How are TBI and PTSD Rated Together?
Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are both common conditions among military veterans. Some veterans suffer from both conditions. In some cases, the two conditions were caused by the same event. However, they are unrelated conditions. PTSD is a trauma-induced mental health condition, while TBI is a physical injury to the brain.
What is PTSD?
PTSD is a mental health disorder caused by experiencing or witnessing a traumatic event. The overall rate of experiencing PTSD is only slightly higher for veterans than it is for the general population (7% v. 6%). However, the rate of PTSD is much higher in veterans from certain eras. For example, 29% of veterans who served in Operation Iraqi Freedom or Operation Enduring Freedom have experienced PTSD at some point in their lives. And, 15% have suffered from PTSD in the past year.
Symptoms of PTSD
PTSD isn’t always recognized or diagnosed in veterans, or diagnosis may be delayed. In part, that is because there’s no simple, objective test for PTSD. In part, it’s because some veterans don’t recognize the symptoms of PTSD or don’t seek out help. Some common PTSD symptoms include:
- Recurrent traumatic memories
- Flashbacks
- Emotional distress or physical symptoms triggered by reminders of the traumatic event
- Memory problems
- Ongoing fear, shame or anger
- Sense of detachment
- Emotional numbness
- Vigilance
- Being easily startled
- Rapid heart rate
- Rapid breathing
- Shaking
- Difficulty concentrating
- Difficulty sleeping
- Irritability
- Aggressive behavior
- Self-destructive behaviors
How is PTSD Rated for VA Disability?
Depending on the condition and the severity, the VA may assign a disability rating of 0% to 100%. Disability ratings are assigned only in 10% increments. A veteran’s disability rating determines the amount of benefits available.
PTSD is rated under the General Rating Formula for Mental Disorders. That means that for PTSD alone, the veteran may be assigned any of the following disability ratings:
- 100% disability rating: Total occupational and social impairment, due to such symptoms as:
- gross impairment in thought processes or communication
- persistent delusions or hallucinations grossly inappropriate behavior
- persistent danger of hurting self or others
- intermittent inability to perform activities of daily living
- disorientation to time or place
- memory loss for names of close relatives, own occupation, or own name
- 70% disability rating: Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as:
- suicidal ideation
- obsessional rituals which interfere with routine activities
- speech intermittently illogical, obscure, or irrelevant
- near-continuous panic or depression affecting the ability to function independently, appropriately and effectively
- impaired impulse control
- spatial disorientation
- neglect of personal appearance and hygiene
- difficulty in adapting to stressful circumstances
- inability to establish and maintain effective relationships
- 50% disability rating:Occupational and social impairment with reduced reliability and productivity due to such symptoms as:
- flattened affect
- circumstantial, circumlocutory, or stereotyped speech
- panic attacks more than once a week
- difficulty in understanding complex commands
- impairment of short- and long-term memory
- impaired judgment
- impaired abstract thinking
- disturbances of motivation and mood
- difficulty in establishing and maintaining effective work and social relationships.
- 30% disability rating: Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as:
- depressed mood
- anxiety
- suspiciousness,
- panic attacks (weekly or less often), chronic sleep impairment, mild memory loss
- 10% disability rating: Occupational and social impairment due to mild or transient symptoms which:
- decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or
- symptoms controlled by continuous medication
- 0% disability rating: A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication
What is TBI?
A traumatic brain injury is a physical injury to the brain. A TBI may be caused by blunt force trauma to the head or by a penetrating wound. It’s important to note that not all head trauma necessarily involves the head coming in contact with an object. For example, a person may sustain a TBI in a motor vehicle accident where their head was jolted sufficiently to cause the brain to bang against the inside of the skull, even though the head didn’t strike the inside of the vehicle. Similarly, a veteran may suffer a TBI from the blast wave from an explosion.
Symptoms of TBI
A traumatic brain injury may cause a wide range of symptoms, some of which you might not automatically associate with a head injury. Some common symptoms include:
- Headache
- Blurred vision
- Light sensitivity
- Speech problems
- Nausea
- Dizziness
- Balance problems
- Ringing in the ears
- Sensitivity to noise
- Memory problems
- Concentration problems
- Depression
- Anxiety
- Sleep changes
- Seizures
- Agitation or combativeness
You’ve probably noticed that there are some overlaps between TBI symptoms and PTSD symptoms. If you’ve suffered a traumatic head injury and have symptoms that may be attributable to PTSD, you should be evaluated for PTSD as well. You may need additional medical care, and you may be entitled to additional VA disability benefits.
