Whether it is a news story about a professional athlete that has been diagnosed with some sort of head injury or a veteran seeking compensation for TBI, injury to the brain is always a hot button issue. In fact, TBI has been named as the ‘signature’ injury of the most recent wars in Iraq and Afghanistan.
So, what do VA disability benefits and neuropsychology have to do with each other? The answer is— plenty!
The initial fight in many TBI cases is whether the veteran even has this condition in the first place. This speaks to the first requirement for proving service connection, that is, a veteran must have a “current disability.”
I’ve seen through my experiences that for these types of cases, unfortunately, most general practitioners just are not equipped to identify, let alone are they equipped to competently diagnose traumatic brain issues. Too many times, I have read files where veterans have a history of in-service trauma to the brain, and are exhibiting what appear to be TBI symptoms; however, the doctors keep diagnosing other conditions, and they miss the fact that the veteran may in fact have a TBI. The failure to recognize TBI harms no one else, except the veteran of course.
When veterans are pursuing claims for service connection for brain injury, the VA will likely schedule a Compensation and Pension (C&P) examination with one of their practitioners in the C&P department. This person may or may not be a doctor. The C&P examiner’s job will be to give an opinion regarding whether or not the veteran does in fact have a valid diagnosis of TBI. If the examiner does give a diagnosis of TBI, then the next step is for the examiner to determine what the symptoms are, if any, and for the examiner to determine, how, if at all, the TBI impacts the veteran.
Normally, during the first round of decision-making, the VA will automatically go with the opinion of the C&P examiner, regardless of what any of the other evidence shows, even if favorable. Therefore, the veteran will likely have to appeal the initial decision.
This is where neuropsychology comes in. Neuropsychology is a branch of clinical psychology that deals with the assessment and treatment of individuals with brain injuries or brain diseases. Psychologists who practice neuropsychology are called “neuropsychologists,” and they have specialized training in the study of the brain.
Because of the way that the VA evaluates TBI claims, it is to the veteran’s advantage to actively pursue the right treatment and the right evaluations, ahead of time! A thorough evaluation from a neuropsychologist can help in this regard, because a neuropsychologist is specifically trained to look for and to diagnose symptoms that may appear to be caused by something else, but, could really in fact be symptoms from TBI. For example, cognitive impairment, headaches, dizziness, tinnitus, concentration problems, memory problems, or even insomnia, can be the result of TBI. A neuropsychologist can also administer comprehensive psychological tests, which are designed to look for TBI and designed to objectively assess the severity any TBI residuals.
When looking at the VA’s rating schedule for TBI, if a veteran has ‘mild’ memory loss or loss of attention or concentration, he or she is entitled to a 10% rating. However, if there is “objective evidence on testing” of these same exact findings, then the veteran is entitled to a 40% rating. If there is objective evidence on testing of “moderate” impairment, then the veteran is entitled to a 70% rating.
Notably, and it is clear from the rating schedule for TBI that objective testing absolutely makes a difference, because the key to a higher rating is “objective evidence on testing.”
The take away is that a thorough neuropsychological evaluation can make the difference between a denial, and no denial. Or, it can make the difference between a 0% rating versus a 70% rating. If it were my claim, I’d want to try to get objective testing from someone who is truly objective, and not from a C&P examiner. This is where neuropsychological testing can certainly go a long ways towards helping the VA to hopefully make the right decision, the first time.