TBI Rating %

Rodney Harp

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Can anyone tell me if there is a standard rating for TBI?
 
Can anyone tell me if there is a standard rating for TBI?
This is going to be long and doesn't really answer your question, I myself got 40%:
8045 Residuals of traumatic brain injury (TBI): There are three main areas of dysfunction that may result from TBI and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation. Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Evaluate cognitive impairment under the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Evaluate subjective symptoms that are residuals of TBI, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” However, separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere's disease, even if that diagnosis is based on subjective symptoms, rather than under the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table Evaluate emotional/behavioral dysfunction under § 4.130 (Schedule of ratings—mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” Evaluate physical (including neurological) dysfunction based on the following list, under an appropriate diagnostic code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions. The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, evaluate under the most appropriate diagnostic code. Evaluate each condition separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine under § 4.25 the evaluations for each separately rated condition. The evaluation assigned based on the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations Consider the need for special monthly compensation for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc Evaluation of Cognitive Impairment and Subjective Symptoms The table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than “total,” since any level of impaired consciousness would be totally disabling. Assign a 100-percent evaluation if “total” is the level of evaluation for one or more facets. 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; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet. Note (1):There may be an overlap of manifestations of conditions evaluated under the table titled “Evaluation Of Cognitive Impairment And Other Residuals Of TBI Not Otherwise Classified” with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition. Note (2):Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation. Note (3):“Instrumental activities of daily living” refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one's own medications, and using a telephone. These activities are distinguished from “Activities of daily living,” which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet. Note (4):The terms “mild,” “moderate,” and “severe” TBI, which may appear in medical records, refer to a classification of TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under diagnostic code 8045. Note (5):A veteran whose residuals of TBI are rated under a version of § 4.124a, diagnostic code 8045, in effect before October 23, 2008 may request review under diagnostic code 8045, irrespective of whether his or her disability has worsened since the last review. VA will review that veteran's disability rating to determine whether the veteran may be entitled to a higher disability rating under diagnostic code 8045. A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating awarded as a result of such review, VA will apply 38 CFR 3.114, if applicable. 8046 Cerebral arteriosclerosis: Purely neurological disabilities, such as hemiplegia, cranial nerve paralysis, etc., due to cerebral arteriosclerosis will be rated under the diagnostic codes dealing with such specific disabilities, with citation of a hyphenated diagnostic code (e.g., 8046-8207). Purely subjective complaints such as headache, dizziness, tinnitus, insomnia and irritability, recognized as symptomatic of a properly diagnosed cerebral arteriosclerosis, will be rated 10 percent and no more under diagnostic code 9305. This 10 percent rating will not be combined with any other rating for a disability due to cerebral or generalized arteriosclerosis. Ratings in excess of 10 percent for cerebral arteriosclerosis under diagnostic code 9305 are not assignable in the absence of a diagnosis of multi-infarct dementia with cerebral arteriosclerosis. Note: The ratings under code 8046 apply only when the diagnosis of cerebral arteriosclerosis is substantiated by the entire clinical picture and not solely on findings of retinal arteriosclerosis.
Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified
Facets of cognitive
impairment and other
residuals of TBI not
otherwise classifiedLevel of
impairmentCriteria
Memory, attention, concentration, executive functions 0 No complaints of impairment of memory, attention, concentration, or executive functions.
1 A complaint of mild loss of memory (such as having difficulty following a conversation, recalling recent conversations, remembering names of new acquaintances, or finding words, or often misplacing items), attention, concentration, or executive functions, but without objective evidence on testing.
2 Objective evidence on testing of mild impairment of memory, attention, concentration, or executive functions resulting in mild functional impairment.
3 Objective evidence on testing of moderate impairment of memory, attention, concentration, or executive functions resulting in moderate functional impairment.
Total Objective evidence on testing of severe impairment of memory, attention, concentration, or executive functions resulting in severe functional impairment.
Judgment 0 Normal.
1 Mildly impaired judgment. For complex or unfamiliar decisions, occasionally unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision.
