I finally won a TDIU for a Vet I’ve written about many times. He was riding shotgun just south of Quan Loi in April ’71 when the Zipperheads command-detonated a monster IED in the road. They were Number 2 in the column and the explosion not only blew their 18-wheeler off the road completely but cut the column off from the lead gun trucks. The rest of the vehicles in the convoy were trapped behind the hole in the road-and it was a daisy. It must have been at least a 250 or 500 lb. MK 82 dud. It plumb messed up  the driver and threw Stuart and his pig clear of the cab. He woke up a few minutes later and dragged his buddy out of the cab which was now almost fully engulfed in flames. And then the shooting began in earnest.

Stuart got a Purple Heart for this. He also got a raging case of TBI with a side of bent brain that never resolved. A week later, he had to report for a toothache and one of his best friends took his place on another convoy. Best Friend was picked off by a sniper and Stuart has been living with that for the last fifty four years. I know exactly how he feels but don’t feel like talking about it any more than he does. It leaves a hole in your mind- the what if… syndrome. The guilt is overwhelming at the time and will never resolve. I’d say whoever says time heals all wounds never was in combat.

So I was appalled over the last five years of repping him that VA just flat out dug in their heels and gave him the bum’s rush every time. No matter what I filed him for, it was always “What part of ‘no’ don’t you get, Graham? I finally was able to get my foot in the door with the TBI by showing these dicks what combat looks like close up. Stuart had pictures of the event.

I edited them and inserted  type-face to identify the  event… and bingo. I resubmitted them as a supplemental claim with a 4138 and VA went back and looked at his STRs. Sure enough, he’d reported to the field aid station for the gash on his head and a ‘scrip for Valium to take the edge off his bent brain. In war, you don’t get to yell Olly Olly In Come Free. Each night begins a new day. All 365 of them.  You strap on the airplane every morning and fly over to kill ’em right back. You get even in your  own mind… until the next friend is KIA. Pretty soon, you quit making friends. Too bad your brain won’t quit making nightmares.

After winning the TBI and headaches, I tackled the Bent Brain syndrome. You’d think with a PH, this would be a cake walk. Well, not exactly at VA. They don’t do cake walking. Apparently, he didn’t measure up. Stuart’s old world. He showered, shaved and put on his good suit to go to the c&p. He dutifully answered all the questions truthfully and tried to rein in his emotions. I get that. Nobody wants to appear like a weak-minded pussy. Men are strong. They don’t cry in public. Or at least those of us who have seen shit we wouldn’t even tell our wives about don’t. The shrink said he had some issues but boy howdy they sure didn’t involve Quan Loi and sent him packing.

Shucks. That flat ass pissed me off. I sought out my specialist psychologist in PTSD and had her do an extensive workup on him in a Zoom call. Sure enough, she dx’d him at 70% and listed a litany of issues the VA shrink blew off as him faking it. That tells me a lot about VA medicine. I’ve spotted this phenomenon frequently. The reason most Vets are denied for PTSD is simple. They dutifully attend these Vet Center Kumbaya meetings and the Kumbayameister with a bunch of initials after his name-none of which say Psy.D- tells you that you have the depressive disorder. You file with it and get the denial that says “Unfortunately, you lack a diagnosis of PTSD.” WTF, over? Your Kumbaya dude already dx’d you with it, right? What happened?

Welcome to the “you can’t get there from here” club. VA has fenced you out unless you want to go off the c&p reservation and get a truly independent opinion from a non-VA expert in bent brains. You will never get that diagnosis once you’ve done the c&p and been identified as someone who has bent brain but it isn’t service connected. They’ll tell you you were abused as a child by your father and that caused it. What the hey? When you had your c&p, they asked you all about your early childhood before military service. You gave them the ammunition to shoot you down.

I can show you a thousand PTSD DBQs that all read the same. “Vet has a megacase of major depressive disorder stemming from events (before) (after) (choose one) service.” With Stuart, I was flummoxed. He had the PH so he should have been a shoo-in.  This is what made it so incredible to see him get shitcannned.

