Traumatic Brain Injury (TBI) Rating System • Military Disability Made Easy

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Traumatic Brain Injury (TBI)

Traumatic brain injury (TBI) is a condition where the brain is damaged because of a traumatic event. A “traumatic event” is any event, like a car accident, IED blast, gunshot wound, falling and hitting your head, etc., that causes damage to the brain.

If the brain condition is caused by an illness or is Genetic, then it is not considered TBI and cannot be rated here. Please see The Central Nervous System page for conditions of the brain and nerves or the Mental Disorders page for psychiatric conditions.

Similarly, there may be other conditions that occur at the same time as the TBI. These conditions could include skin burns, exposure to toxic substances, amputations, etc. Since these conditions are not directly caused by the trauma to the brain, they are not rated here but are rated separately.

Some individuals experience numerous TBIs—they could be exposed to repeated IED blasts, etc. Regardless of how many incidences are experienced, the overall brain condition caused by all the TBIs is rated as a single condition.

The brain is protected by layers of soft tissue and a liquid called cerebrospinal fluid. The fluid and tissues act as a bumper between the brain and the skull. The cerebrospinal fluid also acts as an electrical conduit between the different parts of the brain and nerves, and it carries nutrients from the blood to the brain. If the TBI causes tears in the soft tissues surrounding the brain, this liquid can leak out, disrupting brain function. TBI can also cause the fluid to build up in certain areas, causing increased pressure on that area of the brain (“hydrocephalus”). Likewise, TBI can cause blocks in the blood-flow or Hemorrhaging, which can deprive the brain of the essential nutrients it needs to function. If the blood is unable to take its nutrients to the brain for 4 minutes or longer, damage to the brain cells becomes permanent. Infections (like meningitis) can also result from TBI and cause damage to the tissues of the brain.

The brain controls every single function in the entire body, whether it be involuntary (beating the heart, digesting food, etc.), voluntary (moving the arm, speaking, etc.), or cognitive (thinking, problem solving, making decisions, etc.). Each function is controlled by a different part of the brain, so damage caused by TBI can affect one, many, or all functions of the body. Because of the vast amount of damages that can occur, each case of TBI is very individual and unique. This makes rating a TBI condition rather complicated, but we’ll try to make it a little more manageable.

Because damage to the brain can affect any bodily function, it is essential that each function that is impaired is properly examined. So, if the condition affects the ability to see, thorough examinations must be done on the eyes in order to properly rate the TBI. This goes for every symptom that is present. Examinations do not have to be done on a certain bodily function, however, if there are no clear symptoms to suggest that it has been affected. Similarly, it is essential that the physician fully notes how the condition and all its symptoms affects the individual’s ability to function in necessary daily activities, like cleaning and cooking, self-care, and occupational tasks. Does the condition interfere with the individual’s ability to work? Can they bathe themselves and use the restroom? In addition to this, in many TBI cases, the individual affected may not be able to properly tell the history of their condition and describe all its symptoms to the physicians. It is important in these cases that a third party who is familiar with the entire condition, like a family member, is able to attend all examinations so that everything is properly recorded.

A symptom can only be rated under TBI if it is directly caused by TBI. If a physician does not note in their records that a symptom was caused by TBI, then it cannot be rated here. This includes symptoms and conditions that may develop in the future. Since TBI can affect so many parts of the body, many conditions caused by TBI may not develop until much later. These can only be rated if there is enough solid evidence to prove that they were directly caused by the TBI that occured while you were in the military, and not by any other logical cause.

In January 2014, the VA changed their regulations on rating TBI to plainly state that a few conditions which may not develop until later will always be assumed to have been caused by TBI, and thus are eligible for disability compensation from the VA as soon as they develop, with a few caveats. These conditions include Parkinsonism, Parkinson’s disease, seizures, dementia, depression, and some hormone deficiency diseases. If you have one or more of these conditions, see if it qualifies to be rated under TBI.

Now, immediately after the trauma occurs, the physician will diagnose the severity of the trauma: mild, moderate, or severe. These diagnoses are ONLY for the severity of the initial trauma itself. The severity of the initial trauma and the severity of the lasting symptoms are often very close, but not always. While rare, a person could have severe initial trauma and only mild lasting symptoms. Because of this, the diagnosis of the severity of the initial trauma cannot be used for rating. A rating can only be made on the severity of the resulting conditions and symptoms themselves. More will be said on this under the TBI Rating System below.

