Unless there are special rules that apply, the VA will deny service connection for Traumatic Brain Injury (TBI) unless the Veteran can prove a:
Current diagnosis,
In-service event, disease or injury, and
Medical nexus between the first 2 elements.
Reason for TBI C&P Exam
It is the veteran’s burden to prove he deserves the VA benefits. In certain circumstances, the VA must help the veteran meet his burden. A compensation & pension (C&P) exam is one example of how the VA helps veterans develop evidence. In a C&P exam, the VA asks a qualified professional to answer medical questions related to your claim.
When Should I Expect a TBI C&P Exam?
If you file a claim for a Traumatic Brain Injury based on sudden head trauma during service, then you should expect the VA to schedule a C&P examination.
A C&P exam can help VA answer the following medical questions:
Does the veteran have a confirmed diagnosis of a Traumatic Brain Injury?
Is it at least as likely as not that the TBI was caused or aggravated during active duty service?
How severe are the residuals of the Traumatic Brain Injury?
Who Can Conduct a TBI C&P Exam:
Neurologist,
Neurosurgeon,
Physiatrists, or
Psychiatrist.
Diagnosis of A Traumatic Brain Injury
A Traumatic brain injury occurs when a sudden trauma causes damage to the brain. According to the Department of Defense, more than 313,816 service members have sustained a Traumatic Brain Injury in training or combat. Common causes of this kind of head trauma include blast-related concussion events resulting from training or combat. A Traumatic Brain Injury is known as a signature injury of the Iraq and Afghanistan wars due to the frequency of IED attacks. However, a simple fall down a 10-foot ladder could also damage the brain.
Always Document Your Injuries
If you cannot prove that your that your Traumatic Brain Injury is related to service, then the VA may assume that it happened after discharge. For this reason, it is critical that service members document any and all head injuries. Your case is much easier to win if head trauma is clearly documented in your service medical records. In the absence of official records, statements from witnesses would be helpful. If you file a claim for Traumatic Brain Injury without a confirmed diagnosis, then VA may refer you for a C&P exam.
Medical Nexus for TBI
After a TBI C&P exam confirms a diagnosis, the next question is: what caused it? Is it at least a 50/50 chance that the TBI was caused by in-service head trauma? If your doctor’s answer is “Yes” and he provides a reasonable explanation, then you have your medical nexus. If the doctor answers “No”, then you should consider a second opinion from a private doctor.
What Are Residuals Of A Traumatic Brain Injury?
Veterans with a Traumatic Brain Injury may experience problems long after the initial head trauma. These problems are known as residuals. During a TBI C&P exam, the doctor will determine which TBI residuals are present.
Traumatic Brain Injuryresiduals are broken down into the following 10 categories:
Memory, attention, concentration, and executive functions–
Judgment
Social interaction
Orientation
Motor functions
Visual-spatial orientation
Subjective symptoms
Neurobehavioral effects
Ability to communicate
Consciousness
TBI Rating, TBI C&P Exam
After the TBI C&P exam, the doctor will send a written report to the VA. The report will include how severe your residuals are. If the VA approves your claim, it will likely use this report to assign a percentage rating. VA rates 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%
Every C&P exam involves the doctor asking questions of the veteran. The doctor relies on the veteran to explain his symptoms, some of which may not be present or observable on the day of the exam. Because memory deficits are common TBI residuals, a veteran should attend C&P exams with a spouse, family member, or friend who knows them well. They can fill in the blanks if the veteran is unable to either remember or communicate certain residuals during the exam.
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What is the Criteria for 70% TBI Disability Rating?
What is the Criteria for 70% TBI Disability Rating? After VA grants service connection for Traumatic Brain Injury (TBI disability), VA must determine the correct rating percentage. As a result, the rating percentage determines how much money VA must pay to the veteran. Rather than assign percentages subjectively, VA uses criteria in the Schedule of Ratings.
VA Schedule of Rating Criteria for 70% TBI Disability Rating
The VA Schedule of Ratings breaks down disabilities into different categories. Firstly, each category contains groups of medical problems. Secondly, each group contains a list of disabilities, and each disability has its own diagnostic code. Thirdly, every diagnostic code specifies the symptoms required for various ratings. For example, the 8045 diagnostic code covers residuals of Traumatic Brain Injury (TBI).
