# Brain Injury Pension Decisions



## dunlop303 (16 Apr 2015)

Hi Everyone,

I am new to the board and was looking for other people who had gone threw the process for Traumatic Brain Injury or Diffuse Axonal Injury to be more specific.
Just wondering what to expect in terms of a decision, most of my old army buddies (And I) have already gone threw for physical injuries from IED's and PTSD in some cases.

But due to the nature of brain injuries, this diagnosis comes years later and I don't know anyone that has been down this path or what result to expect.
Everything is in with VAC and a decision is overdue by a Month of course. 

I am sitting at 62% on my previous diagnoses, and after trying to un biasly calc entitlement based on what they say on their website, I estimate anywhere between 28-40% depending on how they interpret the Dr's notes in the diagnosis. Just wondering if that's in line with what others have received.

To be clear; Diagnosis - Traumatic Brain Injury / Diffuse Axonal Injury due to multiple IED blasts and blunt force trauma (all service related).

Numbness, Pain, and Strength loss on left side of body (left hand dominate). "irretractible pain"

Thanks Everyone, I appreciate your sharing of your experience.


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## dunlop303 (28 Apr 2015)

No one else has gone threw the hoops for traumatic brain injury?
VAC adjudication review now coming up on 23 weeks and counting..

The last Rep I spoke to at VAC said the new unofficial standard is 24 weeks rather than their stated 16, and that the Senior Management 
does not want to change the standard publicly however 24 weeks is the standard internally. She said this causes a flood of 8 weeks of calling per application regarding overdue pension decisions.

Unique management style.


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## ixium (28 Apr 2015)

Yep, 24 weeks seems to be it now, they old switcharoo, tell them it takes 16 weeks, have it take 24, but write up all the reports saying the rate of decisions at 16 weeks is at 80+%.

I don't think there is anyone that has had an easy time dealing with VAC over the last year and a bit.


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## dunlop303 (29 Apr 2015)

It's Crazy,

I remember back in '07 when I got back they were calling me weekly bugging me to come in and start a claim for my injuries.
And when I finally did it was only a few months start to finish. Allot has changed since then I guess.


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## blackberet17 (4 May 2015)

Low on manpower to process claims after the budget cuts.


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## ixium (4 May 2015)

blackberet17 said:
			
		

> Low on manpower to process claims after the budget cuts.



For some reason I think I read that CF has more VAC staff per vet than any other country...

I think it more likely has to do with the bureaucratic nightmare of paperwork and hard copies of everything. Can't just fax or email, everything has to be mailed to PEI and Quebec


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## blackberet17 (6 May 2015)

ixium said:
			
		

> For some reason I think I read that CF has more VAC staff per vet than any other country...
> 
> I think it more likely has to do with the bureaucratic nightmare of paperwork and hard copies of everything. Can't just fax or email, everything has to be mailed to PEI and Quebec



Um...not exactly. I've faxed docs in, such as an audiogram (after contact established, of course). And through My VAC Account, I think you can scan and submit documents. If not, I know it's one of the builds coming.


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## Towards_the_gap (16 Jun 2015)

Fellow TBI'er here (for lack of a better phrase).

In regards to your pending decision, numbers wise you're not far off. I know when I went through the table of disabilities for myself and linked symptom to rating in said table, I was pleasantly suprised at the result that VAC came up with, however it only gives you the final number, not what is for what if you know what I mean (5% for this, 10% for that, 3%for this). 

Is there anyway we can make a sticky for Traumatic Brain Injury sufferers on here? Canada seems to be doing a terrible job of tracking/researching this 'signature' injury of the GWOT compared to the states who have whole Centres of Excellence in Brain Injury and numerous studies and trials to draw from. I even asked a neurologist who's been helping me and he just shrugged and suggested botox for the headaches!

VAC cut me a cheque and said have a nice day. It's only thanks to National Geographic and USA Today that I now know I have a higher chance of premature dementia/Alzheimers and other lovely diseases to look forward to, that is if I survive that long (the majority of TBI suffers seem to die by suicide before they get that far.


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## dunlop303 (17 Jun 2015)

Thanks for the reply!

Tell me about it, I am fortunate enough to be going threw the civilian medical system for diagnosis and they are more honest about the facts of the injury, that it is not curable and could kill you randomly one day or paralyze you ect. Interesting timing, I got a call from VAC this morning verifying my bank info and advising they had reached a decision but couldn't disclose the details yet as they are drafting their official letter.

Your right though there are zero resources for this in Canada, VAC and the Feds are trying to smush this and PTSD together so they can be treated at OSI clinics together. I couldn't disagree more, in some cases the impacts are mental / emotional in which case that may work, but in others and mine specifically the impacts are physiological and require nervous system specialists ect. 

