How VA rates TBI
DC 8045 covers cognitive, emotional/behavioral, and physical residuals. For the cognitive and other residuals table, the highest assessed facet controls: 0, 1, 2, and 3 correspond to 0%, 10%, 40%, and 70%; a facet assessed as total corresponds to 100%. An injury described as mild, moderate, or severe is not the current facet level.
Rating criteria from the tool data
| Rating | What VA looks for |
|---|---|
| 0% | Highest clinically assessed facet is level 0. |
| 10% | Highest clinically assessed facet is level 1. |
| 40% | Highest clinically assessed facet is level 2. |
| 70% | Highest clinically assessed facet is level 3. |
| 100% | At least one clinically assessed facet is total. |
Clinical findings needed
Not estimated: a TBI percentage requires clinical assessment of the DC 8045 facets and separation of overlapping residuals. Memory complaints, headaches, or the original injury-severity label cannot establish a facet level here.
What may happen in the exam room
- Clinical evaluation of cognitive and other residuals and review of the injury history.
- Assessment of distinct physical or mental-health diagnoses and overlapping manifestations.
Measurements and findings to understand
- Memory, attention, concentration, and executive functions.
- Judgment, social interaction, orientation, motor activity, and visual-spatial orientation.
- Subjective symptoms, neurobehavioral effects, communication, and consciousness.
Questions the examiner may cover
- What injury and treatment are documented?
- What changes in functioning have persisted?
- Which symptoms have distinct diagnoses, and which overlap with other conditions?
Functional-impact language to think through
Use plain, truthful wording that matches your records and daily limitations. These examples are prompts for accuracy, not scripts.
- Describe concrete memory, planning, communication, or safety difficulties and their frequency.
- Distinguish your observations from conclusions in clinical testing.
Common mistakes to avoid
- Assigning a facet level from a symptom checklist.
- Treating a moderate original injury as a moderate current impairment.
- Counting the same manifestation under TBI and another diagnostic code.
Evidence to organize before the exam
- Injury and treatment records.
- Neuropsychological or other relevant clinical assessments.
- Statements describing observed changes and assistance needed.
Preparation notes
- A distinct diagnosis such as migraine may be evaluated separately when appropriate, but the same manifestation cannot be counted twice.
- A diagnosed mental disorder is evaluated under section 4.130; overlapping manifestations require review.
Official rating source
38 CFR 4.124a, DC 8045. Checked 2026-09-04. Educational preparation only; not a personal rating.
How secondary service connection works
A secondary condition is not automatic. The evidence must connect a current diagnosed disability to an already service-connected condition or its medically indicated treatment.
- Basic evidence: a current diagnosis, an already service-connected primary condition, and competent evidence linking the two.
- Two theories: the primary condition or its treatment caused the new disability under 38 CFR § 3.310(a), or aggravated a pre-existing non-service-connected disability under § 3.310(b). An opinion should address both when the record raises both; causation alone may be inadequate (El-Amin).
- Treatment pathway: service-connected condition → medically indicated medication or surgery → documented adverse effect → current diagnosis. Pharmacy records, start and stop dates, and a treating clinician’s reasoning matter; medication use alone does not establish the connection.
- Weight as an intermediate step: obesity or weight gain can be part of the causal chain under VAOPGCPREC 1-2017, but obesity itself is not a disability for a VA rating.
- Standard of proof: VA applies the “at least as likely as not” standard and reasonable-doubt rule under 38 CFR § 3.102. This guide identifies evidence questions; it does not tell you what to file.
- Avoid pyramiding: 38 CFR § 4.14 prohibits rating the same manifestation twice. Mental-health diagnoses generally use one § 4.130 evaluation for the same occupational and social impairment, and insomnia may be a symptom rather than a separate disability.
- Presumptives are different: qualifying service may make chronic rhinitis, chronic sinusitis, hypertension associated with herbicide exposure, or type 2 diabetes presumptive. OSA is not a PACT Act presumptive. Check current eligibility before seeking nexus evidence for a condition the law may already presume.
- DBQ is not a nexus: a DBQ documents diagnosis and severity; it does not necessarily establish service connection. A VA-accredited VSO can help with filing strategy at no charge.
Other medically indicated treatments for a service-connected condition may support a secondary theory when a clinician documents the adverse effect in this veteran.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Possible secondary conditions to discuss with a qualified reviewer
These are educational issue-spotting notes, not medical nexus opinions. VA decides service connection.
38 CFR § 3.310(d) covers unprovoked seizures following moderate or severe service-connected TBI, absent clear evidence to the contrary. Other scenarios use ordinary evidence rules.
Under 38 CFR § 3.310(d), depression is covered if manifest within 3 years of moderate or severe TBI, or within 12 months of mild TBI, absent clear evidence to the contrary.
A diagnosed headache disorder may be evaluated separately under DC 8100 when manifestations are distinct. Migraines are not on the § 3.310(d) presumed list.
TBI and PTSD may arise from the same event, but one does not automatically cause the other. Review direct service connection and overlapping symptoms.
Review only if diagnosed and medically supported.
Blast exposure may support direct service connection for both conditions; do not assume a secondary relationship.