How is a TBI disability rated?
The VA divides the rating criteria for TBI disability into 10 categories.
Veterans are rated based on the level of severity and impairment in each of these areas:
1. Memory, attention, concentration, and executive functions, including goal setting, planning, self-monitoring, and flexibility in changing actions when they are not productive.
2. Judgment: a veteran’s ability to make reasonable decisions.
3. Social interaction: how often a veteran acts appropriately in social situations.
4. Orientation: a veteran’s awareness of who, where, and when he is.
5. Motor activities: a veteran’s ability to perform previously learned motor activities (such as riding a bike).
6. Visual-spatial orientation: A veteran gets lost, even in familiar surroundings, or cannot point at or name their 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 or communicate basic needs?
10. Consciousness: Is the veteran in a coma or a vegetative state?
Traumatic Brain Injury (TBI) residual scale
VA rates TBI residuals on a scale of 0, 1, 2, 3, or total. Each increment corresponds to a disability rating:
0 = 0% (normal functioning)
1 = 10% (mild)
2 = 40% (moderate)
3 = 70% (severe)
Total = 100%
The VA will award a 100% TBI disability rating if any residuals of TBI are rated “total”. Conversely, the VA will assign a percentage based on the highest-rated residual if no residual is rated “total”. For example, let’s say a veteran has TBI residuals in 3 out of the 10 categories. Therefore, he has a 1 for Judgment, a 3 for the ability to communicate, and a 2 for orientation. In this example, VA will award 70% because 3 is the highest residual rating.
70% TBI Disability Rating Varies
Across the 10 residual categories, the criteria for a 70% rating varies. For example, a Neurobehavioral residual must interfere with or preclude workplace interaction, social interaction, or both on most days. By contrast, VA assigns a 3 if Motor activities are moderately decreased due to apraxia. When in doubt, one should consult diagnostic code 8045 and the associated tables.
The following examples would yield a 70% disability rating for TBI:
A 50 year-old veteran who is often disoriented in time and place.
A 35 year-old veteran whose social interaction is inappropriate most of the time.
A 70 year-old veteran who is unable to communicate either by spoken or written language about half of the time.
Special Monthly Compensation
A veteran may receive special monthly compensation, in addition to a 70% rating, for Traumatic Brain Injury (TBI). As a result, the question is simple: Does your 70% rated TBI disability render you so helpless that you require the regular aid and attendance of another person?
Disability Help Group Case Study
Disability Help Group represented a veteran of the Army who had TBI at 10%. After increasing his rating to 70% for Traumatic Brain Injury, we continued fighting for him to receive special monthly compensation. We were able to prove that he could not care for himself, because the local VA hospital appointed his mother as his VA caregiver. Among other duties, she assisted with medication management, personal hygiene, reminding him of and taking him to appointments, and paying his bill. Therefore, we proved the veteran had a permanent need for regular aid and attendance due to his TBI.
As a result, VA granted Special Monthly Compensation at the (r)(2) rate, increasing monthly payment from $264.02 to $8,343.91.
Do you believe you meet the criteria for a 70% rating for TBI disability? Be sure you start your claim the right way and apply for all the benefits you deserve. Call our team of experts today at (800) 800-3332 or contact us here for your FREE consultation!
Traumatic brain injury (TBI) usually happens when you suffer an injury to the brain. Usually, this can be caused by different events. The most common include falls, car accidents or sports injuries. Most people recover well from symptoms caused by the injury. However, sometimes symptoms can last much longer.
Symptoms of traumatic brain injury
Traumatic brain injuries can cause many different symptoms. These can include difficulty thinking, feeling slowed down or difficulty concentrating. Traumatic brain injuries can cause physical symptoms. These include headaches, nausea or vomiting or feeling tired. Traumatic brain injuries can also cause mood symptoms. Mood symptoms include irritability, sadness or anxiety. Traumatic brain injuries can also interfere with sleep.
