How VA Rates TBI: DC 8045 Residual Facets and Co-Morbid PTSD

Under 38 CFR 4.124a, TBI residuals are evaluated across 10 specific functional facets: memory and attention, judgment, social interaction, orientation, motor activity, visual spatial orientation, subjective symptoms (such as headaches and dizziness), neurobehavioral effects, communication, and consciousness. Each facet is graded from Level 0 (normal) to Level 3 (severe), with Level Total indicating vegetative state.

The final TBI rating percentage is determined by the highest level assigned across any of the first nine facets: a highest level of 1 equals a 10% rating; a highest level of 2 equals a 40% rating; a highest level of 3 equals a 70% rating; and Level Total equals a 100% rating. Individual facet scores are not added together.

Veterans with blast exposure or head trauma frequently suffer from both TBI and PTSD. Under 38 CFR 4.14, symptoms cannot be compensated twice. If an examiner can clinically distinguish cognitive deficits (TBI) from emotional symptoms (PTSD), separate ratings are assigned. If the symptoms overlap completely and cannot be separated without speculation, a single combined rating is assigned under the mental disorders formula.

Service connection requires documented in-service head trauma, loss or alteration of consciousness, and current cognitive or neurological residuals. The Initial TBI DBQ must be conducted by a qualified neurologist, neurosurgeon, physiatrist, or licensed neuropsychologist.