What are the Secondary Conditions?
Traumatic Brain Injury (TBI) is the physical, cognitive and/or behavioral/emotional residual disability that results from an event of external force that causes a brain injury. In addition to these different residuals, it is possible that a veteran may have a separate diagnosable condition that is considered to be a secondary result of TBI. In December of 2013, the regulation on secondary service connection was changed to establish a connection between Traumatic Brain Injury (TBI) and certain illnesses. The full regulation can be found here. According to that regulation, as long as there is no clear evidence to the contrary, the following five conditions are held to be a secondary result of TBI:
- Parkinsonism (including Parkinson’s Disease) – following moderate or severe TBI
- Unprovoked Seizures – following moderate or severe TBI
- Dementias (presenile dementia of the Alzheimer’s type, frontotemporal dementia, and dementia with Lewy bodies) – IF the condition manifests within 15 years following moderate or severe TBI.
- Depression – IF the condition manifests within 3 years of moderate or severe TBI, or within 12 months of mild TBI.
- Disease of Hormone Deficiency (resulting from hypothalamo-pituitary changes) – IF the condition manifests within 12 months of moderate or severe TBI.
Entitlement to secondary service connection for one of the above five conditions, depends on the severity of the TBI and also depends on the period of time between the TBI and the onset of the secondary condition (when the secondary condition manifests). If a veteran’s TBI is of the required severity, and his secondary condition manifests within the required time period, then no medical opinion is needed to determine whether the secondary condition is associated with TBI. If the TBI severity requirement and the time period for manifesting is met, then the above five conditions are automatically associated with TBI.
How the VA Determines TBI Severity
As mentioned above, in order to receive secondary service connection for one of the five included conditions WITHOUT needing a medical opinion, the TBI must be of a certain severity. In looking at this requirement, the VA cares about the INITIAL severity of the TBI. The following table is how the VA evaluates the initial severity of a TBI:
|Normal structural imaging||Normal or abnormal structural imaging||Normal or abnormal structural imaging.|
|LOC = 0-30 min||LOC > 30 min and < 24 hours||LOC > 24 hrs.|
|AOC = a moment up to 24 hrs||AOC > 24 hours. Severity based on other criteria.|
|PTA = 0-1 day||PTA > 1 and < 7 days||PTA > 7 days.|
|GCS = 13-15||GCS = 9-12||GCS = 3-8.|
(LOC = loss of consciousness; AOC = alteration of consciousness/mental state; PTA = post-traumatic amnesia; GCS = Glasgow coma scale)
In order to qualify for a certain level of severity, the TBI does not have to meet ALL of the criteria listed for that level. Also, if a veteran’s TBI meets the criteria for more than one of the levels, the TBI should b evaluated at the highest level in which it meets the criteria.
Evidence Helpful for Initial Severity
Certain evidence can be helpful for the VA when determining the initial severity of a veteran’s TBI. As always, it is important to spend time gathering all of the evidence that you can in order to get an accurate evaluation. Taking the time to make sure this this is done means you may be able save time and money down the road by not having to obtain a private medical opinion. The evidence that is helpful includes:
- Statements of the veteran
- Statements from witnesses of the injury
- History provided by the veteran in medical reports (including VA exams)
- Service treatment records after the TBI
Evidence does not have to be from the exact time of the TBI injury, but it does need to relate to the condition of TBI at or shortly after the time of the injury.
A Gulf War veteran submits his claim for service connection for Parkinsonism secondary to his service connected TBI. The veteran’s separation exam at the time of his discharge mentions a history of TBI in service. However, there is not enough information on the separation exam to determine what the level of severity of that TBI was. The veteran submits a statement describing his loss of consciousness during a battle. The VA reviews the veteran’s prior C&P exam reports and sees a history provided by the veteran that he was told by his fellow service members that he fell unconscious for almost an hour after an explosion went off near him. The veteran also submits a statement from one of his fellow service members that saw the explosion and saw him go unconscious.
The veteran’s statement, along with the statement of his fellow service member, and the history found in the C&P exam reports provides sufficient evidence to determine that he experienced a moderate level of TBI during service. This is true even though his service treatment records do not have sufficient documentation of severity. Because the veterans meets the criteria for a moderate TBI, his Parkinsonism will be service connected secondary to his TBI.