FAQ Friday: How does the VA rate TBI?
Q. What is a Traumatic Brain Injury (TBI)?
Traumatic brain injury (TBI) occurs when brain function is disrupted by a traumatic event such as an IED blast, a gunshot wound, a car accident, personal assault, etc. Rates of TBI among service members have increased substantially since the Iraq and Afghanistan wars, thought to be due to the significant use of IEDs. The VA estimates that 22% of all combat-related casualties sustained by troops in Iraq and Afghanistan are brain injuries, a 10% increase from rates among Vietnam War veterans.
Q. What are common signs and symptoms of TBI residuals?
After suffering a traumatic brain injury, symptoms manifest cognitively, physically, behaviorally/emotionally, or subjectively. Since the brain controls all bodily functions, symptoms can manifest in many different ways. Signs and symptoms of a TBI are unique to the individual, therefore they must be evaluated on a case-by-case basis. Common symptoms of a TBI include:
- Headaches and dizziness
- Visual impairment
- Hearing loss or tinnitus
- Seizure disorder
- Muscle weakness
- Inability to complete intentional motor tasks
- Trouble communicating verbally or in writing
- Paralysis or stroke
- Gait, balance, and coordination disorders
- Trouble concentrating
- Impaired memory, learning, and processing ability
- Poor judgment
- Agitation and aggression
The VA diagnoses traumatic brain injuries as mild (mTBI), moderate, or severe based on the gravity of a veteran’s symptoms. Residuals of mild TBIs usually, but do not always, resolve within about six months after the injury. Residuals of more acute traumatic brain injuries can be long-lasting, permanent, or may take years to develop such as Dementia and Parkinson’s Disease.
Q. How is a TBI diagnosed?
Assessment of a TBI’s initial severity is gauged by:
- Results from MRI, PET, or other x-ray scans
- The length of time that an individual faced an altered state of consciousness
- The amount 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 detailing how the VA measures severity of initial trauma 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.
Q. How is my TBI rated?
A veteran is rated based on existing residuals of a TBI in relation to their cognitive, physical, subjective, and behavioral/emotional effects. A veteran’s rating is not affected by initial severity of the trauma. In order to assess the severity of existing TBI residuals, VA uses an Evaluation of Cognitive Impairment and Other Residuals of TBI not Otherwise Classified. According to CFR §4.124a, this evaluation examines TBI residuals based on the severity of 10 criteria:
- 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?
- Disorientation– 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.
- Consciousness– Is the veteran conscious, in a coma, or in a vegetative state?
These symptoms are rated based on the hindering effects they may present to someone in the workplace and in completing activities of daily life. During an evaluation, VA will assign a level of severity for each of the categories listed above on a scale of 0 to total; these increments equate to VA ratings of 0%, 10%, 40%, 70% or 100%. If your symptom’s severity is scored as “total” in one or more of these categories, you should receive a 100% disability rating. However, the same symptoms cannot be used to rate two separate disorders. Your symptoms cannot be linked to a previously rated condition in order to be rated for TBI; symptoms must be separable per condition for a new evaluation. For instance, if you receive a 100% disability rating for your depression under the TBI rating criteria, you cannot also be separately rated at 100% for your depression.
Q. What if my TBI resulted in a secondary condition?
The following disorders are presumptively service-connected if they manifest within the time frame outlined in CFR §3.31:
- Parkinsonism and Parkinson’s Disease developed at any point following a moderate or severe TBI will be presumptively service-connected.
- Dementia developed within 15 years after a VA-rated moderate or severe TBI will have their Dementia presumptively service-connected.
- Depression manifesting within three years after a moderate or severe TBI, or within 12 months of a mild TBI, will be presumptively service-connected.
Diseases of hormone deficiencies manifested within 12 months of a moderate or severe TBI that result from hypothalamo-pituitary changes will be presumptively service-connected.
Q. Can my TBI qualify me for special monthly compensation (SMC)?
The VA established a level of special monthly compensation specifically for veterans who have experienced a severe TBI, SMC(t). 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).
If you are suffering from TBI residuals after service, you may be entitled to receive disability compensation from the VA. If your TBI claim has been wrongly denied, we may be able to help. Call 401-331-6300 for a free consultation.
Category: Veterans Law