We Provide Answers to Your VA Disability Benefits Questions Here
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How will the VA rating changes for sleep apnea affect my disability?
Sleep apnea is a breathing disorder that interrupts a person’s breathing. This interruption can last from 10 to 30 seconds and may occur up to 400 times a night for those who suffer from a severe case of this condition. Because sleep apnea is both a chronic and progressive condition, it usually worsens over time.
Those who suffer from this chronic condition are at risk of a variety of problems, including four times greater risk of stroke, three times greater risk of heart disease, and an increased chance of being involved in a traffic accident. According to the National Highway Traffic Safety Administration (NHTSA), drowsy driving related to symptoms of sleep apnea is responsible for 100,000 car accidents and over 1,500 deaths a year.
Veterans are particularly susceptible to sleep apnea. Over 420,000 veterans who served in the military following 9/11 and receive disability from the United States Department of Veterans Affairs (VA) have sleep apnea that is service-connected. And although there are many causes of this condition, including age, obesity, and a deviated septum, many doctors believe this condition is also caused by long-term exposure to chemicals and dust. Military personnel often work and fight in environments that contribute to sleep apnea.
Because sleep apnea has been associated with fatigue, heart problems, hypertension, and memory problems, it’s possible for this condition to interfere with your ability to work or sustain gainful employment. If so, you may be eligible for VA Disability benefits. However, the VA rating for sleep apnea is changing, and you may have questions about how those changes affect your current disability or your eligibility if you want to apply.
Questions About the New VA Rating Changes for Sleep Apnea
Because so many veterans are on disability for sleep apnea, the changes to the rating system could have a broad and significant impact. If you’re receiving VA compensation for sleep apnea, here are answers to some questions you may have:
- What are the new changes being made to the VA sleep apnea rating system? There are two changes being made to the rating. Change 1: A veteran must show that the CPAP he’s using is a medical necessity. Thus, a letter from your doctor will be needed to explain that the prescribed breathing device is needed for medical treatment of your sleep apnea. Change 2: Veterans can use breathing devices other than a CPAP and still be eligible for a rating of 50 percent. This is helpful for veterans because doctors can prescribe different devices to treat sleep apnea, including APAP and BiPAP machines and dental aids. Consequently, if your doctor prescribes a CPAP or any other breathing device, and he can provide evidence that in order to treat your sleep apnea condition, your device is medically necessary, it’s likely you’ll be approved for a 50 percent rating.
- Why did the VA make these changes? A primary factor is the cost of sleep apnea disability for veterans. Disability compensation claims for veterans suffering from sleep apnea increased by 150 percent from 2009 to 2014, and according to reports, annual compensation for this condition continues to rise. Additionally, approximately 9 of 10 veterans who receive disability for sleep apnea are given a 50 percent disabled rating. This can mean a monthly payment of over $800.00. Due to the increased cost of compensating for this condition, the rules were reviewed.
- Will the changes affect my current disability benefits or a pending claim? The M21 – 1MR VA Handbook does not specifically state how the changes will impact current and pending claims. It’s recommended that you look at your C-File to see if there is a doctor’s statement providing solid evidence that your breathing device is a medical requirement in treating your sleep apnea. If there is no such statement, it’s a good idea to get one from your doctor and add it to your file. Additionally, ask that your doctor explain why you need the device as if he is providing evidence to an insurance company. Ask that he be detailed and give clear reasons for prescribing the device. If you have a VA doctor, you may want to invest in getting this letter from a private physician. It’s possible that a VA doctor won’t agree to provide this letter for you.
- What if I don’t use my breathing device as often as I should or the way I’m supposed to? The VA rule change states: “If the competent medical evidence of record shows that use of a qualifying breathing assistance device is medically required, the fact that the claimant is not actually using it as prescribed is not relevant.” So for now, if your use of the breathing device is not compliant with the required use, the VA will not reduce or stop your benefits. However, all other medical systems require that, in order to be covered by insurance, a patient must use the breathing device properly and consistently. Thus, it’s possible that the VA will also require that a patient be compliant with his device.
If you are a veteran who suffers from sleep apnea due to your military service, and your symptoms make it difficult to work, or you were denied benefits for this condition, contact us at 402-933-5405. We’ll discuss your situation and determine how we can help get you the VA benefits you deserve.
I believe I’m suffering from fibromyalgia. What should I know about this condition, and can I get disability benefits?
Formerly known as fibrositis, fibromyalgia (FM) is a chronic condition that affects about five percent of the U.S. population. However, because the symptoms of FM vary by individual, it’s a difficult condition to diagnose. The statistics for people suffering from FM are often estimates rather than exact numbers.
While FM is a condition that affects many people, studies show that veterans of the Gulf War are more frequently diagnosed with FM than civilians or non-Gulf War veterans. Additionally, FM is more common in women and characterized by widespread pain in the body’s ligaments and muscles. Very often, people who suffer from FM have had the condition for years before their doctor makes the diagnosis.
