dojN002647.xml

dojN002647.xml

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2002-01-21

Brain Injury Association of New York State

January 21, 2002


Kenneth Zwick
Director, Office of Management of Programs

Civil Division
U.S. Department of Justice
950 Pennsylvania Avenue NW
Washington, DC 20530


(by fax 301 519 5954 and first class mail)


Re: Interim Regulations, September 11th, Victims Compensation Fund

Dear Mr. Zwick:


The Brain Injury Association of New York State strenuously objects to the definition of
"Physical
Harm" contained in the interim final regulation.



The proposed regulation would bar persons who did not seek medical treatment within 24 hours
of the
attack from receiving compensation. This requirement would have the effecting of barring many
persons
who sustained a traumatic brain injury as a result of the September 11th attack from obtaining
compensation.


Traumatic Brain Injury has often been referred to as the "silent epidemic: in part because a brain
injury
often goes unrecognized and untreated for a lengthy period of time. A person who has sustained
a
traumatic brain injury often is the last to be aware that they have a serious medical problem. The
individual is often unaware of the serious memory problems, concentration impairments and
personality
changes that have taken place following a traumatic brain injury. Often the individual is dazed,
confused
and disoriented for an extended period of time. Often times, it is the spouse or parent who first
recognizes that their loved on is no longer the same following an insult to the head.


The medical profession now recognizes that post concussion syndrome is a complex group of
medical
symptoms including, but not limited to memory loss, attention deficit, concentration difficulties,
personality changes, behavioral problems and diminished executive functioning which may
develop as a
result of a traumatic brain injury.



The Center for Disease Control has stated "Because the brain is very complex, every brain injury
is
different. Some symptoms may appear right away, while others may not show up for days or
weeks
after a concussion. Sometimes, the injury makes it hard for people to recognize or to admit that
they
are having a problem. The signs of concussion may be subtle. Early on, problems may be
missed by
patients, family members and doctors. People may look fine even though they are acting or
feeling
differently." (Center for Disease Control, Facts and Concussion and Brain Injury)



The National Institute of Health Consensus Conference on the Rehabilitation of Persons with a
Traumatic Brain Injury (JAMA, Sept. 1999) concluded that the consequences of traumatic brain
injury
"change in severity and presentation over time." Injuries may not become apparent according to
the
consensus conference until individuals attempt to resume their daily activities.



The American Academy of Neurology has listed a set of post concussion symptoms that may
only
become obvious days to weeks after a concussion. They include, "persistent low grade
headaches,
lightheadedness, poor attention and concentration, memory dysfunction, easy fatigability,
irritability and
low frustration tolerance, intolerance to loud noises, sometimes ringing in the ears, anxiety
and/or
depressed mood and sleep disturbance." (Neurology, March 1997)


Because a person with a brain injury is a victim of the "silent epidemic" the proposed regulations
and the
limitation on who is eligible for compensation based upon when they first sought medical
treatment will
work a grave injustice to the many individuals who did sustain a brain injury on September 11th.
The
proposed regulation will bar many persons with a brain injury who may experience life long
difficulties
from needed compensation.



If is respectfully requested that the final regulations for the implementation of the September
11th
Victim
Compensation Fund eliminate the requirement that a person must have sought medical treatment
within
24 hours of the attack.



Very truly yours,






Comment by:


Brain Injury Association, New York State


Albany, N.Y.

2002-01-21