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THE NOGGIN

Brain Injury Alliance of Arizona Newsletter

The Brain Injury Alliance of Arizona (BIAAZ) is a nonprofit organization dedicated to preventing brain

injuries and to improving the lives of individuals with brain injuries through prevention, education,

information, and community support.

August 2015 Vol. 1 Issue

Surviving and thriving Jason Taylor’s incredible recovery from a gunshot wound to the head

Jason Taylor is a medical anomaly. His recovery from a close-range gunshot to the back of his head into a high-functioning traumatic brain injury (TBI) survivor is, by any standard, remarkable.

The American Association of Neuro-logical Surgeons estimates over 90 percent of people who experience close-range gunshot wounds to the head die, so it’s not surprising that Jason’s neurosurgeon, Dr. Paul LePrade, called Jason a “miracle” in Arizona Foothills magazine.

But Jason’s recovery journey mirrors those of brain injury survivors the world over. His current ability to walk, talk, and work were earned with hard work, sacrifice and some very humbling moments.

Defying logic

Jason was shot by Jeremiah Pulaski, a 24-year-old Army veteran who po-lice believe had extreme post-traumatic stress syndrome, or PTSD. The incident occurred outside a Glen-dale bar just past midnight on March 25, 2011, at the tail end of Jason and his wife Mandy’s date night. It had been a good night for the young parents, who left their 18-month-old daughter home with a sitter. After enjoying a surprise gift of courtside seats to a Phoenix Suns game, the couple met Jason’s cousin at a bar to watch a mutual friend perform in a band.

Since they’d both had drinks Jason called a cab to take them home. After about 15 minutes Jason went out onto the sidewalk to see if it had arrived. Two men nearby were discussing the military and Jason casually speculated aloud that he would probably have joined the Marines as a young man.

Jeremiah, who had possibly mixed alcohol with PTSD medication, shot Jason in the back of the head without warning, got on his motorcycle and fled.

He died later that night in a firefight with police in which no police were harmed. The hollow-point bullet exploded in Jason’s cerebellum. He immediately crumpled onto the sidewalk.

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In this Issue

For Jason Taylor, surviving a gunshot wound to the head was just the beginning

BIAAZ’s Dawn Buri brings the Surprise Squad to DES

Resource facilitation: how BIAAZ helps brain injury survivors and caregivers

Legal: Brenda Hamil-ton explains why “mild” TBI is a misnomer

Rehab Ready: Reha-bilitation specialist Ron Leebove

Riding safe: AMSAF and helmet safety

Social Security: The basics of applying

Interview with a survivor: Margaret Barr

Jason Taylor, who survived a

gunshot wound to the back of his

head, with his two daughters,

Alivia, 7 and baby Mia.

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From

Executive

Director Carrie

Collins-Fadell In this month’s edition of The Noggin, you’ll have a chance to get to know the Brain Injury Alliance of Arizona, and what we do, a little bit better. One article features the amazing work of Jeanne Anderson, our resource facilitation manager. Jeanne started our information and support referral out of her home over twenty years ago. Since then, it’s grown into the cor-nerstone of what BIAAZ stands for and why it exists. The program’s history and how the team works, every day, to connect brain injury survivors and caregivers to much-needed re-sources is an inspiring story that proves just how much a handful of caring individuals can achieve. The program has grown into a four-person staff with bilingual services and stands ready to help the over 50,000 Arizona residents who will suffer a brain injury this year. You will also hear the amazing story of Jason Taylor’s recovery journey after a gun shot to the head left his life hanging by a thread. Though his survival is statistically miraculous, his recov-ery challenges will resonate with many of our survivor members. And you’ll get a behind-the-scenes look at how Dawn Buri, BIAAZ’s data manger, brought the Surprise Squad to the Disability Empowerment Center so a fellow DEC worker could get a $25,000 dental makeover. It’s just another example of BIAAZ employees going above and be-yond to help others. We’ve looked to some of our amazing partners in the community to give some practical advice on rehab and social security. This month’s legal issues section, the Gavel, examines why the term “mild TBI” is misleading in terms of its impact on a survivor’s life and how the misnomer can make dealing with insurance companies challenging. Though things tend to slow down in the summer, here at BIAAZ we’re looking ahead to plenty of classes and activities that benefit our community members. We are excited to collaborate with the Phoenix Center for the Arts and invite you to delve into ceramics and theater in pursuit of a well-rounded healthy life. This month’s Professional Network Meeting is an information session on the Americans with Disabilities Act. Turning 25 this year, the ADA impacts all of us because when we all have equal access, we all enjoy life more. In Tucson we are gearing up for Fun and Fit Tucson next month. It’s always been a popular event in Phoenix and is just one way we’re working to expand our statewide reach to every cor-ner of Arizona. This is a community event where trainers will work with individuals who have a brain injury learn about exercises and movements they can do at home.

Carrie Collins-Fadell

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Continued from page 1…

The paramedics who responded to the scene were so certain Jason would-n’t make it they called ahead to an organ donation facility and told them to prepare to receive a large batch of organs.

But Jason didn’t die that night. Instead, he fell into a seven-day concussive coma. Since the rest of Jason’s brain appeared undamaged, Dr. LePrade expected Jason to survive. That was the good news.