According to the American College of Rheumatology, FM is the second most common medical condition that affects the musculoskeletal system (after osteoarthritis). Those with FM not only experience muscle tenderness and pain, they often have “trigger points” that are painful to the touch or with pressure. These trigger points are usually found on the shoulders, neck, arms, hips, and back. Interestingly, those suffering from FM find these trigger spots especially sensitive, but other similar spots on their body are not sensitive. Additionally, people who suffer from other chronic pain conditions such as arthritis don’t find that pressure on those trigger spots is painful.
If you suffer from FM, you may be eligible for Social Security Disability benefits or benefits from the United States Department of Veterans Affairs (VA). To navigate the appeal process to receive benefits for FM, you may want a legal expert to help with your claim.
The Causes of Fibromyalgia
There is no known cause of FM; however, most researchers believe FM is a result of a combination of many types of stressors—not just caused by a single event. Additionally, there are some known factors believed to contribute to or be associated with the development of this condition. Here is a brief look at some factors connected with FM:
- Genetics. While there is no direct genetic link between people who suffer FM—the condition is not passed from parent to child—studies show that people who develop FM are likely to have a family member with this condition. FM has been shown to run in families, especially in mothers and daughters. Thus, it’s possible that heredity is a factor in developing FM.
- A stressful event. Some studies suggest that those people who have experienced physical or emotional trauma or abuse are more likely to suffer from FM.
- Chronic pain from another condition. FM has been linked with other illnesses. The chronic pain of arthritis, systemic lupus erythematosus, and other autoimmune diseases can trigger or factor into the development of FM.
- Infection. Certain infections can bring about FM. Hepatitis C, the Epstein Barr virus, and other infections are linked to FM.
- Repetitive injuries. If you overuse your hands to perform a task repeatedly, such as working with the same tool throughout the day, typing, or writing, you may suffer from Repetitive Strain Injury (RSI). This can be a debilitating condition that has been linked to fibromyalgia.
- Age. While it’s possible for children to develop fibromyalgia, the ages of most who develop this condition range from 20 – 60 years old. Most people develop symptoms during middle age.
- Diet. It’s thought that certain foods may exacerbate the symptoms of FM, including caffeine, dairy, eggplant, potatoes, tomatoes, peppers, fried foods, salty foods, and alcohol.
Researchers do seem to agree that in those who suffer from FM, the brain and spinal cord seem to process pain sensations abnormally. The threshold for pain may be lower, and pain is felt more intensely because the abnormalities in the central nervous system amplify the pain.
We Can Help
FM isn’t a new disease, but only recently have researchers and doctors understood and accepted it. In the past, FM wasn’t always considered a real condition, and some believed it was “all in the head.” However, a 1981 scientific study confirmed FM symptoms and the associated trigger points. Since that time, more testing has been performed on the pain reactions in people with FM.
If you’re a civilian or a veteran and suffer from fibromyalgia and are unable to work, you may be eligible for Social Security or VA disability benefits. Or if you’ve applied and were denied benefits, call Cuddigan Law at (402) 933-5405. We’ll schedule an appointment to discuss your eligibility for compensation.
How does the VA rate my arthritis disability?
According to an article in the 2012 Journal of the American Academy of Orthopedic Surgeons, U.S. soldiers and veterans have been significantly affected by osteoarthritis (OA) and rheumatoid arthritis (RA). OA occurs when cartilage—a connective, structural tissue in the body that’s more flexible than bone—breaks down. RA is an autoimmune disorder that attacks the lining of the joints. Both types of arthritis are painful and sometimes debilitating.
In active service personnel under 40, OA is the leading cause of disability and medical discharge, and those on active duty as well as veterans are two times more likely to suffer from OA than civilians. When a soldier is diagnosed with RA during active duty, the Medical Evaluation Board automatically sets up a hearing that usually results in the soldier’s medical discharge from service. Between 2003 and 2009, Army statistics reported that the number of soldiers medically retired from the Army with at least one type of musculoskeletal condition increased almost 10 times.
Because arthritis is so prevalent in soldiers and veterans, the United States Department of Veterans Affairs (VA) determined that this condition is service-connected if diagnosed within a year of discharge. However, if symptoms of arthritis present in later years, you may still be eligible for VA disability.
Why Soldiers Are At a Higher Risk for Arthritis
OA can impact any joint in the body, but it most often affects weight-bearing joints: the ankles, spine, knees, and sometimes fingers. Often called the “wear-and-tear disease,” OA is painful because when the cartilage breaks down, bare bones rub together. Over time, those bones can thicken, become malformed, and form bony spurs—all of which create pain that can be debilitating.
Soldiers are at an increased risk for OA because the wear and tear on their joints can be extreme and excessive. Those in active duty face rigorous training, multiple deployments, and carry heavy equipment and body armor that can create intense pressure on joints and contribute to arthritis. In the early years of the Iraq and Afghanistan wars, service personnel carried between 80 and 120 pounds of gear. While troops now have lighter tactical gear that is often less than 20 pounds, they may still need to wear heavier armor under certain circumstances.
Additionally, combat wounds such as joint injuries from shrapnel and broken bones from roadside bombs can eventually lead to OA. During the Iraq war, a study of service personnel who were injured on the battlefield found that OA was the main reason these soldiers were discharged.
