How Are TBI and PTSD Rated Together?

by Ken LaVan | Jan 15, 2020 | Veterans Disability, Veteran Disability FAQ

VA Compensation Ratings

TBI and PTSD are frequently rated together. VA pays compensation to veterans for disabilities incurred in or aggravated during their active duty service. In short, there are 10 grades of VA disability compensation: 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, and 100%. Therefore, the higher the disability rating, the higher the monthly compensation VA will pay to the veteran.  For example, a veteran with severe TBI and PTSD will probably receive a higher rating than a veteran with mild hearing loss.

Relations between TBI and PTSD

According to the Department of Defense, more than 313,816 service members have sustained a TBI in training or combat Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. For instance, common causes of this kind of head trauma include blast-related concussion events resulting from training or combat.  On the other hand, PTSD is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event. In most cases, veterans with TBI also develop PTSD from the same event.

Separate Ratings but Rated Together

In most cases, VA will award separate ratings for service-related TBI and PTSD.  However, VA will rate TBI and PTSD together – as a single disability – if they present with identical symptoms.  This is because VA cannot pay a veteran twice for the “same disability” or “same manifestation.” 

Are TBI and PTSD Distinct and Separate?

If VA finds that your PTSD and TBI are indistinguishable, it will assign one rating instead of two.  Therefore, in order to avoid the “same manifestation” issue, figure out which symptoms are from TBI and which are from PTSD. 

TBI causes dysfunction in 3 main areas:

• Cognitive (such as decreased memory or concentration),
• Emotional (such as anxiety, crying spells, or panic attacks), and
• Physical (such as motor and sensory dysfunction, visual impairment, seizures, etc.).

PTSD symptoms fall into 4 categories

• Intrusive thoughts such as repeated, involuntary memories, nightmares or flashbacks of the traumatic event;
• Avoiding people, places, objects or activities that trigger traumatic memories;
• Negative thoughts and feelings toward oneself or others; and
• Arousal and reactive symptoms such as angry outbursts, reckless or self-destructive behavior, and having problems concentrating or sleeping.

Example Case: PTSD and TBI Rated Separately

Let’s say a Marine Corps veteran has TBI and PTSD due to an IED attack he suffered in Iraq and three of his buddies died in the attack.  As a result, he lost part of his left ear in the aftermath.  Today, his TBI presents with mostly physical dysfunctions, including seizures, loss of sense of smell, and inner-ear balance problems.  However, he also experiences frequent flashbacks of the attack.  Unfortunately, he has frequent suicidal thoughts and avoids people because he is racked with survivor’s guilt.  Because they have distinct and separate manifestations, VA will rate them separately.

However, some veterans with TBI and PTSD together only experience emotional/behavioral dysfunction.  In those cases, VA may assign one rating instead of two.  By law, VA must assign the higher of 2 applicable ratings.  So if your PTSD is at a 70% level but your TBI would only rate at 10%, VA would grant “PTSD with TBI” at 70%.

How VA Assigns Ratings for PTSD

The criteria for each VA disability rating for PTSD is listed here:

• 100% = 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 (including maintenance of minimal personal hygiene);
  • disorientation to time or place;
  • memory loss for names of close relatives, own occupation, or own name
• 70% = 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 (such as unprovoked irritability with periods of violence);
  • spatial disorientation;
  • neglect of personal appearance and hygiene;
  • difficulty in adapting to stressful circumstances (including work or a work-like setting);
  • inability to establish and maintain effective relationships.

50% and lower

• 50% = 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 (e.g., retention of only highly learned ……….. material, forgetting to complete tasks);
  • impaired judgment;
  • impaired abstract thinking;
  • disturbances of motivation and mood;
  • difficulty in establishing and maintaining effective work and social relationships.
• 30%= 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 (such as forgetting names, directions, recent events).
• 10% = 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% = 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.

How VA Assigns Ratings for TBI

VA divides the rating criteria for TBI residuals into 10 categories.  Veterans are then rated based on how severe the deficits are in each of these areas:

1. Memory, attention, concentration and executive functions
   • Executive functions include goal setting, planning, self-monitoring, and flexibility in changing actions when they are not productive.
2. Judgment
   • Is the veteran able to make reasonable decisions?
3. Social interaction
   • How often does the veteran act appropriately in social situations?
4. Orientation
   • Is the veteran aware of who, where, and when he is?
5. Motor activities
   • Is the veteran able to perform previously learned motor activities (such as riding a bike)?
6. Visual spatial orientation
   • Does the veteran get lost even in familiar surroundings?  Is he able to point at or name own body parts?
7. Subjective symptoms
   • Symptoms that cannot be measured with objective tests, such as panic attacks and thoughts of suicide.
8. Neurobehavioral effects
   • Examples include lack of motivation, verbal aggression, physical aggression, and lack of empathy.
9. Ability to communicate
   • Can the veteran communicate either by spoken or written language?  Can he communicate basic needs?
10. Consciousness
    • Is the veteran in a coma or a vegetative state?

VA Rates TBI residuals

VA rates these TBI residuals on a scale of 0, 1, 2, 3, or total.

• 0 = 0% (normal functioning)
• 1 = 10% (mild)
• 2 = 40% (moderate)
• 3 = 70% (severe)
• Total = 100%

If any residuals of TBI are rated “total”, then VA will award a 100% rating.  If no residual is rated “total”, then VA must assign a percentage based on the highest rated residual.   For example, let’s say a veteran has TBI residuals in 3 out of the 10 categories.  He has a 1 for Judgment, a 3 for Ability to Communicate, and a 2 for Orientation.  In this example, VA will award 70% because 3 is the highest residual rating.

Get Help Now

Call Disability Help Group, 1-800-700-0652

Because memory deficits are common VA TBI residuals, a veteran should always have an advocate. We specializes in TBI cases and is here to answer your questions now.

• What is the Criteria for 70% TBI Disability Rating?
• TBI C&P Exam
• How Does VA Rate TBI?
• Can I Get TDIU for Agent Orange Exposure?
• What are VA TBI Residuals?
• What is VA Permanent and Total Disability?
• Can I Work and Get TDIU?
• Can I Get TDIU for PTSD?
• VA Disability Rating for PTSD
• VA Permanent & Total Disability
• Yankee Station Agent Orange

Additional Information

• Schedule of Rating for Neurological Conditions
• VA Research on TBI
• Traumatic Brain Injury Information Page, National institute of Neurological Disorders and Stroke
• Traumatic Brain Injury Report, Department of Defense Special Report

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