When the Diagnosis Is Wrong: How a Missed EEG Changed Everything
A case study in why TDRL reviews require more than a rubber stamp — and why diagnostic errors are the first thing I look for.
About 15 years ago, a service member came to me to appeal his findings after a Temporary Disability Retirement List reevaluation. He had originally been placed on the TDRL through the IDES with a diagnosis of conversion disorder, rated at 30% disability. Upon reevaluation, the Informal Physical Evaluation Board had reduced that finding to 10% disability severance — a result that would have cost him his retirement and a significant portion of his benefits.
The diagnosis at the center of his case was conversion disorder — a condition in which a mental health issue disrupts normal neurological function, producing very real physical symptoms such as seizure-like episodes, muscle weakness, or sensory loss. Today, it would be classified as a functional neurological disorder. The military neurologist who made this diagnosis had concluded that my client suffered from psychogenic seizures.
There was one problem: he had never ordered an EEG to confirm it.
Compounding this failure, the VA Compensation and Pension examiner who reviewed the case never questioned the diagnosis, ordered further testing, or sent the case back for additional development. To me, these were serious errors — not technicalities, but the kind of diagnostic shortcuts that determine whether a service member retires with full benefits or walks away with almost nothing.
I had his post-service Tricare provider refer him to an independent neurologist. After extensive testing, he was found to have a focal point seizure disorder — a real, documentable neurological condition that had never been properly identified.
Armed with that diagnosis, I filed an FPEB brief requesting that the panel overturn his previous findings entirely and award him a 60% Permanent Disability Retirement List rating for his seizure disorder. The FPEB gave us an on-the-record decision — overturning the original diagnosis and awarding the 60% PDRL rating we had requested. We then returned to the VA and successfully appealed the errors made on that side of the case as well.
What I learned — and what I do differently because of it
This case permanently changed how I approach every TDRL review I handle. Before I evaluate the merits of a reevaluation finding, I now review the original case file specifically for:
- Diagnostic errors or unsupported conclusions
- Tests that were never ordered but should have been
- Errors or gaps in the original VA C&P examination
- Records from outside treating providers that were not given proper consideration at the time of the initial evaluation
In TDRL cases, the original finding is not a finished product. It is a starting point — and sometimes, it is simply wrong.
If you are approaching a TDRL reevaluation, do not assume your original findings are accurate or final. Call me at 757-481-0772 for a free consultation. I review TDRL cases nationwide and work with clients overseas. The earlier we look at your file, the more options we have.
