Was your TBI claim denied between 2007 and 2015?
Were you 1) evaluated for a traumatic brain injury (TBI) at a VA Medical Center between 2007 and 2015, and, 2) evaluated by an examiner who was not one of the following specialists – a psychiatrist, physiatrist, neurosurgeon or neurologist? If so, you are entitled to another TBI exam performed by one of those four specialists and VA will reprocess your TBI claim.
Note: This special review of prior TBI claims applies to mild TBIs (a.k.a. concussions) as well as to moderate and severe TBIs. It also applies to prior claims for the residuals of a TBI.
Why will VA do this?
In 2007, VA began requiring that initial TBI exams be performed by specialists familiar with the often complicated diagnosis of TBI. Specifically, the exams had to be performed by a psychiatrist, physiatrist, neurosurgeon or neurologist.
As early as late 2007, media reports emerged that claimed that unqualified doctors were conducting C&P Exams for veterans’ TBI claims. Veterans were being misdiagnosed and their TBI claims were being denied.
After initially trying to cover up the scandal, VA ordered an internal review of TBI examinations. Investigators found that the 2007 regulations were not being followed at hundreds of VA Medical Centers. As a result, nearly 25,000 veterans were examined for TBI by unqualified medical professionals between 2007 and 2015.
These findings prompted former Secretary of Veterans Affairs Bob McDonald to grant “equitable relief” to the veterans who had not been examined by qualified specialists. That is, the Secretary made a special exception that allowed these veterans to be re-examined for TBI and have their TBI disability claims reprocessed by their VA Regional Office.
Time is Running Out
VA will allow veterans to submit their claims for reprocessing one year from the date of the VA letter notifying them that they can reprocess the claim. Our findings suggest that most letters were sent out in July of 2016. That leaves only a few months until the cutoff in July 2017. If you received a notification letter from VA, you should use the date of that letter to calculate your deadline. If you did not receive a letter or do not still have it in your possession, you can call your VA Regional Office to find out if you are eligible for reprocessing.
How to Request Reprocessing
You do not need to submit a new claim for TBI. Rather, you should call or submit a written request to your VA Regional Office. If you submit a written request, make sure you specifically state “I am requesting reprocessing under VA’s special TBI review.”
Upon receiving your request, VA will schedule you for a new TBI exam with an appropriate specialist. Once the exam report is completed, VA will reevaluate your prior TBI claim. You can also submit copies of medical evidence from your private physicians for consideration as part of this review.
Exam Tip: If you are having trouble with memory or focus because of your TBI, write down a list of your symptoms before you go to the C&P Exam. Exams can be as short as 5 minutes and VA tends to put more weight on C&P Exams than other medical records.
Warning: VA May Reduce Your TBI Disability Rating
If you were already granted service connection for your traumatic brain injury (and were not examined by one of the four designated specialists at your C&P Exam), you can still get a re-examination. However, you should be aware that VA has reserved the right to potentially reduce your disability rating if they find that your symptoms are not as severe. That is, you are not guaranteed a better rating following your re-examination.
If, after your re-examination, you are granted service connection or an increased rating, you may be entitled to retroactive compensation for your TBI disability. VA is allowed to award an effective date as far back as the date of the original TBI claim. You are entitled to any compensation you would have received starting at the effective date and therefore may be provided retroactive benefits if and when your claim is granted.
If you’re not sure whether your VA examiner was a designated specialist or not, check out our post on C&P Exams to learn how to request a copy of your exam and get your examiner’s name.
For here for more information about TBI claim denials.