I’m looking for some advice or insight from anyone who has dealt with a similar VA/TBI claim situation.
I’m looking for some advice or insight from anyone who has dealt with a similar VA/TBI claim situation.
I separated from service in 2020 and filed my Intent to File that same year. My VSO submitted a claim for TBI after I was diagnosed through a C&P exam and the VA acknowledged it as service connected. Before that, my symptoms had mostly been brushed off as migraines. The original claim was denied because they said there was no treatment record or nexus.
Fast forward to now: last year my supplemental claim was denied, so I filed for a Higher-Level Review (HLR). The HLR reviewer immediately found a duty-to-assist error. We had an informal conference call, and she pointed out that my records clearly contained a diagnosis, nexus, and supporting documentation. She also noted that the VA failed to provide the proper initial C&P exam, which likely would have resolved this years ago.
The claim then got sent back for further development and turned into a new supplemental claim. I was scheduled for another C&P exam, but the VA’s instructions to the examiner specifically stated that the purpose was only to evaluate the residuals/impact of the already-established TBI diagnosis — not to determine whether I had a TBI in the first place.
Because I don’t fully trust the process at this point, I submitted a FOIA request for the exam results. The examiner ended up giving a medical opinion saying I do NOT have a TBI, despite the existing diagnosis already being in my records. They also failed to check boxes related to residuals. Needless to say, I was furious.
I contacted the HLR reviewer again and explained what happened. She told me this kind of thing unfortunately happens more often than people realize. She looked at my file and saw that another exam request had already been scheduled through ACE review. Since then, four more C&P-related documents have been uploaded to my claim.
The HLR reviewer also told me that if the claim is granted, I should be entitled to back pay dating back to my 2020 Intent to File. My biggest concern is that someone is going to intentionally or carelessly derail this claim to avoid that payout.
I know nothing is guaranteed, but has anyone gone through something similar with TBI claims, bad C&P exams, or HLR corrections? Did the VA eventually correct it? Any advice or experiences would really help.