:

Take private action. As the NPR story describes, veterans could be encouraged to voluntarily surrender arms to family and friends when they feel at risk.

Support mental health services. Maintaining and expanding mental health services would help deal with the underlying issues behind the rise in suicides.

Train gatekeepers. Psychiatrists, psychologists, and social workers need training on how to discuss these issues with the clients they serve.

Change the debate. "The public health message is neither anti-gun nor pro-gun. It’s pro-data," says Matthew Miller, associate director of the Harvard Injury Control Research Center. It's a good point to keep in mind for moving ahead.

The Veterans Law Group is one of the most respected advocates for disabled veterans within the legal community. Contact us to learn more.

Reading a Rating Decision​

15 Jun 2017

You served your country selflessly, but during your service you were injured or developed a condition that is still affecting your life today. After applying for veterans’ disability benefits through the U.S. Department of Veterans’ Affairs, you have finally received a decision about your application. Upon opening the decision, you will see two important pieces of information: Notification Letter and Rating Decision.

Reading your veteran disability rating decision

Notification Letter

The Notification Letter is usually stapled on top of the Rating Decision. The date on this notice is important because any additional information or an appeal of the decision (Notice of Disagreement) must be submitted within one year of the date on the letter. The letter will give a brief explanation of the VA’s decision on your claim and, if benefits are awarded, the effective (beginning) date of payments.

Rating Decision

The Rating Decision includes several sections: Introduction, Decision, Evidence, and Reasons for the Decision.

Introduction: The introduction identifies the veteran and his/her qualifying service.

Decision: This section lists all of your conditions and/or impairments, as identified by you or the VA Reviewer. This list can include expressly claimed issues, reasonably raised issues, and subordinate issues.

  • An expressly claimed issue is a condition or impairment that you listed on your application for disability benefits.

  • A reasonably raised issue is a condition or impairment that may not have been listed on your application, but is directly related to a condition or impairment that is listed. For example, if you listed diabetes as a service-connected impairment in your application for benefits and your medical records show that you also have vision problems related to the diabetes, the VA Rating Representative can take your vision problems into consideration, even though you did not specifically list vision problems as an impairment.

  • A subordinate issue stems from a related condition or impairment. For example, a VA Rating Representative may consider additional aid or compensation for a spouse that is caring for a 100% disabled veteran.

The Decision section also indicates whether each condition/impairment was granted or denied service connection, the disability rating, and the effective date of each condition/impairment.

  • Service-connection – Your injury or disease occurred or was aggravated during active duty or active duty for training, or inactive duty training.

  • Disability rating – The VA created the Schedule for Rating Disabilities to help streamline compensation; it is intended to reflect the loss in earnings that a veteran may experience because of their impairments. Ratings range from 0% to 100%.

  • Effective date of impairment – The date that compensation for your conditions/impairments will begin. Generally, this will be the date of the claim (or date you filed your intent to file application), but there are instances where a later effective date is appropriate.

Evidence: This section will include a list of all the evidence that was considered in making the decision to award or deny benefits. This section will also identify any evidence that was requested by the VA, but not received. It is important to compare this section to your own medical records and information. Often, the VA will not receive all of the medical evidence requested, which could lead to a decision that is inaccurate or fails to consider the severity of all of your impairments.

Reasons for the Decision: This is the most important section! Here, the VA Reviewer must include an outline of how the evidence was considered and the regulations used to arrive at the final decisions regarding service-connection, disability, ratings, and effective date.

It is important to review the above documents thoroughly. Your Veterans Service Officer (VSO) can help you understand your decision. Using their experience and knowledge of the regulations, they can review the decision to make sure that the VA followed the proper procedures; reviewed all relevant evidence; and made decisions based on that evidence.

If there is information missing, a clear error, or if you disagree with the decision based on service connection, rating of your impairment, or any other issue, your VSO may recommend that you submit additional information or appeal the decision by filing a Notice of Disagreement. You only have one year from the date on the Notification Letter to take action (without starting the process again from the beginning), so it is important that you review the ENTIRE decision as soon as you receive it!