The bad news was that the cerebellum controls balance, memory, speech and coordination. So when Jason emerged from over three hours of sur-gery the question was not if there would be long-term, permanent impacts of his injury, but how bad those impacts would be.

His own agenda

Jason awoke from the coma unable to do anything more than write on a white board with one hand. He couldn’t move, talk, eat or even breathe on his own. His love for football and the Arizona Cardinals, however, re-mained perfectly intact. Upon waking, one of the first things Jason wrote was a reminder to make the payment for his Cardinals season tickets.

Despite this heartening rally, throughout his recovery some physicians expected Jason’s rehabilitation to be limited. Some even doubted he would ever leave his wheelchair.

Jason, however, refused to accept that. As far as he was concerned, it was just a matter of hard work to getting back to his pre-injury self.

“First and foremost was knowing my job, and knowing what I had to do,” Jason said. “I had a strong idea…of what I wanted to accomplish and where I wanted to go.”

It was a long road back to where he had been. In terms of even the most basic body functioning, Jason was starting from scratch. He had to relearn everything, including automatic functions like how to breathe while eat-ing. But slowly and arduously, Jason began to prove the doctors wrong.

To his family, physicians and nurses, Jason’s progress was astounding. To Jason, it was all part of a process.

“Where I wanted to get back to, it differed from everyone else,” Jason said. “For everybody else, my end result, it already happened, I was alive,” Jason said.

Jason worked hard and, over the course of many months, slowly but surely progressed from a hospital bed to a wheelchair to a gait belt, eventually re-learning to walk.

Amidst his therapists’ and loved ones’ amazement and joy, however, Jason grew increasingly frustrated.

As far as he was concerned, his laborious progress was inadequate and slow.

Turning point

A few times before their physical therapy session,

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Over the past twenty years, the number of head injuries caused by gunshot wounds has increased, according to the American Association of Neurological Surgeons. They are now the leading cause of traumatic brain injury in many urban areas.

Of those with gunshot wound TBIs, self-inflicted wounds from attempted suicide gener-ally have a poorer prognosis than those who are shot acci-dentally or in an assault.

By the Numbers:

Of all TBIs, about 12 per-cent are related to firearms. For people ages 25-34, fire-arms are the leading cause of TBIs.

Of people who die from TBIs, 35 percent suffered from gunshot wound head trauma.

Ninety percent of people shot in the head die, often before the victim is even brought to the hospital.

Of those who do make it to the emergency room, 50 per-cent (half of them) will die in the emergency room.

Out of those fortunate enough to survive a gunshot wound to the head, 50 per-cent will suffer seizures for the rest of their life. Many will be severely disabled, physi-cally and cognitively.

Jason and his wife, Mandy, carrying the Cardi-

nals flag at the 2011 season opener. Photo

courtesy of the Arizona Cardinals.

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Continued from page 3…

Rachel Dorsey, Jason’s physical therapist at Rehab Without Walls, asked Jason how hard he wanted to work that day.

“I would tell her, ‘I want you to work me so hard I want you to have to get a drink of water,’” Jason said. “Because in my mind that was the only way I was going to get back to where I wanted to get back to.”

And Jason did work that hard, giving his all every day. Yet still Jason chafed under what he per-ceived as the slow progress of his recovery.

One day, Rachel noticed Jason seemed discouraged, unusual for him. When she asked what was wrong, Jason said, “The Jason Taylor before would be doing much better.”

Rachel responded with some tough love, bluntly serving Jason a dose cold, hard of perspective.

“She stopped me and said, ‘Listen that Jason Taylor before March 25, 2011 died. He’s dead, he’s gone,’” Jason said.

Rachel told Jason to stop comparing himself to his pre-accident self and instead compare himself to who he was since the day he got shot. From that starting line, Rachel pointed out, Jason was a “medical oddity” that was “doing phenomenal.”

The physical therapist reminded Jason to find the joy in the abilities he did have, skills that gave him a level of independence no one had expected him to regain.

The idea that the old Jason was gone forever struck him deeply and gave him pause.

“That was tough to hear,” Jason said.

Ultimately, he said the conversation just “pushed me to work even harder.”

The conversation helped shift Jason’s perspective, but it didn’t keep him from working to achieve high goals he set for himself.

As he re-learned how to speak, Jason was convinced he wasn’t improving, even though several speech therapists assured him he spoke clearly. He had spent the last several years as a public speaker and recruiter for Brown Mackie College, so the idea that he didn’t enunciate clearly grated on him.

“One of the most difficult [things] I had to overcome was what I heard, and what I heard was slur-ring,” Jason said.

Despite professional reassurances, Jason wasn’t satisfied.

Fortunately, Michael Bidwell, the Cardinals team president, heard of Jason’s devotion to the team and offered him an internship opportunity with the team.

As part of his outpatient rehabilitation program, Jason called season ticket holders to answer any questions, address issues and give them updates on the team.

Sarah Homan, Jason’s vocational therapist at Rehab Without Walls, would record Jason speaking on the phone and they, along with a speech therapist, would break his parts of the conversation down piece by piece and work on his speech.

Family Matters: A high price to pay

Jason’s physical and cognitive therapy were going better than anyone (except perhaps himself) ex-pected, but the shooting took a toll on his family even Jason’s determination couldn’t fix.

