Rating Secondary Conditions caused by TBI
Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.
Traumatic Brain Injury (TBI) is always rated on the symptoms and conditions that it causes. These are called “secondary conditions.”
All of these secondary conditions MUST be proven to be directly caused by the TBI in order to be rated under TBI. If a physician clearly states that a condition was caused by TBI, then it can be rated on the TBI Rating System. If there are no medical records that clearly link the condition to TBI, then it cannot.
TBI can affect the entire body, and so many conditions that it causes may not show up for many years. If a condition develops after separation from the military, it can only be rated by the VA if it can be medically proven to have been caused by the TBI that occurred while on active duty.
The New VA Regulations for Secondary TBI Conditions
Recently, studies have shown a direct connection between TBI and some conditions that develop, on average, a year or more after the original event. To reflect this data, the VA changed their regulations regarding these conditions in January 2014, stating that there is enough data linking these conditions to TBI that they will be automatically considered as caused by TBI as soon as they begin showing symptoms, UNLESS they can be clearly proven to have been caused by something else.
This change in rules does not limit the ability of other conditions to be considered caused by TBI if there is a clear connection between them; it just makes it so that the following conditions cannot be considered not connected in the right circumstances.
These conditions are organized in 5 different categories, each with their own specific rules.
- Parkinson’s disease and/or Parkinsonism (which is rated analogously with Parkinson’s disease) are conditions of the brain that affect its control over the movement of the body parts. These conditions can definitely be rated under TBI as long as they develop anytime after a moderate or severe TBI (see below).
- Seizures can be considered directly caused by TBI, but only in certain circumstances. First, the seizures cannot be clearly caused by an outside factor, like too much insulin. Secondly the initial TBI must have been moderate or severe. If the TBI is moderate or severe and there is no outside factor causing the seizures, then they can be rated under TBI.
- Dementia, specifically Alzheimer’s disease, frontotemporal dementia, and dementia with Lewy bodies, is a condition where a person looses the ability to properly think and reason. Dementia will be considered caused by TBI if it develops within 15 years after a moderate or severe TBI.
- Depression is considered caused by TBI if it develops within 3 years of moderate or severe TBI or within 12 months of mild TBI.
- Hormone deficiencies caused by damage to either the pituitary gland or the hypothalamus, which controls the pituitary gland, can be rated under TBI if it shows symptoms within 12 months of moderate or severe TBI.
The Severity of the Initial TBI
Right after a traumatic brain injury occurs, the physician will determine if the injury was mild, moderate, or severe. There are a couple of different ways to measure this, but for VA disability, only the following is used:
- The brain is normal when imaged with an MRI or similar
- The patient looses consciousness for 30 minutes or less
- The patient is disoriented, confused, has trouble thinking clearly, or similar for 24 hours or less
- The patient has amnesia for 1 day or less
- The Glasgow Coma Scale is 13 – 15
- The brain is abnormal when imaged with an MRI or similar
- The patient looses consciousness for more than 30 minutes but less than 24 hours
- The patient is disoriented, confused, has trouble thinking clearly, or similar for more than 24 hours
- The patient has amnesia for more than 1 day but less than 7 days
- The Glasgow Coma Scale is 9 – 12
- The patient looses consciousness for more than 24 hours
- The patient has amnesia for 7 days or more
- The Glasgow Coma Scale is 3 – 8
Not every requirement for each severity must be met for a TBI to be categorized. Only ONE requirement must be met. So, if the patient is unconscious for 48 hours, but doesn’t have amnesia and only rated a 10 on the Glasgow Coma Scale, their TBI will still be considered severe.
Let’s do just a couple of quick examples to clarify any confusion there might be on how to apply these new regulations.
Example 1. Let’s say Jane sustains a traumatic brain injury while in that military. She loss consciousness for 2 hours, disoriented for 8 hours, and had amnesia for 3 hours. Based on the requirements, her TBI qualifies as moderate because she lost consciousness for more than 30 minutes, even though the other two only qualify for mild.
So, she has moderate TBI and is separated from the military. One year later, she gets into a car accident and sustains another moderate TBI. A year later, she is diagnosed with depression. Does she qualify to get a rating for her depression? Nope. Although the depression only happened 2 years after her initial TBI, it’s impossible to say that the depression was only caused by the initial TBI. Her second TBI is much more likely to have triggered the depression, and since she was not in the military at that time, it isn’t ratable.
Now, this principle can apply to any occurrence that could also cause a certain condition. I used a second TBI just to keep it simple, but any condition that can cause it is just as valid. For example, HIV can cause dementia. If the HIV is diagnosed after separation from the military but before the development of the dementia, it is much more likely that the dementia was caused by the HIV and not the TBI. (This probably wasn’t the best example, since, based on the circumstances, it might still be more probable that the dementia was caused by the TBI, not the HIV. There must be pretty darn good medical proof, though, to convince the VA of that.)
Example 2. After a traumatic brain injury in combat, Shawn had amnesia for 20 hours, but no other symptoms. This qualified as mild TBI. After he retired from the military 10 years later, Shawn was diagnosed with Parkinsonism. Could it get rated?
No. For Parkinsonism to be considered caused by the TBI, the initial injury had to be at least moderate.
Example 3. Alberta received a TBI while in the military. An MRI showed her brain to be abnormal, she had amnesia for 6 days, and she was given a Glasgow Coma Scale rating of 8. She left the military 6 months later and was then diagnosed with Acromegaly, a pituitary condition, 9 months after the initial incident. Is it ratable?