Active duty service members are at risk of experiencing traumatic brain injuries. TBIs can cause significant impairment to a person’s mental, physical, and emotional health during military service and well beyond. How TBI VA ratings are decided is relatively complex, but you could get anywhere from 0% to 100% disability benefits if you experienced one.
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In this article about TBI VA ratings
Your brain is the most important part of your body. It determines how you function, how you feel, and who you are, which is why TBIs are so frightening. A traumatic brain injury can permanently impact your ability to live your life and be you. If your injury is related to your military service, it’s vital to understand how TBI VA ratings are decided.
What is a TBI? (traumatic brain injury)
What is a TBI? A traumatic brain injury results from a blow or bump to the head, a severe jolt of your body, or something penetrating your skull. The trauma doesn’t just break the bones of your skull, but it affects your brain functions. The most common causes of TBIs include falls, gunshot wounds, vehicle crashes, and assaults.
The symptoms of TBIs include:
- Nerve damage
- Blood clots
- Difficulty learning, remembering, or making decisions
- Double vision
- Ear ringing
- Tingling or pain
- Difficulty talking, reading, writing, or explaining things
- Aggression or problems with self-control
- Mood swings and irritability
These symptoms can be temporary or ongoing. More than one TBI may result in Alzheimer’s or Parkinson’s disease. TBIs also are directly linked with post-traumatic stress disorder.
3 levels of TBIs
A concussion is not the same as a TBI. Doctors classify TBIs based on three levels of severity:
- Mild – Mild TBI is essentially a concussion. It typically isn’t severe, but a doctor should still check it out. Repeated concussions can cause long-term problems.
- Moderate – This level of TBI is life-altering and may result in ongoing physical and mental health issues. Someone with a moderate TBI needs ongoing medical treatment.
- Severe – Severe TBI can cause death. People who survive this type of injury need ongoing, extensive treatment and are unlikely to return to their previous levels of functioning.
Proving the level of your TBI will require showing your symptoms and describing the nexus event. Diagnosis from a doctor and details about the event will help your claim.
TBI during military service
Service members can experience TBIs during training and while in combat and are among the groups considered most at risk for TBIs with long-term mental or physical health effects. They also are considered at risk for death and suicide resulting from TBIs. One study found that nearly 4,000 more 9/11 veterans died in the past 20 years than anticipated, and those numbers were highest in veterans with any level of TBI.
Veterans with a diagnosis of mild, moderate, or severe TBI in a medical record should be aware that those labels are not a standard the VA uses to determine a disability rating. According to the Schedule of Ratings, a mild, moderate, or severe TBI is diagnosed “at, or close to, the time of injury rather than to the current level of functioning.”
Veterans with TBIs experience differing levels of disabilities, and some may not be able to maintain employment after their head injury.
How TBI VA ratings are decided
The VA rates the residuals of traumatic brain injury with diagnostic code 8045 in the Schedule for Rating Disabilities.
The three areas of dysfunction resulting from TBI are cognitive, emotional/behavioral, and physical. Here is how the VA rates the conditions in each of these areas of TBI-related dysfunction:
- Cognitive residuals are defined as decreased memory, concentration, attention, and executive functions of the brain. The VA’s process of determining the level of cognitive impairment is complex. It involves evaluating 10 facets of TBI-related cognitive impairment. The VA determines the level of impairment for each facet.
- Emotional/behavioral residuals are mental disorders that the VA rates using the General Rating Formula for Mental Disorders in the Schedule for Rating Disabilities.
- Physical concerns, including neurological ones, resulting from TBI are evaluated under the specific area of physical dysfunction.
Why is getting a VA rating for TBI so complicated?
“A TBI isn’t really an individual distinct disability in and of itself,” said Zack Evans, a VA-certified disability benefits lawyer. “Rather, it’s a cluster of disabilities or symptoms that flow from a single event, the event being the brain injury.”
Because TBIs often involve multiple symptoms, the VA’s rule against pyramiding should be considered. The rule cautions against applying multiple diagnostic codes to a single symptom, but Evans said he’s seen the VA misapply the pyramiding rule in a TBI claim.
He said mental health and headache symptoms are some of the most easily recognizable symptoms in TBI patients.
“They’re demonstrable, so you can observe them,” he said. “You can readily calculate how they affect somebody’s life.” He said TBI survivors will have a stronger VA claim if they get opinions from multiple experts, including a mental health professional.
“I operate on a TBI rule of three, which is that if you are pursuing a traumatic brain injury claim, you should almost always develop claims for mental health and headaches,” Evans said.
Building a VA disability claim for TBI or appealing a VA decision can be complicated. Seeking assistance from a lawyer with experience in VA disability cases can help ensure you are appropriately compensated.
How to service connect traumatic brain injury
If you received a head injury during your military service, some conditions are presumptively connected to a TBI and should automatically receive compensation.
Other conditions may be eligible for benefits if you can connect them secondarily to a TBI that occurred during your military service.
Conditions that may be eligible for secondary benefits include:
- Mental health disorders like anxiety, bipolar disorder, panic disorder, schizoaffective disorder, or schizophrenia. The most common mental health disorder associated with TBI is PTSD.
- Alzheimer’s and dementia
- Sleep disorders
Unemployed because of a TBI?
Veterans with a service-connected TBI who are unable to work may be eligible to receive Total Disability Individual Unemployability benefits. TDIU pays the same monthly amount as a 100% rating. Veterans are eligible for TDIU if they have a single disability rating of 60% or a combined rating of 70% with one rating of at least 40%.
If the effects of a TBI are not expected to improve, a veteran could be eligible for permanent and total disability (P&T). A P&T rating is 100% and is paid for the rest of the veteran’s life.
TBI special monthly compensation
An additional benefit is available to veterans with a service-connected TBI who require regular aid and attendance. This monthly allowance, called SMC-T, is paid in TBI cases in which the veteran needs help with daily activities or would otherwise require hospitalization or care in a nursing home other residential institution.
How to get disability benefits for a TBI
For the VA to consider disability benefits, you must file a claim. The VA will usually request a Compensation and Pension exam. The examining physician will complete a neurological exam. They also will ask you questions about your symptoms and service. If the VA schedules an exam, you should attend it to avoid denial of your claim.
You also can use a Disability Benefits Questionnaire to help your claim. The questionnaire allows your physician to address symptoms, severity, possible causes, and how the condition may be related to other health concerns. A private physician can complete the form for you.
Along with reports from a neurologist, mental health professional, and other doctors, you would want to submit service records that document the injury if they’re available. You also can submit buddy statements from fellow service members and lay statements from people who knew you before and after the head injury and can speak to the changes you’ve undergone.
Once the VA processes your claim for benefits, you will receive a rating decision containing either a grant or a denial. If the VA denies your benefits, you can file an appeal. If you receive more than a 0% rating, you should receive monthly compensation and could be awarded past due benefits back to when you filed your claim.
Woods and Woods can help
If you experienced a traumatic brain injury during your military service, you deserve VA disability compensation. Contact Woods and Woods to file an initial claim or appeal a rating decision. You only pay us if we win.
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FREQUENTLY ASKED QUESTIONS
Yes. A traumatic brain injury can cause physical disabilities and mental health disorders. It can even result in a sleep disorder. TBIs can result in many health concerns, including post-traumatic stress disorder.
Unfortunately, medical and service records don’t always make it home with a veteran. That doesn’t mean you don’t deserve compensation for your injury and its subsequent outcomes on your health. There are ways to build your case, even if your official records no longer exist.