A traumatic brain injury is an event: a blast, a vehicle impact, a fall, a blow to the head. For VA purposes, the event matters mainly because of what it leaves behind. The VA evaluates the residuals - the lasting effects on thinking, mood, behavior, and physical function.
This guide explains how the VA approaches TBI claims, where the rules live, and how the rest of this series breaks the subject down. For the wider picture of how any condition gets connected to service, see our guide to how VA service connection works.
What has to be established
Like any claim, a TBI claim rests on the basic framework in 38 CFR 3.303: a current disability, an in-service event or injury, and a link between them. The in-service event here is the head injury. The current disability is the residual effect.
The VA's page on evidence needed for a disability claim describes the kinds of records that support this - service treatment records, current medical records, and lay statements from people who observed the injury or the change afterward.
How the residuals are rated
Diagnostic Code 8045 in 38 CFR 4.124a divides TBI residuals into three broad areas: cognitive impairment, emotional and behavioral effects, and physical effects. Cognitive impairment is evaluated through a set of facets, each assigned a level of impairment, with the highest facet level driving the overall evaluation.
Our guide to how the VA rates TBI residuals walks through the facets and what each level describes.
Residuals with their own diagnoses
Some residuals have their own recognized diagnoses - headaches, a mood disorder, hearing loss, vision problems, balance disturbance. The regulation directs that those be evaluated under the diagnostic code for that condition rather than folded into the facet table.
Two related guides cover the most common examples: post-traumatic headaches after a TBI and mental health symptoms after a brain injury.
Where veterans start
Every case is different, and there is no obligation at any step. When veterans want to understand what their records actually support, these are the two most common starting points:
- Medical records review
A licensed physician reviews your records for a $250 flat fee and identifies which conditions the available evidence may support. The fee is refunded in full if nothing supportable is identified.
- Nexus letter
When the records support one, a licensed provider writes the medical opinion that addresses the link between your condition and your service.
The pyramiding limit
38 CFR 4.14 prohibits rating the same symptom twice under different diagnostic codes. In TBI claims this comes up constantly, because cognitive and emotional symptoms can appear both in the facet table and in the mental disorders schedule. The rule is not that a veteran cannot have both - it is that the same manifestation cannot be counted twice.
The rest of this series
Each part of a TBI claim has its own guide:
This guide is educational. It summarizes the VA's own published rules and links to the exact sources it relies on. It is not legal or claims advice, and it is not a substitute for an accredited representative, who can advise you about your specific claim. Accredited help is free - search the VA's accreditation database to find a Veterans Service Organization, accredited agent, or attorney.
Frequently asked questions
Does the VA rate the brain injury itself?
No. The VA rates the residuals of a traumatic brain injury - the lasting cognitive, emotional, behavioral, and physical effects. Diagnostic Code 8045 in 38 CFR 4.124a sets out how those residuals are evaluated.
Do I need a documented concussion in my service records?
It helps, but 38 CFR 3.303 allows service connection to be established by the record as a whole. Buddy statements, unit records, and later medical findings can all form part of that record.
Can headaches after a TBI be rated separately?
Diagnostic Code 8045 directs that residuals with their own diagnoses be evaluated under the diagnostic code for that condition, so long as the same symptoms are not counted twice under 38 CFR 4.14.