The PM&R Advantage: Why a Physiatrist Opinion is Your Secret Weapon in Complex TBI & Musculoskeletal Claims

As a VA disability attorney, you're an expert at building a case. But when you get a complex file involving a Traumatic Brain Injury (TBI) or a chronic musculoskeletal condition, who do you turn to for your expert medical opinion? Most firms default to a neurologist or an orthopedic surgeon. While excellent, these specialists are trained to focus on a specific, narrow part of the problem—the brain scan or the surgical fix.

But VA disability isn't just about an injury; it's about impairment. It's about functional loss. This is where your secret weapon comes in: the Physiatrist.

What is a Physiatrist (PM&R)?

A Physiatrist (pronounced fiz-eye-a-trist) is a board-certified physician specializing in Physical Medicine & Rehabilitation (PM&R). We are the medical experts on function.

Think of it this way:

• An Orthopedic Surgeon is the "hardware" expert who fixes the broken bone.
• A Neurologist is the "software" expert who diagnoses the nerve condition.
• A Physiatrist is the "systems integration" expert who diagnoses the impact of the hardware and software problems on the veteran's entire life—their ability to walk, work, think, and function.

My work as a PM&R specialist focuses on diagnosing and managing complex neurologic and musculoskeletal conditions and, crucially, determining their functional consequences.

The PM&R Advantage in Traumatic Brain Injury (TBI) Claims

TBI is the signature injury of the modern era, yet it's notoriously difficult to link to specific disabilities. A C&P examiner might note a "normal CT scan" and dismiss the veteran's complaints. This is a critical error. A TBI is a functional, metabolic injury, not just a structural one.

This is the PM&R advantage:

• Holistic Diagnosis: A neurologist might focus on the headaches and a psychologist on the mood. As a PM&R physician—and former Director of Brain Injury & Stroke Rehabilitation—I am trained to evaluate the entire constellation of TBI symptoms: the cognitive deficits (memory, focus), the physical symptoms (headaches, dizziness, balance), and the emotional/behavioral changes (irritability, depression) as one interconnected condition.
• Connecting Function to Event: I can write the definitive nexus opinion that explains how the blast wave or in-service impact caused a neurometabolic cascade, leading directly to the veteran's current functional impairments in work, life, and social settings.

The PM&R Advantage in Musculoskeletal Claims (Spine, Joints, & Pain)

This is where the difference between a surgeon's opinion and a physiatrist's opinion becomes crystal clear.

• The Surgeon's View: An orthopedic surgeon's report might read, "The MRI shows mild disc bulging at L4-L5, which does not require surgical intervention. The exam is normal."
• The Physiatrist's View: My PM&R report will read, "That 'mild' disc bulge, while not a surgical candidate, is impinging the L5 nerve root. This impingement directly causes the veteran's reported radicular pain, foot drop, and inability to stand for more than 10 minutes. This functional loss, as demonstrated by repetitive motion testing, is directly attributable to their in-service back injury."

I look beyond the static image on an MRI and focus on the functional diagnosis. I can explain why a veteran's pain is real, how it's connected to their service, and how it impacts their ability to earn a living—which is the exact language the VA needs to see.