VA Proposes the Inclusion of 5 Secondary Conditions in Connection with Traumatic Brain Injury

The Department of Veterans Affairs has proposed to amend Section 3.310 of Title 38 of the Code of Federal Regulations (38 3.310 CFR) which concerns disabilities that are proximately due to, or aggravated by, service-connected disease or injury.  The proposal seeks to incorporate five diagnosable secondary conditions that are the result of service-connected traumatic brain injury (TBI).  In the period between 2000-2012, more than 250,000 service members suffered from TBI with 42,000 cases considered “moderate,” a state of disorientation and confusion lasting more than twenty-four hours but less than seven days, and more than 2,500 considered “severe,” with 4,000 added cases of penetrating wounds to the head either caused by weapons or devastating blows that lodge skull fragments into the brain.

The revision of 3.310 would read as follows with the addition of paragraph (d):

§ 3.310 Disabilities that are proximately due to, or aggravated by, service-connected disease or injury.

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(d) Traumatic brain injury. (1) In a veteran who has a service-connected traumatic brain injury, the following shall be held to be the proximate result of the service-connected traumatic brain injury (TBI), in the absence of clear evidence to the contrary:


(i) Parkinsonism following moderate or severe TBI;

(ii) Unprovoked seizures following moderate or severe TBI;

(iii) Dementias (presenile dementia of the Alzheimer type and post-traumatic dementia) if manifest within 15 years following moderate or severe TBI;

(iv) Depression if manifest within 3 years of moderate or severe TBI, or within 12 months of mild TBI; or

(v) Diseases of hormone deficiency that result from hypothalamo-pituitary changes if manifest within 12 months of moderate or severe TBI.


(2) Neither the severity levels nor the time limits in paragraph (d)(1) of this section preclude a finding of service connection for conditions shown by evidence to be proximately due to service-connected TBI. If a claim does not meet the requirements of paragraph (d)(1) with respect to the time of manifestation or the severity of the TBI, or both, VA will develop and decide the claim under generally applicable principles of service connection without regard to paragraph (d)(1).

(3)(i) For purposes of this section VA will use the following table for determining the severity of a TBI:

Mild Moderate Severe
Note: The factors considered are:
Structural imaging of the brain.
LOC—Loss of consciousness.
AOC—Alteration of consciousness/mental state.
PTA—Post-traumatic amnesia.
GCS—Glasgow Coma Scale. (For purposes of injury stratification, the Glasgow Coma Scale is measured at or after 24 hours.)
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.


Details of the studies concerning the specific conditions above can be found here, with scientific evidence based on the 2008 National Academy of Science Institute of Medicine report, Gulf War and Health Volume 7: Long-Term Consequences of Traumatic Brain Injury. The regulations change was proposed on December 10, 2012 and, if approved, would make it easier for veterans to receive their disability benefits, but could also add to the already burdened disability claims backlog.  People wishing to comment on the proposed rule have until February 8, 2013 to do so.