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Brain injury often introduces survivors and caregivers to a new array of health care providers

who specialize in brain injury. Some of the specialties may be completely unknown or confusing

to caregivers looking to find the right care for a survivor. For example, we’ve all heard of an oph-

thalmologist, but how is a neuro-ophthalmologist different? The Brain Injury Alliance of Arizona

offers referral services to help people navigate these sometimes overwhelming choices. Here in

The Noggin, each month we’ll feature a brain injury specialist and explain what they do and the

role they play in the recovery process.

Ron Leebove, Rehabilitation Specialist Brain injury survivors often face a litany of medical issues stemming from their injury, necessitat-ing numerous appointments with many different specialists. Additionally, a survivor may be go-ing through the judicial system as well and, frequently, facing financial uncertainty due to an inability to work or, post-treatment, return to their former job.

It’s a lot for any survivor or caregiver to navigate, but that’s where a certified rehabilitation spe-cialist comes in. They can help coordinate medical care and facilitate connecting brain injury survivors and caregivers with necessary resources.

As a certified independent rehabilitation specialist with over 25 years of experience, Ron Leebove helps brain injury survivors identify quality of life issues, navigate bureaucracy, coordi-

nate medical care and regain whatever measure of independence may be possible.

Ron is not an advocate per se, however. When he assesses a survivor and determines what, if any, recommendation he will make to an agency, he maintains objectivity at all times.

As an independent rehabilitation specialist, Ron does not work for an insurance company. Insurance companies may provide rehabilitation specialists to their clients, but caregivers and survivors should be mindful of the fact that an insurance compa-ny’s rehabilitation specialist will have their company’s best interests at heart as well as the client’s. That doesn’t mean they won’t provide quality, useful service, but it is worth remembering when assessing any recommendations an insurance-employed specialist may make.

There’s no right or wrong time to reach out to a rehabilitation specialist. Brain injury survivors call Ron at different times dur-ing the recovery process for a variety reasons.

Immediately after someone sustains a head injury, Ron focuses on pursuing the best medical care possible for the survivor. That includes going to doctor appointments with the survivor and helping to articulate the survivor’s needs to the health care team.

“Many patients are really not able to go to appointments on their own,” Ron said. “They don’t know what to say to the doctor, the doctor doesn’t spend time with the patient…so I’m there as a person to speak for that person if they want me to.”

This includes articulating the survivor’s symptoms, requesting records, asking for a referral and obtaining documentation.

“I want this to be a team approach,” Ron said. “And I anchor this team to help get things done for that patient.”

As much as possible, Ron develops a relationship with his client’s family and helps educate families about giving the survivor the support he or she needs.

Ron also assists survivors after medical treatment has been completed.

Survivors may have a difficult time finding employment, be unsatisfied with the medical treatment they’re getting, or have vision issues. Friends and family members may contact Ron post-treatment when there are difficulties getting acclimated to changes brought on by the head injury.

“Then there are some survivors, they’re recovered, but they don’t know what kind of work they can do, they don’t know where to look,” Ron said. “That’s the vocational aspect of the program.”

Or, a survivor may not be able to work and needs to apply for Social Security, a daunting process even for caregivers without a brain injury. The majority of rejected Social Security claims occur because paperwork is missing or filled out incorrectly. Ron often helps clients or caregivers submit a complete application file and ensures his client’s case file paperwork is filled out properly. Attorneys may call Ron to have him coordinate a client’s medical care while their case is moving through court.

What Ron can or can’t do for clients will vary based on each individual person, but an independent rehabilitation specialist can make all the difference in how successful a brain injury survivor’s recovery process and transition to post-injury life are.

Ron Leebove, CRC, DABFC

Ron is certified by the Com-

mission of Rehabilitation

Counselor Certification. He

is a Diplomate of the Ameri-

can Board of Forensic Coun-

selors

Rehab Ready

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Connections that count:

BIAAZ’s resource facilitation program helps survivors & caregivers

navigate life post-injury

Few things impact a brain injury survivor’s life more than access to the right service, agency or organization. Once a survivor is discharged from the hospital, the right resources are crucial in helping survivors and caregivers learn to navigate a new normal. Connecting members of the brain injury community to those resources is a core service the Brain Injury Alliance of Arizona provides.

“We’ve had some say, ‘I never knew you were here, I wish I knew about you seven years ago when I had my injury,’” Jeanne Anderson, BIAAZ’s resource facilitation manager, said.

The term resource facilitation may have ominous bureaucratic overtones, but the formal name doesn’t convey the caring, personal attention BIAAZ staff members give anyone who needs the service.

BIAAZ staff understand, sometimes from personal experience, how the aftermath of a brain injury manifests differently for every survivor. They know even if two people are injured in the same part of the brain, aside from similar general symptoms, the injuries will manifest in ways as unique as fingerprints.

That’s why resource facilitation always begins with a conversation, usually over the phone, though sometimes through an email.

“We prefer a personal conversation, to hear about their whole situation and then determine the personal needs of each indi-vidual,” Jeanne said.

After obtaining basic background information, such as what kind of injury a survivor has, how long it’s been since an accident occurred and what, if any, post-accident therapy has been received, the BIAAZ staffer will make suggestions as to what facili-ties, agencies or services the caller may benefit from.

