Featured
> Master Condition List
> Federal Benefits List by Combined Ratings
> Insight into the Claims Process (VBA Perspective)
> Rating Schedule Index
> Filing a VA Disability Claim
> Filing an Appeal

> Death/Survivor Benefits

> Education & Employment

> Health care

> Housing

> Miscellaneous

> VA Disability Compensation

> VA Pension

Rating Schedule for 8045 Traumatic Brain Injury (TBI)

When the brain gets damaged as a result of something like:

  • Car accident;

  • Concussive artillery fire;

  • IED blast;

  • Fall;

  • Gunshot wound;

  • etc.

IMPORTANT NOTES:

  • If your TBI causes the loss of use or requires aid and attendance you may be entitled to Special Monthly Compensation.

  • TBI can be one of the most complicated conditions to rate and it is fairly easy for a rater to mess it up. If you feel you were not rated correctly, you may benefit from requesting a Higher Level Review.

Pyramiding

The VA is prohibited from assigning multiple ratings for the same symptoms. This is complicated by the fact that TBI's rating criteria is a smoothy mix of symptoms! This is particularly true when it comes to Area 10.

The rater should carefully consider how they rate TBI, to give the Veteran the maximum benefit; Meaning running through various scenarios to see which produces the best outcome. See Example for more details.

IMPORTANT NOTE:

  • The VBA is PROHIBITED from awarding vertigo as a separate evaluation from TBI! Even if awarding vertigo would itself be the better evaluation!

    • Does it make sense? No but… If you fit into this situation… you could try appealing to the Board of Veteran Appeals (BVA); since they are NOT bound by VBA policy decisions.

PTSD & TBI

Due to overlapping nature of the symptoms of PTSD and TBI. The VA often WILL lump a Veteran's PTSD and TBI ratings.

However, IF the Veteran's examiner/physician/specialist is able to separate the symptoms of the 2 disorders. The Veteran CAN get 2 separate individual ratings!

Further, if the Veteran had PTSD BEFORE their TBI. This can provide a key element in being able to differentiate the symptoms.

How TBI is Rated

TBI is rated upon the severity of the residual symptoms a Veteran has. There are a total of 10 areas of impairment that the VA considers. The veteran will be evaluated in each of those 10 areas. The area that has the highest level of impairment will be the the basis of the Veteran's SINGULAR TBI rating. UNLESS it is more beneficial to break the symptoms into their own separate ratings(s). See Example for more details.

IMPORTANT NOTES:

  • You are NOT going to get 10 individual ratings!

RATER NOTE:

  • If the examiner notes there are NO residual TBI symptoms, but is able to diagnose a TBI (EVEN IF ACUTE) a 0% rating is to be granted (if service-connection is warranted)!

Severity of Impairment

The schedule runs on a scale of 0-Total. For ease of readability the following tables on this page have been converted to just state the rating percentage.

Rating
 Severity of Impairment
0% 0.
10% 1.
40% 2.
70% 3.
100% Total.

Executive Functioning (Area 1)

This includes but is not limited to:

  • Attention;

  • Concentration;

  • Decision making;

  • Flexibility in thinking;

  • Goal setting;

  • Memory;

  • Organization;

  • Planning ahead;

  • Prioritizing;

  • Problem solving;

  • Speed of information processing; and

  • Spontaneity.

Rating
 Description
0% No problems.
10% Veteran claims to have mild issues in some areas but there is NO objective evidence (testing) that proves the Veteran's claims.
40% Veteran's claim of having mild issues in some areas have been confirmed with testing.
70% Testing shows there is moderate levels of impairment. Moderate levels would result in issues with ability to work/care for oneself.
100% Testing shows severe impairment. Would equate to inability to work/care for oneself.

Judgment (Area 2)

This includes but is not limited to:

  • Comprehend consequences;

  • Consider alternative options;

  • Identify and understand issues;

  • Identify their situation; and

  • Make reasonable decisions.

Rating
 Description
0% Normal.
10% Mild impairment - for complex or unfamiliar decisions, occasionally unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision.
40% Moderate impairment - for complex or unfamiliar decisions, usually unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision, although has little difficulty with simple decisions.
70% Moderate-severe - for even routine and familiar decisions, occasionally unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision.
100% Severe - almost always unable to understand or make reasonable decisions.