How the VA Rates Arthritis
If you have service-connected arthritis, a VA rating specialist will look at the following factors when determining your rating:
- Functional loss. This rating focuses on the limitations of the joint’s range of motion. For example, the VA rating specialist will evaluate an arthritic knee by its ability to perform normal, working movements.
- Instability. The VA rating specialist will categorize instability of the joint in three ways: slight (10%), moderate (20%), or severe (30%). It’s important that your doctor use these three terms to explain your limitations due to arthritis. Additionally, he should explain why your condition falls into that particular category.
- Pain. Most veterans with arthritis experience pain. While the VA rating system doesn’t usually recognize pain as a disability, it may be factored in for arthritis—especially if it affects the knee. Even if your range of motion is fine, and there appears to be no functional loss, the VA may still grant a rating in this category if you can provide evidence that the range of motion is affected by pain when the joint is used in a normal, repetitive way. The VA may recognize that the pain is impacting your ability to use that joint.
If you suffer from OA or RA, and your symptoms make it difficult or impossible to work or sustain gainful employment, you may be eligible for VA disability benefits. Or if you’ve applied and were denied benefits, call Cuddigan Law at (402) 933-5405 Be sure to ask for a copy of our free book, The Essential Guide to VA Disability Claims.
Questions and Answers About Military Sexual Trauma
A significant number of service personnel have experienced military sexual trauma (MST), according to the United States Department of Veterans Affairs (VA). Defined by the VA as threatening, repetitive sexual harassment or sexual assault, including, rape, MST also includes other types of trauma, including pressure to engage in any type of sexual activity that has implied benefits or threatens negative consequences, unwanted sexual touching or advances, and objectionable and offensive remarks about any person’s body or sexual behavior.
In 1991, the Department of Defense (DoD) announced a Zero Tolerance Policy against acts of sexual misconduct. However, these incidents have steadily increased. In 2013, The Military Justice Improvement Act (MJIA) was introduced by Senator Kirsten Gillibrand to change how serious military crimes and offenses—specifically, sexual assaults—are taken to trial. The Act was meant to reform the court-martial trial process, requiring an officer outside of the victim’s chain of command to make the determination about whether the accused should be court-martialed. In 2014 and 2015, the Senate blocked passage of this Act.
Questions About MST
In what’s been called a “culture of sexual assault” in the military, there are many questions about what happens after experiencing a MST. Here are some of the most common questions about sexual trauma in the military and some general answers to those questions:
How many service members have experienced a MST?
Since 2006, it’s reported that over 95,000 military service members have been sexually assaulted. It’s also estimated that in the past 25 years, over 500,000 people in the military have been victims of this crime. In 2012, active duty members who participated in an anonymous survey reported approximately 26,000 incidents of unwanted sexual contact. This contact included aggravated sexual assault, coerced and abusive sexual contact, and rape.
Are women more likely to experience a MST than men?
Both men and women suffer from MST. In a recent, one-year study of service members on active duty, 5 percent of women and 1 percent of men reported experiencing a sexual assault; and 22 percent of women and 7 percent of men experienced sexual harassment. Moreover, of those military members serving in Iraq and Afghanistan who responded to a recent survey, 48,100 women and 43,700 men reported suffering a MST.
In a report released in 2014, the findings show that military sexual assault is a problem that affects both males and females. Nate Galbreath, senior executive adviser for the Pentagon’s sexual assault prevention office, says, “There’s still a misperception that this is a women’s issue and women’s crime.” Data analysis by the Associated Press (AP) found that 1.2 percent of the men surveyed said they’d been sexually assaulted compared to 6.8 percent of the women. “But there are vastly more men in the military,” says the AP. “By the raw numbers, a bit more than 12,000 women said they were assaulted compared with nearly 14,000 men.”
Are all MSTs reported?
According to the DoD, approximately 19,000 incidents of military sexual assault occur every year, and it’s estimated that 85 percent are never reported. Additionally, about 75 percent of both men and women who were sexually assaulted didn’t report these incidents.
What makes reporting a MST so difficult?
For any victim of a sexual assault, reporting the incident can be emotionally daunting and threatening. But there are special factors that make reporting a MST unique in the military. Here are a few of those factors:
- It’s likely that the victim may work in the same service area as the person responsible for the assault—a colleague or teammate—or may live in the same barracks. The victim may have to rely on that person for safety, food, and even health care.
- Victims may feel that speaking out or reporting the assault may make them appear vulnerable or weak in front of their units. They may also feel they’ll lose the respect of their peers.
- Victims may worry that reporting the assault will damage the team spirit or camaraderie of the unit if the assailant is in the same unit.
- Victims may worry because the assailant may have control over their career status and possibility for promotion, and the victim may feel helpless in reporting an incident to that person and may worry that another attack will occur.
Because of these factors, service personnel may feel they face a no-win situation and believe they are trapped by their special circumstances.
What are some of the emotional and psychological problems and outcomes military victims face after a MST?
Military personnel who suffer a MST may experience symptoms soon after the incident or may have psychological and physical symptoms years later. These symptoms can be debilitating and create the following long-term, severe problems:
- A MST can cause panic attacks, depression, anxiety disorders, as well as conditions related to substance abuse.
