medical literature publication

TBI, Medical Opinions And All Important Medical Literature

medical literature publication

One important part of a veteran’s traumatic brain injury claim, or any claim, is the use of medical literature to turn your injury into one you get compensation for.

I have seen time and again where VA medical examiners display their hackery by butchering medical opinions with poor use of medical literature. VA adjudicators then evaluate those bad resources by falsely claiming medical literature does not support the claim.

That was the case for one client over a year ago. VA repeatedly denied the veteran service connection for TBI and the veteran’s secondary condition of a benign brain tumor.

The VA examiners used resources that were inappropriate, and I am about to set out how you can beat back opinions by knowing the difference between good sources of medical literature and bad.

The following discussion is an excerpt from my upcoming guide on traumatic brain injury and residual.



Most veterans are unaware of the different kinds of medical literature you can use to support your claim. Some are more authoritative than others.

Primary Literature

This is the most important kind consisting of papers written on research carried out personally by the author that is published in peer-reviewed journals. Primary literature carries the most persuasive weight if they support your claim.

Secondary Literature

Secondary literature is a type of publication that relies on primary sources of information to create a synthesis of knowledge. These give an overview of the matter, which can be used to track down primary literature sources.

These can carry weight, especially when VA uses less authoritative resources like basic company websites like Mayo Clinic’s website to deny a diagnosis.

Tertiary Literature

This form of literature is written for nontechnical audience, magazines, trade journals, etc. The website may be an example like this, and lazy medical examiners may use these rather than primary or secondary resources.

Grey Literature

This form of literature is usually created by special interesting research or publications. Dow Chemical has its own journals. In those, it published research that was cited by the press as a counter to claims that Agent Orange type dioxins were dangerous.

You need to evaluate these resources with a fair amount of skepticism.


When it comes to VA’s use of tertiary literature like a website page, be sure to check the “terms of use” or “terms and conditions” of the website.

For, the authors provide the warning, “Nothing in the content, products or services should be considered, or used as a substitute for, medical advice, diagnosis or treatment.”

That website is intended for educational purposes. It is not to be used to render a diagnosis. No author is noted on the page. Any use of this page to diagnose your claim is a violation of the terms provided, and you can print those out and provide them to VA when you request an explanation.

Likewise, another common website VA may use is UpToDate. That source states, “The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment.”

The point of VA exam is to diagnose your condition, right?

There are other errors VA examiners commit when using resources like this such as asserting the resource’s lack of inclusion of a symptom or diagnosis means the symptom or diagnosis does not have support to justify service connection.

Such an assertion may be false when the purpose of the website is to provide a general educational understanding of a symptom but not an explanation that covers all aspects.

If you catch an examiner doing this, you need to call that doctor on the carpet in your notice of disagreement. You can support your objection by providing more specific primary literature sources that specifically address your particular claim.

Should you try this approach, be sure you explain the difference between primary, secondary and tertiary literature resources. Some adjudicators may not know the difference, but that difference will be noticed by the Board if you need to appeal beyond the regional office.


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  1. Thanks for the information Ben, the references will take a while for me to get, but I do need to know. This is the first elections that bring out the worst part of my PTSD issues. Hard to get things done, when I have trouble focusing on the every day life stuff, let alone the VA stuff. All, most the comments were appreciated. God help. the Veterans, sounds like we need all the help we can get.

  2. Obama changed one thing big time pro veteran and it is important to know; he changed the standard by which a vet is now judged for compensation. The new standard is that the condition is “as likely as not” to have either caused or aggravated a condition.

    This is huge. The burden of proof to deny is theirs under this criteria, plus examiners are now allowed to factor in issues that happen after service. Morbid obesity post service can and will be used as a factor in a PTSD determination. Divorce too. Any life trend that shows a mental problem, like no friends or quick to hostility, must now be used as factor to determine compensation.

    Here is the REAL kicker; a Catagory One Violent And Disruptive Patient Record Flag is proof and evidence that a veteran has the inability to form social ties and has severe social incapacities! No shit. When I vigorously complained about my flag, the VHA paid for counsellor told me that patients with that flag use it successfully to demonstrate social impairment.

