TBI VA Disability Benefits
Before we discuss the TBI C&P Exam, unless special rules apply, VA will deny service connection for Traumatic Brain Injury (TBI) unless the Veteran can prove a:
- Current diagnosis,
- In-service event, disease or injury, and
- Medical nexus between the first 2 elements.
Reason for TBI C&P Exam
In any VA claim, it is the veteran’s burden to prove he deserves the benefit. In certain circumstances, VA has a duty to help the veteran meet his burden. A compensation & pension (C&P) exam is one example of how VA helps veterans develop evidence. In a C&P exam, VA asks a qualified professional to answer medical questions related to your claim.
When to Expect a TBI C&P Exam
If you file a claim for TBI based on sudden head trauma during service, then you should expect VA to schedule a C&P examination. A C&P exam can help VA answer the following medical questions:
- Does the veteran have a confirmed diagnosis of TBI?
- Is it at least as likely as not that the TBI was caused or aggravated during active duty service?
- How severe are the residuals of TBI?
Who Can Conduct a TBI C&P Exam:
- Physiatrists, or
Diagnosis of 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.
TIP: Always document injuries
If you cannot prove that your TBI is related to service, then VA may assume that it happened after discharge. For this reason, it is critical that service members document any and all head injuries. Your case is much easier to win if head trauma is clearly documented in your service medical records. In the absence of official records, statements from witnesses would be helpful. If you file a claim for TBI without a confirmed diagnosis, then VA may refer you for a C&P exam.
Medical Nexus for TBI
After a TBI C&P exam confirms a diagnosis, the next question is: what caused it? Is it at least a 50/50 chance that the TBI was caused by in-service head trauma? If your doctor’s answer is “Yes” and he provides a reasonable explanation, then you have your medical nexus. If the doctor answers “No”, then you should consider a second opinion from a private doctor.
Veterans with TBI may experience problems long after the initial head trauma. These problems are known as residuals. During a TBI C&P exam, the doctor will determine which TBI residuals are present. For VA purposes, TBI residuals are broken down into the following 10 categories:
- Memory, attention, concentration and executive functions – Executive functions include goal setting, planning, self-monitoring, and flexibility in changing actions when they are not productive.
- Judgment – Is the veteran able to make reasonable decisions?
- Social interaction – How often does the veteran act appropriately in social situations?
- Orientation – Is the veteran aware of who, where, and when he is?
- Motor functions – Is the veteran able to perform previously learned motor activities (such as riding a bike)?
- Visual spatial orientation – Does the veteran get lost even in familiar surroundings? Is he able to point at or name own body parts?
- Subjective symptoms – Symptoms that cannot be measured with objective tests, such as panic attacks and thoughts of suicide.
- Neurobehavioral effects – Examples include lack of motivation, verbal aggression, physical aggression, and lack of empathy.
- Ability to communicate – Can the veteran communicate either by spoken or written language? Can he communicate basic needs?
- Consciousness – Is the veteran in a coma or a vegetative state?
TBI Rating, TBI C&P Exam
After the TBI C&P exam, the doctor will send a written report to VA. The report will include how severe your residuals are. If VA ultimately approves your claim, it will likely use this report to assign a percentage rating. VA rates TBI residuals on a scale of 0, 1, 2, 3, or total.
- 0 = 0% (normal functioning)
- 1 = 10% (mild)
- 2 = 40% (moderate)
- 3 = 70% (severe)
- Total = 100%
Get Help Now
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.
- What is the Criteria for 70% TBI Disability Rating?
- How does VA rate Traumatic Brain Injury (TBI)?
- How to Appeal a Denied TBI Claim?
- What is VA Permanent and Total Disability?
- Can I Work and Get TDIU?