- It is nine times more likely that a female veteran who was sexually assaulted will develop post-traumatic stress disorder (PTSD).
- According to a 1996 study, female veterans become homeless “at a rate 3 to 4 times greater” than civilian women. Additionally, 53 percent of homeless female veterans have suffered MST.
- Military personnel who report a MST are three times more likely to suffer from PTSD, anxiety disorders, and mental disorders—most specifically depression. Additionally, female veterans are likely to develop PTSD over other female veterans who did not experience a MST.
- Female victims of a MST are likely to suffer from eating disorders.
- Headaches, gastrointestinal issues, and pelvic pain are also physical health issues experienced by those suffering from MST.
- MST can affect a victim’s life with a variety of problems, including, difficulty feeling safe, having disturbing nightmares or memories, feeling numb, feeling isolated, problems with irritability and anger, and problems sleeping.
Is there a connection between MST and the rate of suicide in military personnel?
According to a U.S. study, veterans who experienced sexual harassment or sexual assault are at an increased risk of suicide. VA researchers found that men who experienced a MST are more likely to commit suicide by 70 percent over veterans who did not suffer from MST. Likewise, female veterans were twice as likely to commit suicide if they had experienced MST. Moreover, Susan McCutcheon, national mental health director for family services, women’s mental health, and MST at the VA says, “The study found that those veterans who died by suicide were significantly more likely to be treated for mental health conditions that were related to their MST experience.”
How many of the assailants are prosecuted?
It’s likely that any military personnel who rapes or sexually assaults a service member won’t be punished, disciplined, or convicted of a crime. It’s estimated that an assailant of a sexual assault will have over and 85 percent chance of having the assault kept secret and over 90 percent chance of not being court-martialed.
In some respects, this may be considered a vicious cycle. Victims are discouraged from reporting the assault because of the military’s culture of acceptance along with few prosecutions and the intimidating chain of command structure, so the assaults continue.
Moreover, military personnel risk investigation of their sexual personal history, ridicule, demotion, and involuntary discharge if they report a sexual assault by a command officer. A reportedly 90 percent of MST survivors are involuntarily discharged; 80 percent of accused assailants are discharged with honor.
Am I eligible for disability if I’ve experienced a MST?
You may be eligible for VA disability after suffering a MST, but there is key information you must include when making your application. While the VA recognizes you may not have documentation that proves the assault happened and will accept other evidence, it does require evidence that you suffer from a disabling physical or mental disability and that disability was caused or made worse by the assault that took place during your service. Additionally, to submit a successful MST claim, it’s helpful if you have a doctor write a Nexus letter.
If you experienced a MST and suffer from a debilitating condition related to that incident, you may be eligible for VA disability benefits. Or if you’ve applied and were denied benefits, call Cuddigan Law at (402) 933-5405. We’ll schedule an appointment to discuss your eligibility for compensation. Be sure to ask for a copy of our free book, The Essential Guide to VA Disability Claims.
What evidence do I need to receive VA benefits for a military sexual trauma?
Sexual assault and sexual harassment occur all too frequently in the U.S. military. The United States Department of Veterans Affairs (VA) defines military sexual trauma (MST) as threatening, repetitive sexual harassment or sexual assault, including rape. According to the VA, significant numbers of female and male veterans have suffered sexual assault during their military service—nearly one in five females and one in 100 males.
While sexual assault and rape are the most common form of MST, the VA includes other types of trauma in this category, including:
- Pressure to engage in any type of sexual activity that has implied benefits
- Pressure to engage in any type of sexual activity under the threat of negative consequences
- The inability of a person to consent to any type of sexual activity
- Any type of unwanted sexual touching
- Any type of unwanted or threatening sexual advances
- Any type of offensive or objectionable remarks about the body or sexual behavior of any military person
Military personnel can experience an MST while on duty or off and while on base or off. Because the person responsible for the assault may be a colleague or teammate who works in the same service area, may have control over the victim’s service career and promotions, or may live in the same barracks, the victim may have heightened fears of helplessness and worry about the possibility that the attack will happen again.
If you’ve experienced a MST, it’s possible you’re eligible for VA disability; however, there are important elements you need to include with your claim.
Evidence for a Successful MST Disability Claim
The VA is committed to help MST victims because it recognizes the significance and seriousness of a sexual assault. The VA asks all veterans who seek health care if they’ve suffered an MST, and then the data is tracked to record and document how many times any type of incident has occurred. While it’s believed that many MSTs are not reported, the VA’s national screening program reports that approximately 1 in 100 men and 1 in 4 women have experienced some type of sexual trauma.
The VA also recognizes that veterans who experience an MST may suffer from follow-on conditions because of the traumatic incident. Consequently, you are eligible for VA disability benefits for a debilitating mental or physical condition that was due to the MST if you can prove the following:
- An MST incident occurred while you were on active duty.
- Your doctor has now diagnosed you with some type of mental or physical disability such as PTSD, depression, anxiety, or symptoms related to substance abuse.
- Your disability happened because of the MST incident that took place while you were in the service, or your condition was made worse because of that incident.
Because the VA realizes you may not have a military medical record that shows proof of the MST, it accepts other types of substantiating evidence, including:
- Any type of documentation or records showing that you requested a transfer out of your unit.
