Background
Veterans that served in Afghanistan or Iraq in support of Operations Enduring Freedom or Iraqi Freedom have been exposed to hazards that are unique to these two conflicts. Research shows that traumatic brain injury (TBI) is more common in veterans that served in Operation Enduring Freedom and Operation Iraqi Freedom. TBI is considered to be a signature disability of these two conflicts. This increased incidence of TBI has been linked to the increased exposure to blasts from improvised explosive devices, improved protective equipment, improved combat medicine, and improved screening and diagnosis. The VA describes TBI as:
According to Monheit Injury Attorneys, a traumatically induced structural injury and/or physiological disruptions of brain function as a result of an external force that is indicated by new onset or worsening of at least one of the following clinical signs immediately following the event:
- Any period of loss or a decreased level of consciousness
- Any loss of memory for events immediately before or after the injury
- Any alteration in mental state at the time of the injury (confusion, disorientation, slowed thinking, etc.)
- Neurological deficits (weakness, loss of balance, change in vision, praxis, paresis/plegia, sensory loss, aphasia, etc.) that may or may not be transient
- Intracranial lesion
In simpler terms, a TBI happens when something outside the body hits the head with significant force. This could happen when a head hits a windshield during a car accident. It could happen when a piece of shrapnel (shrapnel wounds) enters the brain. Or it could happen during an explosion of an improvised explosive device (IED).
Symptoms of TBI
Symptoms of TBI are associated with the severity of TBI. There are three levels of severity of TBI: mild, moderate, and severe. Mild TBI is characterized by a brief loss of consciousness, post traumatic amnesia for less than 1 hour of the TBI, and normal brain imaging results. Moderate TBI is characterized by loss of consciousness for 1 to 24 hours, post traumatic amnesia for 1 to 24 hours of the TBI, and abnormal brain imaging results. Severe TBI is characterized by loss of consciousness or coma for more than 24 hours, post traumatic amnesia for more than 24 hours of the TBI, and abnormal brain imaging results.
For each level of severity of TBI, the VA then divides the symptoms into three different categories: physical effects, behavioral effects, and cognitive effects. Symptoms of TBI can appear immediately following the injury, or may appear weeks to months after the injury. Common symptoms associated with each category are:
| SEVERITY OF TBI | PHYSICAL EFFECTS | BEHAVIORAL EFFECTS | COGNITIVE EFFECTS |
| Mild | Headache; fatigue; sleep disturbance; visual disturbance; dizziness; nausea; balance problems | Irritability; depression and anxiety; emotional mood swings | Decreased attention and concentration; decreased speed of processing; memory problems; getting lost or confused; decreased awareness and insight regarding difficulties |
| Moderate & Severe | Difficulty speaking and being understood; physical paralysis/weakness/spasticity; difficulties with sense of touch, temperature, movement, position; chronic pain; decreased bowel and bladder control; sleep disorders; loss of stamina; appetite changes; partial or total loss of vision; weakness of eye muscles; double vision; blurred vision; problems judging distance; involuntary eye movements; intolerance of light; decreased or loss of hearing; ringing in the ears; increased sensitivity to sounds; loss or diminished sense of smell; loss or reduced sense of taste | Dependent behaviors; apathy; decreased lack of motivation; irritability; acting out; depression; denial of difficulties | Decreased attention and concentration; distractibility; memory problems; decreased speed of processing; increased confusion; perseveration; impulsiveness; decreased interaction skills; decreased executive function abilities (planning, organization, problem solving, etc); decreased awareness of, and insight regarding, difficulties |
TBI Claims and Secondary Conditions
A veteran should establish the following evidence before submitting a TBI claim to the VA:
- An “impact event” during military service when the TBI occurred
- A diagnosis of TBI with medical documentation of the symptoms and severity
- Lay evidence to provide additional documentation of symptoms
Once a veteran has established that their TBI claim is service-connected, they may be able to claim secondary conditions related to the TBI. A veteran with TBI and one of the following 5 conditions will receive presumptive service connection for their secondary condition:
- Parkinsonism (including Parkinson’s Disease), manifested following moderate or severe TBI
- Unprovoked seizures manifested following moderate or severe TBI
- Dementias of the following types: presenile dementia of the Alzheimer type, frontotemporal dementia, and dementia with Lewy bodies, if manifested within 15 years following moderate or severe TBI
- Depression if manifested within 3 years of moderate or severe TBI, or within 12 months of mild TBI
- Diseases of hormone deficiency that result from hypothalamo-pituitary changes if manifested within 12 months of moderate to severe TBI.
If a veteran with service-connected TBI has one of the above conditions, but it does not meet the severity or timeframe criteria they may still be able to get their secondary condition service-connected. The same thing goes for veterans with service-connected TBI that have a condition other than the five listed above. In these circumstances, the veteran may still receive health care and disability compensation for their secondary condition by obtaining a doctor’s opinion establishing that the secondary condition is related to the service-connected TBI.
