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welcome to another edition of cck live
my name is emma peterson and today i'm
joined by amy odom and caitlin degnan
and we are going to be talking about va
compensation for tbi traumatic brain
injury and ptsd let's jump right in
amy can you start us off by telling us
what is a tbi sure a tbi is a traumatic
brain injury that can be caused by many
factors including a blow to the head
or an object penetrating the brain and
it results in brain dysfunction a common
form of tbi is a concussion but not
every concussion results in tbi that's a
medical
determination that a doctor has to make
whether a particular person's concussion
resulted in tbi
and common causes of tbi include combat
exposure and and car accidents
caitlyn how does va go about diagnosing
tbi so after a veteran suffers a tbi
they're going to have symptoms amaze
will manifest cognitively physically
behaviorally and emotionally amused
residuals often include dizziness
headaches impaired vision or hearing
loss tinnitus weak muscles stroke
seizures or paralysis
coordination balance and gait disorders
difficulty with written and verbal
communication impaired memory and
difficulty concentrating depression or
poor judgment
tbis are initially diagnosed as mild
moderate or severe based on medical
testing and the severity of the
veteran's symptoms and while mild brain
injuries usually resolve themselves
within about six months there can still
be significant residuals associated with
more severe tbis
so va will go about raiding tbis once
they've been service connected and we
have a lot of material on our website
and on our channel about how one goes
about getting service connection if
you're interested
but va goes about rating tbis under 38
cfr 4.124 a
and the diagnostic criteria can be found
in that regulation
these residuals that caitlin just talked
about are going to be rated on scales of
zero through four so one two three are
total
in increments corresponding to the
severity
and what va does is they look at 10
sub-categories or facets
in order to evaluate a tbi so most like
you'll have an examination by a va
examiner who's qualified to do these
examinations they'll look at these 10
subcategories and they'll rate you one
to four depending on the severity in
each category and your highest number
will course in any facet will correspond
to your disability rating and those
ratings can range from zero percent all
the way up to a hundred percent
so the ten subcategories that va will
look to when evaluating your tbi include
impairment of memory attention
concentration and executive function
altered judgment
inhibited social skills
orientation to person place time and
situation
impaired motor activity visual spatial
orientation
subjective symptoms that you might have
that aren't in you know otherwise
included in this list neurobehavioral
effects ability communicate and
consciousness
we're going to put up in the links a
link to some information
for you if you want to read into these
facets further
um but just know that there might be
other conditions associated with your
tbi that you know one would think of
like headaches um or hearing loss and
those need to be written separately
under their own diagnostic code so the
world of tbi really sort of splinters
out from the tbi and then its residual
conditions
there is another regulation
38 cfr
3.310
that allows for presumptive secondary
service connection if you are service
connected for a tbi so let's say your
service can say for a tbi and you later
on develop dementia parkinson's seizures
depression or a hormone deficiency
within certain windows of time and you
have to look to that regulation to see
what those windows are
va will automatically grant service
connection for those conditions
so amy there's a lot of overlap between
tbi and ptsd so why don't you take us
through what ptsd is
yeah so ptsd
often also referred to as post-traumatic
stress disorder or post-traumatic
post-traumatic stress
is a mental health condition
that occurs as a result of experiencing
a distressed distressing shocking or
otherwise traumatic event so whereas tbi
is a neurological disorder
ptsd is a mental health condition
and many veterans develop ptsd from
events they witnessed or experienced
during their military service
um symptoms and severity of ptsd can
vary from person to person some people
don't have very many problems from it
and others have very severe problems
from it
but common symptoms that we see are
re-experiencing the trauma through
intrusive distressing recollections of
the event
flashbacks and nightmares that kind of
thing
emotional numbness and avoidance of
places peoples and activities
that remind you of the trauma as well as
as well as anxiety and depression
and what we call increased arousal which
are things like difficulty sleeping and
concentrating feeling jumpy
and being easily irritated and angered
so caitlyn how is ptsd rated so in order
for va to grant direct service
connection for ptsd a veteran has to
provide proof of a current diagnosis
a statement from that veteran about the
stressor that occurred during service
and a medical opinion that the stressor
was sufficient enough to cause ptsd from
either a va or va contracted
psychologist or psychiatrist
once that ptsd is service connected it's
been rated using the general rating
formula for mental disorders and these
ratings range from 0 to 100
with intervals at 10 30 50 and 70
percent
so for those watching you know you can
probably see where we're going with this
there's a lot of connection between ptsd
and tbi
and numerous studies including one by
the ama the american medical association
notes that there's a strong connection
between tbi and ptsd and that makes
sense often times the same traumatic
event that caused your tbi
is also a very stressful event that can
result in ptsd
and many of the symptoms between the two
conditions overlap
and due to this overlap it can be
challenging particularly for va to
appropriately rate a veteran who should
be service connected for both conditions
