Rating Traumatic Brain Injury (TBI)

The Three Areas of TBI Dysfunction

A TBI can affect you in three different ways. The VA looks at each one separately, rates whatever applies to you, and then combines the ratings using VA math.

Thinking Problems (The 10-Facet Table)

Cognitive impairment means a drop in your memory, attention, concentration, and "executive functions." Executive functions include goal-setting, planning, organizing, prioritizing, problem-solving, judgment, decision-making, self-monitoring, and the ability to change course when something is not working.

Not all of these are affected in everyone, and some may be worse than others. Symptoms can fluctuate day-to-day.

VA scores you on 10 categories (called facets). Each facet is scored 0, 1, 2, 3, or "total" (the highest level). The highest single facet score drives your overall rating, not the average.

How Facet Scores Convert to a Percentage

The 10 Facets

• Memory, attention, concentration, executive functions
• Judgment
• Social interaction
• Orientation
• Motor activity (with intact motor/sensory system)
• Visual spatial orientation
• Subjective symptoms
• Neurobehavioral effects
• Communication
• Consciousness (only "total" is possible, any level of impaired consciousness is 100%)

Mood and Behavior

This is the "two-track" rule that confuses a lot of veterans.

Track A: You Have a Diagnosed Mental Health Condition

If a clinician has diagnosed PTSD, depression, anxiety, adjustment disorder, or another mental health condition, the emotional/behavioral piece is rated under the regular mental-disorder rules (38 CFR § 4.130). That can be a separate rating from your TBI cognitive rating, and the two are combined.

Track B: No Mental Health Diagnosis

If you have mood swings, irritability, or behavior changes from the TBI but no separate mental health diagnosis, those symptoms are scored in the "Neurobehavioral effects" facet of the TBI table and counted toward your overall TBI rating.

Physical Problems

Each physical residual gets rated under its own diagnostic code, not the TBI table. Common physical residuals include:

• Weakness, numbness, or pain in arms, legs, or face (motor and sensory dysfunction)
• Vision loss or eye problems
• Hearing loss and tinnitus
• Loss of smell or taste
• Seizures
• Trouble walking, balance problems, coordination problems
• Speech and communication problems (including aphasia and dysarthria)
• Bladder control problems (neurogenic bladder)
• Bowel control problems (neurogenic bowel)
• Cranial nerve damage
• Autonomic nerve problems (blood pressure, heart rate, sweating)
• Hormone problems (endocrine dysfunction)

This list is not complete. Any other physical condition that came from the TBI gets rated under whichever diagnostic code best fits.

Subjective Symptoms

Subjective symptoms are the things only you can describe, like headaches, dizziness, ringing in the ears, fatigue, or sleep problems. They are common after TBI.

• Subjective symptoms with no separate diagnosis: rated inside the TBI table under the "Subjective symptoms" facet.
• Subjective symptoms that match a named diagnosis (migraine headache, Meniere's disease, etc.): rated under their own diagnostic code, NOT inside the TBI table, even though the diagnosis is based on what you describe.

How the Ratings Combine

Each separately-rated condition (cognitive, mental-disorder, each physical residual) is combined under VA math (38 CFR § 4.25), the same combining table used for all VA ratings. Use our VA Math calculator to combine your ratings.

For combining purposes, the rating you get from the TBI cognitive table is treated as one single condition (not 10 separate facet ratings). That single number combines with your mental-disorder rating, your physical-residual ratings, and any other service-connected ratings.

Special Monthly Compensation (SMC)

If your TBI is severe, VA must also consider whether you qualify for Special Monthly Compensation on top of your percentage rating. SMC pays extra for situations like:

• Loss of use of an arm, leg, hand, or foot
• Blindness or near-blindness
• Deafness in both ears
• Erectile dysfunction
• Needing aid and attendance, including supervision because of cognitive problems (such as needing someone to keep you from wandering off, leaving the stove on, or other hazards)
• Being housebound

SMC for TBI is most often awarded at the SMC-T level, which pays at the same rate as SMC-R.2 ($10,000+/month) for veterans who would need to be in a nursing home or institutional setting because of their TBI but are being cared for at home. See our SMC-T for TBI guide for details.

Important Notes (The CFR Footnotes)

"Mild," "Moderate," "Severe" TBI in Medical Records

These labels classify the injury at the time it happened (based on loss of consciousness duration, Glasgow Coma Score, post-traumatic amnesia). They do NOT control your VA rating. A "mild" TBI at the time of injury can produce severe residuals years later, and the rating goes by current functioning, not the original classification.

ADLs vs IADLs

The TBI table considers both, and they mean different things:

• Activities of Daily Living (ADLs): basic self-care, bathing, dressing, eating, getting in and out of bed, using the toilet.
• Instrumental Activities of Daily Living (IADLs): independent-living tasks, cooking, housework, shopping, doing laundry, managing medications, using a phone, getting around.

Inability to perform ADLs is more severe than inability to perform IADLs and pushes facet scores higher.

Pre-October 23, 2008 TBI Ratings

If you were rated under the older DC 8045 (before the 2008 rewrite), you can ask VA at any time to re-review your rating under the current rules, even if your TBI has not gotten worse. The review is treated as a claim for an increased rating. If the new rules give you a higher rating, the effective date can go back as far as October 23, 2008, but no earlier.

Frequently Asked Questions