Callers aren’t always survivors, either. In many instances, concerned or frustrated family members or caregivers, facing changed behavior from the survivor, call BIAAZ. Many are not even sure what to ask.

“Sometimes they see what’s happening but the survivor doesn’t see it,” Jeanne said. “The survivor’s behavior can be confus-ing, but we can validate that their impressions are genuine, that they aren’t imagining this.”

Behavioral changes that stem from brain injury usually become apparent after the dust of the initial injury-causing incident has settled, when the survivor has returned home and attempts to get back to their old routines.

Continued on page 9...

The Brain Injury Alliance of Arizona’s resource facilitation staff. Top, from left to right: Jeanne Anderson and Courtney Carver. Bottom, left to right: Janice Podzimek and Anna Badilla-Edwards.

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First, Jason estimates about 90 percent of his memories of anything prior to the accident was com-pletely erased, including his own childhood. The loss of his personal history didn’t bother him so much, but not having any early memories of his baby daughter’s life was devastating.

To make matters worse, when Jason returned home after seven weeks of hospitalization using a gait belt to walk, having just graduated from his wheelchair. His limited mobility made physi-cally interacting with his daughter, now nearly a toddler, impossi-ble.

When Jason recounts this particularly cruel fallout from the inci-dent, his voice cracks at the memory and there are long pauses as he attempts to articulate his thoughts through tears.

“Not being able to pick up my daughter, and stand up and hold her, that was hard,” Jason said. “And I couldn’t get down on the floor without help getting up, and I’m a big guy.”

Jason’s marriage also suffered. The accident, and its aftermath, exacerbated issues in Jason’s already troubled marriage. He and Mandy had been in therapy prior to the accident, but the sessions necessarily stopped after Jason got shot.

“I wouldn’t say the incident was directly the reason why Mandy and I got a divorce, but it didn’t help,” Jason said.

His ability to multi-task “basically went out the window,” Jason said.

Not an ideal circumstance while raising a toddler.

Jason also struggled with TBI fatigue. He would go to rehab for six hours a day, eat dinner and then fall asleep until the next morn-ing.

“I didn’t have any energy left to work on [my marriage],” he said. “So that was really hard.” And, his processing speed had reduced considerably, a circum-stance that can make communication difficult. “You couple that with, now Mandy is a basically a single parent, doing it by herself, so that’s a lot of pressure to put on a mar-riage,” Jason said.

About a year after the accident, Jason and Mandy divorced.

Even his divorce only fueled Jason’s determination to get back to life that resembled his pre-injury existence.

“[My wife] was a big part of my inspiration, why I wanted to get back to where I wanted to get back to,

not where everybody else wanted me to get back to,” Jason said.

Ever the optimist, Jason is quick to point out the separation and divorce allowed him to focus on his recovery.

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In fairness to Jason’s health

care team and family, it

should be noted that many

brain injury survivors struggle

with self-awareness post-

injury.

Often, survivors struggle to

accept the cognitive or physi-

cal limitations of their brain

injury.

Beth Lynch, a speech lan-

guage pathologist with

HealthSouth, said it’s not un-

common for recent brain inju-

ry survivors to be unaware of

new limitations caused by

their injury.

“It’s a common situation,”

Beth said. “When someone

comes to acute rehab they

are so recent to their injury

that they haven’t really fully

understood the impacts that

the injury has on their life yet,”

Beth said. “It’s a conversation

I have with a lot of people.”

This can make it difficult for

the survivor to move on with

their lives in a reasonable

manner. It’s important for fam-

ily and rehabilitation experts

to be encouraging but also

realistic when assessing and

working towards a rehabilita-

tion goal.

“It’s really important for peo-

ple in the acute rehab phase

to not compare themselves to

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Continued from page 7...

A New Normal

About two years ago, both Jason and Mandy began to date each oth-er again, slowly rebuilding their relationship.

When it came to his marriage, Jason said “time just healed a lot of wounds.”

They have since had another baby and re-married each other this past June in a small backyard ceremony and another baby is on the way.

Jason has since returned to work, though in a different role as an en-rollment coordinator.

When people tell Jason he looks “normal,” he said they’re often worried he’ll be insulted. But nothing could be further from the truth.

“I always, always say, ‘Thank you,’” Jason said. “Because [they] don’t know how hard I worked, and how hard I try, just to look normal.”

Normal for Jason is a constant effort. Every day he said he works on his speech, gait, space, movements and motions.

But he is not bitter or angry at his gunman. Rather, he is filled with a gratitude that comes with even ordi-nary tasks like buttoning up his shirt.

“I talk about the moral of the story is sometimes bad things happen and you have no control over it,” Ja-son said. “But here’s what you do have control over: you control your attitude and you control your effort. And you make sure those two things are on point at all times.”

And he is thankful for those helped him on his recovery journey.

“I’m not glad I was shot that night, not at all,” Jason said. “However I am grateful for the journey. I am grateful for the people I’ve met along the way. I am grateful for the tools and the people who have helped me get to where I am today. And I am grateful to be here!”

Jason and Mandy with their daugh-

ter, Alivia.

