Traumatic Brain Injury (TBI) has escalated in prevalence since the beginning of the Gulf Wars, and even more so as veterans of Afghanistan and Iraq start coming home. TBI is such a frequent occurrence that it has become known as the “signature injury” of Afghanistan and Iraq veterans. Insurgents would use roadside bombs (IEDs), fire bombs, and other explosives to fend off American soldiers. TBI is characterized by physical and psychological effects, and veterans often feel residual effects of TBI long after the initial injury.
How Does the VA Assess the Symptoms of TBI Residuals?
The long-term disabling conditions that emerge following the initial brain trauma are referred to as TBI residuals or TBI sequelae. Under diagnostic code 8045 Residuals of traumatic brain injury (TBI), the VA categorizes all TBI residuals into three main categories (physical, cognitive, behavioral/emotional).
Cognitive Impairment
Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Not all of these brain functions may have been affected by TBI, and some functions may be more affected than others. Symptoms may even fluctuate from day to day.
Cognitive functional categories include:
- Memory, attention, concentration, and executive functions
- Misplacing
- Judgment
- Social interaction
- Orientation
- Motor activity (with intact motor and sensory system)
- Visual spatial orientation (maps, unfamiliar, following)
Cognitive impairment can also have subjective symptoms that may be only residuals of TBI or be associated with cognitive impairment or other areas of dysfunction. While 38 CFR 4.12a gives a rating chart for subjective symptoms, some residuals have a distinct diagnosis (such as migraines or Meniere’s disease) and will be rated under that specific category.
Subjective symptoms are rated under the following categories:
- Neurobehavioral effects
- Communication (language, gestures, spoken)
- Consciousness
Emotional/Behavioral Dysfunction
Emotional/behavioral dysfunction is rated under 38 CFR 4.130 (mental disorders) when there is a diagnosis of a mental disorder. If there is no diagnosis of a mental disorder, the VA will rate those symptoms according to the cognitive functional/subjective symptoms as described above.
Common emotional/behavioral symptoms include:
- Feeling anxious
- Having quick mood changes
- Depression
- Irritability
Physical/Neurological Dysfunction
Physical/neurological dysfunctions are rated according to the diagnostic code of the specific condition or symptom. These include:
- Motor and sensory dysfunction
- Visual impairment
- Hearing loss & tinnitus
- Loss of sense of smell and taste
- Gait, coordination & balance problems
- Speech and other communication disorders
- Neurogenic bladder
- Neurogenic bowel
- Cranial nerve dysfunctions
- Autonomic nerve dysfunctions
- Endocrine dysfunctions
The VA’s 10-Category Rating System for TBI Residuals
Your TBI is evaluated in ten different areas that look at how the injury impacts your daily life and abilities:
- Cognitive Abilities: Checking your memory, focus, planning skills, and ability to adjust to changes.
- Judgment: Evaluating if you can make sound decisions.
- Social Skills: Observing how well you interact with others.
- Orientation: Understanding if you’re aware of your surroundings and time.
- Motor Skills: Assessing your ability to do physical activities you’ve learned before.
- Visual-Spatial Skills: Seeing if you have trouble navigating even in well-known places.
- Subjective Symptoms: Identifying symptoms like panic attacks that can’t be measured objectively.
- Neurobehavioral Impact: Looking at changes in your motivation and behavior.
- Communication: Determining how well you can speak or write.
- Consciousness: Checking for severe conditions like coma or vegetative states.
When a veteran undergoes a Compensation & Pension examination for TBI, the examiner will assess each of the 10 facets. VA raters use the results from these assessments to determine the veteran’s overall disability percentage.
What Is the VA Rating for TBI Residuals?
After assessing how symptoms impact the veteran’s daily life, the VA rates TBI residuals on a scale from 0 to 100% (Total):
- 0%: Normal functioning, no apparent issues.
- 10%: Mild impact on daily life.
- 40%: Moderate difficulties.
- 70%: Severe challenges in functioning.
- 100%: Total impairment.
If any category is rated as “Total,” the VA will provide a 100% disability rating. Otherwise, the highest rated category determines your overall rating. For example, if you have ratings in three categories — 1 for Judgment, 3 for Communication, and 2 for Orientation, the VA will assign a 70% rating, as 3 is the highest.
The higher the rating, the more disability pay you can get. Additionally, special monthly compensation can be awarded for TBI for problems such as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance, being housebound, etc.
Were You Denied VA Benefits for TBI Residuals?
The VA uses this system whenever they reconsider an assigned rating, such as when a veteran appeals a VA decision. If you were underrated by the VA, appeal as soon as possible and document your condition to get maximum benefits. Our VA-accredited lawyers may be able to fight on your behalf, with no upfront costs.
Get a free evaluation from us today – even if we don’t take your case, we’ll point you in the right direction!
Content Reviewed by
Attorney Allison Reddick
Allison Reddick is a passionate advocate for veterans, combining her extensive health and legal expertise to ensure they receive the benefits and healthcare they deserve. A “triple Gator” graduate of the University of Florida, Allison’s dedication to social justice and public health drives her work at Hill & Ponton, where she specializes in veterans’ disability law.
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