2 Moderately impaired judgment. For complex or unfamiliar decisions, usually unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision, although has little difficulty with simple decisions.
3 Moderately severely impaired judgment. For even routine and familiar decisions, occasionally unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision.
Total Severely impaired judgment. For even routine and familiar decisions, usually unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision. For example, unable to determine appropriate clothing for current weather conditions or judge when to avoid dangerous situations or activities.
Social interaction 0 Social interaction is routinely appropriate.
1 Social interaction is occasionally inappropriate.
2 Social interaction is frequently inappropriate.
3 Social interaction is inappropriate most or all of the time.
Orientation 0 Always oriented to person, time, place, and situation.
1 Occasionally disoriented to one of the four aspects (person, time, place, situation) of orientation.
2 Occasionally disoriented to two of the four aspects (person, time, place, situation) of orientation or often disoriented to one aspect of orientation.
3 Often disoriented to two or more of the four aspects (person, time, place, situation) of orientation.
Total Consistently disoriented to two or more of the four aspects (person, time, place, situation) of orientation.
Motor activity (with intact motor and sensory system) 0 Motor activity normal.
1 Motor activity normal most of the time, but mildly slowed at times due to apraxia (inability to perform previously learned motor activities, despite normal motor function).
2 Motor activity mildly decreased or with moderate slowing due to apraxia.
3 Motor activity moderately decreased due to apraxia.
Total Motor activity severely decreased due to apraxia.
Visual spatial orientation 0 Normal.
1 Mildly impaired. Occasionally gets lost in unfamiliar surroundings, has difficulty reading maps or following directions. Is able to use assistive devices such as GPS (global positioning system).
2 Moderately impaired. Usually gets lost in unfamiliar surroundings, has difficulty reading maps, following directions, and judging distance. Has difficulty using assistive devices such as GPS (global positioning system).
3 Moderately severely impaired. Gets lost even in familiar surroundings, unable to use assistive devices such as GPS (global positioning system).
Total Severely impaired. May be unable to touch or name own body parts when asked by the examiner, identify the relative position in space of two different objects, or find the way from one room to another in a familiar environment.
Subjective symptoms 0 Subjective symptoms that do not interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples are: mild or occasional headaches, mild anxiety.
1 Three or more subjective symptoms that mildly interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment are: intermittent dizziness, daily mild to moderate headaches, tinnitus, frequent insomnia, hypersensitivity to sound, hypersensitivity to light.
2 Three or more subjective symptoms that moderately interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment are: marked fatigability, blurred or double vision, headaches requiring rest periods during most days.
Neurobehavioral effects 0 One or more neurobehavioral effects that do not interfere with workplace interaction or social interaction. Examples of neurobehavioral effects are: Irritability, impulsivity, unpredictability, lack of motivation, verbal aggression, physical aggression, belligerence, apathy, lack of empathy, moodiness, lack of cooperation, inflexibility, and impaired awareness of disability. Any of these effects may range from slight to severe, although verbal and physical aggression are likely to have a more serious impact on workplace interaction and social interaction than some of the other effects.
1 One or more neurobehavioral effects that occasionally interfere with workplace interaction, social interaction, or both but do not preclude them.
2 One or more neurobehavioral effects that frequently interfere with workplace interaction, social interaction, or both but do not preclude them.
3 One or more neurobehavioral effects that interfere with or preclude workplace interaction, social interaction, or both on most days or that occasionally require supervision for safety of self or others.
Communication 0 Able to communicate by spoken and written language (expressive communication), and to comprehend spoken and written language.
1 Comprehension or expression, or both, of either spoken language or written language is only occasionally impaired. Can communicate complex ideas.
2 Inability to communicate either by spoken language, written language, or both, more than occasionally but less than half of the time, or to comprehend spoken language, written language, or both, more than occasionally but less than half of the time. Can generally communicate complex ideas.
3 Inability to communicate either by spoken language, written language, or both, at least half of the time but not all of the time, or to comprehend spoken language, written language, or both, at least half of the time but not all of the time. May rely on gestures or other alternative modes of communication. Able to communicate basic needs.
Total Complete inability to communicate either by spoken language, written language, or both, or to comprehend spoken language, written language, or both. Unable to communicate basic needs.
Consciousness Total Persistently altered state of consciousness, such as vegetative state, minimally responsive state, coma.
 
