How the VA rates traumatic brain injury

TBI is rated on the longest and most structured entry in the schedule: a table of ten facets, each scored on a scale, with the single worst facet setting the rating. It is also the code where the most compensation hides in plain sight, because the schedule tells the rater to rate several residuals separately, and most first decisions do not.

Last reviewed August 2026 · Not legal advice, VA.gov always controls

Residuals of traumatic brain injury are rated under diagnostic code 8045 in 38 CFR § 4.124a. The code opens by dividing TBI residuals into three areas: cognitive (memory, attention, concentration, executive function), emotional/behavioral, and physical. Each area is handled differently, and understanding which bucket a symptom goes in is most of understanding the rating.

The cognitive table: ten facets

Cognitive impairment and subjective symptoms are rated under the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified." It has ten facets:

1. Memory, attention, concentration, executive functions
2. Judgment
3. Social interaction
4. Orientation
5. Motor activity (with intact motor and sensory system)
6. Visual spatial orientation
7. Subjective symptoms (headaches, dizziness, sleep disturbance, and similar)
8. Neurobehavioral effects (irritability, impulsivity, apathy, lack of motivation, and similar)
9. Communication
10. Consciousness

Each facet is assigned a level of impairment of 0, 1, 2, 3, or "total," based on criteria specific to that facet. Memory, for instance, runs from 0 (no complaints) through 1 (mild complaints of memory loss, attention, concentration, or executive functions, without objective evidence on testing) and 2 (objective evidence on testing of mild impairment) to 3 (objective evidence of moderate impairment) and total (objective evidence of severe impairment). Not every facet has every level; consciousness, for example, has only 0 and total.

The residuals that are rated separately

This is where most of the money is. The note to DC 8045 says that any residual with a distinct diagnosis is rated under its own code, separately, rather than folded into the facet table, as long as the same symptom is not counted twice. The commonly separated residuals:

• Headaches, rated under DC 8100 as migraine on the prostrating-attack scale. Post-traumatic headache is the single most common TBI residual, and a 30% or 50% headache rating on top of the TBI rating is routine when it is claimed. See how the VA rates migraines.
• Mental health conditions: PTSD, depression, anxiety, or a cognitive disorder with a psychiatric diagnosis, rated under § 4.130. The note specifically says emotional/behavioral dysfunction is rated under § 4.130 when there is a diagnosis of a mental disorder. See how the VA rates PTSD.
• Seizures, under the epilepsy codes.
• Tinnitus and hearing loss, under § 4.87.
• Vestibular disorders (dizziness, balance) under DC 6204 or 6205.
• Motor and sensory residuals, hemiparesis, cranial nerve damage, under the neurological codes.
• Sleep apnea and endocrine dysfunction (pituitary injury), under their own codes, with an opinion linking them.

The anti-pyramiding rule still applies: a symptom rated under a separate code is not also scored in the facet table. Headaches rated under 8100 come out of the "subjective symptoms" facet. That is a good trade in nearly every case, because the facet caps subjective symptoms at level 2 (40%), while a separate migraine rating plus a TBI rating on the other facets combine higher.

The 2014 presumptions for moderate and severe TBI

§ 3.310(d) presumes five conditions are secondary to a service-connected TBI of moderate or severe grade, with timing rules: Parkinsonism and unprovoked seizures following moderate or severe TBI at any time; dementia within 15 years of moderate or severe TBI; depression within three years of moderate or severe TBI, or within 12 months of mild TBI; and hormone deficiency diseases from hypothalamo-pituitary changes within 12 months of moderate or severe TBI. The severity grade is determined by the Glasgow Coma Scale, length of altered consciousness, post-traumatic amnesia, and imaging, per the table in the regulation. Mild TBI (most blast concussions) qualifies only for the depression presumption, and only within a year.

Service connection for TBI

The in-service event is usually documented: a blast, a vehicle rollover, a fall, a training injury, with a concussion screening or a MACE score in the record. If it is not, buddy statements from people who witnessed the event, the unit's incident reports, and Purple Heart or Combat Action records corroborate. For veterans with combat service, the combat presumption in 38 U.S.C. 1154(b) accepts a credible lay account of the injury.

The diagnosis comes from a TBI evaluation, which the VA runs through a specialist (neurologist, physiatrist, neurosurgeon, or psychiatrist) under its own protocol. A neuropsychological evaluation is the test that moves the cognitive facets above level 1, and it is worth pursuing through your treating providers before the C&P exam if one has never been done.

The exam

The TBI DBQ walks through all ten facets. The examiner scores each one from the history, the record, and the exam. Three things that help:

1. Bring the neuropsych report if you have one. "Objective evidence on testing" is the phrase that separates level 1 from 2 and 3 on the cognitive facets, and it means formal testing.
2. Describe each facet in functional terms. Memory: the appointments missed, the instructions you cannot hold, the notes you live by. Judgment: decisions that went wrong. Social interaction: the relationships that ended. Neurobehavioral: the irritability, the things you have said. The facet criteria use words like "occasionally," "frequently," and "inappropriate," and the examiner needs examples to choose between them.
3. List every residual and say which ones you are claiming separately: headaches, tinnitus, sleep, mood. If the examiner hears "headaches" as a subjective symptom, it goes in the facet table; if you have claimed migraines, it gets its own DBQ.

Read Preparing for a C&P exam for the general approach.

The checklist

1. Documentation of the in-service injury: medical record, incident report, MACE, buddy statements, combat records.
2. A TBI diagnosis, with the severity grade if it was assessed.
3. Neuropsychological testing, if any has been done, or a referral for it.
4. Each residual listed as its own claimed condition on the 21-526EZ: "post-traumatic headaches," "tinnitus," "depression secondary to TBI."
5. Lay statements from family and coworkers on memory, behavior, and judgment changes since the injury.
6. A symptom log for headaches, sleep, and cognitive lapses.