By Sandra Basu
WASHINGTON – The VA published a proposed regulation in the Federal Register last month that would make it easier for veterans with certain diagnosable illnesses associated with brain injuries to claim benefits.
Specifically, VA proposed to add a new subsection to its adjudication regulation by revising 38 CFR 3.310 to state “that if a veteran who has a service-connected TBI also has one of the five illnesses, then the illness will be considered service connected as secondary to the TBI.”
The five diagnosable illnesses that VA lists in its proposed rule include:
• Parkinsonism following moderate or severe TBI,
• Unprovoked seizures following moderate or severe TBI,
• Dementias (to include presenile dementia of the Alzheimer type and post-traumatic dementia) within 15 years of moderate or severe TBI,
• Depression, if manifest within three years of moderate or severe TBI or within 12 months of mild TBI,
• Diseases of hormone deficiency that result from hypothalamo-pituitary changes manifest within 12 months of moderate or severe TBI.
“We must always decide veterans’ disability claims based on the best science available, and we will,” Secretary of Veterans Affairs Eric K. Shinseki said in a written statement. “Veterans who endure health problems deserve timely decisions based on solid evidence that ensure they receive benefits earned through their service to the country.”
The VA said it will publish a final regulation after it considers all public comments received during the next 60 days.
The VA said its decision to add these medical conditions was based on findings in a 2008 Institute of Medicine report, “Gulf War and Health, Volume 7: Long-Term Consequences of TBI.”
That report pointed out that troops who suffer severe or moderate TBI are at an increased risk for developing health problems, such as Alzheimer’s-like dementia, aggression, memory loss, depression and symptoms similar to those of Parkinson’s disease.
“In its report, the IoM’s Committee on Gulf War and Health concluded that ‘sufficient evidence of a causal relationship’ — the IoM’s highest evidentiary standard — existed between moderate or severe levels of TBI and diagnosed unprovoked seizures,” the VA explained in a written statement. “The IoM found ‘sufficient evidence of an association’ between moderate or severe levels of TBI and Parkinsonism; dementias (which VA understands to include presenile dementia of the Alzheimer type and post-traumatic dementia); depression (which also was associated with mild TBI); and diseases of hormone deficiency that may result from hypothalamo-pituitary changes.”
Rep. Mike Michaud (D-ME), ranking Democrat on the House Veterans’ Affairs Committee, said in a written statement that the change was “good news” and “will help a lot of veterans who are struggling with the effects of traumatic brain injuries.”
He also pointed out that “VA needs to be prepared for the new claims, which could stress an already backlogged and overwhelmed claims process.”
Under the proposed rule, VA said service connection depends, in part, on the severity of the head injury and the period of time between the injury and the onset of the secondary illness. The VA also explained that the proposed rule does not preclude a veteran from establishing direct service connection, even if time and severity standards are not met.
The Defense and Veterans Brain Injury Center reports that in 2011 alone more than 33,000 medical diagnoses of TBI were made in troops. It also says these diagnoses are not all deployment-related, with the majority occurring in a nondeployed setting.
“Common causes of TBI include crashes in privately owned and military vehicles, falls, sports and recreation activities, and military training,” DVBIC’s website explains.
While implantable devices have shown promise in reducing rehospitalization for heart failure (HF), VA researchers sought to determine if options that are less expensive and non-invasive would have comparable results.
Legislation to prevent VA from outsourcing creation of its drug formulary and to require more input from medical professions is being considered in Congress.