Diagnosing and Rating TBI Residuals

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. 

This guide explains how the VA evaluates TBI residuals, how to increase your rating, and what to do if your claim is denied. 

How Does the VA Assess the Symptoms of TBI Residuals? 

The long-term symptoms and conditions that persist after a brain injury are called 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 and 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

What Is the VA Rating for TBI Residuals? 

When a veteran undergoes a Compensation & Pension examination for TBI, the examiner will assess 10 different areas in which TBI residuals impact daily life and abilities. VA raters use the results from these assessments to determine the veteran’s overall disability percentage on a scale from 0% (normal functioning) to 100% (total impairment). 

• 0%: Normal functioning, no apparent issues. 
• 10%: Mild impact on daily life. 
• 40%: Moderate difficulties. 
• 70%: Severe challenges in functioning. 
• 100%: Total impairment. 

The VA’s 10-Category Rating System for TBI Residuals 

1. Cognitive Abilities: Checking your memory, focus, planning skills, and ability to adjust to changes. 
2. Judgment: Evaluating if you can make sound decisions. 
3. Social Skills: Observing how well you interact with others. 
4. Orientation: Understanding if you’re aware of your surroundings and time. 
5. Motor Skills: Assessing your ability to do physical activities you’ve learned before. 
6. Visual-Spatial Skills: Seeing if you have trouble navigating even in well-known places. 
7. Subjective Symptoms: Identifying symptoms like panic attacks that can’t be measured objectively. 
8. Neurobehavioral Impact: Looking at changes in your motivation and behavior. 
9. Communication: Determining how well you can speak or write. 
10. Consciousness: Checking for severe conditions like coma or vegetative states. 

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. 

Individual Unemployability for TBI Residuals 

Total Disability Based on Individual Unemployability (TDIU) is a benefit that pays at the 100% disability rate to veterans who cannot maintain substantially gainful employment due to one or more service-connected conditions, even if their combined rating is less than 100%. You are eligible for it if:   

• Your TBI residuals significantly impair your ability to work, especially in jobs that require concentration, memory, planning, social interaction, or physical coordination. 
• You experience frequent migraines, seizures, mood instability, or executive dysfunction that interfere with consistent job performance. 
• You are unable to perform sedentary work due to fatigue, cognitive slowing, or psychiatric symptoms tied to TBI.  

To qualify for TDIU you must a) have one service-connected disability rated at 60% or more, OR b) have two or more disabilities with one rated at 40% or more and a combined rating of at least 70%. 

Additionally, veterans who don’t meet either of these thresholds can qualify on an extraschedular basis under 38 C.F.R. § 4.16(b) if the TBI residuals clearly prevent substantially gainful employment. This is defined as employment earning more than the poverty threshold and not considered sheltered or marginal. 

How to Apply for TDIU 

1. Complete and submit VA Form 21-8940 (Veteran’s Application for Increased Compensation Based on Unemployability) 
2. Submit VA Form 21-4192 (Request for Employment Information), which will also be sent to your most recent employer 
3. Provide medical evidence or C&P exam results showing the impact of TBI on employment 
4. Include lay statements from family, employers, or colleagues explaining work limitations 

Special Monthly Compensation (SMC) 

Special Monthly Compensation is an additional tax-free benefit paid on top of regular VA disability compensation when a veteran has specific severe disabilities or combinations of disabilities that result in extraordinary levels of impairment, such as loss of use of limbs, sensory organs, or the need for aid and attendance. You qualify for SMC due to TBI residuals if the injury results in one or more of the following: 

• Loss of use of an arm or leg 
• Neurogenic bladder or bowel requiring catheterization or appliances 
• Needing help with dressing, bathing, feeding, toileting 
• The inability to leave home unassisted (housebound) 
• Severe sensory deficits, such as complete loss of vision or hearing 
• Impaired memory, judgment, or ability to manage daily life independently   

If you’re already rated for TBI and develop new or worsening residuals that limit daily functioning, you can submit a claim for SMC using VA Form 21-2680 (for Aid & Attendance or Housebound). A C&P examination or private physician statement may be required to confirm your level of need. 

The VA will then evaluate whether your combined disabilities meet the threshold under SMC categories such as SMC-L, SMC-R1, or SMC-T, depending on severity. For example, a veteran with a 100% TBI rating who needs help bathing, dressing, and managing medication due to cognitive and physical limitations may qualify for SMC-L for Aid and Attendance. 

Frequently Asked Questions

Can I receive both TDIU and SMC for TBI?

Yes. If you are unemployable due to TBI and also meet criteria for needing aid and attendance or being housebound, the VA may award both SMC and TDIU. If, however, the VA unfairly denies you the full range of benefits you should be receiving, our VA-accredited lawyers are ready to fight on your behalf, with no upfront costs. Get a free case evaluation here.

How can I prove my symptoms are related to my TBI and not something else?

A medical professional, especially a neurologist or neuropsychologist, can perform evaluations that distinguish TBI residuals from other causes like aging, stress, or unrelated mental illness. Neurocognitive testing and imaging (e.g., MRI) can support your claim by pinpointing the source and effects of brain trauma.  

Can I get separate ratings for migraines or other conditions caused by TBI? 

Yes. If your TBI leads to additional diagnosable conditions, such as migraines, seizures, depression, or anxiety, the VA may rate those conditions separately. These are considered secondary service-connected disabilities, and their ratings are combined with your primary TBI rating using VA’s combined ratings table. 

What should I include in my claim to make it stronger?

Include detailed medical records, a formal diagnosis from a specialist, nexus letters linking your condition to service, and personal statements or buddy letters describing the impact of your symptoms.

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.