How Does VA Rate TBI?

What is Traumatic Brain Injury (TBI)?

Understanding the basics will help you learn how VA Rates TBI. Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. According to the Department of Defense, more than 313,816 service members have sustained a TBI in training or combat.  Common causes of this kind of head trauma include blast-related concussion events resulting from training or combat.  In fact, TBI is known as a signature injury of the Iraq and Afghanistan wars due to the frequency of IED attacks.  However, a simple fall down a 10-foot ladder could also damage the brain.  Any veteran who suffered TBI during service should obtain a VA rating to fairly compensate for this significant injury.

Only Specific Doctors can Diagnose TBI

Because TBI involves damage to the brain, it may affect nearly every other body system.  Any symptoms secondary to the initial brain trauma are called residuals.  Before VA will rate TBI, it must confirm that it has been medically diagnosed.  For VA purposes, only one of the following specialties can diagnose TBI:

1. Neurologist,
2. Neurosurgeon,
3. Physiatrists, or
4. Psychiatrist.

Ultimately, TBI is a medical question best answered by a doctor.  However, a veteran and his family should be on alert if any common TBI residuals present themselves.

Common Residuals – VA Rates TBI

There are 3 main areas of dysfunction that may result from TBI:

• Cognitive (such as decreased memory, concentration, attention, and executive functions of the brain)
• Emotional/behavioral (such as anxiety, crying spells, panic attacks, short temper), and
• Physical (such as motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems).

If you have any of these symptoms after a sudden hit to the head during service, then you should get checked for TBI immediately.

VA Rates TBI

After VA concedes service connection for TBI, it turns to the current TBI residuals.  VA divides the rating criteria for TBI residuals into 10 categories.  Veterans are then rated based on the level of severity and impairment in each of these areas:

Rating based on level of severity

1. Memory, attention, concentration and executive functions: Executive functions include goal setting, planning, self-monitoring, and flexibility in changing actions when they are not productive.
2. Judgment: Is the veteran able to make reasonable decisions?
3. Social interaction: How often does the veteran act appropriately in social situations?
4. Orientation: Is the veteran aware of who, where, and when he is?
5. Motor functions: Is the veteran able to perform previously learned motor activities (such as riding a bike)?
6. Visual spatial orientation: Does the veteran get lost even in familiar surroundings?  Is he able to point at or name own body parts?
7. Subjective symptoms: Symptoms that cannot be measured with objective tests, such as panic attacks and thoughts of suicide.
8. Neurobehavioral effects: Examples include lack of motivation, verbal aggression, physical aggression, and lack of empathy.
9. Ability to communicate: Can the veteran communicate either by spoken or written language?  Can he communicate basic needs?
10. Consciousness: Is the veteran in a coma or a vegetative state?

TBI disability rating

• 0 = 0% (normal functioning)
• 1 = 10% (mild)
• 2 = 40% (moderate)
• 3 = 70% (severe)
• Total = 100%

If any residuals of TBI are rated “total”, then VA will award a 100% rating.  If no residual is rated “total”, then VA must rate based on the highest rated residual.   For example, let’s say a veteran has TBI residuals in 3 out of the 10 categories.  He has a 1 for Judgment, a 3 for Ability to Communicate, and a 2 for Orientation.  In this example, VA will award 70% because 3 is the highest residual rating.

Special Monthly Compensation -VA Rates TBI

If you are trying to get the most VA compensation for TBI, then do not stop at the standard rating criteria.  Depending on the circumstances, a veteran may be entitled to Special Monthly Compensation for TBI.  This would be in addition to any ratings VA assigns under § 4.124a.

How We Won This Case

We represented a 30 year-old combat veteran of the Army.  He came to us with a 10% rating for residuals of TBI.  After developing the case, we urged VA to rate his TBI residuals at no less than 70%.  In addition, we discovered that his mother had been his primary caregiver since his return from military service.  Among other duties, the veteran’s mother assisted with medication management, personal hygiene, reminding him of and taking him to appointments, and paying his bill.  The local VA hospital had already appointed the mother as his VA caregiver.  We argued that the record clearly showed the veteran has a permanent need for regular aid and attendance due to his TBI.  In response, VA increased the TBI rating to 70% and granted Special Monthly Compensation at the (r)(2) rate.  As a result, the veteran’s monthly payment changed from $264.02 to $8,343.91.

Get Help Now

Call, 1-800-700-0652

Every C&P exam involves the doctor asking questions of the veteran.  The doctor relies on the veteran to explain his symptoms, some of which may not present or observable on the day of the exam.  Because memory deficits are common TBI residuals, a veteran should attend C&P exams with a spouse, family member, or friend who knows them well.  They can fill in the blanks if the veteran is unable to either remember or communicate certain residuals during the exam.

Related Articles

• What is the Criteria for 70% TBI Disability Rating?
• TBI C&P Exam
• What is VA Permanent and Total Disability?
• How are TBI and PTSD Rated Together?
• Can I Get TDIU for PTSD?
• What are VA TBI Residuals?
• What is VA Permanent and Total Disability?
• Can I Work and Get TDIU?
• VA Disability Rating for PTSD
• VA Permanent & Total Disability

Additional Information

• Schedule of Rating for Neurological Conditions
• VA Research on TBI
• Traumatic Brain Injury Information Page, National institute of Neurological Disorders and Stroke
• Traumatic Brain Injury Report, Department of Defense Special Report