1. Traumatic Brain Injuries Texas Veterans Commission Abel Guevara & Robert Pantoja Spring 2009

2. Definition and Causes of TBI • TBI definition • Leading causes of TBI

3. Incidence of TBI • Number being compensated • Number from Iraq and Afghanistan • Number of combat-related TBIs • Symptoms following TBI

4. Anoxic Brain Injury • Definition of Anoxic Brain Injury • Anoxic brain injury and the Rating Schedule, • Analogous rating of TBI

5. Minimum evaluation (VA) • Minimum ratings, • Improvement following TBI.

6. Instrumental Activities of Daily Living • Definition of Activities of Daily Living for TBI • Definition of Activities of Daily Living for A&A • Assessment of TBI residuals

7. Duty to Assist (VA) • Evidence of record, • Types of evidence, • Neuropsychological testing

8. Apraxia • Definition of Apraxia • Effect on brain, • Testing for apraxia, • Separate neurological evaluations.

9. Three areas of dysfunction • Cognitive, • Emotional/behavioral, • Physical (including neurological)

10. 1. Cognitive Impairment • Signs • Executive functions of the brain • Rating procedures

11. Eval. of Cognitive Impairment and subjective symptoms (VA) • DC 8045 • Each facet contains criteria for assigning a level of impairment for each facet as appropriate • Levels of impairment • Assign a 100% evaluation • Overall Evaluation

12. 2. Emotional/behavioral Dysfunction • Evaluating Emotional/behavioral, • Absence of a a mental disorder, • Rating Note, • Overall evaluation.

13. 3. Physical and Neurological Impairment • Evaluation of physical (including neurological) dysfunctions

14. Other conditions identified • Other rating concerns….

15. Mild, Moderate and Severe • TBI classifications

16. Practical Exercise GWOT veteran with history of two TBI in Iraq due to IED explosions. He does have a current diagnosis of post traumatic stress disorder. History on VAE was passenger in a vehicle hit by IED, LOC for about 10 minutes. Reports second TBI with LOC for 20 minutes. Complaints include headaches, described as migraines. He is able to work as long as he takes medication. Headaches occur four times A day and last 5 minutes. He denies numbness, burning, weakness or paralysis. He complains of fatigue, sleep disturbance, restlessness, and Confusion when attempting to perform more than one task at a time. He complains of memory problems, slowness of thought process, Concentration and attention problems. He says blurry vision makes Reading difficult. He says he has hearing loss, anxiety and is Hypersensitive to sound. He does not report difficulty understanding directions, problems with smell Or taste. He does not report sensitivity to light or general discomfort and pain.

17. He complains of dizziness about five times per day. He does not Have vertigo or seizures. He is able to brush his teeth, take showers, vacuum, drive, climb Stairs, dress himself, cook and take out the trash Objective findings on the exam show normal cranial nerve exam Normal coordination, normal motor and sensory exam. There is no peripheral nerve involvement. He displayed concentration difficulties. His orientation was normal His attention was normal. He displayed mild memory loss – cannot Remember names, directions or recent events. Diagnosis: Migraine Headaches associated with TBI Memory and Concentration difficulties on exam associated with TBI. STRs provide NP exam results. Diagnosis of Depressive Disorder, PTSD, Explosive Disorder, Primary Insomnia. Adjustment Disorder. History of TBI in childhood (no residuals) and TBI twice in Iraq with LOC from both.

18. Questions

19. Handouts • TBI PowerPoint • Glossary of Terms • VA Fast Letters 08-34 and 08-36 • Traumatic Brain Injury ~ Quick Guide • VA News Release September 23, 2008 • VBAs Traumatic Injury Protection (TSGLI) Program • Frequently Asked Questions about TSGLI