How is TBI Rated for VA Disability?
The rating process for TBI is more complex than for most conditions. That’s because TBI is rated based on “residuals” in three different categories: cognitive, emotional/behavioral, and physical. Physical residuals are generally rated based on their own specific listings under separate schedules. Cognitive and emotional/behavioral impairments are rated based on a table that includes 10 areas of consideration:
- Memory, attention, concentration and executive functions, including goal setting, planning, self-monitoring, and flexibility in changing actions when they are not productive
- Judgment, involving the ability to make reasonable decisions
- Social interaction, based on an assessment of the veteran’s ability to behave appropriately in social settings
- Orientation, including awareness of time, place and identity
- Motor activities, involving the ability to perform previously learned motor functions
- Visual spatial orientation, such as the ability to point to and identify body parts or the tendency to get lost in familiar surroundings
- Subjective symptoms, such as panic attacks, suicidal thoughts and other symptoms that cannot be measured with objective tests
- Neurobehavioral effects, such as lack of motivation, verbal aggression, physical aggression, and lack of empathy
- Ability to communicate in writing or verbally
- Consciousness, which may only be rated 0 or total
The VA assigns each of these TBI residuals a score of 0, 1, 2, 3, or total. The veteran is then assigned the disability rating associated with the highest score in any area. The disability ratings associated with each score are:
0 = 0% (normal functioning)
1 = 10% (mild)
2 = 40% (moderate)
3 = 70% (severe)
Total = 100%
Combining PTSD and TBI Ratings
In most cases, VA will award separate ratings for service-related TBI and PTSD. Note that when PTSD and TBI are rated separately, any emotional/behavioral symptoms are rated under the PTSD schedule.
When the two conditions are rated separately, the VA disability ratings are combined as they would be in any other situation involving two or more service-connected disabilities. Here’s an example of how the VA determines that rating:
A veteran is assigned a 70% disability rating for TBI and a 50% disability rating for PTSD. Obviously, the veteran can’t be more than 100% disabled. The VA starts with the first disability rating–in this case 70%. Then, the next disability rating is applied only to the remaining or residual capacity.
In this example, the veteran was 70% disabled as a result of the TBI. That means there’s 30% left to work with. The 50% disability is applied to that 30% (.30 x .50) for a rating of 15%. The 15% is added to the original rating for a total of 85%. However, disability ratings are rounded to the nearest 10%. So, this veteran would receive a 90% disability rating.
If the two conditions are indistinguishable–for example, if the only symptoms of either condition are agitation, depression, anxiety and sleep disruptions, all of which may be symptoms of either condition–the VA will assign whichever disability rating is higher under a single finding such as “PTSD with TBI.” This usually results in a lower disability rating than if you had a combined rating based on separate ratings for each disability.
PTSD, TBI and SSD
SSD benefits work differently than VA disability benefits. The main differences are:
- There are no partial benefits under Social Security’s disability benefits program: to qualify, you must be unable to engage in substantial gainful activity
- The Social Security Administration (SSA) doesn’t care how you became disabled, while VA disability benefits are only available for service-connected conditions
- You must have worked and paid in to the Social Security system to qualify for SSD
That means you may qualify for SSD benefits for your TBI and/or PTSD and not VA disability benefits, or the other way around. It’s also possible that you may qualify for both benefits.
How Can a Disability Benefits Advocate Help?
Any disability claim can be complicated. Ensuring that you have provided all of the necessary documentation in the right format, including medical evidence, can mean the difference between approval and denial.
When you’re filing a claim for PTSD and TBI, the process can be even tougher. First, the symptoms of both of these conditions can make it harder to navigate the process. Second, the overlap between the two conditions means it may take more work and additional documentation to establish that you suffer from both conditions and that those conditions should be rated separately.
The experienced disability benefits advocates at Disability Help Group work with disabled Americans every day to ensure that they have access to the benefits they deserve. Our advocates have learned the intricacies of the claims and appeals processes so you don’t have to, and know what type of documentation is required to establish your claim, secure the highest possible disability rating, or dispute a negative determination.
To learn more about how we can help, call us today at 800-800-3332 or fill out our contact form.
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