    My point in support of Bens excellent article, is that the rules have changed in the last eight years and ANY proof that the injury was “as likely as not” must be used under the rules. So in addition to knowing what THEY are using to judge, knowing that your own life history, even a PRF, can and will be used in your favor if you know these rules.

    It will be the first time a set of divorce papers ever did anything for you….

    1. My problem with redturtle984’s post is that it continues the never ending and evil status quo, which is to unfairly deny monthly SC compensation for the right and original claimed condition’s, and replacing those conditions with manufactured and untrue mental labels which could have never reared their ugly heads, if the original claim had’nt been illegally and immorally denied, and if veterans were’nt foced to deal with a super hostile government, and compromised examiners!

    2. Well said, Redturtle984.

      It’s also worth noting that under the actual rules, a Veteran’s claimed in-service condition can actually be a condition the Vet had before service but their military service made that condition worse…it gets really hairy then because both sides of the aisle can start to parse out environmental conditions. The “as likely as not” sounds better as “more likely than not” and that’s how I learned it from hadit dot com years back because when I finally made my initially claim and did it all myself, Obama had already changed that as quick as he sent troops to Afghanistan.

      I will add that if a Vet can swing it even through State Medicaid or even Free Clinics; getting Independent Medical Opinions because your own Dr.’s stuff is supposed to carry some weight, whether the VA looks at it is a crapshoot depending on what mood the examiner is in that day or what his tally for his/her Performance Bonus looks like. 🙂

  3. And the never ending and all important (for THEM) game of using forced counseling and therapy sessions to determine if your emotional problems were caused and/or exacerbated by miltary service or combat! They give you super hostile examiners, and the veteran has ZERO choice in who he talks with! Remember that Russian rocket that exploded 60 feet away, and was so loud and unexpected that you thought the world had ended? Remember how it left you partially deaf for life, and with total and complete noise aversion for life, which is a brain process type of TBI? Marry that to your belief in men’s rights, and you will be summarily denied, or approved, with all KINDS of profoundly unfair and untrue mental labels! You want to know why? The non veteran and non combat veteran jewish woman conducting the exam is not only getting points, bonuses, and promotions for denials, but she is a raging feminist who hates your guts for believing in men’s rights, and wants REVENGE!

  4. This is good advice for any condition claimed Ben, but I have to ask, how would a veteran know what literature may be used and from where when the VA denies a claim?
    I ask because I don’t recall ever seeing a cited reference.

    Does it shock me that a VA rater or adjudicator might use Dr. Google? Not at all.

    Another question Ben. You mention the site Up-to-date. Have you noticed these types of sites referenced in more than one denial?

    If I saw a denial from Muskogee referencing that site, a denial from Denver and a denial from Philly referencing the same site, I would be thinking there was instruction sent to adjudicators on sites they should reference when issuing their denial.

    One would think that instruction would have a rough legal basis, not one that could be easily blown out of the water by citing the sites own Terms and Conditions.

    That’s like citing what was read on a bottle of Dr. McGillicuddy.

  5. what the heck is going on here with all this crazy conspiracy junk…isnt this supposed to about us Vets getting our benefits? Im really tired of folks co-opting this forum with their nutty and offensive political memes.

    1. Shannon,

      Most of us here do have an opinion that what is need to change the VA at this point is a total change in Management. From the top on down.

      I do believe your comment is meant rude and offensive and note that you are not a regular commenter on this blog.

      Was there something you wanted to discuss in relationship to Ben’s article “TBI, Medical Opinions And All Important Medical Literature”? Or are you only commenting to troll disabled Veterans because they have an opinion?

      1. @Shannon,
        If you read my first comment today, you would be aware of how vets are screwed over constantly by the VHA AND VBA! It IS in conjunction with today’s blog!

        All the other things we veterans discuss is pertinent to gaining evidentiary knowledge of what is transpiring within our country and world.
        Without this knowledge, we, and others, would not be ‘keeping up with current affairs!” A necessity in today’s world.

        So, I, and others on here, can only conclude by your insulting comments, your nothing but a freaking TROLL!
        Go somewhere else and spew your drival. We don’t want to read it here.


