THE Challenge! Spring 2011

THE Challenge!
Classifying
Brain Injury
as a Chronic
Disease
By Brent Masel, M.D., President and Medical Director,
Transitional Learning Center, Galveston, TX
9
Implicit in the nomenclature, Traumatic
Brain Injury (TBI), is the notion that trauma
to the brain is the result of an injury and
that the injury will heal. Medical conditions
that are referred to as injuries most often have
a prescribed protocol for treatment that almost
always results in a resolution that cures the
injury. However, this is not the case with TBI.
By its very nature, each TBI has its own unique
signature, which will manifest as one of, or a
constellation of, neurological effects. While
many of the 1.7 million TBIs sustained annually
in the U.S. are, indeed, injuries from which each
patient recovers, or is cured, more than 125,000
of these are permanent and incurable. For these
TBIs, the classification of “disease” is more
appropriate than that of “injury.”
Disease is defined in the Free Online Dictionary
as representing a “deviation from or interruption
of the normal structure or function of any body
part, organ or system that is manifested by a
characteristic set of symptoms and signs and
whose etiology, pathology and prognosis may
be known or unknown.” And, the results of a
TBI can be described in these terms.
Take the first phrase of the definition: a “deviation from or
interruption of the normal structure or function of any body
part, organ or system…” The results of a TBI do cause these
things to affect the individual’s brain and neurological system.
The next part states that these deviations and interruptions “…
are manifest by a characteristic set of symptoms and signs…”
which applies to the constellation of symptoms associated
with a TBI. The definition concludes with “…whose etiology,
pathology and prognosis may be known or unknown,” which
speaks to the progressive disease process initiated by a TBI.
This is why it
is imperative
that the medical
insurance
industry, medical
community, and
the communityat-large,
understand TBI
as a disease
state that is
progressive in
that, over time,
it has deleterious
effects on other
organ systems.
THE Challenge! | Spring 2011
In general, the insurance industry uses the term
“sickness” rather than “disease” to describe TBI.
Sickness is defined by one medical insurance
industry provider as: “illness, disease of condition
of a covered person which first manifests itself
after the effective date of the policy and which
this policy is in force for such person. Sickness
includes any complications of recurrences
that relate to such sickness while the policy
is in force of the person.” (H. Kelso, personal
communication, June 30, 2008). When applied
to TBI, this definition implies that TBI is a onetime
illness that has a beginning and a resolution.
While this is the case for many individuals who
sustain a TBI, it is not the case for quite a few.
This is why it is imperative that the medical
insurance industry, medical community, and the
community-at-large, understand TBI as a disease
state that is progressive in that, over time, it has
deleterious effects on other organ systems.
Scientific data exist that supports the fact that
neither an acute TBI, nor a chronic TBI, is a
static process – that a TBI impacts multiple
organ systems, is disease-causative, and diseaseaccelerative.
Classification of TBI as the beginning of a disease
process would facilitate treatment as outlined for the full
continuum of care, which should be paid for by medical insurers
and managed on a par with other diseases
Despite the fact that individuals with a TBI who survive the
acute event do not die of their brain injury per se, TBI is
a disease. There are many similar examples in the field of
medicine. Chronic kidney disease is an independent risk factor
for cardiovascular disease. Patients with chronic kidney disease
are more likely to die of cardiovascular disease than end-stage
renal failure. Patients do not succumb to AIDS. They die from
other diseases, such as pneumonia, caused by the AIDS disease.