Traumatic Brain Injury (TBI): How VA Rates TBI and Its Residuals

If you took a blast wave in Iraq, got rattled in a Humvee rollover, or caught the wrong end of a training accident, you already know TBI isn't something that just "goes away." The headaches linger. Sleep gets weird. Your memory stops cooperating. Your spouse starts noticing you're not quite the same person who left for deployment.

Here's what makes TBI especially frustrating when it comes to VA ratings: the brain injury itself is only part of the picture. The residuals — the headaches, mood changes, cognitive issues, sleep problems, hormone disruption — often cause more day-to-day impairment than the original injury. And how VA rates all of it determines whether you walk away with 10%, 70%, or 100%.

This guide breaks down how VA actually evaluates TBI under 38 CFR § 4.124a, Diagnostic Code 8045 — what the facets are, how the ratings stack with other conditions, and what trips veterans up when they file.

The Basics: Diagnostic Code 8045

VA rates TBI under Diagnostic Code 8045, which lives in the neurological section of the rating schedule (38 CFR § 4.124a). Unlike most conditions where you look at one set of symptoms and pick a percentage, TBI uses a facets-based system.

There are ten areas (called "facets") of cognitive impairment and subjective symptoms that VA scores separately, from 0 to 3 plus "total." Not every facet has every level, though. Consciousness, for example, is only ever "total," and Subjective symptoms stops at 2. Your overall TBI rating is driven by whichever facet scores the HIGHEST — not an average, not a combination. The highest single facet score sets your rating:

Highest facet score of 0 → 0% rating
Highest facet score of 1 → 10% rating
Highest facet score of 2 → 40% rating
Highest facet score of 3 → 70% rating
Highest facet score of "total" → 100% rating

Notice the gaps. There is no 20%, 30%, 50%, 60%, 80%, or 90% rating under DC 8045. Just 0, 10, 40, 70, and 100. This surprises veterans who expect the usual 10% increments.

The Ten Facets

The ten areas VA evaluates are:

Memory, attention, concentration, executive functions
Judgment
Social interaction
Orientation
Motor activity (with intact motor and sensory system)
Visual spatial orientation
Subjective symptoms (headaches, dizziness, insomnia, hypersensitivity to sound/light)
Neurobehavioral effects
Communication
Consciousness

Each facet gets scored based on the degree of impairment. For example, under "memory, attention, concentration, executive functions," a score of 1 means mild memory loss noted by complaint but not objectively verified. A score of 2 requires objective testing showing mild impairment that causes mild functional impairment. A score of 3 requires objective testing showing moderate impairment that causes moderate functional impairment. A score of "total" means objective testing shows severe impairment that causes severe functional impairment. The regulation doesn't make "total" depend on whether you can work.

The scoring criteria for each facet are specific and written into DC 8045. The examiner on your Compensation and Pension (C&P) exam is supposed to walk through every facet and assign a number.

Why the Rating Alone Doesn't Tell the Whole Story

Here's where it gets interesting — and where a lot of veterans leave money on the table.

DC 8045 explicitly allows separate ratings for distinct conditions that happen to share symptoms with TBI, as long as they can be clearly separated from the TBI residuals themselves. This is where the real rating leverage lives.

If you have a diagnosed, service-connected migraine disorder on top of your TBI, that gets rated separately under DC 8100 — up to 50% on its own. If you have a mental health condition (PTSD, depression, anxiety) that's distinct from the "neurobehavioral effects" facet of TBI, that gets its own rating under 38 CFR § 4.130. If you have an endocrine disorder caused by pituitary damage from the TBI, that rates separately under the endocrine schedule.

The one thing VA WILL do is apply the pyramiding rule under § 4.14 — you can't be rated twice for the same impairment under two different codes. But distinct, separable manifestations are fair game under Esteban v. Brown. A separate migraine diagnosis is not the same thing as the "subjective symptoms" facet. And the rating schedule is blunt about mental health: when there's a diagnosed mental disorder, VA is supposed to rate the emotional and behavioral symptoms under § 4.130. The neurobehavioral effects facet is for when there's no mental health diagnosis.

This is exactly the kind of nuance that gets missed on initial rating decisions. If your TBI claim came back with everything bundled into a single DC 8045 rating and no separate codes for your migraines or mental health, that's often grounds for a Higher-Level Review or Supplemental Claim. At Augustus Miles, our VA-accredited attorneys see this issue often.