Your also correct on how I estimated what % I thought I would get, just essentially match up the diagnosis form with their entitlement form and add up all the little numbers. 

In addition to the diseases it can lead too, a big question I have is the consequences of needing strong medications for the rest of my life both physically and mentally.. Do they accept ownership for that, how is entitlement determined? Do you have to wait for liver failure? ect.

If you don't mind, can you PM me with the summary of your decision and if the impacts were more mental or physical? I think that is one of the biggest hindrances on applicants, no one wants to disclose "how much" they got. But it makes it difficult to spot a decision that is way off the mark if no one knows what other people got for similar situations.


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## Towards_the_gap (17 Jun 2015)

Hi, I've sent a PM.

In summary, the effects were a mix of mental/physical. Started off with consistent headaches, I was in 2 IED strikes (<6m away from both, no physical injuries) where I 'saw stars', didn't lose conciousness but felt numb and dizzy and nauseaus afterwards, plus got hit with a Carl G backblast in between as well. 

Anyways started off with daily, 6-8 out of ten on pain scale, headaches, progressed to short term memory loss, severe emotional disturbances, and weight gain. 

Fun times.


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## dunlop303 (17 Jun 2015)

Thanks Again,

I appreciate the information, similar situation 2 IED's but I was on top of them in a tank luckily. Both caused injury, one knocked me out. 
Its hard for me to tell because I was diagnosed with PTSD quite a while back so who knows which symptoms are which, but I only discovered this after I started losing strength and sensation on the left side of my body for no apparent reason.


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## blackberet17 (17 Jun 2015)

dunlop303 said:
			
		

> Do they accept ownership for that, how is entitlement determined? Do you have to wait for liver failure? ect.



Not sure who you mean by "they"...

What you may be looking at down the road - for which I can't provide a timeline - are claims for medical conditions which arise as a consequence of the primary medical condition.

Example:

Cpl Bloggins suffers from PTSD, as a result of experiences and trauma while in service in Country D. He applied for disability benefits, and VAC awarded disability benefits for his PTSD.

IOT treat his PTSD symptoms, Cpl Bloggins has to take medications X, F, and M. All three, according to the _Compendium of Pharmaceuticals and Specialties_ (a pharmacist's bible, essentially), may cause gastro-esophageal reflux disease (GERD).

After a couple years, and a couple years of taking medications X, F, and M, Cpl Bloggins develops GERD.

To eliminate other possibilities, we know Cpl Bloggins has never had so much as a bad burp, nor had to take Pepto-Bysmol for that nasty chili the mess served one night.

Cpl Bloggins applies to VAC for disability benefits, with a medical opinion in hand, and extracts from the _Compendium of Pharmaceuticals and Specialties_ for his three medications.

VAC reviews the application and - in light of the medical evidence - determines, yep, Cpl Bloggins' GERD is related to the medications taken to treat the PTSD. Disability benefits are awarded for GERD, as a consequence of the awarded PTSD condition.


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## putz (17 Jun 2015)

I am closely following this.  I was treated for a TBI and left on medication for 2 years longer then I was supposed to be.  I am now experincing some of the affects of long term use of this medication.


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## blackberet17 (17 Jun 2015)

Traumatic Brain Injury (TBI) is also relatively new as a medical condition. The Center for Disease Control (CDC) in the US didn't start tracking it - for lack of a better term - until 2002 as its own, specific medical condition, i.e. separate and distinct from brain lesions and bleeds, concussions, etc. It is also a term separate from penetrating head injuries, which is an important distinction.

The other thing is, on the military side of TBI, we didn't start seeing them until Afghanistan, due to the nature of the combat and traumatic injuries which were occurring amongst deployed personnel, in part due to the IEDs.

Some of the side effects of TBI are only starting to be understood, not unlike how it took almost a hundred years to go from trench fever to shell shock to PTSD.


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## Towards_the_gap (17 Jun 2015)

blackberet17 said:
			
		

> Traumatic Brain Injury (TBI) is also relatively new as a medical condition. The Center for Disease Control (CDC) in the US didn't start tracking it - for lack of a better term - until 2002 as its own, specific medical condition, i.e. separate and distinct from brain lesions and bleeds, concussions, etc. It is also a term separate from penetrating head injuries, which is an important distinction.
> 
> The other thing is, on the military side of TBI, we didn't start seeing them until Afghanistan, due to the nature of the combat and traumatic injuries which were occurring amongst deployed personnel, in part due to the IEDs.
> 
> Some of the side effects of TBI are only starting to be understood, not unlike how it took almost a hundred years to go from trench fever to shell shock to PTSD.