as well as other secondary conditions
so for example you might suffer from
depression sleep trouble memory problems
and those can be a result of tbi they
could be a result of ptsd or even both
and additionally as i mentioned many
veterans with tbi will develop ptsd from
that event that caused the tbi
um so we'll have both physical and
emotional trauma from the same event
and then the emotional trauma can worsen
the physical um so amy what happens from
here how does va go about rating ptsd
and tdi if they exist together well the
important thing to remember is that you
can't get two readings for the same
symptoms
and the problem with ptsd and tbi is
that they often cause the same symptoms
so um one of the
the facets or the areas that emma talked
about that va will look at with tbi is
behavioral neurobehavioral disturbances
and that's things like inappropriate
behavior
um irritability that kind of thing but
that is exactly what is also considered
in the rating for ptsd
and you can't get two ratings based on
that that symptom so
another
example is if you have a veteran who's
service connected for ptsd
and experiences flashbacks hyper
vigilance social isolation and severe
sleep impairment with trouble falling
and staying asleep
and it's also highly irritable
that person probably
that person's ptsd rating probably takes
these symptoms into account
and if later it becomes clear that that
veteran also suffered a tdi that causes
sleep impairment and irritability
um
that person's not going to be able to
get a separate reading for that tbi
unless there are additional symptoms
caused by the pts the tbi that are not
already considered in the ptsd rating
so for example if that veteran has
headaches
or
some
slowness in speech or something like
that that's not
considered by the ptsd rating you can
get a separate rating for those symptoms
and by law
the a must always give you the highest
of the rating so
in the example where the veterans
symptom tbi symptoms completely overlap
with the ptsd symptoms if the veteran
would get a 70 rating under the tbi
criteria and only a 30 rating under the
ptsd criteria
while the veteran can't get both the 70
and the 30 va is required by law to give
the veteran the 70 under the tvi
criteria in lieu or instead of the 30
under the tbi criteria that's called the
duty to maximize benefits so caitlyn
what kind of compensation are veterans
looking at for tbi and ptsd so just like
any other disability
you know the va is going to rate give
the veteran a rating
and that's the level that they're going
to be compensated at so for example if a
veteran is rated at a 100 disability
rating that equals 3
146 dollars per month for ptsd or tdi
while on the other hand a 50 disability
rating would equal 905 dollars per month
a full list of compensation rates can be
found online on our website
now if va is rating you for multiple
conditions such as tbi and ptsd the
veteran will receive a combined
disability rating that might result in
increased compensation so for example if
a veteran has a 30 rating for ptsd and a
10 rating for tbi
those would be combined using va math to
equal a 37 combined rating which would
then result in a 40 combined rating
overall
va map is a little bit different than
the typical arithmetic that you're
probably used to so we would suggest
checking out the va disability
calculator on our website if you're more
interested in that math additionally
caitlin isn't there a special benefit
that veterans can receive
in terms of special monthly compensation
just for folks with tbi yes so veterans
who suffer debilitating residuals of a
tbi might qualify for smct which is an
additional special monthly compensation
reserved specifically for veterans who
have suffered a tbi
the criteria for this includes that the
veteran needs regular aid in attendance
for those residuals of a tdi that
veteran is not eligible for a higher
rating of aid in attendance under smcr2
the veteran would need hospitalization
nursing home care or other residential
institutional care without the in-home
aid in attendance you can check out our
blog post about this benefit as well if
you're interested in more information
great thanks caitlin
so that really wraps up our discussion
of tbi and ptsd amy any final thoughts
yes don't be discouraged from filing a
claim for tbi if you have a diagnosis of
tbi just because you are already service
connected for a ptsd or some other
mental health disability um because
there are ways as we talked about to get
separate ratings repeat for tbi if your
symptoms are
are distinct yes i would say that
especially because this braiding is so
symptom driven this is really an area
where it's so important to be really
upfront and honest with your va examiner
um to be upfront and honest about the
late statements that you're submitting
because all of the different ways that
these residuals might be affecting you
that's how va is going to determine your
rating so providing that information is
probably the most important thing that
you can do here and piggybacking off of
that i would say that you should also
speak with an accredited rep a vso an
attorney whoever you're working with
because this can get very complicated
quickly
and
it's unfortunately i think an area in
which va struggles to rate veterans
appropriately
they often will combine the ptsd and tbi
without doing an assessment to see if
the symptoms can be separately rated
they will perhaps not give you a
separate rating for migraines if you
have those in addition to tbi and ptsd
so it really is an area where your
benefits could add up quite quickly um
and it just needs to be sort of laid out
very clearly for va in order for that to
happen
so i'd reach out to someone
if you need assistance doing that
but that really ends our discussion
today of ptsd and tbi um my name is emma
peterson with amy odom and caitlin
degnan and thanks for tuning in and be
sure to subscribe to our channel if
you're interested in more va benefit
content thanks so much
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you