Social Security disability benefits for traumatic brain injury
You can apply for Social Security disability if you have a TBI. However, you must meet certain requirements to receive benefits. Generally, your condition must interfere with your normal daily activities. Additionally, your symptoms must keep you from working for at least 12 months. To qualify for Social Security disability insurance benefits (SSDI) you also must have worked a certain number of years recently.
Social Security definition of traumatic brain injury
Social Security provides a listing of impairments, known as the “Blue Book”. The Blue Book provides specific conditions you must meet to qualify for disability benefits. Typically, the listings consider the most extreme severity of symptoms. Social Security considers traumatic brain injury under listing 11.18.
Listing 11.18 traumatic brain injury
Social Security considers traumatic brain injury as brain damage caused by skull fracture, a closed head injury or penetration by an object into the brain tissue. To qualify under the listing you must show:
The inability to control the movement of at least two extremities (either an arm and a leg or two arms or two legs AND
Extreme difficulty in balancing when standing or walking, standing up from a seated position or using the arms OR
“Marked” physical problems and a “marked” limitation (for at least 3 months post-injury) in any one of the following:
Thinking
Interacting with others
Finishing tasks
Regulating emotions and controlling your behavior
Meeting the listing for traumatic brain injury
Social Security defines marked as more than moderate but not extreme. “Marked” means having a serious limitation in that area of functioning. “Extreme” means not being able to function in that area at all.
What if my traumatic brain injury doesn’t meet the listing?
Many people will not meet the listing for traumatic brain injury. However, you can still get disability benefits. Specifically, you need to show that your traumatic brain injury limits your functioning and keeps you from working. If you don’t meet the listing, Social Security considers your residual functional capacity (RFC). Your RFC includes the most you can do despite your conditions.
Example 1: traumatic brain injury and Social Security disability
For example, Donald had a car accident and hit his head. He lost consciousness when he hit his head. Following his accident, Donald started having frequent headaches. He started having problems with his balance. Donald also started having trouble remembering things and concentrating. He became irritable easily. Social Security found that Donald’s symptoms would cause him to miss work frequently. They also found that he would not be able to stay focused throughout a work day. Therefore, Social Security approved his case.
Medical evidence for traumatic brain injury
Social Security needs evidence showing that your symptoms cause severe problems. Therefore, you must provide medical evidence related to your traumatic brain injury. Generally, medical evidence includes your doctor’s notes, test results and imaging. Your doctor should document:
Any physical problems using your arms or legs
Difficulty with balance or coordination
The frequency and severity of ongoing symptoms such as headaches or blurred vision
Behavioral changes in your mood or personality
Problems with focus or concentration
Side effects from medications
RFC forms for traumatic brain injury
Frequently, traumatic brain injuries cause both physical and mental symptoms. An RFC form can help explain how your condition impacts your functioning. It should be very detailed. It should include all of your symptoms and treatment. Your doctor should include both your physical and mental limitations. An experienced disability advocate can provide these forms to you.
Social Security grid rules
Social Security uses a chart called the Medical-Vocational guidelines, known as the “grid rules”. They use this chart to help evaluate your disability claim. These grid rules make it easier for people over 50 to win their disability case. The grid rules make it even easier for people over 55. The grid rules allow Social Security to approve your case if you can’t do your past work, even if you can do other types of less physical work.
Example 2: grid rules over 50
For example, Paula, 53, suffered a TBI. Her symptoms included frequent headaches, poor sleep and difficulty concentrating. Paula previously worked as a cashier and warehouse worker. Social Security found that Paula could not stand or walk for long periods. They also found she could only perform simple and routine tasks. She was not able do either of her past jobs. Social Security found she could do simple, seated jobs. However, under the grid rules, Paula was approved for benefits.
Example 3: grid rules over 55
In another example, Bob worked as a mail carrier. He suffered from a TBI. Following his injury, he started having seizures. He also suffered from weakness in his arms and legs and mood swings. Social Security found that Bob could not return to his job as a mail carrier. Social Security found that he could do other less physical jobs. However, since Bob was 57 years old, the grid rules applied. Social Security approved his disability claim.
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If you do not understand how VA rates or weighs TBI residuals this article will help.
Are Your VA TBI Residuals Related to Service?