Finding answers to your disability claims questions doesn’t have to be difficult. Take our free quiz today to determine what resources are available for your specific needs.


Additional Resources:

Schedule of Rating Disabilities

Combined Ratings Table

Compensation Table




Category: Disability Claims Information

Fighting Hate and Intolerance: Vets Step Up

08 Jun 2017

One of the most divisive challenges our country faces is spreading intolerance and the use of hate campaigns to target vulnerable people. Since the last presidential election, instances of both individual and group sponsored hate attacks have been multiplying across America. The Southern Poverty Law Center (SPLC) has been a leader in teaching tolerance and tracking hate movements in this country since the 1960's.

A new tolerance movement, #VetsFightHate, is taking to social media to spread the word about diversity, inclusion, and tolerance. The group is responding to hate-filled and intolerant messages on social media targeting immigrants. With so many current and former military members being new immigrants and first generation Americans, these veterans can speak with authority and experience about what it is like to be an immigrant in an America they serve and honor.

More than most, military veterans know that the best way to win a fight is to stop it from escalating, rather than from bringing a bigger gun to the battle. With an eye toward de-escalation, these immigrant veterans are bringing a message to increasingly divisive social media to stop and think before writing something that could be harmful or hateful; to understand who our immigrants are, and what they are contributing to America; to remind everyone what it means to live another person's life, and walk in their shoes.

In America, we respect our veterans. Or at least, we say we do. Many of our veterans are people of color, new immigrants, women--the very groups that are marginalized and victims of intolerance and hatred. #VetsFightHate is reminding people who we are, what we've done for our country, and the positive that comes from working together toward a common goal.

For more information about veterans' challenges and issues, please contact us.


This Happened in a Man's World: Female Veterans and Military Sexual Trauma

01 Jun 2017

The rate of suicide for female veterans is six times the rate of their civilian counterparts, and there is a very strong association between PTSD, sexual victimization as children and during military service, and suicide. The majority of efforts through the VA focus on the significantly larger population of male veterans, though recent efforts have been made to reach out to female veterans with women's clinics. But many women still see the VA as a man's world, part of the same man's world as the military. And that world is both a source of pride and betrayal. 

Female veterans are dealing with a great deal of ambivalence about their service, and are suffering the effects of PTSD and other mental and physical health effects of service. With a system that seems steeped in the same male culture that engendered the sexual assault, the VA is not the first place female vets turn to for help. The military is both the system they wanted to serve, and be a part of; it is also the system that, for many women, condoned silence in the name of loyalty.

With a pattern of sexual exploitation as children, and the dangerously high rates of revictimization and sexual assault in the military--a 2013 Rand study showed 26,000 cases of sex abuse across uniformed service--women veterans face challenges coping with their PTSD. President Obama signed the Female Veterans Suicide Prevention Bill in July 2016; the bill calls for concentrated efforts for outreach and collaboration between mental health professionals. However, changing the culture that has engendered this degree of sexual violence against women and children is not going to begin by trying to take care of the victims.

Women veterans are at higher risk of suicide and debilitating mental health, and have less access to healthcare that addresses their particular needs. For more information on PTSD, please contact us.

Compensation & Pension Exams and DBQs

01 Jun 2017

Once you have begun an application for veterans disability benefits, you may be required to complete a medical exam called the Compensation & Pension Exam. This examination is sometimes referred to as the C&P Exam or the VA Claims Exam. The exam is given by a doctor who works for the Veterans Administration (VA) or a private doctor that is contracted by the VA to complete the exam. The physician will examine your condition and document your disability on a Disability Benefits Questionnaire (DBQ). The DBQ will be used by the VA when deciding your disability claim.

C&P ExamsKeep in mind that the C&P exam is only one part of your veterans disability application. The doctor who examines you will not make the decision regarding your disability claim. The DBQ form that the doctor completes is only one of the materials used by the VA to determine your disability rating. 

What is a DBQ?

The DBQ was created to “help streamline the collection of necessary medical evidence for the purpose of processing Veterans’ claims.” At your scheduled C&P Exam, a VA clinician will complete the DBQ to document the severity of the condition or illness that led to your application for veterans’ disability benefits.

