VA Compensation for TBI and PTSD: How to Avoid Pyramiding

CCK Law: Our Vital Role in Veterans Law

VA provides disability compensation ratings to veterans for both Traumatic Brain Injury (TBI) and Post-Traumatic Stress Disorder (PTSD), but may merge the two conditions into one rating unless veterans provide careful medical evidence showing that the overlapping symptoms belong to separate conditions.

Key points of this article include:

• Monthly VA compensation for TBI and PTSD can range from $180.42 to $3,938.58 for a single veteran with no dependents.
• TBI and PTSD often have overlapping symptoms, which can lead to rating complications due to VA’s policy on pyramiding.
• Depending on which specific symptoms a veteran has, they can have their TBI and PTSD rated separately and then combined or rated together from the start.

Watch CCK Law Partners Emma Peterson and Amy Odom and Associate Attorney Kaitlyn Degnan discuss VA disability compensation for TBI and PTSD:

What Is TBI and PTSD Pyramiding?

During the disability rating process, VA raters may have a hard time distinguishing whether a specific symptom has been caused by TBI or PTSD.

“Many of the symptoms between PTSD and TBI overlap,” says Emma Peterson, partner at CCK Law. “Due to this overlap, it can be challenging for VA to appropriately rate a veteran who should be service connected for both conditions.”

For example:

• Depression, trouble sleeping, and memory problems can occur in cases of TBI and cases of PTSD. Additionally, veterans who suffered TBIs during their military service are often more likely to develop PTSD.
• Traumatic brain injuries often involve both physical and emotional trauma (e.g., fear from a near-death experience), and emotional trauma can be a stressor that causes a veteran to develop PTSD. Similarly, the stress of a TBI can worsen a veteran’s pre-existing mental health condition.

VA may take two routes to determine disability ratings for veterans with symptoms of both TBI and PTSD:

1. The first method is to rate TBI and PTSD separately and then combine the individual percentages with “VA math” into an overall rating.
2. The second method is to treat them as one condition and rate just TBI or PTSD — whichever would have received the highest rating. When VA does this, it is usually to avoid “pyramiding.”

The first method (separate ratings for TBI and PTSD) will result in a higher ratings. Therefore, it is important for veterans to understand “pyramiding.”

What Is Pyramiding?

Pyramiding is giving multiple ratings for the same disability or symptom, and it is generally forbidden under VA regulations.

Essentially, this means that even if a veteran has a symptom (e.g., sleep impairment) that could be applied to their PTSD and TBI, VA will only take that symptom into account for one of these disabilities, and not both.

“The problem with PTSD and TBI is that they often cause the same symptoms,” says Amy Odom, partner at CCK Law. “For instance, one of the areas VA will look at when rating TBI is neurobehavioral disturbances like inappropriate behavior or irritability. But that is exactly what is also considered in the rating for PTSD. And you can’t get two ratings based on those same symptoms.”

For example,

• Say a veteran is service connected for PTSD due to an in-service combat event. They experience flashbacks, severe trouble falling and staying asleep (i.e., sleep impairment), and high irritability when around others. Since these are often symptoms of PTSD, their VA rater takes these symptoms into account when determining a percentage rating for their PTSD.
• A year or two later, it becomes clear that the veteran also suffered a TBI. Sleep impairment and irritability, in addition to being symptoms of PTSD, are core symptomsof traumatic brain injury.
• However, since the veteran already had their sleep impairment and irritability evaluated for their PTSD rating, they cannot also have those same symptoms evaluated for their TBI rating. Under VA pyramiding rules, these symptoms can only be factored into the rating for one of these conditions, not both.

Because of this pyramiding rule, the particular symptoms the veteran is suffering from for each condition become more important and can directly affect which method VA uses to rate the veteran’s PTSD and TBI.

It is also important for veterans to remember that, by law, VA must choose whichever condition would give the veteran the highest overall rating. This plays a large role in the eventual rating the veteran will receive.

