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Traumatic Brain Injury (TBI) Claims
Roger Hale, Veterans Law Attorney
As most veterans that have suffered from a TBI know, the rating system used by the VA is anything
but easy. Most of these same veterans and their families also know that the VA finally admitted to
performing “improper” screenings on at least 25,000 veterans. This admission did result in
major changes to the TBI screening and rating process, but it is still far from perfect.
What a lot of TBI victims or their families do not realize is that there are multiple other “disabilities/impairments” that come into play when dealing with a TBI and the VA rating system. The
VA often just messes up when evaluating these medical problems due to the underlying TBI.
These problems might be mental, physical or neurological.
The VA uses a Manual called the M21-1 Compensation and Pension Manual. This “manual” is basically the “Bible” for the VA in working claims. It has 11 “Parts” but we are really only concerned
about “Part III” which is further broken down into numerous Sub-parts, Chapters, Sections and
Sub-Sections. I bet a lot of heads are spinning already and we have only just started! Anyway, we
are going to look at “M21-1, Part III, Subpart iv, Chapter 4, Section G- Neurological Conditions and
Convulsive Disorders”. This “part” of the M21-1 discusses TBI’s.
What happens in a lot of TBI claims before the VA, the veteran (or his family member) has filed
a claim for a “TBI” or maybe even just said “head injury” or “brain injury”. However, there are other
problems that often go along with a TBI that MIGHT be entitled to a disability rating which is IN
ADDITION to the rating for the TBI itself. Things such as migraines, generalized anxiety disorders,
memory problems, self-care, pain, vision or hearing problems and many, many others are
associated with a TBI, and could result in additional compensation for the veteran.
The VA, in making their evaluations of the other diagnosis associated with a TBI will always
rely upon the “C&P” medical exam/opinion that they have requested. The Doctors writing the
opinions will sometimes take the easy way out when preparing their report and ends up
causes problems for the veteran.
For example: The C&P exam finds that the veteran has a TBI and adjustment disorder with
anxiety & depression. However, the Doctor finds that he/she is not able to tell the difference
(differentiate) in what portion of each symptom was due to each diagnosis. So, seeing this finding,
the VA Rater might issue out a Rating Decision that says the TBI is entitled to 10% and the
Adjustment Disorder with anxiety & depression is 50%, BUT since the Doctor can’t tell which
symptoms are related to which diagnosis, the veteran is only entitled to the higher rating of 50%,
NOT to 10% AND 50%. This would short change the veteran 10% in benefits.
The veteran will be confused for sure with this type of finding. Especially since IF the “Rating
Decision” sheet is included with the “Notification of Award” sheet that is sent to the veteran, and the
Notification of Award letter says the veteran is entitled to 30% for “TBI and adjustment disorder with
anxiety & depression”, yet the Rating Decision findings say he is entitle to 10% for the TBI and
makes a separate finding of 30% for the Adjustment Disorder with anxiety & depression.
So, again, in the above example, the veteran is awarded 50% total instead of 60%.
TBI claims are very complex and the VA follows very complex regulations and policies when
evaluating these injuries. I would always strongly recommending that the veteran or family member
assisting the veteran contact an experienced and accredited representative after receiving an award
for a TBI. In fact, contacting someone before filing your claims COULD make a huge difference
in the outcome. While it is possible to “win” a TBI claim on your own, it is one of the very few
claims that I believe require at least the input of an experienced and accredited representative.
It normally should cost the veteran nothing to at least get some pointers before filing the claim.
Have you had problems filing your TBI claim? Speak with veterans law attorney Roger Hale today!
Your VA refers to any illness or injury as a condition.
You must have a specific medical diagnosis to claim a condition. For example,
you can't generalize by saying "My bones hurt." You'll need a
medical diagnosis such as "osteoarthritis, left knee" or similar.
The very best listings of all VA rateable conditions will be found in
Below you'll find a listing of DBQ's of rated conditions.
As you research and develop your claim, you should find your condition in
The Schedule For Rating Disabilities as well as its specific DBQ.
Once you've done that you'll know exactly what VA is looking for so that they
can service connect and rate your disabling condition.
Things You'll Need
Research Your Claim
Need Help With Your OSA Diagnosis
and Service Connection?
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