There are over 70 different DBQs depending on the diagnosed condition, which range from psychological conditions to the loss of the sense of smell. Each DBQ can be used to provide more information about your experience with that particular medical condition or symptom. 

How a C&P Exam is Scheduled

After you apply to the VA for disability benefits, make sure that the VA Medical Center that you attend has your current address. They will automatically schedule your appointment and send you a C&P Exam notice by mail or contact you via phone to schedule a date/time for the exam. A letter will provide you with the details of the appointment, including the date and time.

Before your exam date, you should:
  • Review the date and time of the exam; if you need to reschedule, do so right away.

  • Gather together your medical records.

  • Call and confirm your appointment.

Preparing for the Exam

What to bring to the C&P Exam:
  • Exam notice: Have your appointment letter with you.

  • Medical records: Bring all previous doctor reports and tests to the appointment.

  • Prescriptions: If you are taking any medications, bring the information for each prescription with you.

  • A spouse or friend: You may be nervous, especially if this is your first C&P Exam. Consider bringing someone who can give you support and help you remember details about your condition. 

The Exam

The length of your exam will depend on the type of disability you have claimed. The doctor will ask questions and prepare a DBQ. You may be given a physical exam, but that does not always happen. It depends on the disability being examined.

Provide your doctor with as much information as possible. Be honest and straightforward, and do not exaggerate your symptoms. Go over each of your conditions, and provide the physician with details regarding your medication, treatments, pain and suffering, and anything else that is related to your disability claim. Depending on the type and number of conditions you’re claiming, either a single doctor or multiple doctors will examine you. If more than one doctor must examine you, than multiple exams will be scheduled. For example, a back specialist may examine you for chronic back pain, while a psychiatrist would examine you separately for posttraumatic stress disorder (PTSD).

Mental health exams

If your disability includes an evaluation for a mental health condition, then your psych exam will consist primarily of the doctor asking you questions. You will need to explain your symptoms and possibly complete a psychological test. 

DBQs Completed by Private Physicians

While a VA clinician is often more familiar with the DBQ and understands its value when making a disability determination, having a private physician complete it can be helpful. Many veterans will choose to have a private specialist or a long-time treating physician complete the form because of their extensive knowledge of the disabling condition or the veteran’s treatment history.

Keep in mind that the VA will not reimburse you for any expenses related to the completion of a DBQ by your private physician. However, veterans will not be charged for any appointments scheduled by the VA with a VA clinician or contracted physician. 

Which DBQ Form Should I Use?

Many clinicians will select the appropriate DBQ forms for use in your exam. However, especially if your private physician will be completing the exam, it is important to come prepared with the correct form(s).

The DBQ forms are listed by symptom and body part or system. Some conditions have their own specific DBQ form and other conditions fall under a broad system or condition. If you have a condition that is not listed, it is perfectly fine to choose a DBQ form that is more generically related or falls into a broader category. For example, under the Psychological category, the VA lists three forms: Eating Disorders; Mental Disorders (other than PTSD), and Review Post Traumatic Stress Disorder. If you suffer from anxiety, your best option would be the Mental Disorders form because anxiety falls under that broad category.

If you have multiple conditions that fall under a broad category, you may use one form to document the severity of all of the related conditions. If your claim for disability benefits involves more than one condition and they are not related, you should use a separate form for each condition.

Summary

A C&P Exam is one of the most important components used by the VA to determine your disability claim. Make sure that you attend all your C&P appointments and get the appropriate DBQ forms completed at each one. If you fail to report to one of your exams, the VA may prolong its decision or determine your rating “as-is” based only on the other materials submitted with your claim.

Remember, the C&P exam is a doctor’s evaluation of your condition for VA disability purposes, not for treatment. You will not receive any treatment or prescriptions. Rather, the doctor will be evaluating your disabilities. If you have any questions about your C&P exam(s) or DBQs, discuss them with your Veterans Service Officer (VSO) to make sure you are prepared for your appointment.

