New Rules for Veterans Disability Related to TBI's

Thousands of service members returning home from Iraq and Afghanistan suffer from traumatic brain injury (TBI). So many, in fact, that TBI is called the “signature injury” of these wars. This has been attributed in part to the common use of roadside bombs (IEDs), fire bombs, and other explosives by insurgents.

Traumatic brain injury is characterized by both physical and psychological impairments, and oftentimes, veterans suffer from residual effects of TBI. In those cases, the VA may not recognize those residual symptoms as being caused by traumatic brain injury, and this creates a limitation on the benefits a veteran can receive.

Because the Department of Veterans Affairs (VA) has been criticized for underestimating the effects of TBI and not awarding benefits to many veterans suffering from TBI, the VA has proposed a revised regulation, 38 CFR 3.310, to help more veterans with TBI to qualify for benefits.

The proposed rule recognizes five illnesses as being caused or worsened by TBI. A veteran who can establish service-connection for traumatic brain injury (that is, that the TBI resulted from military service) may be able to get an increase in benefits based on these illnesses once the new rule is finalized.

After the proposed rule becomes final, the following diseases will be presumed to be service-connected:

  • Parkinson’s disease that is diagnosed following moderate or severe TBI
  • seizures for which no cause has been established following moderate or severe TBI
  • certain dementias if diagnosed within 15 years after moderate or severe TBI
  • depression that is diagnosed either:


    • within three years of moderate or severe TBI, or
    • within one year of mild TBI
  • hormone deficiency diseases that are diagnosed within 12 months of a diagnosis of moderate to severe TBI.

The VA will use the following evidence to rate TBI as mild, moderate, or severe:

  • MRI, PET, or other scans
  • length of an altered mental state or altered state of consciousness
  • length of loss of consciousness
  • length of amnesia, and
  • score on the Glasgow Coma Scale (a test used after head injuries).
When the VA presumes that a condition is service-connected, this means the veteran does not have to prove that the illness or injury was caused while they were in service. Medical evidence won’t be needed because the VA decides that the mere existence of the disease or medical condition is enough to establish service connection. This is much easier than having to submit evidence to prove the disability was caused during service.
Veterans who would like to be evaluated for TBI, brain injuries, and illnesses resulting from TBI may be eligible for a Gulf War Registry Exam. This is a free exam that does not require enrollment in the VA health care system. Veterans are eligible for this exam if they served during 1990-1991 in Operation Desert Storm, Operation Iraqi Freedom, Operation New Dawn, Operation Desert Shield, or the Gulf War. To ask for the Gulf War Registry Exam, call the Environmental Health Coordinator at your local VA medical center or clinic.

Traveling with a Person who has Disabilities

If you like to travel, but worry about leaving a loved one at home who has a disability, consider taking them with you!  Think of the experience that you and your loved one will be able enjoy and remember!  Here are some tips to traveling with a person who has disabilities:

One thing is to research how easy the city can be to navigate, and how accommodating the city is to wheelchair accessibility.  If you do an internet search of the city's name, and "navigating with special needs," you will be able to find out if this city is an option for you! It will tell you about the sidewalk conditions, and the quality of public transportation, and options for taxi services. If the city has bad public transportation, look into driving services that may be available. 

Look for hotels that will help accommodate your needs, and are close to the sights that you would like to see. Think about things that make your loved one feel comfortable, such as air conditioning.  This will make your trip go more smoothly if the comforts and familiarity that they are used to are also offered at the hotel that you are staying at.  

Consider flying to make your trip shorter.  The airports provide wheelchairs, and offer assistance on and off the plane, and to your next gate, all free of charge.  They also allow you more boarding time so that your loved one can get settled in to their seat without feeling rushed. This will help you avoid long car rides, and you will be able to enjoy your stay at your destination for a longer period of time! 

When getting off of the plane, look into having a car to wait for you.  They will help with your luggage, and you will avoid all of the hassle of trying to hail a taxi.  This will make the trip less stressful, and more relaxing. Take lots of breaks while you are site seeing. Traveling is exhausting, and you don't want to wear your loved one out early on in the trip.  Make time for naps and relaxation!

Make sure to keep any medication on you!  You don't want them to be in your luggage if it gets lost, or delayed.  Carry them in the original bottles, and write down the generic names, just in case you need to find a quick replacement.  If you are traveling outside of the country, write down the interpretation for the reasoning to the medication, such as "high blood pressure." Also look up how to say the things they are allergic to.  

Make sure that you always carry your loved one's doctor's phone number.  A couple of good things to keep on hand at all times are water (to keep hydrated), energy bars and almonds (For a quick boost), Advil, Neosporin, and anti-diarrhea medication.  

