What is a Traumatic Brain Injury (TBI)?
- TBI may be classified as mild, moderate, severe, or penetrating.
- The severity of the injury is determined by a physician at the time of the injury.
- A TBI disrupts the way your brain functions. It may knock you unconscious, make you feel confused, or feel as though you have altered consciousness.
- Every blow to the head does not necessarily result in TBI, yet repeated concussive experiences over time can have a cumulative effect.
- Most TBI is mild. A concussion is another term used to describe a mild TBI.
Symptoms of a TBI are generally divided into three categories – physical, cognitive, and emotional. Someone with a TBI may experience:
- Balance problems
- Vomiting or nausea
- Sensitivity to light
- Problems sleeping
- Ringing in the ears
- Difficulty concentrating
- Gaps in memory
- Slowed thinking or poor attention
- Trouble finding words
- Mood swings
Generally, someone with a more severe TBI will experience more severe symptoms. However, even mild TBI can have an impact on a veteran’s social, emotional, cognitive, or physical health.
How common is TBI?
A report produced by the Defense and Veteran Brain Injury Center (DVBIC) found that more than 414,000 veterans and service members have been affected by traumatic brain injury (TBI) between 2000 and 2019. While the majority of these cases were mild, their long-term effects are just now being discovered as more and more veterans suffer from cognitive, behavioral, and psychological conditions connected to their injury. Yet many service members and veterans struggle with making the connection between their injury and its long-term effects.
Service Connection for TBI
The best way to establish a service connection for TBI is to document any concussive blows to the head when they happen. Even mild concussions can have long-term impacts if you continue to experience them over time. However, if documentation was not completed at the time of the incident, establishing a service connection for TBI must include three vital things.
- You must have a current diagnosis of TBI. This may be established at a VA health care center or a with civilian provider. However, if your disability is only loosely connected to a TBI you experienced in the service, it is unlikely you will be successful in your efforts.
- Documentation of an in-service occurrence or incident that caused the disability or at the very least aggravated the condition. If you had a singular concussive blow to the head, it is important that you gather all of the documentation you can relative to that incident. Your documentation should include the date and time of the event, medical attention you received, whether your condition improved or deteriorated over time, how the incident impacted your ability to focus, think, work, and your mental state after the incident. Consider all possible causes of your TBI including firefights, explosions, training exercises, garrison incidents, etc. and their subsequent documentation.
- A medical nexus that connects the current, diagnosed disability to the in-service occurrence, incident, or exposure. The medical nexus is vital to your disability claim. It is this document that will establish the ties between your TBI and your service. A strong nexus statement will include detailed information regarding changes to your personality, mental state, intellectual capacity, or physical ability.
Common Secondary Service Connections to TBI
A secondary service-connected disability is an additional benefit for something that emerges as the result of your first disability. Once, a veteran is diagnosed with a service-connected TBI they may be eligible for five secondary diagnoses.
- Parkinson’s disease, following moderate, severe, or repeated TBI.
- Dementia as long as it manifests within 15 years after a moderate or severe TBI.
- Depression if it manifests within 3 years of the moderate or severe TBI or within 12 months following a mild TBI.
- Hormone deficiency diseases that are the result of hypothalamo-pituitary changes, so long as they manifest themselves within 12 months of a moderate or severe TBI.
Another secondary service-connected disability for TBI would be post-traumatic stress disorder (PTSD), especially if the TBI was the result of a combat experience. In fact, the two diagnoses are so interconnected that the evaluation procedures overlap. If you experienced both a moderate TBI and symptoms of PTSD, PTSD would be considered the secondary service-connected disability to TBI. Be sure to speak with your health care provider about both.
Any secondary service-connected disability claims will need to follow the same procedure as the primary claim including gathering documentation of the illness and creating a medical nexus that connects the disability to your current TBI diagnosis.
Compensation & Pension (C&P) Exams for TBI
If your claim does not contain the information required for the VA to make a decision regarding your disability, you may be required to complete a Compensation & Pension (C&P) exam. This exam is generally conducted at a VA health center by VA medical staff, with the intent to either refute or support your claim. Prior to your exam, you will need to submit all of your medical records and documentation to the VA for them to review once you arrive.
The health care provider that conducts your C&P exam is evaluating your health for the purposes of your VA claim. Once they have finished the C&P exam, they will write a report and send it on to the VA claims processor over your case.
How does VA Rate TBI?
The VA determines disability as a cross-section between service connection, diagnosis, and function. Each service-connected disability is assigned a rating from 0 to 100 percent in 10 percent increments. In the case of TBI rating, this scale is adjusted for ratings of 0, 10, 40, 70, and 100 percent. In some cases, TBI may qualify the veteran for more than 100 percent disability when the veteran cannot care for themselves or requires aid for daily living beyond that of a normal TBI rating. This is known as Special Monthly Compensation or SMC.
TBI rating for disabilities is based on three areas of dysfunction.
- Cognitive impairment – Decreased memory, concentration, or attention as well as affected decision making and impulsivity.
- Emotional/behavioral – Depression, anxiety, irritability, etc.
- Physical – Headaches, vomiting or nausea, dizziness, balance issues, hormone dysfunction, etc.
Additionally, the severity of the injury itself that resulted in the TBI is considered based on four factors:
- The Glascow-Coma Scale – A diagnostic tool used to evaluate consciousness after a brain injury.
- Alteration of Consciousness – How long you were unaware of your surroundings, experiencing memory gaps, or in an altered mental state.
- Loss of Consciousness – How long you were unconscious after the injury.
- Post-Traumatic Amnesia – How long before you regained memory of the event and the time before and after.
Your disability will be determined by your score on each of the severity measures combined with your continued dysfunction in each of the three areas of disability.
TDIU for TBI
If you cannot work based on your service-connected disability, you may qualify for Total Disability Individual Unemployability (TDIU). To receive benefits you must:
- Have at least 1 service-connected disability that is rated at 60% or more or a combination of 2 or more service-connected disabilities with at least 1 rated at 40% or more for a combined total of 70% disability; and
- Document that you cannot maintain a steady job that supports you financially (known as substantially gainful employment) because of your service-connected disability.
TDIU is especially important for veterans who have suffered severe TBI that has left them in need of constant care.
If you have been denied a TBI claim and need help, contact Hill & Ponton for a no-obligation free consultation.