I understand that 13 years is not necessarily a long time in medical terms, especially in epidemiological terms, however the US has done research that far outstrips ANYTHING the canadian medical community has done (ie nothing of note). If they are only starting to notice these side effects in the medical community then surely they should actually be in touch with the dudes suffering the symptoms.

On that note, has anyone with a TBI been contacted by any sort of medical institution to at least track your progress/symptoms?

* Mods, can we make this into a TBI sticky? *


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## SteadyPolaris (18 Jun 2015)

I finished an application for a mild TBI with neuroendcrince dysfunction about a year ago. Took 11 months to be processed. Was denied because it was not necessarily attributable to service. They often don't show up or get diagnosed for years. So there is no record of the medical condition that no one was looking for or had even heard of at the time of my injury.

Getting a neuropsych assessment may be easier than going the organic brain injury route. Getting the drugs and hormones paid for is a bit of a nonstarter so far. Was told to appeal, but that is such a hassle. All I've wanted is drug coverage as I have grown very dependent on the replacement hormones.


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## dunlop303 (18 Jun 2015)

Sorry to hear that, the medication costs can get out of control fast. In a few months I was over 3k in medication costs before coverage kicked in for that condition. 
Even then my Dr and I had to justify the medication because apparently there were less expensive alternatives to treat the condition. 

Can you tie it back to any events in your service? Witness testimony could help if immediate medical attention was not sought / recorded.
Curious in relation to the lack of treatment options I have for this, what medications are you finding effective?


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## dunlop303 (22 Jun 2015)

A Decision was reached this morning on my application, and the letter sent according to my VAC.
Rather than wait for a week to get the hard copy and see what has come out of this prolonged process, I thought i'd give them a call as I had when my PTSD claim had 
concluded and they gave me the details over the phone. 

Apparently they cant do that anymore, wont say the decision or the %. In my opinion over the phone is much safer than mail as its real time and you provide about 5 security
answers.

Oh well whats another week at this point, they say that in the near future decision letters will be added to your "My VAC" account. 

Its a little concerning that they are so secretive this time kind of like "I don't want to tell him it was unfavorable, let him read about it" it seems. But they verified my banking information last week so who knows im conflicted.

I'll let you know when I hear, or better yet read about it.


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## dunlop303 (23 Jun 2015)

The ombudsman's office called me this morning and filled me in, it was rated at %15 - the same amount I was rated at for a broken pelvis and tailbone.. Injuries that heal in 6mths.
TBI, and more specifically diffuse axonal injury, are injuries that do not heal.

I don't really know what to say.


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## blackberet17 (24 Jun 2015)

dunlop303 said:
			
		

> The ombudsman's office called me this morning and filled me in, it was rated at %15 - the same amount I was rated at for a broken pelvis and tailbone.. Injuries that heal in 6mths.
> TBI, and more specifically diffuse axonal injury, are injuries that do not heal.
> 
> I don't really know what to say.



Wait and see what criteria VAC determined you met according to the Table of Disabilities. From there, you can build your case for a higher Medical Impairment rating.


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## dunlop303 (24 Jun 2015)

Thank you I appreciate your advise.

Do I need to request that information in some way? I don't remember there being much in terms of entitlement justification on previous letters.

Thanks again


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## blackberet17 (25 Jun 2015)

dunlop303 said:
			
		

> Thank you I appreciate your advise.
> 
> Do I need to request that information in some way? I don't remember there being much in terms of entitlement justification on previous letters.
> 
> Thanks again



Your Official Decision will contain some basic information, including the Medical Impairment rating they've awarded; the Quality of Life level awarded; and the medical evidence they reviewed in preparing their decision.

Because of the complexity of TBIs, it could be assessed under either Chapter 19 or Chapter 20 of the Table of Disabilities (http://www.veterans.gc.ca/pdf/dispen/tod2006/tod_total_2006.pdf).

Instead of guessing which one they used, once you get your decision, you can request a copy of the Assessment Worksheet, which the Department used to breakdown and calculate your assessment. You can request this by contacting the Department or the Bureau of Pensions Advocates. This is information in YOUR file. Do not hesitate to ask for it, it's your right.

If it wasn't for ATIP rules, I could print it for you, but alas 

Also, I just found this. Not sure if it's helpful, but hoping it is:

http://www.veterans.gc.ca/pdf/about-us/research-directorate/mtbi-report-sep08.pdf

http://www.veterans.gc.ca/eng/news/salute/article/398


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## dunlop303 (25 Jun 2015)

These are great resources thank again!