TBI Secondary Conditions: The § 3.310(d) Presumption

There's a specific presumption built into 38 CFR § 3.310(d) for TBI residuals that most veterans don't know about. If your TBI is already service-connected AND it meets a certain severity threshold, VA will PRESUME five specific conditions are secondary to the TBI, without a separate nexus opinion, unless there's clear evidence pointing to another cause:

Parkinsonism (following moderate or severe TBI)
Unprovoked seizures (following moderate or severe TBI)
Dementias (presenile dementia of the Alzheimer type, frontotemporal dementia, or dementia with Lewy bodies, if it shows up within 15 years of a moderate or severe TBI)
Depression (within 3 years of moderate or severe TBI, OR within 12 months of mild TBI)
Hormone deficiency diseases from hypothalamo-pituitary changes (within 12 months of moderate or severe TBI)

Two things to notice. First, depression is the only condition on this list with a pathway for MILD TBI — the other four require moderate or severe. Second, three of the five come with a time window counted from the injury: dementia within 15 years, depression within 3 years (12 months if the TBI was mild), and hormone deficiency within 12 months. Parkinsonism and unprovoked seizures have no time limit.

If your TBI occurred years ago and you've since developed Parkinsonism or unprovoked seizures after a moderate or severe TBI, or one of the covered dementias within 15 years of one, the presumption may apply even if you've never connected the dots before. Depression and hormone deficiency have much tighter windows. Missing a window doesn't end the claim, though: VA will still decide it under the usual secondary-service-connection rules if the medical evidence ties the condition to your TBI. The severity determination (mild vs. moderate vs. severe) comes from the medical evidence surrounding the original injury — Glasgow Coma Scale scores, duration of loss of consciousness, post-traumatic amnesia, structural imaging findings.

Severity Classification Matters More Than Veterans Realize

When VA documents a TBI, they classify it as mild, moderate, or severe based on the characteristics at the time of injury — NOT the current symptoms. A veteran can have mild TBI by classification but severe current residuals, or the reverse.

The mild, moderate, or severe label doesn't change your DC 8045 percentage — the rating schedule says so directly.

Where it matters is service connection: it gates access to the § 3.310(d) secondary presumption (mostly moderate/severe, with depression as the exception). It has nothing to do with SMC-T, which turns on how much care you need now because of your TBI residuals, not on how the original injury was labeled.

If VA's records have your TBI misclassified — say, listed as mild when the acute hospital records show moderate — that's worth challenging. The classification can be revisited based on the original injury records if those contradict a later VA finding.

SMC-T: The TBI-Specific Aid and Attendance Level

For the most severe TBI residuals, there's a specific Special Monthly Compensation level — SMC-T — codified at 38 CFR § 3.350(j). Congress created it in 2010 (effective October 1, 2011), and VA wrote it into its regulations in 2018. It applies to veterans whose service-connected TBI residuals require regular aid and attendance plus a higher level of care — personal health-care services every day at home, provided by a licensed professional or by someone working under a licensed professional's regular supervision — so that without that care they'd need hospitalization, nursing-home care, or other residential institutional care.

SMC-T pays at the SMC-R(2) rate — significantly above the base 100% compensation. It's intended to allow severely-impaired TBI veterans to receive in-home care rather than being institutionalized. If you or someone you're caring for falls into this category, it's worth confirming SMC-T is on the table rather than defaulting to a lower SMC level.

Common Problems on TBI Rating Decisions

A few patterns show up again and again on TBI rating decisions:

Inadequate C&P exams. VA's exam policy has a specialist rule, but it's narrower than it sounds. If there's no TBI diagnosis on record yet, a neurologist, neurosurgeon, physiatrist, or psychiatrist has to make it. If you were already diagnosed (in service, for example), a clinician who completed VA's TBI exam training can do the residuals exam. If your first TBI diagnosis came from anyone else, that's worth challenging, because an exam VA orders has to be adequate.

Everything lumped under DC 8045. The examiner scores the facets and VA assigns one TBI rating, with migraines, depression, and sleep issues all absorbed into the facet scores. Separate ratings can get overlooked. That's often worth raising on appeal.

Facet scores anchored to subjective reports. If the examiner wrote "veteran reports occasional memory problems" and scored memory at 1, but your spouse's lay statement and your work performance records show daily, significant trouble, the exam may have missed how bad it really is. On the memory facet, levels 2 and up require objective evidence on testing, so the fix is often formal neuropsychological testing. Your spouse's statement and work records then show what that impairment does to your day-to-day life.

The depression pathway under § 3.310(d) overlooked. This is the one secondary presumption that applies to MILD TBI. If you had a mild TBI and developed depression within 12 months, that's a presumptive secondary claim VA should have granted without a separate nexus battle.

