If you’ve suffered multiple head injuries through the years and are experiencing confusion, memory loss, or a decline in your motor functions, you may have Chronic Traumatic Encephalopathy (CTE). CTE is a disorder found in veterans who experienced multiple traumatic head injuries. While CTE is rare in veterans, medical experts still consider the population at high risk.
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In this article about CTE and veterans:
You know you’re getting older, but suddenly it seems like you can’t remember anything. You spend a lot of your day confused and suddenly find it difficult to remember where to put back the milk or how to make the bed. Perhaps you had head injuries in the war, but that was years ago. Maybe you were even diagnosed with post-traumatic stress disorder (PTSD) resulting from the head injuries, but now you know something different is happening. You’re not angry. You’re confused. Your doctor said it could be Chronic Trauma Encephalopathy. But what does that even mean, and are there VA disability benefits for it?
What is CTE?
Chronic Trauma Encephalopathy (CTE) is a brain condition resulting from multiple head traumas and repeated concussions.
The study of CTE is relatively new in the scientific medical community, which is one of the challenges in diagnosing it. It also shares symptoms with many other conditions, including PTSD and Parkinson’s, making it difficult to pinpoint.
People with CTE have symptoms that include cognitive, behavioral, mood, and motor changes. In other words, the symptoms are diverse and depend somewhat on the individual, creating another challenge with diagnosis.
CTE symptoms include:
- Difficulty thinking or remembering
- Problems completing basic tasks
- Impulsive behavior
- Difficulty eating
- Emotional instability
- Substance use
- Suicidal thoughts
- Issues with motor functions
Another challenge with diagnosing CTE is that symptoms don’t start immediately after a head trauma occurs. Instead, they’re thought to develop over the years due to repeated head traumas.
CTE also can only be seen in an autopsy after a person dies, making it difficult to study. But doctors and scientists now recognize it as a legitimate diagnosis, even if they can’t see it on brain scans.
CTE is most common in people who play contact sports, like football or boxing. But it also has been seen in military members with multiple head injuries, sometimes due to being in explosive combat zones.
4 stages of CTE
CTE isn’t immediate. It develops in four stages.
- Stage 1 – People in the first stage of CTE report headaches and memory loss as the primary symptoms. They may also experience depression and have explosive tempers.
- Stage 2 – Mood swings set in during the second stage. They include depression and aggression. People in this stage still have headaches and a difficult time remembering things. Some people experience suicidal ideation in this stage.
- Stage 3 – People in this stage begin experiencing more significant cognitive concerns. They have problems with memory and challenges completing basic daily tasks like making a bed or even buttoning a shirt. People in this stage also begin becoming apathetic instead of angry or sad.
- Stage 4 – People begin having difficulty speaking and moving in this stage. They move slowly and may experience tremors. They also may experience psychotic symptoms like paranoia.
The stages don’t proceed according to a schedule. Depending on the person, they could develop over years or even decades, which is another challenge in diagnosis. Experts think the onset of symptoms begins in a person’s 20s or 30s and even for some around 60.
How is CTE different from other TBIs?
CTE differs from other Traumatic Brain Injuries (TBIs) in how symptoms occur and progress. Multiple TBIs cause CTE. A TBI is immediately diagnosable because symptoms begin as soon as the head trauma occurs. Treating TBIs can help them heal. With CTE, the damage to the brain is already there when symptoms start to appear.
Repeated blows to the head and concussions cause CTE, although not everyone who experiences repeated head trauma develops the condition.
Athletes, veterans, and others who experience repeated head traumas are at risk for the condition.
There is no test to diagnose CTE, so doctors use a combination of knowledge regarding head traumas and symptoms to diagnose it.
CTE causes proteins to build up in the brain and, later, atrophy. Unfortunately, doctors can’t see these changes on brain scans.
Risk for CTE in veterans
Veterans are at risk for CTE, depending on their combat experience, activities during service, and experiences before joining the military. VA disability benefits are available for injuries that occur during active duty service, regardless of whether the injuries happen on base, during leave, or even during recreational activities not related to military activity.
Veterans who were stationed in areas with frequent bomb blasts are more likely to have experienced multiple head injuries and, therefore, more likely to develop CTE.
However, although veterans are considered at risk, the frequency of CTE discovered in veterans is still far below that of athletes who play or have played contact sports.
Veterans are considered “at risk” for CTE, but the cases are so low that researchers still think of it as “rare” in veterans.
How the VA rates CTE
The VA rates CTE the same way it rates traumatic brain injury with diagnostic code 8045 in the Schedule for Rating Disabilities.
The three areas of dysfunction resulting from TBI are cognitive, emotional/behavioral, and physical. Here is how the VA rates the conditions in each area of TBI-related dysfunction:
- Cognitive residuals are decreased memory, concentration, attention, and executive functions of the brain. The VA’s process of determining the level of cognitive impairment is complex. It involves evaluating 10 facets of TBI-related cognitive impairment. The VA determines the level of impairment for each facet.
- Emotional/behavioral residuals are mental disorders that the VA rates using the General Rating Formula for Mental Disorders in the Schedule for Rating Disabilities.
- Physical concerns, including neurological ones, resulting from TBI are evaluated under the specific area of physical dysfunction.
A veteran who experienced several hits to the head during service and has symptoms of dementia, cognitive problems, mood disorders, and other symptoms of a TBI years after service may have CTE.
How to service connect CTE
If you’re diagnosed with CTE, there are two ways to connect it with your service, so you’re eligible for VA benefits. You can either prove a direct or aggravated service connection.
A direct service connection is possible if you experienced repeated hits to the head throughout service or if you played on a military football or boxing team.
To prove a claim for direct service connection, VA-certified disability benefits lawyer Cecilia Ton said you must show three things:
- You have a current disability.
- You experienced a TBI during service.
- There’s a nexus between the two.
She said, many times, the VA will look to a veteran’s service records — personnel and treatment records — to look for evidence of a disability during service. If they don’t find evidence of a head injury, lay evidence from a statement from the veteran or others can prove that the event happened.
But a veteran doesn’t always have to prove that the head injury happened during service. They could show that the service aggravated an existing condition.
Aggravated service connection is when a veteran experienced multiple concussions or head injuries before joining the military then continued to be exposed to head trauma throughout service. Even if the disability was documented on a veteran’s entrance exam, the VA has a duty to prove that military service didn’t aggravate the condition, Ton said.
“If your condition is service connected based on aggravation, your condition will be rated a bit differently than normal,” she said. “The VA is going to have to establish a baseline rating for your condition, which looks at the severity of the condition before the aggravation occurred. Then, it will assign a rating for the severity of the condition after the aggravation. It’ll then compare the ratings, take the difference, and assign the rating.”
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Let Woods and Woods help
Being diagnosed with CTE can be frightening and confusing, especially because it occurs so long after you experience head injuries and perhaps even multiple other diagnoses to explain your ever-changing symptoms. Regardless of your path to the diagnosis, you deserve support from the VA for service-related injuries. Woods and Woods can help you get the compensation you deserve. Contact us today.
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FREQUENTLY ASKED QUESTIONS
Yes, veterans can develop CTE as a result of multiple head injuries. While the diagnosis is still considered rare in veterans, they are also considered at high risk for head injuries and, therefore, CTE.
The VA doesn’t have a specific disability rating for CTE. It’s rated under Traumatic Brain Injuries (TBIs). But the VA does compensate for CTE based on the severity of symptoms and the connection with military service.
A doctor diagnoses CTE based on a history of head injuries and the specific symptoms a person is experiencing. There are no official diagnostic tests for CTE.