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Continued from page 6…

Often, this happens when brain injury survivors who are released from the hospital had no behavioral rehabilitation or

education about some of the long-term, permanent impacts of brain injury.

At other times, hospital staff aren’t trained to educate caregivers and survivors. Insurance limitations are another factor. Still other hospitals simply have too many patients to guarantee proper exit counseling. Many caregivers assume that the re-lease from the hospital means the recovery phase has ended.

“I would say that most of our calls emanate after they’ve been home a short time, especially when they’ve been out three or four months,” Jeanne said. “Especially when they are trying to go back to school or work.”

BIAAZ can’t fix everything, of course. It can’t change what insurance will and won’t cover, it can’t resolve legal issues and it can’t give medical advice. However, it can help survivors and caregivers get started on exploring possible options.

It is rewarding and fulfilling work.

“I love seeing the families and the survivors make that connection, and realize that there is help out there for them,” Jeanne said.

A change you can see

The result of a successful resource facilitation call can be extraordinary.

Survivors may get connected with a rehabilitation service that allows them to increase their social skills and regain a life beyond home, where many survivors are bound, sometimes without proper diet and little mental stimulation.

The phone call could lead to anything from entry into an extensive, out-patient rehabilitation program to informing a survivor about an accessible class or activity.

Jeanne remembers one member who was in a wheelchair and couldn’t verbalize. Although he had a DigiVox, he wasn’t sure how to use it. Jeanne told his caregiv-ers about Kamp Kan Do, the week-long camp at Whispering Pines Ranch in Pay-son, Arizona, for which the BIAAZ offered attendance scholarships.

It was an amazing experience for the survivor.

“His face lit up,” Jeanne said. “He was able to leave the house, socialize and make new friends.”

One of those friends also used a DigiVox and showed him how to use it. Later, he even tried to sing the words to a song he enjoyed with other campers.

“The staff, the volunteers, were just in tears because it was the first time since his injury he was able to get a sound out,” Jeanne said. “It’s one of the best memo-ries from many years of camp.”

The staff don’t always get to see the results of their work, but when they do it’s always rewarding.

“Some survivors and family members call to say thank you,” Jeanne said. “They come in after they’ve been in rehab. Their speech is better, or they’re walking now with a cane or walker where they were never out of that wheelchair,” Jeanne said. “It’s amazing and emotional. Those moments make you want to work harder.”

Deep roots, branching out

The resource facilitation program is closely tied to the root foundations of BIAAZ, an organization that began in 1983 in Tucson because family members of survivors wanted to help other caregivers.

“We knew that there was a need,” Jeanne said. “We knew that other people were out there, but they didn’t know what to do.”

Jeanne, along with former Phoenix city councilwoman Kathy Dubs, had a small list of known professionals they knew could help survivors get rehabilitation.

“She and I did that basically out of our home,” Jeanne said. “At first it was just a handful to start with. We had a very short list on one sheet of paper.”

As the need for BIAAZ’s services grew, the organization expanded, eventually finding a home for its offices in the Disability Empowerment Center in Phoenix.

Jeanne, working with Dawn Buri, BIAAZ’s data manager, and other staff slowly but surely began to cultivate resources. The list began to branch out from physicians to therapists, state agencies, attorneys and other fields.

Continued on page 15...

“We knew that there was a need. We knew

that other people were out there, but they

didn’t know what to do.”

Jeanne Anderson, BIAAZ resource

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Are “mild” TBIs really mild? By Brenda Hamilton

Brenda Hamilton is a personal injury and wrongful death paralegal with more than 35 years experience who works for Warnock, MacKinlay & Carman in their Scottsdale office. Her interest in TBIs was peaked when she had an immediate family member who sus-tained a “mild TBI” and had to battle with worker’s compensation and automobile insurers to establish the seriousness of injuries that caused 100% disability. She works closely with the catastrophic in-jury team at WMC to assist families with TBI issues and is well-versed in helping attorneys and insurers understand the serious-ness and long-term consequences of a mild TBI.

The diagnosis of “mild traumatic brain injury (‘TBI’)” is very common following a significant motor vehicle collision. TBI can occur even without a direct trauma to the head. The forces of a whiplash (“acceleration-deceleration injury”) can be a significant cause of TBI. Diagnostic tools such as x-rays, CTs and MRIs can be negative for injury, however, this only means that there is no active brain bleed or appreciable swelling. When there are symptoms of a concussion (another term for TBI) or if there has been a short-term loss of consciousness, but negative radiology findings, the usual diagnosis is “mild TBI.”

This is truly a misnomer, as mild TBI includes not only those with minor symptoms that resolve in a week or two, but can include very significant cognitive defects and permanent and debilitating injuries. Unfortunately, when a vehicle insurer is evaluating a claim, the word “mild” sends the wrong impression, and adjusters often do not comprehend the extent of injury that may be included in a mild TBI.

This is where effective legal representation by a firm with staff familiar with TBI, and particularly mild TBI, is critical. First and foremost, a legal team can assist the injured client’s return to wellness as much as possi-ble. The firm may provide assistance with referrals to the best professionals to aid in recovery. Experts and doctors will be needed who can not only treat the TBI survivor, but also medically document the nature and extent of the “mild” injury. Finally, the lawyer needs an understanding of mild TBI findings sufficient to edu-cate the insurers, advocate on behalf of the TBI patient, and present the claim in a way to obtain an appropri-ate recovery.