Before VA will assign a rating for TBI, it must first determine whether it is related to service. The question is whether VA should award service connection for TBI. Generally, VA will deny service connection for TBI unless the following elements are met:
Proof of a current diagnosis,
Proof of an in-service event, disease or injury,
and
Proof of a medical nexus between the first 2
elements.
Do you have a current TBI diagnosis
If you file a claim for TBI without a confirmed diagnosis, then you should expect VA to deny the claim. It is not enough for the veteran to say they have VA TBI residuals. Before VA will rate TBI, it must confirm that it has been medically diagnosed. For VA purposes, only one of the following specialties can diagnose TBI:
Neurologist,
Neurosurgeon,
Physiatrists, or
Psychiatrist.
Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. If you had sudden head trauma during service, you may have VA TBI residuals in the following areas:
Cognitive (such as decreased memory, concentration, or attention),
Emotional/behavioral (such as anxiety, crying spells, short temper), or
Physical (such as seizures or balance problems)
If you have any of these symptoms, then you should probably get checked for a TBI. To prove the current diagnosis element, one of the approved specialties must provide the diagnosis.
In-service event, disease or injury
According to the Department of Defense, more than 313,816 service members have sustained a TBI in training or combat. Common causes of this kind of head trauma include blast-related concussion events resulting from training or combat. In fact, TBI is known as a signature injury of the Iraq and Afghanistan wars due to the frequency of IED attacks. However, a simple fall down a 10-foot ladder could also damage the brain.
If you cannot prove that your VA TBI residuals are related to service, then VA may assume that it happened after discharge. For this reason, it is critical that service members document any and all head injuries. Your case is much easier to win if head trauma is clearly documented in your service medical records. In the absence of official records, statements from witnesses would be helpful.
Medical nexus is required to prove VA TBI residuals
Proving the first 2 elements of the claim is not enough. To win a TBI claim, you still need medical evidence linking your current diagnosis to the in-service event. In most cases, a statement from your doctor can provide a medical nexus.
Fortunately, a medical nexus does not have to express 100% certainty. Instead, here is the question: is it at least a 50/50 chance that the TBI was caused by in-service head trauma? If your doctor’s answer is “Yes” and he provides a reasonable explanation, then you have your medical nexus.
Rating VA TBI Residuals
After VA concedes service connection for TBI, it turns to the rating percentage. The rating percentage determines how much money VA must pay to the veteran. The ratings for TBI residuals are covered in the VA Schedule of Ratings.
VA divides the rating criteria for VA TBI residuals into 10 categories. Veterans are then rated based on the level of severity and impairment in each of these areas:
Memory, attention, concentration and executive
functions: Executive functions include goal setting, planning, self-monitoring,
and flexibility in changing actions when they are not productive.
Judgment: Is the veteran able to make reasonable
decisions?
Social interaction: How often does the veteran
act appropriately in social situations?
Orientation: Is the veteran aware of who, where,
and when he is?
Motor functions: Is the veteran able to perform
previously learned motor activities (such as riding a bike)?
Visual spatial orientation: Does the veteran get
lost even in familiar surroundings? Is
he able to point at or name own body parts?
Subjective symptoms: Symptoms that cannot be
measured with objective tests, such as panic attacks and thoughts of suicide.
Neurobehavioral effects: Examples include lack
of motivation, verbal aggression, physical aggression, and lack of empathy.
Ability to communicate: Can the veteran
communicate either by spoken or written language? Can he communicate basic needs?
Consciousness: Is the veteran in a coma or a
vegetative state?
VA rates TBI residuals on a scale of 0, 1, 2, 3, or total. Each increment corresponds to a disability rating:
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 rate 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.
Because memory deficits are common VA TBI residuals, a veteran should always have an advocate. Disability Help Group specializes in TBI cases and is here to answer your questions now.
VA rates TBI residuals on a scale of 0, 1, 2, 3, or total. Each increment corresponds to a disability rating. 0 = 0% (normal functioning); 1 = 10% (mild); 2 = 40% (moderate); 3 = 70% (severe); or Total = 100%.
How does VA review TBI residuals?
VA divides the rating criteria for VA TBI residuals into 10 categories. Veterans are then rated based on the level of severity and impairment. For example, Neurobehavioral effects include lack of motivation, verbal aggression, physical aggression, and lack of empathy.