After I filed him this time, the VA pukes came unglued. Sorry Charlie. We don’t accept private IMOs from Vets. It has to be one of our own who decides if he has a psychosis. Well, yes that’s  true. But in the real world of winning VA claims, once they deny you, going off the reservation to get a real independent medical opinion is the only way to win. Why VA raters say otherwise is simple. They have an agenda. If you believe them, you lose. And you’ll keep on losing if you keep sending in “proof” that you have it from folks with MSW, MHS, MHW and about a hundred other cute acronyms which don’t include Psy.D or Ph.D or whatever.

The same thing applies to TBI. You need a neurologist to say you have it. A regular doctor with MD or GP after his name doesn’t have the finesse VA neurologists have to deny you. Besides, you may have sought out one of the doctors on VA’s Shit list of bogus IMO people. In that case, you’re doubly screwed because then you get the moniker “faking TBI” added into your file. Credibility is your currency in trade. You never want to be branded as a fake. That’s one of the biggest claim killers in the book.

Now, the subject line of this blog is important. When your private Psychologist or Psychiatrist does his/her assessment on you after your denial, they get to write up a DBQ . Certain parts of the document are going to be the quintessential elements that determine a) service connection and b) how high you’re rated. VA doesn’t advertise what they are. Shoot. Neither do the shrinks. It’s secret squirrel shit as far as I can tell. So, I’ll take you on a tour of the document. Here’s a 100% rating for an example. This Vet is purely a MDD claim for depression due to his blindness. If he had a TBI comorbidity, it would endorse that, too.

MDD DBQ for A&A

Note that part 3  on  page 3 where I highlighted it. Each box from “no mental disorder” to “total occupational and social impairment” is a percentage. No MDD means denied. Each one after is the rating from 10 to 100.  Now scroll down to page 6 of 8. Note in Section III SYMPTOMS, it says “for VA rating purposes, check all symptoms that apply to the Vet’s diagnosis.” Certain of these symptoms will determine if you get 50, 70 or 100%. In addition, if “intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene” is checked off, it means you need aid and attendance.

I don’t know why others who write VA blogs like mine don’t reveal this information. The VA tells you in §4.130 in haec verba what they use to determine the ratings percentage:

VA PTSD ratings 

100%

Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.

70%

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships.

50%

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.

30%

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).

10%

Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.

0%

A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.

The regulations say you must suffer from some –but not necessarily all- of the symptoms listed for each ratings % in order to receive that ratings %. See? That wasn’t so hard. But be forewarned that you aren’t going to get away with blowing smoke up the psychologist’s butt. They have many ways of cross-testing you as a quality control check to weed out the fakers.

And now for the clincher. When I have a private psychologist do my IMOs for my client, I ask them to include a synopsis on what his or her employment future looks like based on the diagnosis. Can s/he still work? Can they function well enough to sell time-share condos from their own living rooms and make $12,000 bucks a month in a sedentary physical work environment?   Or might they be prone to explode and to tell a potential customer to f— off and die because they (the potential customer) didn’t want to buy the condo?

By prepositioning this information into the IMO, you solve the next problem. If your Vet is only 70%, VA isn’t going to get all warm and fuzzy and grant TDIU. They’ll say he has a dynamite future in real estate and can still work. With Stuart, I had my psych add in what appeared to be an innocuous statement saying  he was trained in welding and did that for 30 years. Then his significant other came down with cancer so he switched over to the role of caregiver until she died. And, outside of that, his employment potential was now nil.

When I got back from DC and Orlando, I had the HLR informal conference with a 22-year retired Vet and DRO. He said he just didn’t see enough in the file to warrant TDIU. I pointed to my Psych’s comment saying he was never going to get rich in real estate. Bingo. TDIU. Of course, the Purple Heart didn’t hurt nor did the TBI shit.

redact RD 4.26.23

redact Code sheet 4.26.23

I use this technique with other IMOs where I ask the IMO author to opine on other residuals of a disease like Hepatitis C. Those of us who were early users of Interferon come down frequently with DM II and a host of other shit. I have the author connect these to the disease  process and then file later for them and reuse the IMO a second time.

I don’t charge for my knowledge. I don’t monetize this game. I help Vets-just like they’d help me if the shoe was on the other foot. Welcome home Stuart. I’m sorry it took so long. And that’s all I’m gonna say about that.

P.S. Resident 51st Inf. LRRP Edd sent me this. Ouch.