I have not read / found that paper yet either, very interesting to see what level of understanding the medical community is at on TBI.
I'll definitely request the breakdown, something seems a little off even if the rating was confined to one of the two chapters you mentioned below.
My original estimate was based on chapter 17, since most of the symptoms of my injury are physiological. But I can understand having to rate it within the actual injuries section.

Like you said though, since TBI is so complex and its impacts so inconsistent im not sure it fits into a specific box. I would think, once the injury is established as credible, assess via the symptoms.
Ex, as Towards the Gap mentioned his symptoms are psychiatric. I don't believe I have those types of symptoms from this injury, but more physical. ect.

Either way thanks again for the help, its really appreciated.


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## blackberet17 (25 Jun 2015)

The adjudicators may have also used the General Assessment table...which, not to confuse things, but isn't actually a Table in existence in the Table of Disabilities. It's used to assess as best and fairly as possible those medical conditions which don't fit perfectly into one specific box (chapter). We'll leave that possibility for another time 

The assessment of any condition is based on the symptoms. The hardest, in my book, to assess are psychiatric conditions, because so much of the symptomology is subjective - what the patient feels/sees/reacts to. The easiest are musculoskeletal, as we're usually talking about something measurable, like range of motion.

Because a TBI is considered neurological, it would fall under Chapter 20. When there are effects on physical limitations, that's when Chapter 17 or 19 would be used, per the following instructions to Chapter 20, quote:

"• Impairment from brain injury or disease affecting the upper limbs only or the lower limbs only (but not both) is rated within Chapter 17, Musculoskeletal Impairment.")

and

"• Impairment from brain injury or disease resulting only in both upper and lower limb effects is rated within Chapter 19, Activities of Daily Living."


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## dunlop303 (25 Jun 2015)

Ah. thanks I didn't catch that before. So I would be rated on table 19 then, as its an upper and lower deal.
I'll re-calculate based on that,


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## blackberet17 (25 Jun 2015)

dunlop303 said:
			
		

> Ah. thanks I didn't catch that before. So I would be rated on table 19 then, as its an upper and lower deal.



That's why you've got me!  ;D


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## dunlop303 (25 Jun 2015)

One other thing I don't understand, why is Intractable pain only worth %13 in chapter 19 vs. %34 in chapter 17?
Its odd, because the Intractable pain my Dr. identified on the medical form was upper body. Everything else is mostly numbness on the majority of the left side.
Oh, and some strength loss on left side.


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## Towards_the_gap (26 Jun 2015)

And for some depressing reading:

http://www.nationalgeographic.com/healing-soldiers/blast-force.html


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## blackberet17 (29 Jun 2015)

dunlop303 said:
			
		

> One other thing I don't understand, why is Intractable pain only worth %13 in chapter 19 vs. %34 in chapter 17?
> Its odd, because the Intractable pain my Dr. identified on the medical form was upper body. Everything else is mostly numbness on the majority of the left side.
> Oh, and some strength loss on left side.



I would only be hazarding a guess, as I've only dealt with one Chapter 19 assessment since the 2006 Edition came on line. I'll see what I can find out.


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## dunlop303 (30 Jun 2015)

Thanks. I appreciate any light you could shed.


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## blackberet17 (11 Aug 2015)

dunlop303, so sorry it took so long to get you an answer.

I got a response back from one of the doctors as to why there are two medical impairment ratings for intractable pain, in two different chapters of the 2006 Edition of the Table of Disabilities.

To summarize, the medical impairment rating of 34 for intractable pain contained within Chapter 17 - Musculoskeletal Impairment is used to rate musculoskeletal conditions which cause pain in one region; for example, pain from disc disease of the lumbar spine.

This is the only medical impairment rating used in determining the disability assessment.

The medical impairment rating of 13 provided for intractable pain in Table 19.7 - Other Impairment - Chronic Pain is *not* the only medical impairment rating provided for painful conditions assessed in Chapter 19 - Impairment in Activities of Daily Living.

Conditions assessed in Chapter 19 have pain located in more than one region; for example, a condition such as rheumatoid arthritis.

These "Chapter 19" conditions are rated using all seven of the tables in the chapter, Table 19.1 to Table 19.7. Each table is meant to capture a different aspect of the impairments suffered by the patient in performing of self-care and activities of daily living due to the condition (the description of what is assessed is included in the table's "title". Impairment due to pain would also be assessed in these seven tables. The medical impairment ratings from each of these seven tables are added then together, and one total medical impairment rating is awarded for the overall disability due to the medical condition.

Does this help?


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