Social Interaction (Area 3)

This includes but is not limited to:

  • Ability to interact with others.

Rating
 Description
0% Always appropriate.
10% Occasionally inappropriate.
40% Frequently inappropriate.
70% Inappropriate most or all the time.

Orientation (Area 4)

This includes:

  1. Person - Knowing who they are

  2. Place - knowing where they are

  3. Time - knowing the time/date

  4. Situation - knowing what they are doing

Rating
 Description
0% Always orientated.
10% Occasionally unable to identify 1 of the 4.
40% Occasionally unable to identify 2 of the 4; OR often unable to identify 1.
70% Often unable to identify 2 or more.
100% Consistently unable to identify 2 or more.

Motor Activity (Area 5)

This includes:

  • Ability to physically do things.

IMPORTANT NOTE:

  • This is purely based upon apraxia. Which means the brain is the source of the motor difficulty. I.E. there is nothing wrong with the nervous system or the muscles.

Rating
 Description
0% Normal.
10% Normal most the time, but mildly slowed at times.
40% Mildly slowed most the time; OR moderately slowed at times.
70% Moderately slowed most the time.
100% Severely slowed most the time or movement is impossible.

Visual Spatial Orientation (Area 6)

This includes but is not limited to:

  • Judging distances;

  • Not get lost;

  • Reading maps; and

  • Using a GPS device.

Rating
 Description
0% Normal.
10% Mild - occasionally gets lost in unfamiliar surroundings, has difficulty reading maps or following directions. Is able to use assistive devices such as GPS.
40% Moderate - usually gets lost in unfamiliar surroundings, has difficulty reading maps, following directions, and judging distance. Has difficulty using assistive devices such as GPS.
70% Moderate-severe - gets lost even in familiar surroundings, unable to use assistive devices such as GPS.
100% Severely - may be unable to touch or name own body parts when asked by the examiner, identify the relative position in space of two different objects, or find the way from one room to another in a familiar environment.

Neuro-behavioral Effects (Area 7)

Symptoms that revolve around emotions and mental health.

This includes but is not limited to:

  • Apathy (feeling indifferent or uncaring);

  • Belligerence (acting aggressively);

  • Impaired awareness of disability;

  • Impulsivity;

  • Irritability;

  • Lack of cooperation;

  • Lack of empathy (ability to understand and share feelings);

  • Lack of motivation;

  • Moodiness;

  • Physically aggressive;

  • Unpredictability; and

  • Verbally aggressive.

Rating
 Description
0% May have symptoms, but they do not interfere with ability to work or form relationships.
10% Symptoms occasionally interfere with the ability to work or form relationships.
40% Symptoms frequently interfere with the ability to work or form relationships.
70% Most days, symptoms interfere or prevent ability to work or form relationships; OR Occasionally requires supervision to prevent harm to self or others.

Communication (Area 8)

This includes ability to:

  • Read;

  • Speak;

  • Understand spoken words; and

  • Write words.

Rating
 Description
0% No issues.
10% Comprehension or expression, or both, of either spoken language or written language is only occasionally impaired. Can communicate complex ideas.
40% Inability to communicate either by spoken language, written language, or both, more than occasionally but less than half of the time, or to comprehend spoken language, written language, or both, more than occasionally but less than half of the time. Can generally communicate complex ideas
70% Inability to communicate either by spoken language, written language, or both, at least half of the time but not all of the time, or to comprehend spoken language, written language, or both, at least half of the time but not all of the time. May rely on gestures or other alternative modes of communication. Able to communicate basic needs.
100% Complete inability to communicate either by spoken language, written language, or both, or to comprehend spoken language, written language, or both. Unable to communicate basic needs.

Consciousness (Area 9)

Yes or no.

Rating
 Description
0% Awake.
100% Coma or vegetative state.

Subjective Symptoms (Area 10)

This is a catch all for symptoms only the Veteran can attest to, that do not fit into the other areas.