- Any proof that you have a problem with substance abuse.
- Any proof that shows your job performance has changed, you’re exhibiting changes in social behavior, or your economic situation has changed.
- Any proof that you’re exhibiting incidents of depression or anxiety.
- Any and all police or rape crisis center records.
- Any medical records that show you’ve had tests for sexually transmitted diseases or a pregnancy test.
- Any acknowledgement or statements from counselors, military co-workers, family, friends, or clergy who know what happened.
- Any documentation you’ve kept on your own, including journals or diaries that detail the trauma.
What to Do If Your Claim Is Denied
It’s possible that the VA will deny your claim because it believes you haven’t provided enough evidence. Even though the VA accepts that there’s a service connection even without medical records from your time in service that prove an MST, many times claims are denied because that evidence doesn’t exist. If you’ve been denied or your application is being processed, you’re still eligible to receive counseling and other health care services for medical issues related to your MST. The VA has improved and increased resourcing to help veterans address these related conditions.
If you experienced an MST and suffer from a debilitating condition like PTSD or depression, or the VA denied your MST compensation, it’s often difficult to win an appeal, and it’s helpful if you have a disability attorney to help you. Call Cuddigan Law at (402) 933-5405. We’ll schedule an appointment to discuss your eligibility for compensation. Be sure to ask for a copy of our free book, The Essential Guide to VA Disability Claims.
What is the VA Polytrauma System of Care, and how can it help me?
Combat service can make soldiers especially vulnerable to a traumatic brain injury (TBI)—particularly those who served in the Iraq and Afghanistan Wars. Exposure to improvised explosive devices (IEDs), land mines, rocket-propelled grenades, and mortar rounds increases the risk of suffering a TBI. However, a TBI can happen to anyone, not just military personnel. It’s possible for the head to experience a severe blow or violent jolt for many reasons. Car accidents, sports-related incidents, and slip and falls can all result in a brain injury. Because the force of the blow jostles the brain from side to side inside the skull, the brain can bruise, bleed, or become damaged at the points of impact.
When combat soldiers are involved in a blast or an explosion, they often suffer additional injuries along with a TBI. This is called polytrauma. The term polytrauma means that multiple injuries have occurred to more than one organ and body part during a traumatic event. One of the injuries is usually considered life threatening, and all of the injuries occur in a single event. Along with a TBI, a soldier can suffer visual and hearing problems, the loss of a limb, a spinal cord injury, post-traumatic stress disorder, and other physical, emotional, psychological, and cognitive damage.
Because military personnel often experience severe and complex polytrauma injuries, they require specialized support services. Consequently, the Veterans Health Administration (VHA) makes available a program to help treat polytrauma. The Polytrauma System of Care (PSC) provides care and treatment for veterans who suffer the effects of just a TBI or other health conditions, illnesses, or injuries that are a result of the same event.
What Criteria Is Needed for Admission Into a PSC?
The VA provides basic guidelines about who can be admitted into a PSC program. In general, all veterans who were discharged from military service under any condition other than dishonorable, qualified to receive disability benefits, and are medically stable can be admitted into the PSC. The patient must:
- Have suffered multiple injuries—cognitive, physical, or emotional—that are secondary to the trauma
- Not be breathing on a ventilator
- Show that he will likely benefit from a rehabilitation program
- Show that he does not require one-to-one staffing for any reasons, including behavioral or medical
- Show the need for an extensive and complete rehabilitation care plan and evaluation
Additionally, the VA accepts referrals for admission into the PSC. These referrals can come from Department of Defense (DOD) sources, the TRICARE healthcare program, sources within the VA medical center, and even self-referrals, family referrals, and from those who are non-VA healthcare providers.
The Importance of Rehabilitation After a TBI
A critical part of the recovery process after a TBI is rehabilitation. The goal is to help the patient function in everyday life. Medical personnel show patients how to adjust to their disabilities and modify their living environment to make day-to-day activities and routines easier to deal with.
After experiencing a TBI, some patients need medication to address physical and psychiatric issues. It’s important that medical personnel prescribe and administer these medications carefully because those who have suffered a TBI are sensitive and susceptible to side effects, and some patients may have adverse reactions to some medicines. Additionally, it’s helpful if family members provide support by being a part of the program. The PSCs can provide guidance for this.
A service member who is injured in active duty is usually treated at a Department of Defense (DoD) Military Treatment Facility—at first to a facility abroad and then at a facility stateside. If the soldier’s injuries were severe, he may need rehabilitation services after being discharged. After the soldier is stabilized, he is typically transferred to a VA PRC for acute, inpatient rehab. At these centers, TBI treatment focuses on helping the patient cope with the changes in a normal, daily routine. This may involve the patient learning about the medications necessary to take care of the medical issues and understanding ways to deal with cognitive, behavioral, and health problems. Additionally, the patient may need to learn more about attending physical, occupational, and speech-language therapies and dealing with new technology devices that will provide assistance.
We Can Help
If you suffered a TBI during your military service, it’s essential that you receive the right kind of care to support your recovery. Likewise, getting the proper compensation payments is critical to your future. At Cuddigan Law, we understand the appeal process for those who seek and need disability for TBIs. We know that TBI disability cases are challenging, but we also know it’s possible to win them. Call us at (402) 933-5405 for a free evaluation of your case.