“Say the veteran’s TBI symptoms completely overlap with their PTSD symptoms,” says Amy Odom. “If the veteran would get a 70 percent rating under the TBI criteria, but only a 30 percent rating under the PTSD criteria (the veteran can’t get both the 70 and the 30), VA is required by law to give the veteran the 70 percent rating under the TBI criteria instead of the 30 under PTSD.”

Watch VA-Accredited Claims Advocate Rachel Foster give a rundown of pyramiding rules and how they apply to disability claims:

When Would VA Rate Only My TBI or PTSD (Not Both)?

VA might rate a veteran’s TBI and PTSD as a single condition if the veteran suffers from symptoms that could be attributed to both PTSD and TBI, making it difficult for the VA examiner to separate the two conditions under VA’s pyramiding rules, per 38 CFR § 4.14.

For instance, some symptoms that can be caused by PTSD or TBI include insomnia, irritability, depression, and anxiety. If the veteran mostly suffers from these shared symptoms, then their VA rater might simply assign the veteran a single rating covering both conditions.

Veterans should note that this method will likely lead to a lower overall rating and therefore less VA compensation for TBI and PTSD.

When Would VA Give Ratings to Both My TBI and PTSD?

VA would be more likely to rate a veteran’s TBI and PTSD separately if the veteran suffers from symptoms that can be more easily distinguished as being caused by either TBI or PTSD.

For instance: If a veteran’s TBI symptoms are mostly physical (e.g., headaches, impaired vision, or balance issues), whereas their PTSD symptoms are mostly psychological (e.g., distressing flashbacks or hypervigilance), then it will be easier for a VA rater to identify which symptom belongs to each condition. This is fairly likely to lead to the veteran receiving separate disability ratings, one for PTSD and one for TBI.

Once these separate ratings are determined, VA will then combine the ratings together using VA math. For example:

• Say a veteran is assigned a 30 percent PTSD rating and a 10 percent TBI rating.
• Using VA math, a special formula would be used to combine these ratings, which would result in a 37 percent rating.
• Because VA rounds percentage ratings to the nearest 10 percent, this would result in an overall disability rating of 40 percent for the veteran.

Veterans should note that this method leads to a higher overall disability rating than being rated for only one condition, therefore granting veterans more VA compensation.

For veterans who suspect that they have separate PTSD and TBI conditions, the next step would be to understand how TBI and PTSD are individually rated.

In the video below, CCK Law Reviewing Attorney Nick Scripter and colleagues cover the basics of VA math:

How Is TBI Rated Individually?

VA rates traumatic brain injuries based on the residual symptoms a veteran is currently experiencing because of the trauma under 38 CFR § 4.124a.

VA rates these residuals on a scale of 0, 1, 2, 3, or total, with each of these increments corresponding to a disability rating. Ratings range from 0 to 100 percent.

VA divides the rating criteria of TBI residuals into 10 subcategories to evaluate the condition. Veterans are then rated based on the level of severity and impairment in each of these areas of functioning:

1. Impairment of memory, attention, concentration, and executive functions
2. Altered judgement
3. Inhibited social skills
4. Orientation to person, time, place, and situation
5. Impaired motor activity
6. Visual-spatial orientation
7. Subjective symptoms
8. Neurobehavioral effects
9. Ability to communicate
10. Consciousness

How Is PTSD Rated Individually?

For VA to grant direct service connection for post-traumatic stress disorder, a veteran must provide proof of:

1. A current diagnosis of PTSD;
2. A statement from the veteran about the stressor that occurred during service; and
3. A medical opinion that the stressor was sufficient to cause PTSD from a VA psychologist/psychiatrist, or a psychologist/psychiatrist under contract with VA

PTSD is then rated using the General Rating Formula for Mental Disorders under 38 CFR § 4.130. Ratings range from 0 to 100 percent, with intervals at 10, 30, 50, and 70 percent. Veterans do not need to experience each symptom listed in the criteria to be eligible for that rating.

100 percent – 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 percent – 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 that 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 percent – 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 percent – 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 percent – Occupational and social impairment due to mild or transient symptoms that decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.

0 percent – 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 Much Is VA Compensation for TBI and PTSD?

