TBI VA rating: scale, residuals and exam

TBI is rated on a table of ten facets, each scored on a scale, with the single worst facet setting the table rating. The code also tells the rater to rate residuals that have their own diagnosis separately, as long as the same symptoms are not counted twice.

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

VA rates a service-connected traumatic brain injury on its current residuals, under diagnostic code 8045. Cognitive problems and subjective symptoms are scored on a table of ten facets, and the highest level on any facet sets that rating: 0%, 10%, 40%, or 70%, or 100% if any facet is total. Residuals with their own diagnosis, such as migraine, a mental disorder, or tinnitus, are rated separately and combined with it, as long as the same symptoms are not counted twice (38 CFR § 4.124a, DC 8045).

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 has only "total," because the regulation treats any impaired consciousness as totally disabling; social interaction and neurobehavioral effects stop at 3; and subjective symptoms stop at 2.

The residuals that are rated separately

Separately rated residuals combine with the facet rating under § 4.25 instead of being absorbed into it. The text of 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, or by analogy to, DC 8100 (migraine) on the prostrating-attack scale: 10% for characteristic prostrating attacks averaging one in 2 months over the last several months, 30% for characteristic prostrating attacks averaging once a month over the last several months, and 50% for very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability. Less frequent attacks are 0%. 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 code 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: tinnitus under DC 6260 in § 4.87, hearing loss under the tables in § 4.85.
• 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. When headaches have their own diagnosis, DC 8045 says to "separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache," so they are rated under, or by analogy to, DC 8100 and taken out of the "subjective symptoms" facet. Note (1) to DC 8045 says that if the symptoms of two conditions cannot be clearly separated, VA assigns a single rating under whichever set of criteria better reflects the overall impairment from both.

The 2014 presumptions for TBI residuals

§ 3.310(d) presumes five conditions are secondary to a service-connected TBI, four of them only after a moderate or severe TBI, with timing rules: Parkinsonism and unprovoked seizures following moderate or severe TBI at any time; dementia of three named types (presenile dementia of the Alzheimer type, frontotemporal dementia, and dementia with Lewy bodies) 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 structural imaging, loss of consciousness, alteration of consciousness, post-traumatic amnesia, and the Glasgow Coma Scale, per the table in § 3.310(d)(3). It is based on the symptoms at or shortly after the injury, the TBI does not have to meet every criterion in a column, and it is placed at the highest level any one criterion reaches, unless that criterion is the same at both levels, as with normal structural imaging. Mild TBI qualifies only for the depression presumption, and only within a year. Missing a window or a severity grade does not end the claim: § 3.310(d)(2) says VA then decides it under the ordinary secondary service connection rules, on the medical evidence. And the grade matters only here; Note (4) to DC 8045 says the mild, moderate, or severe label does not affect the rating itself.

Service connection for TBI

Start with the record of the in-service event: a blast, a vehicle rollover, a fall, a training injury, and any concussion screening score recorded at the time. Where the record is thin, buddy statements from people who witnessed the event, the unit's incident reports, and Purple Heart or Combat Action records can help corroborate it. For a veteran who engaged in combat with the enemy, 38 U.S.C. § 1154(b) accepts satisfactory lay evidence of the injury if it is consistent with the circumstances of that service, even with no official record.

The diagnosis comes from a TBI evaluation. VA's adjudication manual, M21-1, requires the initial TBI diagnosis to be made by one of four specialists: a physiatrist, psychiatrist, neurosurgeon, or neurologist. Once that diagnosis is of record, a generalist clinician who has completed VA's TBI training module may do later TBI exams. Levels 2 and above on the memory, attention, concentration, and executive functions facet require objective evidence on testing, so any cognitive testing your treating providers have already done belongs in the record.

The exam

The TBI DBQ is on VA's list of questionnaires not available for public use. M21-1 requires the examiner to address all the facets, and any facet left blank must be explained in the DBQ's remarks as related to a non-TBI condition. The examiner scores each one from the history, the record, and the exam. Three things that help:

1. Bring any test results you already have, such as a neuropsychological report. "Objective evidence on testing" is the phrase that separates level 1 from 2, 3, and total on the memory, attention, concentration, and executive functions facet.
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. Describe every residual: headaches, ringing in the ears, sleep, mood. A residual with its own diagnosis, such as migraine, is rated under its own code; symptoms without one are scored in the subjective symptoms facet.

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

The checklist

1. Documentation of the in-service injury: medical record, incident report, any concussion screening results, buddy statements, combat records.
2. A TBI diagnosis, with the severity grade if it was assessed.
3. Any neuropsychological or other cognitive testing already done.
4. The residuals you want decided, named on the 21-526EZ: for example "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.

Sources

• 38 CFR § 4.124a, Diagnostic Codes 8045 and 8100: the ten-facet TBI table, the highest-facet rule and 0/10/40/70/100 scale, the instruction to rate distinctly diagnosed residuals separately, Note (1) on symptoms that cannot be separated, Note (4) on severity labels, and the migraine criteria.
• 38 CFR § 3.310(d), Disabilities that are proximately due to, or aggravated by, service-connected disease or injury: the five conditions presumed secondary to service-connected TBI, their time windows, and the mild/moderate/severe grading table.
• 78 FR 76196 (Dec. 17, 2013): the final rule that added § 3.310(d), under which five conditions are held secondary to service-connected TBI, effective January 16, 2014.
• 38 CFR § 4.25, Combined ratings table: how the TBI rating and each separately rated residual combine, largest first, rounded to the nearest 10.
• 38 CFR § 4.85, Evaluation of hearing impairment and § 4.87, Schedule of ratings: ear: Tables VI, VIa, and VII in § 4.85, which turn audiometric results into a hearing loss rating, and Diagnostic Codes 6204, 6205, and 6260 in § 4.87, for vestibular disorders, Meniere's syndrome, and tinnitus.
• 38 U.S.C. § 1154(b), Consideration to be accorded time, place, and circumstances of service: the combat rule accepting satisfactory lay evidence of an injury consistent with the circumstances of combat service.
• M21-1, Part IV, Subpart i, Chapter 3, Section A and Section B: IV.i.3.A.1.j, requiring the initial TBI diagnosis to be made by a physiatrist, psychiatrist, neurosurgeon, or neurologist, and IV.i.3.B.1.n, requiring the TBI examiner to address all the facets and explain any left blank.
• VA, Public Disability Benefits Questionnaires: lists the initial and review TBI DBQs among those not available for public use.
• VA, VA claim exam (C&P exam): a claim exam gathers information for the decision, the provider does not treat you or prescribe medicine, and you may be asked to get other tests at no cost.