What medical nexus proves TBI?
To win a TBI claim, you still need medical evidence linking your current diagnosis to the in-service event. In most cases, a statement from your doctor can provide a medical nexus.
Understanding the basics will help you learn how VA Rates TBI. Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. According to the Department of Defense, more than 313,816 service members have sustained a TBI in training or combat. Common causes of this kind of head trauma include blast-related concussion events resulting from training or combat. In fact, TBI is known as a signature injury of the Iraq and Afghanistan wars due to the frequency of IED attacks. However, a simple fall down a 10-foot ladder could also damage the brain. Any veteran who suffered TBI during service should obtain a VA rating to fairly compensate for this significant injury.
Only Specific Doctors can Diagnose TBI
Because TBI involves damage to the brain, it may affect nearly every other body system. Any symptoms secondary to the initial brain trauma are called residuals. Before VA will rate TBI, it must confirm that it has been medically diagnosed. For VA purposes, only one of the following specialties can diagnose TBI:
Neurologist,
Neurosurgeon,
Physiatrists, or
Psychiatrist.
Ultimately, TBI is a medical question best answered by a doctor. However, a veteran and his family should be on alert if any common TBI residuals present themselves.
Common Residuals – VA Rates TBI
There are 3 main areas of dysfunction that may result from TBI:
Cognitive (such as decreased memory, concentration, attention, and executive functions of the brain)
Emotional/behavioral (such as anxiety, crying spells, panic attacks, short temper), and
Physical (such as motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems).
If you have any of these symptoms after a sudden hit to the head during service, then you should get checked for TBI immediately.
VA Rates TBI
After VA concedes service connection for TBI, it turns to the current TBI residuals. VA divides the rating criteria for TBI residuals into 10 categories. Veterans are then rated based on the level of severity and impairment in each of these areas:
Rating based on level of severity
Memory, attention, concentration and executive functions: Executive functions include goal setting, planning, self-monitoring, and flexibility in changing actions when they are not productive.
Judgment: Is the veteran able to make reasonable decisions?
Social interaction: How often does the veteran act appropriately in social situations?
Orientation: Is the veteran aware of who, where, and when he is?
Motor functions: Is the veteran able to perform previously learned motor activities (such as riding a bike)?
Visual spatial orientation: Does the veteran get lost even in familiar surroundings? Is he able to point at or name own body parts?
Subjective symptoms: Symptoms that cannot be measured with objective tests, such as panic attacks and thoughts of suicide.
Neurobehavioral effects: Examples include lack of motivation, verbal aggression, physical aggression, and lack of empathy.
Ability to communicate: Can the veteran communicate either by spoken or written language? Can he communicate basic needs?
Consciousness: Is the veteran in a coma or a vegetative state?
TBI disability rating
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 rate 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.
Special Monthly Compensation -VA Rates TBI
If you are trying to get the most VA compensation for TBI, then do not stop at the standard rating criteria. Depending on the circumstances, a veteran may be entitled to Special Monthly Compensation for TBI. This would be in addition to any ratings VA assigns under § 4.124a.
How We Won This Case
We represented a 30 year-old combat veteran of the Army. He came to us with a 10% rating for residuals of TBI. After developing the case, we urged VA to rate his TBI residuals at no less than 70%. In addition, we discovered that his mother had been his primary caregiver since his return from military service. Among other duties, the veteran’s mother assisted with medication management, personal hygiene, reminding him of and taking him to appointments, and paying his bill. The local VA hospital had already appointed the mother as his VA caregiver. We argued that the record clearly showed the veteran has a permanent need for regular aid and attendance due to his TBI. In response, VA increased the TBI rating to 70% and granted Special Monthly Compensation at the (r)(2) rate. As a result, the veteran’s monthly payment changed from $264.02 to $8,343.91.
Every C&P exam involves the doctor asking questions of the veteran. The doctor relies on the veteran to explain his symptoms, some of which may not present or observable on the day of the exam. Because memory deficits are common TBI residuals, a veteran should attend C&P exams with a spouse, family member, or friend who knows them well. They can fill in the blanks if the veteran is unable to either remember or communicate certain residuals during the exam.