A neuropsychologist tests for and diagnoses a mild TBI by conducting a broad range of testing, coupled with an interview, to pinpoint the injury and develop a plan for recovery. It sometimes surprises survivors to see how specifically the testing reveals exactly what issues he has been dealing with on a daily basis. But without the referral for this in-depth testing, there is usually little documentation of the extent of the injury, especially since there are no positive radiological findings to show the damage or injury to the brain. As a result, neces-sary treatment often never begins.

The American Congress of Rehabilitation Medicine defines mild traumatic brain injury as including any one of the following symptoms after external application of force to the brain (not the skull, so acceleration-deceleration injuries, or whiplash, are included): 1) any loss of consciousness (“LOC”) of any duration; 2) loss of memory of events immediately before or immediately after the injury (“amnesia”); 3) any alteration in mental state at the time of accident, i.e., disorientation, feeling dazed or confused; or 4) focal neurologic

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THE GAVEL BRAIN INJURY SURVIVOR LEGAL ISSUES

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Brain Injuries and Social Security Disability Benefits in Arizona

Brain injuries often cause significant impairments, including life-long disabilities. A traumatic brain injury can prevent a person from returning to work and may also make it impossible to find a new job in which they are able to earn a gainful living. A person that has suffered a brain injury in Arizo-na may be able to qualify for disability benefits through the Social Security Administration (SSA). Social Security Disability (SSD) can include benefits paid through two separate programs:

Social Security Disability Insurance (SSDI)

AND

Supplemental Security Income (SSI)

Both of these programs may be available to persons with brain injuries, though in order to qualify, an applicant must meet both the technical and medical eligibility requirements. Medical qualification is the same for both programs. It requires you have a medical condition that:

is formally diagnosed and well documented, is a severe impairment that prevents you from earning a gainful living, and has lasted or is expected to last at least 12 months.

In addition to meeting these basic eligibility rules, your brain injury must also meet the SSA’s severi-ty level requirements, which appear in the Blue Book manual, the SSA’s medical guide for evaluat-ing disabilities. The listing for a traumatic brain injury appears in the Blue Book under Section 11.00F. This listing explains that brain injuries or cerebral traumas can cause various symptoms and complications and that the SSA may evaluate a brain injury claim under the following Blue Book medical conditions:

Convulsive Epilepsy Non-convulsive Epilepsy Stroke (central nervous system vascular accident) Organic mental disorder

A brain injury that meets a Blue Book listing automatically meets the SSA’s medical eligibility re-quirements. Even if your claim doesn’t meet a listing though, you may still be able to receive disabil-ity benefits. For this to occur, the SSA must look at your ability to work. They assess your limita-tions, including all mental, physical, and emotional limits your brain injury causes. This is done through a residual functional capacity (RFC) analysis.

To get benefits through an RFC, your brain injury must prevent you from working in any job for which you’d otherwise be qualified. The SSA takes all of your limitations as well as your age, work experience, job training, and formal education into account. If you’re deter-mined unable to work through an RFC, then you’re medically qualified for benefits. In addition to satisfying medical eligibility cri-teria, applicants must also meet technical or financial rules for SSDI and/or SSI.

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deficits that may or may not be passing/transient.

Injuries in which the LOC exceeds thirty minutes, the Glasgow Coma Scale is less than of 13-15 thirty minutes post-injury, and the duration of amnesia is longer than 24 hours, are not considered mild.

Many insurance adjusters see the word “mild” before TBI and fail to comprehend the severity of the injury. After all, the survivor may present very coherently and appear normal. But the varied and “mild” symptoms experienced by the survivor can be life-changing, and it is often diffi-cult, if not impossible, for the survivor to explain the specif-ic symptoms to his doctor given his cognitive deficits.

Mild TBI symptoms may include not only the classic concussion symptoms of which everyone is aware (dizziness, blurred vision, nausea), but also a broad range of issues not as easily recognized, such as head-ache; visual disturbances; mild or severe cognitive issues including memory, attention, recall; multi-tasking challenges, executive function/problem solving; behavioral or emotional problems such as anger, irritability, sadness/crying, anxiety, depression, apathy or impulsivity. Short term memory and storage issues often leave people confused. They may have difficulty staying oriented, which results in issues like difficulty finding their own vehicle in a parking lot, losing keys and having no recall when they are locat-ed. Survivors may find themselves in odd situations in which the injured person simply cannot reconcile a situation with the facts his brain can recall. Some injuries leave a person overwhelmed with limited short term memory processing abilities, leaving them unable to make a simple restaurant choice, select food from a shelf at the grocery store, respond to a typical question or do a normal task in the workplace.

Clearly, a very significant injury can be sustained and still categorized as a “mild TBI.”

Mild TBI generally comprises 70-90% of all TBI’s. While most physicians are well-trained in manage-ment of moderate or severe TBIs, the more subtle deficits of mild TBIs are often unrecognized, left with-out significant care or treatment, and heavily disputed by defending insurers. Historically, studies confirm more than 80% of mild TBI patients, with a first concussive event, recover fully within one year. It is the repeat TBI patients, such as athletes with a history of strikes to the head (i.e., football players), who are most at risk for non-recovery, and others who for reasons unknown are unable to achieve a full return to their pre-accident brain health.

