Tuesday, November 02, 2010

I Wanted My Brain Back using VA system

I Wanted My Brain Back”
What happens when you’re a PhD economist and you suddenly can’t remember things or think straight? One woman’s story of perseverance reveals some of the mysteries of the brain.

By Sherri Dalphonse Published Thursday, March 01, 2007

It was a beautiful June Saturday afternoon. Anne Forrest steered her white Acura onto Memorial Bridge. The Lincoln Memorial rose before her.

Back from a business trip to Panama, Anne had picked up her cat from a colleague at the Environmental Law Institute, a nonprofit where she worked as an economist.

After crossing the bridge, she bore right at the Lincoln Memorial and dropped down toward Rock Creek Parkway. She craned her head to the left, watching for her chance to merge onto the parkway.

As Anne waited, a woman in an SUV hit her from behind. Both drivers got out to inspect the damage—Anne’s car had a dent in the back—and exchange information. A Park Police officer took an accident report. Anne felt shaken but looked fine; she got in her Acura and drove on.

“Who knew?” she says. “But that changed my entire life.”

The next day, June 15, 1997, Anne went to the Texas State Society Father’s Day picnic with Michael Crider, a man she was dating. Both Anne and Michael had grown up in Texas. One of their first dates, a year earlier, had been at this annual event.

Anne spent part of the picnic on the phone, trying to resolve a problem at work, but couldn’t grasp what her boss was saying.

Early Monday morning, she woke up feeling cold, nauseated, and with “the worst headache I have ever had.” At work, Anne would start to dial a phone number but couldn’t get through all the digits. She told colleagues about her accident and her headache. They urged her to see a doctor.

The primary-care physician thought Anne had whiplash. He wanted to see her twice a week to keep her under observation.

Two weeks later, Anne was on I-270, driving to church, when her right foot and right arm went numb.

“That was my wake-up call,” she says.

Neurologist Lewis Eberly diagnosed it as a mild traumatic brain injury.

When Anne’s car was rear-ended, it started a chain reaction in her head. The brain is made up of millions of nerve cells connected by fibers called axons. When Anne’s head was thrust from side to side and front to back, some axons—which carry messages between brain cells—were torn or twisted.

Traumatic brain injury has been called a “silent epidemic.” Each year, the Centers for Disease Control and Prevention say, 1.4 million Americans sustain a traumatic brain injury, or TBI—often in car accidents, falls, or sports mishaps. Experts believe the number of TBIs is higher because the estimate reflects only emergency-room visits, and many patients never go to a hospital.

Three-quarters of cases are concussions or mild brain injuries. “Mild” means the patient was never unconscious or wasn’t unconscious for a long time. The results can be anything but mild.

If brain injury is an “epidemic,” why is it a silent one? “Because many of us have sustained a concussion, and two-thirds of individuals who sustain a concussion are back to normal by three months,” says Gregory O’Shanick, medical director for the Brain Injury Association of America.

But many who sustain a head injury have problems remembering things and concentrating. Accidents can be so minor that neither doctor nor patient makes the connection. Your teenage son is having difficulty at school? Must be inattention, not that hockey injury. You’re 50 and forgetting things? Must be age, not that fall off a bicycle months ago.


Unless a veteran comes to medical facility bloody. Most PCP will not send patient/vet
for neuro exam and assume the damage is done.

Capacity to manage financial affairs
Mental competency, for VA benefits purposes, refers only to the ability of the veteran to manage VA benefit payments in his or her own best interest, and not to any other subject. Mental incompetency, for VA benefits purposes, means that the veteran, because of injury or disease, is not capable of managing benefit payments in his or her best interest. In order to assist raters in making a legal determination as to competency, please address the following:

a.What is the impact of injury or disease on the veteran's ability to manage his or her financial affairs, including consideration of such things as knowing the amount of his or her VA benefit payment, knowing the amounts and types of bills owed monthly, and handling the payment prudently? Does the veteran handle the money and pay the bills himself or herself?

b.Based on your examination, do you believe that the veteran is capable of managing his or her financial affairs? Please provide examples to support your conclusion. If you believe a Social Work Service assessment is needed before you can give your opinion on the veteran's ability to manage his or her financial affairs,


Overlap in the symptoms of residual effects of concussion, PTSD, depression, and chronic pain is well recognized and is the rationale for an interdisciplinary approach. The majority of veterans who are screened have been determined not to have BI, yet many have symptoms that are evaluated and treated — according to clinical practice guidelines developed by a panel of experts, including Hoge.2 Mental health services are integrated into these programs, and patient education regarding an expected positive outcome is a cornerstone intervention.

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