Understanding VA Ratings for Traumatic Brain Injury

Traumatic Brain Injuries (TBIs) are among the most complex and misunderstood conditions in the VA disability system. Whether caused by blast exposure, falls, or blunt trauma during service, TBIs can result in lasting cognitive, emotional, and physical impairments. TBIs range from mild to severe, and symptoms may appear immediately or emerge over time, making service connection and assessment difficult. Understanding how VA evaluates these injuries and their related secondary conditions can help build a stronger claim.

How VA Evaluates Traumatic Brain Injury

VA evaluates TBIs under Diagnostic Code 8045, which highlights the three categories of residual impairments:

1. Cognitive impairments
2. Emotional/behavioral dysfunction
3. Physical/neurological dysfunction

Each is scored from 0 (normal) to 3 (severe), with an additional “total” impairment category. In scoring, VA looks at frequency, severity, and impact of each category’s symptoms on everyday function, including whether the symptoms contribute to unemployability. The highest-rated category determines the overall TBI rating:

It is important to note that when a veteran exhibits symptoms of TBI that meet the diagnostic criteria for a separate condition or disorder, such as PTSD or migraines, VA must evaluate the condition under the diagnostic criteria for that specific condition, and award the veteran the more favorable rating.

Cognitive Impairments

VA assesses cognitive impairments by evaluating deficits in memory, attention, judgment, communication, and executive functioning skills. During evaluation, VA assesses how the veteran functions in daily life and whether deficits in memory, decision-making, organization, or problem-solving are present. The severity of each facet is based on how significantly the deficit interferes with routine activities, employment, or social interactions.

Common Challenges Present with Cognitive Impairment:

• Short-term memory
• Planning, prioritizing, and organizing
• Multi-step, or complex instructions and directions
• Multi-tasking
• Expressing ideas, or finding the right words
• Processing language, or following conversations

Emotional/Behavioral Dysfunction

Emotional/Behavioral dysfunction includes symptoms like irritability, depression, impulsivity, anxiety, social withdrawal, or inappropriate behavior. If these rise to the level of a diagnosable condition (e.g., PTSD, anxiety disorder), VA will defer to the mental disorders rating schedule to provide a rating evaluation. However, if the veteran’s symptoms do not meet diagnostic criteria for a formal mental health disorder, VA will evaluate the severity of these symptoms under the TBI residual rating framework and consider the impact on interpersonal relationships, judgment, and emotional regulation.

Common Secondary Conditions and Symptoms:

• Post-Traumatic Stress Disorder (PTSD), or other panic disorders
• Major depressive disorder
• Generalized anxiety disorder
• Personality changes (e.g., increased irritability and impulsivity)
• Substance use disorders (commonly used as a coping mechanism for symptoms)
• Social anxiety or withdrawal
• Sleep disturbances and insomnia

Physical/Neurological Dysfunction

The physical and neurological dysfunction category includes a wide range of residuals that can result from TBI, such as headaches, balance and coordination problems, seizures, sensory deficits, speech difficulties, endocrine disorders, and motor impairments. Some symptoms result in secondary conditions and are provided separate ratings under their own diagnostic codes. For example, if a veteran experiences prostrating migraine headaches or has developed seizure activity as a result of TBI, those conditions are evaluated using their respective criteria in the neurological rating schedule.

Common Secondary Conditions:

• Migraines or chronic headaches
• Seizure disorders
• Vestibular conditions, including tinnitus, vertigo, or balance problems
• Visual impairments, such as photophobia or tracking problems
• Endocrine disorders, including hypothyroidism, ED, Chronic Fatigue Syndrome, or pituitary dysfunction
• Autonomic dysfunction, such as irregular heart rate and blood pressure issues
• Motor weakness or coordination deficits, including neuropathy
• Speech production issues, including slurred or slow speech

Tips for Strengthening a Traumatic Brain Injury Claim

A strong TBI claim depends on comprehensive and credible evidence. This includes:

• in-service documentation of head injury or related incident,
• medical records diagnosing TBI and detailing current symptoms,
• neuropsychological evaluations to assess cognitive deficits, and
• lay statements from the veteran or family and friends explaining behavioral or functional changes.

When preparing for a TBI claim, be sure to document your symptoms over time with personal logs, treatment records, or buddy statements. Lay testimony should emphasize functional impact on daily life, work, and relationships. Be sure to file for secondary conditions like migraines, ED, or sleep issues when present.

If you would like additional guidance on your TBI or other VA disability claims, please contact the legal professionals at West & Dunn online through our Contact Us page or by telephone at (608) 535-6420 for a Consultation.