        Also, on WFTV, Channel 9 news, just now.

        Obamy is on his way to Vietnam. Why? He’s going to give them taxpayers $$$$ to help extract “bombs” that were left there by our military. He’s also, again, “apologizing for the war!”

        When will that fruitcake realize he’s not helping with America’s image around the globe?!?!

        I will only guess “Shannon” will conclude this is a “conspiracy theory”!

    2. Hey Elf,

      Did you happen to catch Hillary’s coughing fit today where she says she need some weed?

      “Hillary Clinton Laughed Off Her Last Coughing Fit with a Marijuana Joke”,
      by Tommy Christopher | 4:06 pm, September 6th, 2016

      At: “”

      or did you happen to catch the MSNBC tape titled “Hillary Clinton Coughs Up Mysterious Green Substance Into Water During Cleveland Rally”? It is pretty gross.


  6. Right now, LIVE in Virginia Beach, VA.

    Google this to watch

    “LIVE: Donald Trump Campaign Event in Virginia Beach, VA 9/6/16”


  7. I want to inform y’all someone is monitoring this site today.
    I’ve tried three times to include additional news coming out from reputable news sources over what took place over the weekend.
    1.) The President of the Philippines calling our POTUS a “Son of a Bitch!”
    2.) The unraveling of the Middle East due to the failed policies of Obama, H. Clinton and now Kerry.
    3.) The insulting way our POTUS was treated by the Chinese when he landed. Or, how Susan Rice was caught having heated words with a Chinese Official on the tarmac.

    There’s more out there.

  8. Here’s a “WTF moment” everyone can laugh at.

    From “”

    “Opinion: Union Bosses, VA Bosses Rigging System for Failure”

    5 Sept. 2016
    “” | by Rep. Jeff Miller

    This isn’t the same article Seymore put on earlier this weekend.
    Seems we’ve got a lot of pussies running around in Washington DC.
    Although Miller is telling it truthfully, this could be why he’s not running for reelection.


    1. Maybe he’s just adding to the plot of his future “Tell All Book” in how he tried to “save the VA”? His words always sound good but they always end-up just being farts in the wind. 🙂

    2. Here’s more “WTF MOMENTS” which came out
      over our “Labor Day Weekend”!

      The President of the Philippines called Obama a “Son of a Bitch”! Why? Because Obama was telling him how to run his country. Seems the President of the Philippines has told his citizens they can do what they want to anyone who disrespects their country. And that includes those who are drug dealers or drug smugglers, (Paraphrasing)! He’s told his citizens to shoot drug dealers and smugglers!
      He told Obama his country is “…a sovereign nation!” He can run his country the way he wants.
      He also called our ambassador something I won’t mention here.

      China, when Obama landed there, didn’t have the debarcation ladder ready. Accually they couldn’t find one!
      Susan Rice got into a “heated discussion with a Chinese Official on the tarmac”! Bad move Susan!

      From what’s being said in the conservative news sources, Obama isn’t, and wasn’t, well received by the Chinese Government.


      Also, there’s a lot of other articles coming out from how other countries are laughing at us.
      All because of Obama’s refusal to stay out of their internal/external policies.

      I guess Obama really does consider himself some form of “GOD like creature”!


      The Middle East is completely in chaos. All due to Obama, H. Clinton and now Kerry’s implementations of how they should run their countries!
      Putin is basically telling Obama to stay out of his way. When it comes to bombing ISIS.
      Syria, Turkey, Iran and others, including Russia, are pushing the U.S. into something.

      Look at what Iran has done since Obama’s (Failed) Iran Deal!


      “Hildabeast” keeps blaming Russia for all the “hacking” going on with her email woes. Even though there’s not one shread of evidence to her accusations! It was reported DHS was responsible for the release of the emails.

      She’s going to keep pushing President Putin into that “proverbial corner”! What happens when anyone gets pushed too hard, folks?

      1. Hey Crazy Elf,

        From what I am reading Putin was the star of the show at the G20 summit.

        Regarding the President of the Philippines you have to remember that is supposedly our increased Navy actions in the South China sea is to support a claim by the Philippines that China is violating there rights. Must be more Horse Hockey from our government.