Grizz13
Thank and you are right and I guess it did answer my question. They will give me whatever they want. It was good to se the guide. I have 30% For vertigo and 10% for tinnitus from MTBI. That was from pre-MEB VA ratings. Currently awaiting VA Decision approval on MEB C&Ps for TBI and host of other stuff.
 
What was the score they put down in your NARSUM? I would/should be in there in the part that covers your TBI. This should help you find your answer.;)
 
I had 3 mTBIs on my last tour to AFG in 2011 with 2 Purple Hearts and took and Neuro Psyc test that was found inconclusive possibly due to all the 13 meds I was on. So even though I suffer almost all the after effects of TBI they found me fit for duty in my NARSUM b/c the Neuro Psyc test was inconclusive. Did anyone of you have to take a Neuro Psyc test? My OTs clearly write up all the time my cognitive and memory and pain issues with my TBI... what do you think?
 
PSYOP Warrior,
Here is what they wrote in my NARSUM:
b. Traumatic brain injury (mild) with residual migraine without aura and light sensitivity, 346.11. Fails to meet retention standards IAW AR 40-501, Chapter 3-30g,j, 41e

If you are still having headaches and other symptoms associated with mTBI, then you should fight it. Also, you should have your loved ones write sworn statements on your conditions. They should specify on the letters how you were before deployment and how you are now. Also, should be listed how it affects your daily living activities.

Hope this helps!
 
On my 3947 (NARSUM) It lists all ehight of the different claims. The only one with a write up is the one that I was found unfit for. Diequilibrium due to blast exposure. The rest just have "meets retention standard behind them".
 
did anyone have to take a neuro psyc test though. they are basing my rating at 0% b/c the test was found inconclusive and they didnt consider the OT notes and my cognitive/memory disorders a year afterwards
 
The testing I had was with a QTC doc (Face to Face) and then a over the phone interview.
 
Psy,

I had to take the VA neuropsych exam.....and I am still pissed. They also did not take ANY of my OT nor doctors exams diagnosing me with mTBI with memory and concentration residuals. The VA exam said I was performing sub-standardly to get a higher rating, my test was inconclusive, and they wrote that I was malingering. I am raising it to highers and may do a Congressional. I spent eight months in TBI rehab and physical therapy. I added my doctors notes as evidence in my rebuttal and addendum and they STILL only took the VA's neuropsych writeup. As a result, my 3947 states 'mTBI with no cognitive residual effects.'

When I called legal, they said they are seeing a lot more of the word 'malingering' put into VA exam results. I have requested a MILITARY retest, so we'll see what happens. I am also going to see if I can get it changed somehow in the DoD/VA results.

Draco
 
Psy,

I had to take the VA neuropsych exam.....and I am still pissed. They also did not take ANY of my OT nor doctors exams diagnosing me with mTBI with memory and concentration residuals. The VA exam said I was performing sub-standardly to get a higher rating, my test was inconclusive, and they wrote that I was malingering. I am raising it to highers and may do a Congressional. I spent eight months in TBI rehab and physical therapy. I added my doctors notes as evidence in my rebuttal and addendum and they STILL only took the VA's neuropsych writeup. As a result, my 3947 states 'mTBI with no cognitive residual effects.'

When I called legal, they said they are seeing a lot more of the word 'malingering' put into VA exam results. I have requested a MILITARY retest, so we'll see what happens. I am also going to see if I can get it changed somehow in the DoD/VA results.