This includes but is not limited to:

Rating
 Description
0% Symptoms that do not interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples are: mild or occasional headaches, mild anxiety.
10% 3 or more symptoms mildly interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment are: intermittent dizziness, daily mild to moderate headaches, tinnitus, frequent insomnia, hypersensitivity to sound, hypersensitivity to light.
40% 3 or more symptoms moderately interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment are: marked fatigability, blurred or double vision, headaches requiring rest periods during most days.

TBI Rating Example

Veteran has the following symptoms:

Is examiner able to separate TBI and mental health symptoms?: NO

Okay so lets start cutting this apart!

So social interactions and PTSD are same set of symptoms, we CANNOT award a separate ratings for those within consideration! So lets cross those out and set aside PTSD.

Looking at the TBI areas, we only have area 10 left. However, since the subjective symptoms (headaches, and tinnitus) themselves will rate higher under their own schedules we can cross those out and set them aside.

We still have sensitivity to light and vision impairment and area 10 remaining. But wait! We need to go back to the area 10 part of the schedule and re-run it! Since we parted out the other subjective symptoms, area 10 now rates 0%.

So how does our end rating look?

It would look like this:

Rating
 Condition
70% PTSD.
30% Headaches.
10% Tinnitus.
0% Residuals of Traumatic Brain Injury with sensitivity to light and vision impairment.

Common Secondary Conditions

Due to the TBI rating consisting of a whole host of symptoms. If the TBI is shown to be the cause of secondary conditions. Those secondary conditions can be service-connected.

Again, be aware of pyramiding - the Veteran CANNOT have the same symptom rated twice!

Presumptive Secondary Conditions

In 2014, Congress Recognized that there was enough evidence to support the establishment of several presumptive conditions for those who experienced varying degrees of TBI.

IMPORTANT NOTE:

  • If there is clear evidence that the condition was more likely caused by another after service TBI, disease, etc. Then service-connection can still be denied!

The following 5 conditions are those that have been recognized as being presumptive. Each with their own rules. Such as the severity of the TBI experienced during service as well as the time frame in which the condition needs to be diagnosed since the TBI event.

  1. Parkinson's disease - moderate or severe TBI (during life of Veteran).

  2. Seizures - moderate or severe TBI (during life of Veteran).

  3. Dementia (Alzheimer's disease) - moderate or severe TBI (within 15 years).

  4. Depression - mild (within 1 year) moderate or severe TBI (within 3 years).

  5. Hormone deficiencies due to damage to the Pituitary gland or the hypothalamus - moderate or severe TBI (within 1 year).

Severity of TBI

The severity is determined during the time surrounding the events immediately following the TBI event.

IMPORTANT NOTE:

  • The Veteran only needs to meet ONE bullet in a category to fall within it.

  • Mild:

    • Brain was normal when imaged;

    • Veteran lost consciousness for 30 minutes or less;

    • Veteran was disoriented, confused, had trouble thinking clearly, or similar for 24 hours or less;

    • Veteran had amnesia for 1 day or less; or

    • Glasgow Coma Scale is 13 – 15.

  • Moderate:

    • Brain was abnormal when imaged;

    • Veteran lost consciousness for 30 minutes but less than 24 hours;

    • Veteran was disoriented, confused, had trouble thinking clearly, or similar for more than 24 hours;

    • Veteran had amnesia for more than 1 day but less than 7 days; or

    • Glasgow Coma Scale is 9 – 12.

  • Severe:

    • Veteran lost consciousness for more than 24 hours;

    • Veteran had amnesia for 7 days or more; or

    • Glasgow Coma Scale is 3 – 8.

Unemployability

As you saw the TBI schedule is a bit all over the place and is not particularly great at compensating Veterans.

However, if your TBI and/or your other service-connected disabilities make you unable to hold down gainful employment. You should apply for Total Disability based on Individual Unemployability (TDIU).

Disability Benefits Questionnaire (DBQs)

To get an idea of how a C&P exam will be conducted it is recommended that the Veteran look at the applicable DBQ.

Veteran's may ask a physician to complete a DBQ on their behalf to submit with their claim. For more information on DBQs click HERE.

Having Trouble Finding Your Condition?

  • Click HERE to view the Master Condition List.

References