Brain Injury Pension Decisions
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dunlop303 said:
Your Official Decision will contain some basic information, including the Medical Impairment rating they've awarded; the Quality of Life level awarded; and the medical evidence they reviewed in preparing their decision.
Because of the complexity of TBIs, it could be assessed under either Chapter 19 or Chapter 20 of the Table of Disabilities (http://www.veterans.gc.ca/pdf/dispen/tod2006/tod_total_2006.pdf).
Instead of guessing which one they used, once you get your decision, you can request a copy of the Assessment Worksheet, which the Department used to breakdown and calculate your assessment. You can request this by contacting the Department or the Bureau of Pensions Advocates. This is information in YOUR file. Do not hesitate to ask for it, it's your right.
If it wasn't for ATIP rules, I could print it for you, but alas
Also, I just found this. Not sure if it's helpful, but hoping it is:
http://www.veterans.gc.ca/pdf/about-us/research-directorate/mtbi-report-sep08.pdf
http://www.veterans.gc.ca/eng/news/salute/article/398
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These are great resources thank again!
I have not read / found that paper yet either, very interesting to see what level of understanding the medical community is at on TBI.
I'll definitely request the breakdown, something seems a little off even if the rating was confined to one of the two chapters you mentioned below.
My original estimate was based on chapter 17, since most of the symptoms of my injury are physiological. But I can understand having to rate it within the actual injuries section.
Like you said though, since TBI is so complex and its impacts so inconsistent im not sure it fits into a specific box. I would think, once the injury is established as credible, assess via the symptoms.
Ex, as Towards the Gap mentioned his symptoms are psychiatric. I don't believe I have those types of symptoms from this injury, but more physical. ect.
Either way thanks again for the help, its really appreciated.
I have not read / found that paper yet either, very interesting to see what level of understanding the medical community is at on TBI.
I'll definitely request the breakdown, something seems a little off even if the rating was confined to one of the two chapters you mentioned below.
My original estimate was based on chapter 17, since most of the symptoms of my injury are physiological. But I can understand having to rate it within the actual injuries section.
Like you said though, since TBI is so complex and its impacts so inconsistent im not sure it fits into a specific box. I would think, once the injury is established as credible, assess via the symptoms.
Ex, as Towards the Gap mentioned his symptoms are psychiatric. I don't believe I have those types of symptoms from this injury, but more physical. ect.
Either way thanks again for the help, its really appreciated.
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The adjudicators may have also used the General Assessment table...which, not to confuse things, but isn't actually a Table in existence in the Table of Disabilities. It's used to assess as best and fairly as possible those medical conditions which don't fit perfectly into one specific box (chapter). We'll leave that possibility for another time
The assessment of any condition is based on the symptoms. The hardest, in my book, to assess are psychiatric conditions, because so much of the symptomology is subjective - what the patient feels/sees/reacts to. The easiest are musculoskeletal, as we're usually talking about something measurable, like range of motion.
Because a TBI is considered neurological, it would fall under Chapter 20. When there are effects on physical limitations, that's when Chapter 17 or 19 would be used, per the following instructions to Chapter 20, quote:
"• Impairment from brain injury or disease affecting the upper limbs only or the lower limbs only (but not both) is rated within Chapter 17, Musculoskeletal Impairment.")
and
"• Impairment from brain injury or disease resulting only in both upper and lower limb effects is rated within Chapter 19, Activities of Daily Living."
The assessment of any condition is based on the symptoms. The hardest, in my book, to assess are psychiatric conditions, because so much of the symptomology is subjective - what the patient feels/sees/reacts to. The easiest are musculoskeletal, as we're usually talking about something measurable, like range of motion.
Because a TBI is considered neurological, it would fall under Chapter 20. When there are effects on physical limitations, that's when Chapter 17 or 19 would be used, per the following instructions to Chapter 20, quote:
"• Impairment from brain injury or disease affecting the upper limbs only or the lower limbs only (but not both) is rated within Chapter 17, Musculoskeletal Impairment.")
and
"• Impairment from brain injury or disease resulting only in both upper and lower limb effects is rated within Chapter 19, Activities of Daily Living."
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dunlop303 said:
That's why you've got me! ;D
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One other thing I don't understand, why is Intractable pain only worth %13 in chapter 19 vs. %34 in chapter 17?
Its odd, because the Intractable pain my Dr. identified on the medical form was upper body. Everything else is mostly numbness on the majority of the left side.
Oh, and some strength loss on left side.
Its odd, because the Intractable pain my Dr. identified on the medical form was upper body. Everything else is mostly numbness on the majority of the left side.
Oh, and some strength loss on left side.
Towards_the_gap
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And for some depressing reading:
http://www.nationalgeographic.com/healing-soldiers/blast-force.html
http://www.nationalgeographic.com/healing-soldiers/blast-force.html
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dunlop303 said:
I would only be hazarding a guess, as I've only dealt with one Chapter 19 assessment since the 2006 Edition came on line. I'll see what I can find out.
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dunlop303, so sorry it took so long to get you an answer.
I got a response back from one of the doctors as to why there are two medical impairment ratings for intractable pain, in two different chapters of the 2006 Edition of the Table of Disabilities.
To summarize, the medical impairment rating of 34 for intractable pain contained within Chapter 17 - Musculoskeletal Impairment is used to rate musculoskeletal conditions which cause pain in one region; for example, pain from disc disease of the lumbar spine.
This is the only medical impairment rating used in determining the disability assessment.
The medical impairment rating of 13 provided for intractable pain in Table 19.7 - Other Impairment - Chronic Pain is not the only medical impairment rating provided for painful conditions assessed in Chapter 19 - Impairment in Activities of Daily Living.
Conditions assessed in Chapter 19 have pain located in more than one region; for example, a condition such as rheumatoid arthritis.
These "Chapter 19" conditions are rated using all seven of the tables in the chapter, Table 19.1 to Table 19.7. Each table is meant to capture a different aspect of the impairments suffered by the patient in performing of self-care and activities of daily living due to the condition (the description of what is assessed is included in the table's "title". Impairment due to pain would also be assessed in these seven tables. The medical impairment ratings from each of these seven tables are added then together, and one total medical impairment rating is awarded for the overall disability due to the medical condition.
Does this help?
I got a response back from one of the doctors as to why there are two medical impairment ratings for intractable pain, in two different chapters of the 2006 Edition of the Table of Disabilities.
To summarize, the medical impairment rating of 34 for intractable pain contained within Chapter 17 - Musculoskeletal Impairment is used to rate musculoskeletal conditions which cause pain in one region; for example, pain from disc disease of the lumbar spine.
This is the only medical impairment rating used in determining the disability assessment.
The medical impairment rating of 13 provided for intractable pain in Table 19.7 - Other Impairment - Chronic Pain is not the only medical impairment rating provided for painful conditions assessed in Chapter 19 - Impairment in Activities of Daily Living.
Conditions assessed in Chapter 19 have pain located in more than one region; for example, a condition such as rheumatoid arthritis.
These "Chapter 19" conditions are rated using all seven of the tables in the chapter, Table 19.1 to Table 19.7. Each table is meant to capture a different aspect of the impairments suffered by the patient in performing of self-care and activities of daily living due to the condition (the description of what is assessed is included in the table's "title". Impairment due to pain would also be assessed in these seven tables. The medical impairment ratings from each of these seven tables are added then together, and one total medical impairment rating is awarded for the overall disability due to the medical condition.
Does this help?
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