Draco

I had the malingering/ or "diagnosis of PTSD for secondary gain" originally in my NARSUM. I told my PEBLO that it shouldn't be in there, medical facts were all that mattered, not the opinion of a doctor whom has never treated me. They took it out and my NARSUM went from 8 pages to 22 pages (all medical information). I TOO got the "mTBI with no cognitive residual effects" yet my tests show otherwise... so I just left it. The test prove there is cognitive effects.
 
Does anyone besides me think that all of this might have something to do with contracting doctors to do these exams. Think about it. The last time you tried to get into see a civilian doctor that was ANY GOOD and did not have to wait to get in because they are so busy. So what quality of care are we getting for the tax payers $??? On my one hour phone interview with the doctor. I spent pretty much the whole conversation explaining what the military does. He did not know what body armor or kevlar was, what a mortar round is or can do. I said MRAP and he said M What? How can you diagnose anything if you do not even understand what soldiers do? My hearing test was another example that they are told to play it down. The Doctor said to me yes you have some substatial hearing loss but it may get better and its not that bad for a guy your age.. Any 5th grade health student knows that once you damage the hearing, it is a done deal. The point was that it was fine and documented fine prior to deployment and getting my bell rung by 4 blasts.
I really don't care anymore if the VA gives me anything for hearing or TBI or anything other than what I have already. I already have the Unfit for duty for 30% VA. I just need the 199 to get done and to me so I can be on my way.
 
i havent got my ratings back but my 199 has PTSD as unfit for duty (50% I guess) and spinal injury as unfit for duty (20% i guess) and TBI, reocurring, as fit for duy - I had my bell rung 4 times - 2 LOC and the neuro psyc test fucked me. been in TBI clinic for over a year and still have trouble doing daily things....
 
Does anyone besides me think that all of this might have something to do with contracting doctors to do these exams. Think about it. The last time you tried to get into see a civilian doctor that was ANY GOOD and did not have to wait to get in because they are so busy. So what quality of care are we getting for the tax payers $??? On my one hour phone interview with the doctor. I spent pretty much the whole conversation explaining what the military does. He did not know what body armor or kevlar was, what a mortar round is or can do. I said MRAP and he said M What? How can you diagnose anything if you do not even understand what soldiers do? My hearing test was another example that they are told to play it down. The Doctor said to me yes you have some substatial hearing loss but it may get better and its not that bad for a guy your age.. Any 5th grade health student knows that once you damage the hearing, it is a done deal. The point was that it was fine and documented fine prior to deployment and getting my bell rung by 4 blasts.
I really don't care anymore if the VA gives me anything for hearing or TBI or anything other than what I have already. I already have the Unfit for duty for 30% VA. I just need the 199 to get done and to me so I can be on my way.

The contracted doctors do everything they can to try to lowball the SM's. I was very lucky as I am Army and went to the closest base (Nellis AFB). My contractor doctor there was an old lady, really great, and wanted to make sure I was treated right, so she referred me to a good civilian doctor as well. So, going into my MEB exams at Fort Irwin, I already had 2 doctors recommendations, and both said the same thing. The contracted doctors at Irwin, still tried to screw me over, but I had so much evidence backing my side, they had to change their tune. Everything was good except the Irwin Psych. said something along the lines of "mTBI has no lasting or significant deficits" EVEN THOUGH my 2 doctors (nellis and civilian) show bonafied cognitive deficits due to TBI. It is what it is I guess. I am pretty sure the VA will look more at the two doctors who spent months with me instead of a doctor what spent 30 minutes with me.
 
did anyone have to take a neuro psyc test though. they are basing my rating at 0% b/c the test was found inconclusive and they didnt consider the OT notes and my cognitive/memory disorders a year afterwards
I took multiple tests, the first few were inconclusive like yours, but they finally said I did have TBI... They were having a hard time because of my MH diagnosis issues since I was borderline PTSD... I was years for them to figure the whole thing out...
 
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