Helpful Tips for People with TBI's to Maintain Independence

People who get their TBI later in life, often feel that their independence has been taken away.  Here are some helpful tips to help you maintain some of that independence!


To address problems with memory, attention span, and organization:

Try creating daily schedules and checking things off as you do them. 

Use alarms to remind yourself of things you need to do throughout the day, such as taking medications.  Keep calendars where they are easy to see, and review and update them every day.

Have specific places for things that you use a lot, such as your house keys. 

If reading is challenging, listen to recorded books from the local library.

Play games that use memory and problem solving skills, such as cards, dominoes, checkers, chess, word search puzzles, and board games. 

Reduce distractions such as noise and clutter to help make you concentrate and make fewer mistakes. 


If you want to feel more in control of your emotions and behavior:

Try to avoid things that make you angry or frustrated.

Make time to do the things you enjoy, such as hobbies or being with friends.

Allow yourself to grieve your losses.

Accept help from people you trust.

Get enough sleep and rest.  Being tired and in pain can make it harder to cope.

Join a support group to share your experiences and learn from others.


To ensure that you are being as safe as possible:

Keep emergency contact numbers on the refrigerator, where they are easy to find, and see. 

Remember that you may need more help than you realize.  Ask for support from a family member or friend. 

Use household appliances that have fewer risks until you have been evaluated.  For example, use the microwave instead of a stove.

If you want to drive, have an evaluation before getting behind the wheel.  If you can’t drive, look into an alternative transportation in your community.

Install safety grab bars near the toilet, and in the tub if you have poor strength and balance. 

Look into some sort of an emergency call button so that you are able to call for help if need be.

If you would like to get back into participating in work, school, or volunteer opportunities:

Think about things you enjoy and are good at.  How can you apply these to work, school, or volunteer positions?

Meet with your employer or school administrator to talk about your skills, and what you need help with.

Consider taking a different job in the same company if you are having trouble at work.

Ask for feedback or assistance from a trusted friend or colleague.   

Understanding an Individual with a TBI

A brain injury occurs every 23 seconds.  3.1 Million Americans live with a Brain Injury.  Obtaining knowledge of Traumatic Brain Injuries will help you understand a client or family member who has one and it will improve the quality of services that you provide to individuals with brain injuries. 

The brain controls everything that we do.  Breathing, walking, talking, thinking, behaving, and feeling are all connected to the brain. Damage to the brain may vary in extent, area, and type of damage, depending on a variety of factors relating to the nature of the injury, the severity of the injury, how the injury occurred, and the quickness of medical response.  Brain Damage occurs in a TBI in 3 different areas.  The Focal Damage would pertain to damages such as skull fractures, contusions or bruises under the location of a particular area of impact.  The Fronto-Temporal Contusions/Lacerations refers to the bruising of the brain, or tearing of blood vessels in the frontal and temporal lobes of the brain caused by the brain hitting or rotating across the ridges inside the skull.  The Diffuse Anoxal Injury refers to when the shifting and rotation of the brain inside the skull will result in tearing and shearing injuries to the brain’s long connecting nerve fibers or axons.  If the brain damage is from a medical incident that results in an infection, swelling of the brain or anoxia, the damage tends to be more diffused.  If the brain damage is related to a medical incident like a stroke or aneurysm, the damage tends to be more focal.

Every person with a brain injury is vastly different because every individual is different prior to an injury, and all brain injuries are different within themselves.  Damage to the brain may vary in extent, area, and type of damage depending on a variety of factors relating to the nature of the injury, the severity of the injury, how the injury occurred, and the quickness of medical responses, among other factors.  Every person adjusts differently to the changes that result from brain injury. Therefore, every person with a brain injury needs differing types and levels of support.  The results of brain injuries can be categorized into the following areas:   Physical, Cognitive, Executive Functioning, Affective Behavioral, and Psychosocial.    

Since every person is different, it is very important to get to know your family member’s or client’s abilities.  A good acronym to remember for this is ROAD.  This stands for Read/Review, Observe, Ask questions, Don’t assume.  ROAD will help to support an individual with a brain injury. 

There are some things to keep in mind and remember while you are with an individual with a Traumatic Brain Injury.  Remember to stress the individual’s strength’s.  Be honest, but gentle and tactful when helping them.  Don’t take things personally; people with brain injuries tend to not have a filter.  Treat everyone with dignity and respect, and never talk down to this person.  Avoid arguments and blame.  Respect differences, and understand you’re own and the person’s cultural and personal values.  Remember that progress may be slow, but keep at it-it works!!  Lastly, make sure you give yourself a pat on the back for a job well done! 

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