There are also several scales that you might find on your medical reports that are used to determine the initial severity of the trauma: the Glasgow Coma Scale (GCS) and the Rancho Los Amigos Scale are some examples of these scales. Physicians may also determine the initial severity of the trauma by how long the individual is unconscious or, if there is any amnesia, how long it lasts. All of these things are only used to determine the initial severity of the trauma and are not used to rate the condition. Just ignore them when rating TBI.

Similarly, the physician might refer to an individual’s condition as Post-Concussion Syndrome (PCS) on the report. This is just a generic term that refers to any group of conditions and symptoms caused by TBI. This term is not important to rating. Ignore it as well.

The symptoms/conditions caused by TBI can last a few days or weeks to a few years or permanently. It is hard to predict just how long the symptoms may last. The majority of symptoms in the majority of cases of mild TBI resolve within the first three months following the trauma. Only between 10-20% of mild cases have symptoms that last one year or more. The majority of symptoms of moderate TBI resolve, or at least improve significantly, in the first 6 months after the trauma. With severe TBI, it is impossible to really predict how long the symptoms will last or improve, if at all. Because of this uncertainty, the condition is simply rated on the severity of the symptoms at the time of examination (for DoD, this would be the examination closest to the date of separation).

There are three kinds of conditions and symptoms that can be caused by TBI: cognitive, physical, and emotional/behavioral. Cognitive conditions interfere with the ability of the brain itself to function properly. They can affect the brain’s ability to process information, reason, problem-solve, make decisions, organize, prioritize, etc. Physical conditions deal with the ability of the body to function. Emotional and behavioral conditions address psychological health, like depression, hallucinations, etc.
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TBI Rating System

TBI is rated on the symptoms/conditions that it causes. To try and make TBI rating more manageable, we will first discuss the basic principles behind rating TBI. Then we will discuss how to rate the various kinds of conditions/symptoms as well as give lists of the most common conditions and symptoms caused by TBI. We will end with detailed examples of how to rate TBI without getting overwhelmed. There will be a lot of information up front, but hang in there. Hopefully the examples will help make it easier.

First, the code. There is only one code for TBI:

Traumatic Brain Injury (TBI)

Traumatic brain injury (TBI) is a condition where the brain is damaged because of a traumatic event. A “traumatic event” is any event, like a car accident, IED blast, gunshot wound, falling and hitting your head, etc., that causes damage to the brain.

If the brain condition is caused by an illness or is Genetic, then it is not considered TBI and cannot be rated here. Please see The Central Nervous System page for conditions of the brain and nerves or the Mental Disorders page for psychiatric conditions.

Similarly, there may be other conditions that occur at the same time as the TBI. These conditions could include skin burns, exposure to toxic substances, amputations, etc. Since these conditions are not directly caused by the trauma to the brain, they are not rated here but are rated separately.

Some individuals experience numerous TBIs—they could be exposed to repeated IED blasts, etc. Regardless of how many incidences are experienced, the overall brain condition caused by all the TBIs is rated as a single condition.

The brain is protected by layers of soft tissue and a liquid called cerebrospinal fluid. The fluid and tissues act as a bumper between the brain and the skull. The cerebrospinal fluid also acts as an electrical conduit between the different parts of the brain and nerves, and it carries nutrients from the blood to the brain. If the TBI causes tears in the soft tissues surrounding the brain, this liquid can leak out, disrupting brain function. TBI can also cause the fluid to build up in certain areas, causing increased pressure on that area of the brain (“hydrocephalus”). Likewise, TBI can cause blocks in the blood-flow or Hemorrhaging, which can deprive the brain of the essential nutrients it needs to function. If the blood is unable to take its nutrients to the brain for 4 minutes or longer, damage to the brain cells becomes permanent. Infections (like meningitis) can also result from TBI and cause damage to the tissues of the brain.

The brain controls every single function in the entire body, whether it be involuntary (beating the heart, digesting food, etc.), voluntary (moving the arm, speaking, etc.), or cognitive (thinking, problem solving, making decisions, etc.). Each function is controlled by a different part of the brain, so damage caused by TBI can affect one, many, or all functions of the body. Because of the vast amount of damages that can occur, each case of TBI is very individual and unique. This makes rating a TBI condition rather complicated, but we’ll try to make it a little more manageable.