Could my PTSD symptoms be related to my traumatic brain injury during combat?
Yes. It’s very possible that a traumatic brain injury (TBI) experienced during military service can cause post-traumatic stress disorder (PTSD). Studies show a close connection between these two conditions—especially in veterans. According to the Journal of the American Medical Association Psychiatry, it is twice as likely for a service member to suffer from PTSD if he experienced a serious brain or head injury. Additionally, military personnel returning from the Afghanistan and Iraq wars are more likely to suffer from a TBI due to their increased risk of being caught in blasts from improvised explosive devices (IEDs).
Understanding a TBI and PTSD
A sudden jolt or blow to the head is often the cause of a TBI. This neurological trauma damages the brain due to the rapid jostling motion of the brain inside the skull. As a result, the brain may swell, bruise, or bleed. While TBIs often occur because of sports injuries, falls, assaults, and vehicle accidents, they’re most commonly associated with incidents involving combat soldiers—most specifically those returning from Iraq and Afghanistan. Over 260,000 veterans who were deployed to these wars were diagnosed with a TBI.
PTSD is a psychological condition that often occurs after a person experiences or witnesses a terrifying event or is exposed to a situation where he feels threatened, extreme fear, helpless or trapped, or that he might die. That person may have flashbacks, extreme anxiety, nightmares, and unsettling thoughts about what happened. Of the nearly 3 million veterans of the Afghanistan and Iraq wars, it’s estimated that up to 20 percent suffered from PTSD in 2014. The highest estimation of veterans from both of these wars suffering from diagnosed or undiagnosed PTSD is over 450,000.
Theories suggest that the violent events that lead to a TBI during combat can be especially upsetting and disturbing, which may explain the link between head injuries and PTSD. Veterans who suffer from PTSD have usually been involved in a deep emotional trauma. And researchers have found that the way the brain changes following this trauma—both structurally and functionally—may contribute to the occurrence of PTSD.
Because PTSD can bring on feelings of depression, anxiety, sadness, and isolation, talking to a professional can sometimes help. However, experts don’t believe that communication with a professional resolves the damage to the brain caused by a TBI. Many believe that a TBI and PTSD are not independent of one another; rather, they are most often connected.
VA Disability for a TBI and PTSD
Regulations and requirements have changed and expanded over the past few years for disability compensation for veterans with TBI and/or PTSD. Here is a brief look at the requirements for each condition.
In 2010, the requirements for receiving disability for PTSD were made simpler. No longer did veterans have to provide proof that an event occurred causing their PTSD. This rule applied to both combat veterans and all veterans who were involved in and experienced fear because of a terrorist or hostile situation. Here is a look at some of the requirements to establish a service-related connection for PTSD:
- You need to have a current diagnosis of PTSD.
- You need to provide a statement about the traumatic situation or event that you experienced during your military service.
- You need a medical opinion from a VA psychiatrist or psychologist, or one who is under contract with the VA, that states the event could have caused the PTSD.
- You need to show that the event or situation was consistent with your military experience.
For a TBI
The VA rates a TBI as mild, moderate, or severe. Here is the evidence used to make that determination:
- The VA uses various scans, including an MRI and a PET.
- The length of time the veteran was in an altered state of consciousness or mental state.
- The length of time the veteran was unconscious.
- The length of time the veteran suffered amnesia.
- The veteran’s score on the Glasgow Coma Scale—a test that doctor’s use after a TBI.
The severity level of a TBI isn’t determined on the veteran’s symptoms; rather, it’s evaluated from the time the injury was sustained. If there isn’t sufficient medical evidence, the veteran may not be eligible for disability for a service-related injury.
Our Disability Attorneys Help Veterans in Need of Benefits
A TBI or PTSD is often difficult to diagnose because you may not experience symptoms until weeks or months after you were injured by the trauma. If you have a service-related TBI and/or PTSD, you may be eligible for VA disability compensation. Call us today at 402-933-5405 to ask us a question about your disability case, or download our free book, The Essential Guide to VA Disability Claims.
If my TBI caused another illness, can I obtain VA disability for it?
A traumatic brain injury (TBI) has been referred to as the “signature injury” of the Afghanistan and Iraq Wars; however, it’s not a new condition, and both civilians and veterans experience TBIs. Each year, over 1.5 billion people suffer a TBI in the U.S., and the Centers for Disease Control and Prevention (CDC) reports that TBIs contribute to approximately 30 percent of all injury deaths. Additionally, over 50,000 people die of TBIs annually.
A TBI is usually the result of a sudden blast, explosion, or assault that produces a concussive blow to the head and interferes with normal brain function. The intense, rapid shaking of the brain that occurs inside the skull can pull nerve fibers apart and damage brain tissue.
For those who serve in the military, there is a greater risk for a TBI. These head injuries are suffered by over 20 percent of U.S. troops who are wounded during combat. They are caused most often by improvised explosive devices (EIDs), gunshot wounds, grenades, mortars, and land mines. Research has found that TBI symptoms last for a longer period of time for veterans than for civilians, with some veterans reporting symptoms for up to two years following the injury. For some military personnel, a TBI contributes to permanent disability, and veterans who suffer a head injury may be eligible for disability from the United States Department of Veterans Affairs (VA).