Finding answers to your disability claims questions doesn’t have to be difficult. Take our free quiz to determine what resources are available for your specific needs.

Additional Resources:

VA Claim Exam Overview

VA C&P Exam Frequently Asked Questions

VA Claim Exam Tips Sheet



Category: Disability Claims Information

Orange Essential Oils, Genes and PTSD

25 May 2017

One of the challenges of dealing with PTSD is the difficulty of finding an adequate treatment. There are few medications for PTSD that are FDA-approved. However, relief may soon be easier than you thought.

Scientists at George Washington University have conducted research that found that orange essential oils (essential oils are naturally produced by plants) can reduce the symptoms of fear-related emotional issues, including PTSD.

During the research, it was discovered that mice who were treated with orange essential oils were less likely to display fearful behavior later on. In addition, they had fewer immune cells that were associated with the biochemical pathways linked to PTSD.

Essential oils are much more economically viable than pharmaceutical medications. They can be mixed with food and drink, applied to the skin, or inhaled. Although the full impact of orange essential oils on PTSD still needs to be studied further, this does show a promising start for a possible treatment.

In related news, new studies have shown that PTSD may be linked to DNA and genes. A study by the Psychiatric Genomics Consortium showed that certain genes are possibly linked to PTSD and that European and American women are more genetically likely to develop PTSD. People with a genetic risk for other emotional issues, such as schizophrenia, are also more likely to develop PTSD. The study pooled together data from 20,000 people who were involved in 11 various multi-ethnic studies around the world.

Are you a veteran suffering from PTSD in need of legal help? Contact us today!

Veteran Unemployability and Volunteer Work

18 May 2017

The issue of volunteering is an important one for veterans, because vets have always contributed to their communities and the country. After facing the challenges of living with a disabling condition as a result of military service, many veterans find the additional burden of not contributing to the world in a real way extremely disheartening.

But there are several ways vets can volunteer and have a positive impact on their communities without putting their disability rating or benefits in jeopardy. The employability rating is for those who are unable to work full-time. Contributing several hours a week as a volunteer does not imply the ability to work full-time.

It may help any concerns to volunteer in a field that was different from the previous job or occupation. Helping out at the local food bank, delivering supplies or giving elderly people rides to the doctor's office are all needed help that will not imply the ability to return to work. Working as a Foster Grandparent or a Big Brother or Sister is very important volunteer work. Many vets serve on advisory boards or committees, or help with veterans issues on an on-call basis.

The social interaction that comes with volunteering is important, and the feeling of being part of the community, and contributing, is one that many vets have always experienced. The isolation that comes after a disabling injury or illness can be very destructive to self-esteem and family dynamics. Volunteering in the community may be one way to continue to contribute to the world.

For more information on veteran unemployability, please contact us.

Nexus Letter

18 May 2017

You courageously served your country and completed your military service, but you were left with an injury or illness that is limiting your ability to live life to the fullest. If you are a veteran of the U.S. Armed Forces and have a current injury or condition that is connected to that service, you may be eligible for disability compensation.

If your service or medical records are incomplete or do not demonstrate the connection between your impairment and your service, you can choose to submit additional materials to support your veterans disability claim. While your Veterans Service Officer (VSO) can help you determine what information you should submit, one of the most common supporting materials is a “nexus” letter.

What Is a “Nexus” Letter?

In order to qualify for veterans’ disability benefits, you must be able to show that your current condition or injury began during your military service or was aggravated by what you experienced during that service. In other words, you need to show that there is a “nexus” or connection between what happened in the military and your current medical condition. A nexus letter is written by a doctor, specialist, or expert and provides insight into your injury to confirm its connection to an event or injury that occurred during your military service.

Why Do I Need a Nexus Letter?

Many injuries or conditions are difficult to connect directly to your military service. Common examples include back and knee injuries, cancer, mental impairments, etc. Since service members are often reluctant to get something treated while they are in the service, or they simply underestimate the severity of an injury when it first occurs, this can pose a challenge for proving a connection at a later date.

