Our staff is here to help: Monday-Sunday 9am to 6pm (800)-800-3332

Tag: traumatic brain injury

What Is Traumatic Brain Injury?

Posted on by Ken LaVan

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. 

Call Now for a Free Case Review, 800-700-0652

Make sure you start your SSDI and VA disability claim the right way and apply for all the benefits you deserve. Contact us now for a free consultation.

How Are TBI and PTSD Rated Together?

Posted on by Ken LaVan

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.

Additional Information

FAQs

How does TBI effect you?

Traumatic Brain Injury (TBI) can cause 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.) problems.

Should I hire an advocate?

Absolutely. You should hire a disability expert that has argued hundreds of VA Compensation claims.

What is a veterans disability advocate?

A veterans disability advocate represents you before the VA. Hire a representative that has argued similar fact patterns to your case.

What are VA TBI Residuals?

Posted on by Ken LaVan

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:

  1. Proof of a current diagnosis,
  2. Proof of an in-service event, disease or injury, and
  3. 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:

  1. Neurologist,
  2. Neurosurgeon,
  3. Physiatrists, or
  4. 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:

  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 functions: 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 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.

Get Help Now

Call, 1-800-700-0652

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.

Additional Information

How Does VA Rate TBI?

Posted on by Ken LaVan

What is Traumatic Brain Injury (TBI)?

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:

  1. Neurologist,
  2. Neurosurgeon,
  3. Physiatrists, or
  4. 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

  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 functions: 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?

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.

Get Help Now

Call, 1-800-700-0652

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.

Related Articles

Additional Information

TBI C&P Exam

Posted on by Ken LaVan

TBI VA Disability Benefits

Before we discuss the TBI C&P Exam, unless special rules apply, VA will deny service connection for Traumatic  Brain Injury (TBI) unless the Veteran can prove a:

  1. Current diagnosis,
  2. In-service event, disease or injury, and
  3. Medical nexus between the first 2 elements.

Reason for TBI C&P Exam

In any VA claim, it is the veteran’s burden to prove he deserves the benefit.  In certain circumstances, VA has a duty to help the veteran meet his burden.  A compensation & pension (C&P) exam is one example of how VA helps veterans develop evidence.  In a C&P exam, VA asks a qualified professional to answer medical questions related to your claim.

When to Expect a TBI C&P Exam

If you file a claim for TBI based on sudden head trauma during service, then you should expect 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 TBI?
  • 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 TBI?

Who Can Conduct a TBI C&P Exam:

  • Neurologist,
  • Neurosurgeon,
  • Physiatrists, or
  • Psychiatrist.

Diagnosis of 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.

TIP: Always document injuries

If you cannot prove that your TBI is 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. If you file a claim for TBI 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.

TBI Residuals

Veterans with TBI 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.  For VA purposes, TBI residuals are broken down into the following 10 categories:

  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 functions – 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?

TBI Rating, TBI C&P Exam

After the TBI C&P exam, the doctor will send a written report to VA.  The report will include how severe your residuals are.  If VA ultimately 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%

Get Help Now

Call, 1-800-700-0652

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.

Related Articles

Additional Information

What is the Criteria for 70% TBI Disability Rating?

Posted on by Ken LaVan

What is the Criteria for 70% TBI Disability Rating? After VA grants service connection for Traumatic Brain Injury (TBI), 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 TBI rated?

The VA divides the rating criteria for TBI residuals 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 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% 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 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 to 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 render you so helpless that you require the regular aid and attendance of another person?

Disability Help Group Case Study

A We 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.

Free Case Review

Do you meet the criteria for a 70% rating for TBI?  Call now, 1-800-700-0652, or click here for a free TBI claim evaluation.

Related Articles

Additional Information