VA Approves New Regulations for TBI Disability
In the past, the VA was criticized for minimizing the effects of a TBI and not recognizing it as a disability deserving of benefits. However, two changes in less than 10 years improved the rating system and the criteria for receiving disability benefits for a TBI.
In 2008, the VA modified its evaluation criteria for determining service ratings for TBIs. Originally, the criteria allowed for only a 10 percent rating for any one “subjective symptom”—this relied on the self-reporting of the veterans suffering from the head injury. Headaches, dizziness, and concentration issues were just some of those subjective symptoms. When the VA changed the rating system, these types of symptoms were evaluated using three classifications and the combined disability level of all three: physical symptoms, emotional symptoms, and cognitive symptoms.
Later, in 2014, a new regulation took effect that recognized five illnesses as being caused or worsened by a TBI. This regulation made it easier for some veterans who experienced a moderate or severe TBI and, ultimately, suffered additional medical conditions because of it, to receive disability benefits. It also empowered the VA to make decisions on disability claims more quickly.
Presumed Service-Connected Conditions to TBI
The 2014 regulation was enacted after the National Academy of Sciences, Institute of Medicine (IOM) reported finding a connection between moderate and severe TBIs and these illnesses. Eligibility for benefits is determined by the level of severity of the TBI and the time that has elapsed between the second illness and the injury that caused the TBI. Even if veterans don’t meet the time and severity guidelines, they can still file a claim that establishes a service-related condition.
In part because of the IOM findings, the VA now recognizes the following diseases as “presumed service-connected” to TBIs:
- Certain dementias. The VA will recognize these dementias if the veteran is diagnosed within 15 years following a moderate or severe TBI.
- Parkinson’s disease. This disease is presumed a service-connected condition related to a TBI if it’s diagnosed following a moderate or severe brain injury.
- Depression. The VA recognizes depression if it’s diagnosed within one year of a mild TBI or three years of a moderate or severe TBI.
- Seizures. The VA recognizes seizures if no cause has been found for them after the veteran experiences a moderate or severe TBI.
- Hormone deficiency diseases. Certain diseases of the pituitary and hypothalamus glands are eligible for disability if they’re diagnosed within 12 months of a moderate or severe TBI.
The 2014 regulation is also an attempt to speed up and simplify disability claims after a veteran shows a service-connected TBI. Once the veteran proves this, the VA then accepts the relationship between the illness and the TBI without requiring any other evidence.
Veterans suffering a TBI can have lasting, debilitating symptoms. At Cuddigan Law, we understand that veterans deserve benefits for their disabilities. That’s why we provide free information to help veterans with their claims. Download our free book, The Essential Guide to VA Disability Claims, or call us today at 402-933-5405 to discuss your disability case.
What is a DBQ, and should I use one for my disability claim?
A Disability Benefits Questionnaire (DBQ) is a form designed to be used as part of their evaluation process for VA disability benefits. This downloadable form helps speed up the process of a veteran’s disability claim.
When veterans use a DBQ, they have more control over their claims process. Using this form allows veterans to visit a primary care provider for their medical evaluation as an alternative to or to rebut a compensation and pension (C&P) exam at a United States Department of Veterans Affairs (VA) clinic or facility. Sometimes the veteran submitting this information early in the claims process avoids the necessity of a C& P examination. Because the form uses standardized language and check boxes to help provide critical information, an accurate disability rating can be made quickly and more easily.
Questions About the DBQ
The DBQ is a relatively new form available to veterans, so there are questions about how to use it. Here are some of the most common questions about the DBQ and some general answers to those questions:
Will having my doctor fill out a DBQ really expedite my claim? While there is no statistical evidence that proves the DBQ accelerates the claims process, many veterans have reported their satisfaction with the time to process their claims.
Will the VA pay for me to see my own doctor? No. If a veteran chooses to see his own doctor for a medical evaluation instead of a reporting for a C&P exam, he is responsible for all related charges, co-pays, and travel costs. Because veterans have the option to take the DBQ to their own physician, they are also responsible for any extra charge the doctor might require for filling out this form. Asking your doctor to complete the form is the same as asking him to add support to your claim by writing a letter or provide evidence of a medical condition.
Is there a DBQ for every condition? No. However, there are over 70 DBQs that cover many medical conditions. Some DBQs are available for a specific, single condition such as prostate cancer or high blood pressure, and others can be used for related conditions. The VA provides a complete list of available forms and covered conditions. The current list defines nearly every condition that a veteran can receive compensation for.
What DBQs aren’t available to private health care providers? The following medical exams have no DBQs:
- The initial exam for PTSD
- Tinnitus and Hearing Loss
- Residual effects of a Traumatic Brain Injury
- Residual effects of a Cold Injury such as frostbite and hypothermia
- Protocol examinations for prisoners of war
- Examinations for those who served in the Gulf War
- General exams for Compensation
- General Exams for Pension
Who is allowed to fill out a DBQ? Any health care provider who has an active medical license is required to sign the DBQ and affirm the condition of the veteran. The DBQ can be completed by:
- The veteran’s personal health care provider
- A Veterans Health Administration (VHA) clinician
It’s important to note that some medical professionals and some professionals in specialty fields may decline to fill out a DBQ.