        China and Turkey made a very strong showing for the class picture by joining Putin in the photo front and center. Obama was kick off to the side and in the back of the photo.

        Oh and I understand that North Korea even helped out by providing the fireworks during the summit. With the three missiles launched toward Japan that splashed down in the Sea of Japan.

        Must be truly a lot of excitement for Obama on his way out the door.

      2. Hey Elf,

        Given China’s protection of North Korea and their close relationship. I have to wonder if China’s President Xi Jinping didn’t get with Putin and Erdogan and say watch this just before the three missiles launch from Kim Jong-un in North Korea.

        Then sat back and laughed at the prank as Obama’s security and Obama had a oh shit moment.

        Since Erdogan blames the Fethullah Gülen and who is tied to the Clinton Foundation for the failed Coup. Also with the installation of the new Thadd Missile systems being installed aimed at China and Russia. It is almost like Obama has been pulling hood shit by pointing guns at their heads.

      3. Hey, Seymore, it looks like Obamy might want to sit back and keep his pie hole shut for the few more months he’s in office. Every time he opens it, he makes a complete fool outta himself.

        I also hope “The Hildabeast” keeps her trap shut and drops out of this race!
        Putin’s already shown his distain for her. As has MANY other world leaders!

        It’s come out this morning, (Sept 6, 2016), on Fox News, that alleged “interview” the FBI had with her was rigged for her to NOT be indicted!
        Here’s a couple of facts on it.
        1.) It was “unlawful for the FBI to NOT record her!”
        2.) They “tricked her”, at the beginning, by “stamping SECRET on one of her emails!”
        She immediately stated “…nothing in that email was classified!” Thereby, making all other statements, ie; “I can’t recall how to view classified material”, statements lies!
        3.) According to FBI rules and regulations, Cheryl Mills was NOT supposed to be in the room with her!
        This is according to Judge Napialano (sic)! (Sorry, I don’t know how to spell his name!)

        Today’s CNN POLL shows Trump up by a few points over “The Hildabeast”! As do many other polls.
        I think it’s curtains for “The Butcher of Benghazi”!

      4. Hey Elf,

        On your statement “According to FBI rules and regulations, Cheryl Mills was NOT supposed to be in the room with her!”

        Cheryl Mills is her attorney. But also there is an exception to that rule when the person being questioned is Incapacitated by mental disease or defect and needs a guardian present.

      5. Seymore, that “exception” you give is then proof positive “The Hildabeast” should not be allowed to run! LOLOLOL

    3. no reason for Miller to run. he’s smart enough to realize he had no power to actually effect change at VA nor hold anyone accountable. he writes good op-eds but no teeth for his committee’s on VA.

  9. “Confrontation” seems to be the norm at VA.
    Am I missing something here?
    Is VHA’s, and VBA’s, using “non-medical documentation”, NOT intended for veterans to receive compensation? Is this a way to screw veterans? Who woulda thought that!?!?

    Every time I’ve been to a VHA, whether a hospital or clinic, the healthcare professionals, always “write-up” in the “progress report” some gibberish no veteran could possibly receive any form of compensation.
    This also includes where a veteran isn’t even thinking about compensation!
    For example: a veteran is there for something not related to his/her military service. The physician will write up something so vague, it doesn’t resemble what the veteran actually said, or came there for! Confusing to say the least!
    Why do they do this?
    Because that’s how they were trained! Never tell the truth, seems to be their “motto”!

    1. many vets have learned this the hard way. after tests came ba k positve, for the 4th time!, i had a VA neuro write some nonsensical stuff that the positive could be something else and cited some off the wall seminar in Europe to pseudo back his BS up.

      i only caught it due to doing my own research after a few pro-veteran websites educated me about the nonsense at VA. the confidence came too, after private doctors confirmed tests with the med evidence clearly in mil med records.

      and yes, i can only conclude like you and others, this is the way the VA has trained them and incentivized them via bonuses. hundred’s of thousands of veterans have the same story. no way we all are wrong. so yeah, the VA does this trickery as you mentioned.

      confrontations too. they seem to be experts at pushing those buttons.