Single veterans with no dependents can earn VA compensation for TBI and PTSD ranging from $180.42 to $3,938.58, depending on their disability percentage rating.

As of 2026, the VA disability rate benefit amounts are as follows:

• 0 percent disability rating: $0.00 per month
• 10 percent disability rating: $180.42 per month
• 20 percent disability rating: $356.66 per month
• 30 percent disability rating: $552.47 per month
• 40 percent disability rating: $795.84 per month
• 50 percent disability rating: $1,132.90 per month
• 60 percent disability rating: $1,435.02 per month
• 70 percent disability rating: $1,808.45 per month
• 80 percent disability rating: $2,102.15 per month
• 90 percent disability rating: $2,362.30 per month
• 100 percent disability rating: $3,938.58 per month

These percentage ratings are based on the severity of the veteran’s TBI and PTSD, with more serious symptoms generally earning veterans a higher rating.

Is There Special Monthly Compensation (SMC) for TBI?

Yes, veterans who suffer debilitating residuals of a TBI may qualify for SMC(t), a level of special monthly compensation reserved specifically for veterans who have suffered traumatic brain injuries. Criteria for SMC(t) includes:

• The veteran needs regular Aid and Attendance for residuals of a TBI.
• The veteran is not eligible for a higher level of A&A under SMC(r)(2).
• The veteran would need hospitalization, nursing home care, or other residential institutional care without in-home A&A.

Is TDIU Possible for Veterans with PTSD and TBI?

Yes, we recommend that all veterans with PTSD or TBI — and even more so, both conditions — look into TDIU, or total disability based on individual unemployability, if their conditions are making it difficult to find or keep employment. TDIU status grants compensation and benefits equal to a total disability rating even if a veteran’s rating(s) do not add up to 100 percent.

CCK Law has significant experience with TDIU. Contact us for a free case evaluation.

How Do I Challenge a VA Decision About My TBI/PTSD Claim?

Veterans have three ways to challenge a VA decision under the Appeals Modernization Act (AMA). Each of these three review “lanes” fits a different situation, depending on whether a veteran has new evidence or believes VA made an error.

• Supplemental Claim — Submit new and relevant evidence, such as a medical opinion distinguishing TBI symptoms from PTSD symptoms, for VA to consider.
• Higher-Level Review — Ask a senior VA reviewer to take a fresh look at the same evidence, without submitting anything new.
• Board Appeal — File a Notice of Disagreement so a Veterans Law Judge at the Board of Veterans’ Appeals (BVA) can review the case.

Under 38 CFR § 3.2500, veterans generally have one year from the date on the denial letter to choose a lane and keep their original effective date.

Because TBI and PTSD symptoms often overlap, a denial in this area frequently comes down to a pyramiding dispute or a disagreement over which condition caused a particular symptom. This makes a Supplemental Claim built around a new nexus opinion, one that clearly separates TBI residuals from PTSD symptoms, a common and effective option.

Was Your Claim for VA Compensation for TBI and PTSD Denied? Contact CCK Law

Frequently Asked Questions About VA Compensation for TBI and PTSD

Does having both TBI and PTSD automatically increase your combined rating?

Not necessarily. If the symptoms overlap exactly, pyramiding rules may result in only the higher-rated condition having a rating. As a result, having two service-connected conditions usually raises a combined rating, but rarely by as much as veterans expect.

Can you get 100 percent VA disability from TBI and PTSD?

Yes, a veteran can reach a rating of 100 percent if:

• either or both of their TBI and PTSD ratings are given a 100 percent rating, OR
• if they are given separate ratings that — when combined using VA math — reach 95 percent or higher (since VA rounds up to the nearest 10 percent), OR
• when their symptoms prevent substantially gainful employment (resulting in total disability based on individual unemployability (TDIU)).

Do you need a new C&P exam to get TBI and PTSD rated separately?

Usually, yes. VA typically schedules a new Compensation and Pension (C&P) exam when a veteran files a Supplemental Claim asking VA to reevaluate how their TBI and PTSD symptoms are rated together. A Higher-Level Review, by contrast, does not include a new exam, since it only reviews the evidence already in the veteran’s file.