FAQ Friday: How does the VA rate Traumatic Brain Injury (TBI)?
What is a Traumatic Brain Injury (TBI)?
Traumatic brain injury (TBI) can be caused by many factors, such as a blow to the head or an object penetrating the brain, and may result in brain dysfunction. A concussion, for example, is a common form of TBI; however, not all TBIs are concussions. For the most recent generation of veterans, TBIs are increasingly more widespread due to increased use of Improvised Explosive Devices (IEDs). Specifically, VA estimates that 22 percent of all combat-related casualties sustained by servicemembers in Iraq and Afghanistan are caused by traumatic brain injuries, a 10 percent increase from rates among Vietnam War veterans.
How Are TBIs Diagnosed?
After suffering a TBI, symptoms may begin to manifest cognitively, physically, behaviorally, and/or emotionally. These symptoms of a TBI are unique to the individual and must be evaluated on a case-by-case basis. However, the most common symptoms include the following:
- Dizziness and headaches
- Visual eyesight impairment
- Tinnitus or hearing loss
- Weak muscles
- Stroke or paralysis
- Coordination, balance, and gait disorders
- Difficulty with written and verbal communication
- Impaired memory
- Difficulty concentrating
- Poor judgment
TBIs are diagnosed as mild, moderate, or severe based upon medical testing and the severity of the veteran’s symptoms. Residual symptoms of mild TBIs usually, but do not always, resolve within about six months after the injury. Residual symptoms of more acute TBIs can be long-lasting, permanent, or may take years to manifest (e.g. Parkinson’s disease, dementia).
Assessment of a TBI’s initial severity is measured by:
- The results from MRI, PET, CT, or other medical imaging scans
- The length of time that a veteran faced an altered state of consciousness
- The length of time that a veteran remained unconscious
- The length of post-traumatic amnesia
- The score the initial trauma receives on the Glasgow Coma Scale
Below is a table outlining how VA measures the severity of an initial trauma in order to diagnose a TBI:
Note: The classification (mild, moderate, severe) measured by the table above has no bearing on VA’s evaluation for a rating decision, only to measure the initial severity of a TBI.
How Does VA Rate My TBI?
VA evaluates a TBI based on the residual symptoms a veteran is currently experiencing as a result of the trauma, according to an Evaluation of Cognitive Impairment and Other Residuals of TBI not Otherwise Classified, under 38 CFR § 4.12a. VA rates these residuals on a scale of 0, 1, 2, 3, or total, with each of these increments corresponding to a disability rating:
VA divides the rating criteria of TBI residuals into 10 subcategories in order to evaluate the condition. Veterans are then rated based on the level of severity and impairment in each of these areas of functioning:
- Impairment of memory, attention, concentration, and executive functions. According to the VA, executive functions include: rate of information processing, setting goals, the ability to plan ahead, prioritizing, problem solving, decision making, spontaneity, and flexibility in altering unproductive actions or behaviors.
- Altered judgement. Is the veteran able to identify their situation, weigh alternatives, and understand consequences to make reasonable decisions?
- Inhibited social skills. Is the veteran able to act appropriately in social situations?
- Is the veteran aware of: the people around them, their own being, the time and date, where they currently are, and what they are doing there?
- Diminished motor activity (while sensory and motor systems are intact). Such as inhibited intended movement.
- Visual spatial disorientation. Is the veteran aware of their surroundings? Veterans with visual spatial disorientation may find it difficult to navigate familiar territory, even with direction.
- Subjective symptoms. Symptoms that cannot be measured with objective tests. A veteran must experience three or more moderate-to-severe subjective symptoms in order to be rated for them. Examples may include, but are not limited to, depression and anxiety.
- Neurobehavioral effects. These can include irritability, unpredictability, impulsivity, verbal aggression, lack of cooperation, and impaired awareness of disability.
- Worsened ability to communicate. This includes communication by spoken or written word, as well as the ability to comprehend spoken and written language.
- Is the veteran conscious, in a coma, or in a vegetative state?
It is important to note that the same symptoms cannot be used to rate two separate disorders. A veteran’s symptoms cannot be linked to a previously rated condition if they are to be considered as part of the rating for a TBI. For instance, if you receive a 100 percent disability rating for your depression under the TBI rating criteria, you cannot also be separately rated at 100 percent for your depression.
Can My TBI Qualify Me for Special Monthly Compensation (SMC)?
VA established a level of special monthly compensation (SMC), referred to as SMC(t) specifically for veterans who have experienced a severe TBI. SMC(t) shares the monthly compensation amount of SMC(r-2), but without the strict requirements needed to qualify for SMC(r-2). A veteran’s service-connected TBI qualifies them to receive SMC(t) if:
- They are in need of regular aid and attendance (A&A) due to the residuals of TBI. A&A is characterized by a veteran’s inability to dress, bathe, feed, use the restroom, or avoid exposure to hazards in daily life by themselves.
- They would otherwise require residential institutional care (i.e. hospitalization or nursing home) if they did not receive regular, in-home A&A.
- They do not qualify for a higher level of A&A under SMC(r-2).
What If I Cannot Work Due to My TBI?
Veterans who are unable to secure and follow substantially gainful employment as a result of their TBI may qualify for Total Disability based on Individual Unemployability (TDIU). TDIU allows veterans to be compensated at the 100 percent rate, even if their conditions do not combine to equal a 100 percent schedular rating.
Call Chisholm Chisholm & Kilpatrick LTD for a Free Case Evaluation
If you are a veteran suffering from a TBI and its residuals, you may be eligible to receive disability compensation from VA. If your TBI claim has been denied, Chisholm Chisholm & Kilpatrick LTD may be able to help you file an appeal. Call 800-544-9144 for a free case evaluation.
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