      1. The VA manager’s have taught their employees to deny claims on purpose.

        They are to assist veterans in their claims. This is and has not been done for decades.

        They have lied to many. Many Vietnam veterans. Telling them that their military record’s were distroyed in the saint Louis ? in may 1973

        They have even pulled this lie on veteran’s discharged after the fire happened.

        They. Told me This and I was discharged after the fire in October

        They kept sending denial letters after denial latter’s. Stating we need More proof. !

        They knew that it would be impossible for the veterans to get the needed information.

        Because. The VA has the proof and the military record’s. (hiding them)

        Veterans give up and let their claims lapse. This let’s the VA off the hook. If the veterans ever win their case and all back pay is lost. !

        They. Do it on purpose. !

        What they don’t know is for every claim denied. The veterans don’t receive the care They deserved

        Because Of greed. Take PTSD If you don’t have in writing s service connected disability for PTSD. You can not be treated

        What happens to those veterans. Those veterans due to treatment. Treat themselves With alcohol or drugs. !

        Have problems with family and friends. Become homeless. Lose everything

        And many moose their lives By suicide or are shut up. By the veterans coming in contact with the police and locked up. !

        Why. Because people like Diana rubins and Graves have instructed VA employees to deny. Shread. Destroy veterans record’s

        The back log of claims dropped by thousands. How did they do this. !

        Denial letters to every claim and the cycle continues.

        Graves and Rubins collect $400 thousand. To move and be by each other. !

        Go. In front of congress and plead the fifth. Tell their employees. Go ahead and laugh. We’ll see who has the last laugh. !

        They. Knew that higher management would not do anything and do everything they can to ensure these ladies. Stay to continue to deny veterans claims.

        It seems that their employees eather do as they say or they will lose their job’s. !

        Again. The VBA denies claims on purpose and the veterans pay the price. Many Times with their own lives. !

        VBA. Reply Good Ridence. One less veteran to mess up my Bonous. !

        What a sham. What an outrage. These people should be in jail. ( Treason)

        Crimes against humanity. !!!!!!

        Deny. Deny. Die

    2. My question would be why an adjudicator is surfing the web for some website for information on a medical condition rather than looking at the evidence presented, whether it’s medical treatment records or the C&P examiners notes.

      If they are surfing for reasons to deny a veteran rather than accepting the evidence in front of them, they are ignoring giving the veteran the benefit of the doubt…in addition to the medical evidence.

      1. 91Veteran, I do believe, “giving the veteran the benefit of the doubt” is, by law, what VA is supposed to do!

        Problem is, we veterans can’t seem to get that across to them.

        I still, after almost 48 years, can’t get VA to admit to “severe eye damage, caused by an explosion”, while serving in Vietnam (1968)!

        Even though there’s a great deal of evidence in my Army medical records. VA healthcare professionals don’t want to even talk about it!

        Plus, there’s additional evidence someone changed specific documentation, in my Army records. Which, if I were to have tried to enlist, even back then, the military would have said “NO”!
        A physician, (retired Lt. Col), who no longer works at VHA, confirmed this in front of my wife!
        He quit because of all the BS he was getting from the administration!

  10. Benjamin- All great advice. One would never know the VA is actually tasked to ASSIST Veterans because it’s not without confrontation from the get-go. Instead, the VA makes itself an ASS to Veterans from the get-go.

    Nice “Bad VA Art” today. She MUST be either VA Artificial Intelligence or simply a high-end manikin as I have never seen such a friendly and welcoming face at ANY VA. 🙂

    1. Thank you namnibor, and all of my fellow vets who regularly contribute to this blog that Ben has created for us veterans. I feel safe being part of this group and appreciate the information Ive gained from the regulars and occasional contributors. It definitely goes beyond what I read in the papers or watch on the news. Thank you for sharing your personal journey with me and giiving me hope. I do my best to ignore the occasional trolls who derive a sick pleasure by attacking others on this site. I’ll continue to quietly read the articles written, as well as the excellent feedback that’s offered by all of you. I have a much better understanding of the VA, thanks to the courage of so many of you!

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