Traumatic Brain Injury (TBI) in Veterans

A Traumatic Brain Injury (TBI) is defined as “a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury.” A servicemember can suffer from a TBI during military service as the result of combat or training exercises, a car accident, playing sports, or falling.

In recent years, there has been an increase in the number of veterans who suffer from a TBI related to military service. Many people attribute this to better protection in combat. The Defense and Veterans Brain Injury Center (DVBIC) reported nearly 414,000 TBIs among U.S. service members between 2000 and late 2019. More than 185,000 Veterans who use VA for their health care have been diagnosed with at least one TBI, most of which were classified as mild. Because TBIs are so common, and because they present differently for everyone and often include secondary conditions, it is important to know how to obtain and maximize VA benefits for these conditions.

How to Identify a TBI

The best way to identify and treat TBI is by consulting with your healthcare provider or a VA healthcare provider as soon as possible. TBIs are typically assessed using a computed tomography (CT) scan, which will show evidence of brain bleeding, bruising, or swelling. To determine the severity of a TBI, providers will also consider the length of loss or alteration of consciousness, the length of memory loss, and how responsive the individual was after the injury.

How to File a Claim for a TBI

You can file a claim for VA disability benefits for a TBI and any residuals the same way you file a claim for any service-connected condition: online, by mail, in person, by fax, or with the assistance of a professional.

1. File online: File for disability compensation online
2. File by mail:
   • Complete the VA application for disability benefits and mail it to this address:
     • Department of Veterans Affairs
     • Claims Intake Center
     • PO Box 4444
     • Janesville, WI 53547-4444
3. File in person at your local VA Regional Office
4. File by fax:
   • If you’re in the U.S., fax your application to 844-531-7818.
   • If you’re outside the U.S., fax your application to 248-524-4260.
5. File with the help of a trained professional, such as an accredited attorney, claims agent, or Veterans Service Organization (VSO) representative.

How to Obtain the Proper Rating for TBI

The first step to maximizing benefits for a TBI is to consult the VA’s Rating Schedule for a TBI. The guidance for rating TBI is listed under Diagnostic Code 8045, which can be found here: TBI Rating Schedule. First, the VA recognizes three main areas of dysfunction that may result from a TBI: cognitive, emotional/behavioral, and physical. Most physical dysfunctions and mental disorders can be rated separately, as detailed below. Thus, the TBI evaluation Table focuses on cognitive and subjective symptoms.

Cognitive impairment includes decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. The VA will assess these symptoms based on a Table called “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified,” which is discussed below.

For emotional and behavioral impairment, if there is a diagnosed mental disorder secondary to TBI, the VA will evaluate that based on a separate mental impairment Rating Schedule. Where there isn’t a separately diagnosed mental disorder, the VA will assess the emotional and behavioral symptoms based on the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” Table.

The Table used to assign a rating for TBI can be found here: Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified. The Table contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, including 0, 1, 2, 3 and total. Not every facet has every level of severity. The veteran’s rating for TBI will be determined based on the highest level of impairment among all the facets:

• 0 = 0 percent;
• 1 = 10 percent;
• 2 = 40 percent;
• 3 = 70 percent;
• Total = 100%

For example, if 3 is the highest level of evaluation for any facet, the veteran will receive a 70% rating. As another example, if one facet warrants a “total” evaluation, the veteran will receive a 100% rating. To obtain the most accurate rating, veterans must be open and honest about all of their TBI symptoms, even the subjective ones.

How to Maximize Benefits for TBI

A service-connected TBI often coincides with other conditions, all of which should be considered related to military service and compensated accordingly.

For example, physical impairment related to a TBI could include 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; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions. If a veteran suffers from any of these conditions, or other possible physical impairments due to the TBI, then those conditions should be rated separately.

Several years ago, the National Academy of Sciences, Institute of Medicine (IOM) published a report, Gulf War and Health, Volume 7: Long-Term Consequences of Traumatic Brain Injury, which found “sufficient evidence” to link moderate or severe levels of TBI with the five ailments: Parkinson’s disease, certain types of dementia, depression, unprovoked seizures or certain diseases of the hypothalamus and pituitary glands. Thus, it is now easier for veterans with service-connected TBI to obtain secondary benefits for these conditions.

More recently, in a 2017 study, nearly half of soldiers who had a mild TBI while serving in Afghanistan or Iraq had post-concussive symptoms such as sleep problems, forgetfulness, irritability, and headaches three months after their deployment. This suggests that mild TBI is associated with continuing problems for longer than has been generally recognized in the active-duty population.

Therefore, veterans and advocates should be sure to apply for VA disability benefits for any condition related to the TBI.

Additionally, veterans and advocates should consider whether to apply for Special Monthly Compensation for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc.

Contact our Veterans Advocates Today

Obtaining the proper rating for TBI and its residuals can be complicated and cumbersome. Vets National Advocates can help you fight for the compensation you deserve. Contact Vets National today, at 877-777-4021.