Once a person has sustained a TBI, he is at risk for more severe symptoms and lack of recovery for any future TBI. Unfortunately, Arizona law does not allow compensation for a possible future injury that is not reasonably foreseeable nor probable, and the current status of medical literature does not show this increased susceptibility as a permanent medical condition, even though most TBI medical providers have special increased evaluation, care and treatment protocols for those who have sustained a prior TBI. Cur-rently, there are no generally insurer-accepted objective tests that document this future susceptibility as a permanent medical condition, and thus there is no compensation for permanency or future care if the TBI patient recovers as many do.

An astute legal team well-versed in mild TBI can assist the person in working with his family to present an accurate picture to the appropriate medical providers, and obtain the evaluations to properly present the claim and obtain a fair value for the client.

Mild traumatic brain injuries (mTBI) can occur even without dam-

age to the skull when sudden impact causes the brain to crash

against the inside of the skull,. This is how whiplash leads to mTBI.

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Helping people, specifically brain injury survi-vors and their caregivers, is what Brain Injury Alliance of Arizona staffers do every day. But recently Dawn Buri, BIAAZ’s data manager, went beyond the scope of her day job and helped a friend win a $25,000 dental makeo-ver.

Dawn first met Christine Ojeda, a work incen-tive consultant for the Arizona Bridge to Inde-pendent Living, during work breaks at the Dis-ability Empowerment Center, where both ABIL and the BIAAZ offices are located.

They became friendly, some-times commiserating over the challenges of having dental issues.

“When I initially met her, we both had really horrible, failing teeth,” Dawn said.

Dawn was fortunate enough to get her dental work done and saw how hopeful it made Christine.

For Christine, dental work was more than cosmetic. She was in constant pain every day and couldn’t eat anything but soft food.

“I was self-conscious about it but it was health,” Christine said. “Health was more extreme than the cos-metic I think.”

Financially, however, Christine’s dental work was out of reach, though she was doing the best she could to save money for it.

When Dawn saw that KPHO, Phoenix’s CBS news affiliate, was giving away a $25,000 dental makeover from Freedom Dental as part of their “Surprise Squad” series, she said “immediately, I thought of [Christine].”

During the show, a person in need is sur-prised with assistance.

“I thought this would be perfect for her,” said Dawn. “She could get her teeth fixed and fi-nancially she’s not going to have to worry about it.”

To nominate Christine, Dawn wrote a two-page essay explaining why Christine de-

served the dental makeover.

“Because her passion for assisting others is so strong, she often gives and gives but never takes,” Dawn wrote about Christine. “She de-serves to be seen from the outside as much as the beautiful person she is on the inside.”

The Surprise Squad came during the BIAAZ’s annual Rays of Hope conference for brain in-jury survivors and caregivers. Both Dawn and Christine were manning their organization’s table between conference sessions when the

camera crew came in and told Chris-tine the good news.

Christine had all her teeth removed and received dental implants. The procedure only took a day but Chris-tine said it has impacted every aspect of her life. She is no longer in daily pain and a lower back pain issue has completely disappeared.

And then there’s the food. Christine has been able to enjoy celery, drinks with ice in them, peanuts and more.

“I love ice cream,” Christine said. “I never liked it before because just one little bite was torture.”

Christine is filled with gratitude for Dawn.

“Dawn has one of the biggest hearts I’ve ever known in my life,” Christine said. “And she’s changed my life because of her big heart.”

BIAAZ’s Data Manager, Dawn Buri, left, nomi-

nated Christine Ojeda, who works at ABIL in

the Disability Empowerment Center, for a

$25,000 dental makeover.

Something to smile about

Dawn Buri, BIAAZ’s data man-

ger, successfully nominated a

friend for a $25,000 dental

makeover.

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Continued from page 9...

The resources were written on sticky notes stuck to large sheets of paper from an easel flip pad. Before long, the pages were “circling our office, all these flip pages with resources.”

Finally, the pages were taken off the wall, and the resources organized into cate-gories and put into a database.

The database is more than just a list of brain injury professionals and state agen-cies, however.

Many of the long-term care and residential facilities needed to be vetted prior to being put on the list, and not all made it. An elderly care facility, for example, is not appropriate for a 30-year-old brain injury survivor. Likewise, a mental health facility may be equally unequipped to handle the unique needs of brain injury.

That led to BIAAZ offering brain injury training programs to staff members of resi-dential facilities.

“So many people in these areas weren’t aware of specific brain injury needs, and because of that we offer training in brain injury and different levels of brain injury to professionals,” Jeanne said.

Now, to be a BIAAZ resource, a facility must have a staff member trained in brain injury and agree to train new staff in brain injury as well.

Another program that grew out of the resource facilitation program is the BIAAZ’s network of support groups because so many caregivers expressed a desire to talk to people who understood their situation. Initially there was only one group, but now BIAAZ sponsors several groups throughout the state. Still, there’s more to do.

“There’s potential to reach thousands of more people that have a brain injury,” Jeanne said. “I just want them to know we’re here to help them.”

Jeanne Anderson, resource facilita-

tion manager

Continued from page 11...