Hormone testing never ordered. Pituitary damage from TBI can cause testosterone deficiency, growth hormone deficiency, thyroid issues. Veterans report fatigue, low libido, and mood problems — VA can chalk it up to depression without ever ordering endocrine labs. If you have TBI and persistent fatigue/mood symptoms, pushing for hormone testing can open a whole secondary claim pathway.

Augustus Miles handles this exact kind of post-decision review. Our VA-accredited attorneys dig into what the C&P examiner actually wrote, what facet scores were assigned, and what separable conditions got buried. The support team at Augustus Miles is made up of veterans — many of them former clients — and they know the VA claims process from the veteran's side.

What a Fully-Rated TBI Case Can Look Like

To show how the stacking works, here's a hypothetical veteran with service-connected TBI from a 2007 IED blast:

TBI residuals under DC 8045 — highest facet score of 2 (memory/concentration) → 40%
Migraine headaches with very frequent, completely prostrating and prolonged attacks that cause severe economic inadaptability, DC 8100 → 50%
Major depressive disorder secondary to TBI under § 3.310(d), rated under § 4.130 → 50%
Tinnitus, DC 6260 → 10%
Sleep apnea secondary to TBI, requiring a CPAP machine, DC 6847 → 50%

Under § 4.25 these ratings combine (they don't add) and round to the nearest 10%. The combined rating works out to around 90%, and depending on the specific facet documentation and whether TDIU applies, this veteran could reach the 100% rate. At the 2026 rates, a 40% rating pays about $800/month, a 90% rating about $2,360/month, and 100% over $3,900/month, all tax-free for a veteran alone. Rates shown are 2026 figures — check va.gov for current amounts.

That's the kind of gap that can open up between a first decision and a rating with the separable conditions properly broken out. Results depend on each veteran's medical evidence.

If Your TBI Decision Doesn't Feel Right

TBI claims are among the most complicated in the VA system. Facet scoring is subjective, separable conditions are easy to miss, and the C&P exam quality varies wildly depending on who conducted it.

If you've already gotten a rating decision on your TBI and the number feels low — or you suspect the examiner didn't fully understand your residuals — Augustus Miles can help. Our VA-accredited attorneys handle Higher-Level Reviews, Supplemental Claims, Board appeals, and rating-increase claims for TBI veterans. You pay nothing upfront; our fee is a percentage of any past-due benefits we recover. If we don't win, you don't pay.

Frequently Asked Questions

What percentages can VA assign for TBI under Diagnostic Code 8045?

Only 0%, 10%, 40%, 70%, or 100%. The DC 8045 rating is driven by the highest single facet score across the ten cognitive and behavioral facets — not an average. There is no 20%, 30%, 50%, 60%, 80%, or 90% rating under DC 8045 itself. Separate conditions (migraines, mental health, hormone issues) can be rated under their own diagnostic codes and combined with the TBI rating.

Can I get a separate rating for migraines on top of my TBI rating?

Yes, as long as the migraines are a distinct diagnosed condition that can be separated from the TBI residuals rated under DC 8045. Migraines are rated under DC 8100, up to 50% on their own. The pyramiding rule (§ 4.14) only bars rating the same impairment twice — distinct, separable manifestations are allowed under Esteban v. Brown.

What is the TBI secondary presumption under § 3.310(d)?

If your TBI is already service-connected, VA presumes five conditions are secondary without a separate nexus opinion (unless there's clear evidence pointing elsewhere): parkinsonism, unprovoked seizures, certain dementias, depression, and hormone deficiency diseases from pituitary damage. Four of the five require moderate or severe TBI. Depression is the only one with a pathway for mild TBI — within 12 months of the injury. Three of the five also have a time window: dementia (15 years), depression (3 years, or 12 months after a mild TBI), and hormone deficiency (12 months). Parkinsonism and unprovoked seizures have none.

What is SMC-T and how does it apply to TBI veterans?

SMC-T is a Special Monthly Compensation level under 38 CFR § 3.350(j), created by Congress in 2010 (effective October 1, 2011) and written into VA's regulations in 2018, specifically for veterans whose service-connected TBI residuals require regular aid and attendance plus a higher level of care at home. Without that care they'd need hospitalization, nursing-home care, or other residential institutional care. It pays at the SMC-R(2) rate — well above base 100% compensation — and is designed to allow severely-impaired veterans to receive in-home care.

Can Augustus Miles help if I already got a TBI rating I think is too low?

Yes. Augustus Miles handles post-decision work — Higher-Level Reviews, Supplemental Claims, Board appeals, and rating-increase claims. Our VA-accredited attorneys review what the C&P examiner wrote, what facet scores were assigned, and what separable conditions (migraines, depression, hormone issues) may have been missed. You pay nothing upfront; the fee is a percentage of past-due benefits if we win.