What if the VA feels my DBQ isn’t filled out completely? If the VA believes your DBQ is incomplete, that means it doesn’t include the proper information needed give your disability a rating. While the VA will try to collect the necessary information during the claims process, it may not be able to obtain all that’s needed. If this happens, the VA may schedule you for a C&P exam.
Can evidence from past test results be used on the DBQ? The VA has no set rules about the age of test results. If past test results indicate your present medical condition and the level of your disability, your doctor should state this and include those test results in your DBQ.
At Cuddigan Law, we understand how critical it is for veterans to get disability benefits. If you have questions about your disability claim or about using a personal doctor and a DBQ for your medical exam, we can help. Call us today at 402-933-5405 to ask us a question about your disability case, or download our free book, The Essential Guide to VA Disability Claims.
What kinds of test should I expect during my VA C&P exam, and what happens after?
A Compensation and Pension Exam—often referred to as a C&P exam—is a doctor evaluation used by the United States Department of Veterans Affairs (VA) when determining approval or denial of a veteran’s disability claim. A C&P exam is used by the VA to rate disabilities, diagnose conditions, and determine if you have a service-connected disability.
After you’ve applied for disability and the VA is working to process your claim, it’s almost guaranteed that you’ll receive a call or letter asking you to report for a C&P exam. Usually this exam will take place at a VA hospital or clinic, and if you have more than one disability, you may have to report for additional exams.When you get the letter schdueling the exam call the number on the appointment letter and find out what kind of exam you are going to have. It is important to look at the Disability Benefit Questionnaire (DBQ) form ahead of time to know what to expect.
What Happens During a C&P Exam?
A C&P exam is really nothing more than a doctor appointment; however, you don’t receive medication or treatment. Instead, the doctor will focus on your physical or psychological condition and evaluate your situation in the following ways:
A Psychological Condition
If you are suffering from a psychological condition or disorder that creates stress and negatively impacts multiple areas of your life, the doctor will ask you questions and give you an opportunity to describe the symptoms you’ve experienced and how the stress has affected you. The doctor may also ask you to complete some standard psychological tests—for example, a memory test to see how many words you can remember a few minutes after you read them from a list. This part of the exam is minor and routine.
A Physical Condition
If you are suffering from a physical illness, injury, or condition, the doctor will examine you to evaluate your situation. He may ask you questions, order lab work, and conduct medical tests standard for your condition.
It’s important to note that when the doctors asks “How are you?” most people are programmed to answer “Fine” or “Okay.” The C&P exam is not the time to respond this way—because honestly, if you were doing fine, you wouldn’t be seeking disability compensation. If you want the doctor to accurately assess your illness, injury, or situation, you need to be honest and give detailed information about why you’re not okay. If your doctor writes in his report that you claimed you were doing pretty well, your claim will likely be denied.
For most any VA disability claim, a C&P exam is required, and it’s important to know what happens at the appointment. But it’s also important to know what happens after your exam and how it affects your claim.
What Happens After a C&P Exam?
After you’ve had your C&P exam, the doctor will prepare a report that may include information on your medical history, your current symptoms, and the severity of your symptoms, along with a professional opinion about whether your disability is service related.
Once the doctor finishes the report, he sends it to the VA Regional Office where your claim will be processed. It’s important to remember that it’s the Ratings Veterans Services Representative (RVSR) at the VA Regional Office that makes the determination about your eligibility for disability benefits—not the doctor. And while the C&P exam is a key piece of data in the decision making process, the RVSR bases the decision on all evidence submitted for a claim.
Your C&P exam will typically result in one of two outcomes: Favorable or Unfavorable. Here is a brief overview of both result types:
- The doctor wrote a nexus letter, giving his medical opinion about why he believes your condition is service related.
- The doctor reviewed all of your medical records and stated this in his exam report.
- The doctor was skilled, experienced, and well qualified.
- The exam was performed accurately; all questions were answered completely; all necessary testing was performed and completed; and the exam report was marked “Veteran friendly.”
If your C&P exam result was unfavorable, it may mean that one or more of the Favorable points was missing from the doctor’s report, and you may want to do the following:
- Get expert medical help. If you want to refute the report, have an independent medical examination (IME) or get an independent medical opinion (IMO). An IMO may or may not require your physical presence; rather, the doctor forms his opinion after reviewing all of your records.
- Get legal representation. Get help from an accredited VA attorney. Because the VA can be difficult to navigate, having a skilled attorney to guide you through the process can be very beneficial.
- Don’t wait. If you delay refuting an unfavorable C&P exam and wait until after your claim has been denied, you may add 4 – 5 years to your claim.
At Cuddigan Law, we understand how critical it is for veterans to get disability benefits. That’s why we provide free information to help veterans with their claims. Download our free book, The Essential Guide to VA Disability Claims, or call us today at 402-933-5405 to ask us a question about your disability case.