For SSDI, you must have work credits from

your employment history. These credits accumulate as you pay Social Se-curity taxes.

For SSI, you must have limited income and other financial resources, but no work credits are necessary.

An SSDI application can be completed online via the SSA’s website, or you can apply in person at your local SSA office. SSI applications must be made in-person, because a personal interview is required. Arizona’s largest cities often have multiple offices, but even some of the state’s smaller communities have SSA branches at which you can apply. Here are just a few of the offices with which you can schedule an appointment by calling 1-800-772-1213:

Casa Grande, 501 N. Marshall St., Casa Grande, AZ 85222

Douglas, 600 E. 15th St., Douglas, AZ 85607

Glendale, 5907 W. Kings Ave., Glendale, AZ 85306

Nogales, 1760 N. Mastick Way, Nogales, AZ 85621

Tucson, 88 W. 38th St., Ste 100, Tucson, AZ 85713

If your claim is denied, you will need to have your case reevaluated at one of Arizona’s ODAR offices. In Arizona, it takes nearly 500 days to have a hearing scheduled.

Article by Deanna Power, community outreach coordinator of Social Security Disability Help. She became passionate about helping people with disabilities after working with them throughout college in the Best Bud-dies program. She assists people who visit the company website and answers Social Security questions for recipients or potential applicants.

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According to the Centers for Disease Control and Protection, or CDC, motor vehicle and traffic inci-dents account for 17 percent of all traumatic brain injuries, or about 200,000 brain injuries a year. That’s why we’re introducing Traffic Stop, a month-ly feature that highlights traffic safety tips to help prevent future brain injury caused by accidents.

Arizona averages about 3,000 motorcycle accidents per year according to the Governor’s Office of Highway Safety. Though exact percentages aren’t available, the Brain Injury Alliance of Arizona knows from its membership that many of those injured sustain traumatic brain injuries.

Fortunately, the Arizona Motorcycle Safety and Awareness Foundation, a nonprofit organization dedicated to reducing motorcycle accidents and increasing safety awareness helps prevent head inju-ries by promoting safe riding habits. Every year, AMSAF helps future and current riders stay safe through scholarships for basic motorcycle training classes, prevention outreach efforts and educat-ing the motorcycle community.

One topic AMSAF focuses on is edu-cating riders about the importance of using a proper helmet. Although legal-ly a helmet is an option in Arizona, countless studies have shown it’s the safe choice.

Here are some tips, courtesy of the Snell Memorial Foundation, a nonprof-it organization that certifies helmets for safety, on how to ensure a helmet will give the maximum protection possible.

A helmet should fit snugly, with pads breaking in and becoming more comfortable over time as they break in.

Never cut away or alter the liner of a helmet. They are very specifically designed to absorb im-pact. If you feel you would need to change the helmet’s liner, try a different helmet instead.

Always securely fasten the chin strap.

Never use a second-hand helmet. Damage to the helmet may not be visible, but may be weaken-ing the helmet’s integrity.

Don’t rest the helmet on handlebars as this can damage the liner.

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Need support? BIAAZ facilitates several

survivor and caregiver support groups

that meet monthly throughout the Valley.

Check out our Facebook page for more

information. Or, ask to subscribe to our e-

Blasts by emailing info@BIAAZ.org.

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Survivor

Q & A:

Margaret Barr

When and why did you become a member of the BIAAZ?

My injury was back in 1969. I was almost 5-years-old. I had many years that I had lived with my T.B.I. I had much to learn.

In 2009 I became a member. I had a sensed my way of living was coming to a different direction all together in my life. The help I needed was at BIAAZ: I hoped to get on my feet again. My search now was "How to live with a brain injury.” I had spent most of my life living (with a brain injury) without any concept of really understanding it. I eagerly longed to ask endless questions.

What is something about being a brain injury survivor you'd like other people to know? That each of us have a purpose in life. To strive, to rise up and to strive to be all that we can be: There is Hope, there is a Dream.

What are some the things you are most proud of in your recovery journey been? Or the most challenging?

A. 1986- Giving my life to Christ Jesus 24/7.

B. That I have made it through each adversity from 1984 with no turning back.

What are some of your interests, hobbies or activities you enjoy?

To encourage and motivate. I do have an interests to help others in their jour-ney to realize they have a purpose, to believe in themselves, and to continue to rise up in all that they can be.

Activities: Horse Back Riding, Campfire, and spending time up in the beauti-ful mountains. (When I can, that is where I like to be). For day-to-day activi-ties I enjoy programs, which I can rely on to help keep me learning and grow-ing. When the time comes and I can order DVDs, I will be learning so much more. I love most of all to be learning. Bible Studies, family, friends, cooking and a quiet place to regroup is also important.

Margaret recently wrote and published a new book called When the Rose Pet-als Unfolded. .

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WITH HEARTS FULL OF GRATITUDE, THE BRAIN

INJURY ALLIANCE OF ARIZONA THANKS ITS

SPONSORS FOR THEIR SUPPORT.

Diamond Sponsors

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Silver Sponsor

Bronze Sponsors

WITH HEARTS FULL OF GRATITUDE, THE BRAIN

INJURY ALLIANCE OF ARIZONA THANKS ITS

SPONSORS FOR THEIR SUPPORT.