Rules Eased for Veterans’ Brain Injury Benefits

By James Dao | The New York Times | December 7, 2012

The Department of Veterans Affairs will propose new regulations on Friday that will make it easier for thousands of veterans to receive health care and compensation for certain illnesses that have been linked to traumatic brain injury.

The regulations, which will be published on Monday in the Federal Register, lists Parkinsonism, unprovoked seizures, certain dementias, depression and hormone deficiency diseases related to the hypothalamus, pituitary or adrenal glands as eligible for the expanded benefits.

The proposal, which must undergo a 60-day public comment period, could open the door to tens of thousands of veterans filing claims with the Veterans Benefits Administration, which is already struggling to process a huge inventory of such claims.

Since 2000, more than 250,000 service members — some still on active duty — have received diagnoses of traumatic brain injury, or T.B.I., according to the Defense Department. Though T.B.I. is commonly viewed as resulting from blast exposure, the vast majority of those injuries were diagnosed in nondeployed troops who were involved in vehicle crashes, training accidents or sports injuries.

The Department of Veterans Affairs says that a much smaller number of veterans — about 51,000 — are currently receiving benefits for service-connected traumatic brain injuries. However the department acknowledges that thousands more troops with T.B.I. may be eligible for the expanded benefits.

Veterans of prior wars will also be eligible for the benefits, if they can demonstrate that a traumatic brain injury was connected to their military service.

Under current rules, a veteran with one of the five illnesses has to provide medical evidence that the disease is the result of military service in order to receive veterans’ benefits.

The new rule would potentially speed up and simplify their cases, provided a veteran could first demonstrate a service-connected traumatic brain injury.

Once that is established, the department will accept without further evidence that any of those five diseases was caused by the T.B.I., making the veteran eligible for additional compensation and health care for that particular disease.

The regulations include some significant restrictions on eligibility, however. Veterans with Parkinsonism — a neurological syndrome often resulting in tremors or muscle rigidity — as well as unprovoked seizures, dementias and hormone deficiency diseases will be eligible only if their traumatic brain injury was moderate or severe.

The vast majority of such injuries, about 8 in 10, are classified as mild, with most of the rest moderate and a small number severe. The Institute of Medicine, an independent research unit of the National Academy of Sciences, defines a mild traumatic brain injury as involving a loss of consciousness or memory lasting less than 30 minutes. Severe T.B.I. entails loss of consciousness or memory lasting more than 24 hours.

The Department of Veterans Affairs said in a news release that it based its policy on a 2008 Institute of Medicine study, which concluded that evidence linking mild T.B.I.’s to the diseases was only “limited or suggestive.”

“We must always decide veterans’ disability claims based on the best science available,” the secretary of veterans affairs, Eric K. Shinseki, said in the release. “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 proposed regulations also set time restrictions for some of the illnesses. Dementias must become apparent within 15 years of a moderate or severe traumatic brain injury. Hormone deficiency diseases must manifest themselves within one year of a moderate or severe brain injury. And depression must become evident within three years of a moderate or severe brain injury or within one year of a mild one.

The limits in the coverage are likely to draw criticism from veterans’ groups. Still, the announcement clearly pleased advocates who had spent years pushing for expanded benefits for T.B.I.

“Veterans should be pleased with the new regulations,” said Paul Sullivan, a leading advocate for the proposed regulations. But Mr. Sullivan, who is director of public relations for a law firm, Bergmann & Moore, that handles veterans’ claims, said the department must increase training and staffing to ensure that it can handle the wave of new claims likely to result from the new policy.

The last time the department significantly expanded benefits — in 2010, for several diseases linked to Agent Orange, the defoliant used in Vietnam — it prompted a tidal wave of new claims, significantly adding to the department’s backlog. Though the department has cleared most of those Agent Orange claims, it still has an inventory of nearly 900,000 pending claims.

Department officials said they had no plans to hire extra personnel to handle the new regulations, noting that they did not anticipate that the number of additional claims would be very large.

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