Because damage to the brain can affect any bodily function, it is essential that each function that is impaired is properly examined. So, if the condition affects the ability to see, thorough examinations must be done on the eyes in order to properly rate the TBI. This goes for every symptom that is present. Examinations do not have to be done on a certain bodily function, however, if there are no clear symptoms to suggest that it has been affected. Similarly, it is essential that the physician fully notes how the condition and all its symptoms affects the individual’s ability to function in necessary daily activities, like cleaning and cooking, self-care, and occupational tasks. Does the condition interfere with the individual’s ability to work? Can they bathe themselves and use the restroom? In addition to this, in many TBI cases, the individual affected may not be able to properly tell the history of their condition and describe all its symptoms to the physicians. It is important in these cases that a third party who is familiar with the entire condition, like a family member, is able to attend all examinations so that everything is properly recorded.

A symptom can only be rated under TBI if it is directly caused by TBI. If a physician does not note in their records that a symptom was caused by TBI, then it cannot be rated here. This includes symptoms and conditions that may develop in the future. Since TBI can affect so many parts of the body, many conditions caused by TBI may not develop until much later. These can only be rated if there is enough solid evidence to prove that they were directly caused by the TBI that occured while you were in the military, and not by any other logical cause.

In January 2014, the VA changed their regulations on rating TBI to plainly state that a few conditions which may not develop until later will always be assumed to have been caused by TBI, and thus are eligible for disability compensation from the VA as soon as they develop, with a few caveats. These conditions include Parkinsonism, Parkinson’s disease, seizures, dementia, depression, and some hormone deficiency diseases. If you have one or more of these conditions, see if it qualifies to be rated under TBI.

Now, immediately after the trauma occurs, the physician will diagnose the severity of the trauma: mild, moderate, or severe. These diagnoses are ONLY for the severity of the initial trauma itself. The severity of the initial trauma and the severity of the lasting symptoms are often very close, but not always. While rare, a person could have severe initial trauma and only mild lasting symptoms. Because of this, the diagnosis of the severity of the initial trauma cannot be used for rating. A rating can only be made on the severity of the resulting conditions and symptoms themselves. More will be said on this under the TBI Rating System below.

There are also several scales that you might find on your medical reports that are used to determine the initial severity of the trauma: the Glasgow Coma Scale (GCS) and the Rancho Los Amigos Scale are some examples of these scales. Physicians may also determine the initial severity of the trauma by how long the individual is unconscious or, if there is any amnesia, how long it lasts. All of these things are only used to determine the initial severity of the trauma and are not used to rate the condition. Just ignore them when rating TBI.

Similarly, the physician might refer to an individual’s condition as Post-Concussion Syndrome (PCS) on the report. This is just a generic term that refers to any group of conditions and symptoms caused by TBI. This term is not important to rating. Ignore it as well.

The symptoms/conditions caused by TBI can last a few days or weeks to a few years or permanently. It is hard to predict just how long the symptoms may last. The majority of symptoms in the majority of cases of mild TBI resolve within the first three months following the trauma. Only between 10-20% of mild cases have symptoms that last one year or more. The majority of symptoms of moderate TBI resolve, or at least improve significantly, in the first 6 months after the trauma. With severe TBI, it is impossible to really predict how long the symptoms will last or improve, if at all. Because of this uncertainty, the condition is simply rated on the severity of the symptoms at the time of examination (for DoD, this would be the examination closest to the date of separation).

There are three kinds of conditions and symptoms that can be caused by TBI: cognitive, physical, and emotional/behavioral. Cognitive conditions interfere with the ability of the brain itself to function properly. They can affect the brain’s ability to process information, reason, problem-solve, make decisions, organize, prioritize, etc. Physical conditions deal with the ability of the body to function. Emotional and behavioral conditions address psychological health, like depression, hallucinations, etc.
Return to Top
TBI Rating System

TBI is rated on the symptoms/conditions that it causes. To try and make TBI rating more manageable, we will first discuss the basic principles behind rating TBI. Then we will discuss how to rate the various kinds of conditions/symptoms as well as give lists of the most common conditions and symptoms caused by TBI. We will end with detailed examples of how to rate TBI without getting overwhelmed. There will be a lot of information up front, but hang in there. Hopefully the examples will help make it easier.

First, the code. There is only one code for TBI: