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Brain injury (TBI)

Traumatic brain injury (TBI) - leftover effects

What it is

A TBI is a brain injury from a blow, blast, or jolt to the head; 'residuals' are the problems that stay afterward.

VA's code numbers for this: 8045

What the examiner will do

Who does it: A VA doctor or a VA contract examiner. VA's exam page (updated Aug 15, 2025) names four contract companies: Loyal Source Government Services, OptumServe Health Services, Leidos QTC Health Services, and Veterans Evaluation Services (VES). (LHI is an older name; it is now part of OptumServe.) You can't pick which one. Answer every call or letter about scheduling.

  • The FIRST TBI exam must be done by one of four specialists: a psychiatrist, physiatrist (rehab doctor), neurosurgeon, or neurologist (VA policy; verify current M21-1 wording).
  • They ask about the injury, then go through each of the 10 areas. They may do memory tests (like recalling words), balance, eye, and nerve checks. They may order neuropsychological testing.
  • Often 45-90 minutes, plus any testing on another day.

Tests, in plain words

The 10 areas (facets)
1) Memory, attention, focus, and planning. 2) Judgment. 3) Social behavior. 4) Knowing time, place, and people (orientation). 5) Movement planning. 6) Finding your way / seeing where things are (visual-spatial). 7) Symptoms you feel (headache, dizziness, fatigue, ringing, sleep, light/noise sensitivity). 8) Behavior changes (irritability, impulsiveness, aggression). 9) Talking and understanding (communication). 10) Consciousness. Only the single worst area sets the percent - they are NOT added up.
Neuropsychological testing
Paper, puzzle, and computer tests of memory and thinking. Levels 2 and up for memory need 'objective evidence on testing.' Ask whether you'll get this testing.
Other problems rated separately
Headaches, hearing loss, tinnitus, vision, seizures, balance, and a mental health diagnosis are rated under their own codes. But the same symptom can't be counted twice.
Mild/moderate/severe label
The 'mild TBI' label from the time of injury does NOT decide your rating. Your current problems do.

The examiner fills out a form called a DBQ. You can read it ahead of time: Initial Evaluation of Residuals of TBI DBQ and Review Evaluation of Residuals of TBI DBQ (both not public) (opens VA's site).

The rating levels, in plain words

VA picks the level that best matches how often and how badly the condition affects you.

  • 0%

    VA checks 10 areas ('facets'). If your worst area is level 0 (no real problem), the rating is 0%.

    VA's exact words

    If no facet is evaluated as 'total,' assign the overall percentage evaluation based on the level of the highest facet as follows: 0 = 0 percent

    Rule: 38 CFR 4.124a, DC 8045 and table 'Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified'

  • 10%

    Your worst area is level 1. For example only: memory or focus feels a bit worse, but tests don't show it; or 3+ symptoms like headaches, dizziness, ringing ears, poor sleep, or light sensitivity mildly affect work, chores, or family.

    VA's exact words

    1 = 10 percent

    Rule: 38 CFR 4.124a, DC 8045 and table 'Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified'

  • 40%

    Your worst area is level 2. For example only: testing shows mild memory or focus problems that mildly affect daily life; or 3+ symptoms moderately affect work or family, like headaches that make you rest most days.

    VA's exact words

    2 = 40 percent

    Rule: 38 CFR 4.124a, DC 8045 and table 'Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified'

  • 70%

    Your worst area is level 3. For example only: testing shows moderate memory or focus problems; or even routine decisions are sometimes hard; or social behavior is wrong most of the time.

    VA's exact words

    3 = 70 percent. For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet.

    Rule: 38 CFR 4.124a, DC 8045 and table 'Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified'

  • 100%

    Any one area is at 'total.' For example only: severe memory problems on testing, can't make even routine safe choices, or loss of consciousness (coma or similar).

    VA's exact words

    Assign a 100-percent evaluation if 'total' is the level of evaluation for one or more facets.

    Rule: 38 CFR 4.124a, DC 8045 and table 'Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified'

What to track before your exam

What to write down: Memory slips, getting lost, headaches, dizziness, light or noise sensitivity, sleep, anger or mood changes, and things a family member notices.

How: For 30 days, keep a short daily note. A spouse or child should keep their own notes too - people with TBI often don't notice their own changes. Write down the injury story once: date, what happened (blast, crash, fall), and who was there.

Your log: what to write each time

  1. Date
  2. Forgot something important? what
  3. Lost track of a conversation or task?
  4. Got lost or confused about time/place?
  5. Headache (0-10) and had to rest?
  6. Dizzy or off-balance?
  7. Light or noise bothered me?
  8. Irritable or blew up?
  9. What family noticed

Tap Print this page to get a blank log sheet and your exam-day checklist on paper.

Exam-day checklist

Tick each one off. Nothing you tick is saved or sent anywhere.

What to bring: Bring a photo ID, your list of medicines and doses, your home log, and any new private records you have not sent to VA yet. VA says you don't have to bring anything, but your notes help you remember. A spouse or caregiver may come along. VA says you can ask the examiner if they can stay in the room. The examiner may ask them to wait outside.

Tell the examiner

Honest exam rules

  • Tell the whole truth. Don't add to it. Don't shrink it.
  • Describe a normal day AND your worst days. Say how often the worst days happen.
  • Answer the question you were asked. Skip the habit of saying 'I'm fine' or 'it's not that bad' when it is.
  • It's OK to read from your log or notes. Hand the examiner a copy if they will take it.
  • Don't act out symptoms or guess at numbers. If you don't know or can't remember, say so.
  • If something hurts or makes you worse during the exam, say so right then.
  • Fraud warning: knowingly giving VA false information is a federal crime (18 U.S.C. 1001) and can cost you all your benefits (38 U.S.C. 6103). Honest, complete answers protect you.
  • Memory tests measure your real ability. Just try your best - effort checks are built into many of them.

Common mistakes

  • Thinking the facets are added together. Only the highest one counts.

    Where this comes from: 38 CFR 4.124a, DC 8045 and table 'Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified'

  • Rating headaches or a mental health condition twice. If symptoms overlap, VA gives one rating under whichever code fits best.

    Where this comes from: 38 CFR 4.124a, DC 8045 Note (1); 38 CFR 4.14

  • Not getting memory testing. Levels 2+ for memory need objective test results.

    Where this comes from: 38 CFR 4.124a, DC 8045 and table 'Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified'

  • Older TBI ratings (before Oct 23, 2008) can ask for review under the current rules.

    Where this comes from: 38 CFR 4.124a, DC 8045 Note (5)

  • Not asking about special monthly compensation (SMC) for serious TBI effects, like needing help at home.

    Where this comes from: 38 CFR 4.124a, DC 8045 text on SMC

Questions to ask together

A spouse, grown child or friend can read these out loud. Talk about each one before the exam, so nothing gets left out.

  1. Since the injury, what have you noticed about memory - forgetting appointments, repeating questions?
  2. Do you get lost or confused in places you know?
  3. How often do you get headaches that make you stop and rest?
  4. Have your temper, patience, or mood changed?
  5. Do lights or noise bother you more than before?

Rule changes you may hear about

Today's rules (above) are what VA uses unless a change is final.

  • Proposed, not law yet

    VA's proposed neurological rule would mostly move the TBI table to sit right under DC 8045 (no big change to levels). It also discusses blast exposure research.

    Where it stands: Proposed Nov 12, 2024. Not final as of Oct 30, 2026.

    89 FR 88917, RIN 2900-AQ73

Sources

Checked against VA's rules on October 30, 2026.

Helping The Brave doesn't file or prepare claims. This guide is free education, not medical or legal advice. The VA examiner measures and VA decides your rating.