Perhaps you hurt your knee performing work during your service and instead of seeking treatment, you bought a knee wrap from the grocery store and took some aspirin. Now your knee is in terrible shape and is limiting your ability to stand, walk, and sit. However, it is likely that the Veterans Benefits Administration (VBA) will not be able to verify the connection between your knee injury and the problems that you are experiencing now because you did not get treatment at the time of your injury. This is where a letter from your doctor, specialist, or psychologist or psychiatrist (depending on the nature of your impairment) can be especially helpful and supportive of your claim.

Another example involves exposure to Agent Orange. The VBA has recognized exposure to Agent Orange as a presumptive cause of several types of cancer and/or disease. While many veterans suffer from the effects of exposure to Agent Orange, they often have difficulty drawing the connection to their military service because their condition is not on the presumptive list of conditions. A nexus letter from an oncologist or other expert can provide additional support to the claim and may establish service connection, resulting in approval for disability benefits.

What Should a Nexus Letter Include?

As stated earlier, a nexus letter should be written by an expert. Most of the time, this will be your treating physician, a specialist (like an oncologist), or a psychologist or psychiatrist; someone who has expertise in your condition or type of injury.

The expert should review all of your related medical records, including service medical records, before drafting a nexus letter. The expert should indicate in the letter which records were reviewed so that the reader understands the history and depth of the expert’s observations and opinions. Additionally, it is always more persuasive if you have been examined recently by the expert that is drafting the letter.

The letter should be clear, concise, and should detail your injury or condition and how it relates to an injury or event that occurred during your military service. Fortunately, the expert does not need to state that he or she is 100% positive that the triggering accident or event caused your current injury or impairment. The expert only needs to express whether “it is more likely than not” that your illness or injury was incurred or aggravated during your active service.

Nexus letters can be a powerful resource and provide valuable support to your claim for disability benefits. It is helpful to first discuss with your VSO the potential experts that could write your nexus letter(s) before deciding who to ask. Your VSO may be able to suggest a doctor or specialist who is familiar with the veterans’ disability claims process and who may have written successful nexus letters for other veterans.

The VA disability benefits claims process can be lengthy, overwhelming, and frustrating, but finding answers to your disability claims questions doesn’t have to be difficult. Take our free quiz today to determine what resources are available for your specific needs.


Additional Resources:

eBenefits

Presumptive Conditions caused by Agent Orange



Category: Disability Claims Information

The Tangled Threads of Service-Connected Disability, Incarceration, and Immigration Status

11 May 2017

Service-connected psychiatric disability and traumatic brain injury are commonalities among veterans with substance abuse challenges and involvement with the criminal justice system. While these facts may point to a failure of the system to support service members who are injured in the line of duty, and the generalized failure to provide adequate treatment and support for substance abuse, the system is a catastrophic failure when the veteran faces deportation because of immigration status.

Many enlistees assume that serving in the military, and receiving an honorable discharge, entitles them to citizenship. It does not. There is a procedure for applying, and a timeline, but there is no automatic entitlement. Veterans who served honorably, and who do not apply for the expedited citizenship and residency while on active duty, can be, and are, being deported regularly. They will be allowed back in the US when they die, to be buried in a veterans' cemetery.

While deportation of undocumented veterans has become common, the real challenge is for those veterans who are eligible for VA health care and are deported. VA eligibility still exists, though there are no VA treatment centers in Mexico or Central America. With no assistance for working through the system, that eligibility for services is often lost and veterans go without care.

The most common deportation practice with veterans who are undocumented are for those with a criminal justice conviction. The VA can stop pensions for veterans incarcerated in federal facilities, and families do not automatically receive the stopped pensions. Many families, afraid of becoming known to the system and being deported, never apply for benefits or assistance due to families.

Veterans and their families who are undocumented are facing challenging times. Many are afraid to access the system that has been put into place for their service connected injuries, because of the threat of deportation if they become identified by the system. Legal counsel can assist veterans and family members to access the VA system, and provide advice and assistance with issues of immigration status and threatened deportation.

For more information on psychiatric disability & veterans, please contact us.

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