When the VA rates residuals of traumatic brain injury, three main areas of dysfunction are considered: cognitive, emotional/behavioral, and physical. It is important to note that when the VA uses terms such as “mild”, “moderate” and “severe” when rating TBI, these terms refer to the classification of TBI made at, or close to, the time of the injury, rather than the severity of the current symptoms.
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 impairment is rated by a table included in this regulation. Cognitive functional categories include:
- Memory, attention, concentration, and executive functions
- Social interaction
- 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)
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.
Physical/neurological dysfunctions are rated according 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
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.