Inside the exam room
1. A qualified examiner will review the injury, treatment, and lasting changes. Identify injury records and say when dates or details are uncertain.
2. The examiner asks how symptoms affect daily life and may test memory, attention, judgment, communication, or movement. Be ready to describe a recent problem, how often it happens, and its effect. Examples: forgetting an appointment despite a reminder, or losing track of steps while cooking. Use your own experience.
3. Describe reminders, supervision, or help with daily tasks, and what you still do independently. For example, explain whether someone checks your medicines or helps you follow a familiar route. Say how often help is needed. The examiner also checks whether another condition explains the same symptoms.
How VA rates TBI
Describe changes in memory, attention, decisions, behavior, and movement. The examiner checks each area; VA calls each one a facet. Under DC 8045, the highest level in the thinking and other-effects table controls: levels 0, 1, 2, and 3 correspond to 0%, 10%, 40%, and 70%; a level of total corresponds to 100%. How the original injury was described—mild, moderate, or severe—does not decide the level now. Physical and emotional problems also need review.
What each rating percentage means
Match the whole description with your exam and records. A single symptom or illustration does not decide your rating.
| Rating | What the rule requires |
|---|---|
| 0% | The highest level the examiner records for an area such as memory or judgment (a facet) is level 0. |
| 10% | The highest level the examiner records for an area such as memory or judgment (a facet) is level 1. |
| 40% | The highest level the examiner records for an area such as memory or judgment (a facet) is level 2. |
| 70% | The highest level the examiner records for an area such as memory or judgment (a facet) is level 3. |
| 100% | The examiner records total impairment in at least one area (a facet is total). |
Which exam or test results are needed?
This tool cannot estimate a brain-injury rating. A qualified health care professional must check memory, judgment, communication, and other areas, and separate symptoms already counted for another condition. A memory complaint, headache, or the original injury label cannot set the percentage. VA uses DC 8045 for this review.
What may happen in the exam room
- A qualified health care professional checks thinking, behavior, and physical problems that remain after the injury.
- They check which problems have separate diagnoses and which share the same symptoms.
What the measurements tell you
- Memory, attention, concentration, and planning or organizing tasks.
- Making decisions, dealing with people, knowing where you are, moving, and finding your way around.
- Symptoms you notice, changes in behavior, communicating, and staying aware and awake.
Questions the examiner may cover
- What injury and treatment are recorded?
- What changes in functioning have persisted?
- Which symptoms have distinct diagnoses, and which overlap with other conditions?
Questions to expect
What lasting changes affect thinking, behavior or communication?
Explain: Give recent examples involving memory, attention, planning, judgment or communication and the reminders or supervision needed.
Rating connection: DC 8045 assesses separate facets. The highest assessed facet controls the cognitive evaluation; the injury being called mild or severe does not determine the current rating.
Which physical symptoms and overlapping diagnoses are documented?
Explain: Identify tests, diagnoses, daily help and uncertain causes rather than assigning every symptom to TBI yourself.
Rating connection: Distinct residuals may use other codes. The same manifestation cannot be counted twice under TBI and another diagnosis.
Your answer outline
Since [approximate period], I have noticed [change]. For example, [actual event]. It happens about [frequency], and I now use [support or adjustment]. My records describe [injury or exam results in your records, if known]. [What remains uncertain].
Mark approximate dates and counts as estimates.
My notes: ________________________
Service connection records
1. How is this connected to your service?
For a direct claim, identify your current disability, what happened in service, and evidence linking them. Being on active duty or orders alone does not prove that link.
- Write the 5 Ws and how: who was there; what happened; when; where; why you were there; how the problem began. Add duty status, treatment, witnesses, and records. Mark uncertain dates as estimates.
- Guard or Reserve: find your orders, dates, duty type, and any line-of-duty records. Active duty, training, and drills have different rules.
- Secondary condition: it may start after service. Identify the service-connected condition and evidence that it caused or worsened this problem. A medical opinion may help explain the link.
- Started before service? Record what changed during service. Presumptive condition? Check the required diagnosis and service history; qualifying claims do not require separate proof of a link.
- Already service connected and seeking an increase? Focus on what has worsened and the records showing it.
If you do not know the cause, say so. Do not guess a medical connection.
Explain what changes in daily life
Describe both what you can do and what becomes difficult. Include how often it happens and how long it lasts.
- Describe concrete memory, planning, communication, or safety difficulties and their frequency.
- Distinguish your observations from conclusions in medical tests.
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 symptom or effect under TBI and another diagnostic code.
Records to get ready before the exam
- Injury and treatment records.
- Neuropsychological or other relevant exam results.
- Statements describing observed changes and assistance needed.
Preparation notes
- A distinct diagnosis such as migraine may be evaluated separately when appropriate, but the same symptom or effect cannot be counted twice.
- A diagnosed mental disorder is evaluated under section 4.130; the same symptoms require review.
Official rating rule and code numbers
Use this source to check the full rule and its medical terms: 38 CFR 4.124a, DC 8045. Source review recorded 2026-09-04.
Could one health problem have caused another?
A condition VA has already linked to your service may cause another health problem or make it worse. VA calls this secondary service connection. Having both conditions does not prove the link. Your records need to show a current diagnosis and explain how the first condition or its treatment affected the second.
- Start with your records. Find the current diagnosis, the condition VA already linked to service, and evidence from someone qualified to explain the connection.
- Ask about cause and worsening. Did the first condition or its treatment cause the new disability, or make an existing disability worse? These are different questions. The rules call them causation under 38 CFR § 3.310(a) and aggravation under § 3.310(b). If both are raised by your records, the medical opinion should address both; answering only the cause question may not be enough (El-Amin).
- If treatment may be involved, collect the dates. List the medicine or surgery prescribed for the condition VA linked to service, the side effect, and the new diagnosis. Bring pharmacy records and dates when treatment started or stopped. A provider must explain the connection in your case; taking a medicine alone does not prove it.
- If weight gain may be involved, ask how it fits. Weight gain or obesity can be a step between the first condition and another diagnosed disability under VAOPGCPREC 1-2017. Obesity itself does not receive a VA disability rating.
- You do not need absolute certainty. VA uses the “at least as likely as not” standard and the reasonable-doubt rule under 38 CFR § 3.102. Ask a VA-accredited representative how the evidence applies to your claim.
- The same symptom cannot be counted twice. This is the rule against pyramiding in 38 CFR § 4.14. Mental-health diagnoses generally share one § 4.130 rating when they affect the same work and social abilities. Trouble sleeping may be a symptom rather than a separate disability.
- Check whether VA already assumes a link to service. Some conditions qualify based on where or when you served. These are called presumptive conditions. Examples can include chronic rhinitis, chronic sinusitis, hypertension after qualifying herbicide exposure, and type 2 diabetes. Sleep apnea (OSA) is not a PACT Act presumptive. Check eligibility before seeking a medical opinion about the link.
- An exam form and a medical opinion do different jobs. A Disability Benefits Questionnaire (DBQ) records the diagnosis and how severe it is. It may not explain why it is linked to service, often called a nexus. A VA-accredited veterans service organization (VSO) can help you file at no charge.
If another prescribed treatment may have caused a problem, ask your health care provider to record what happened and explain the connection in your case.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Other health problems to ask about
Use these notes to ask your provider about problems you already have. Your records must explain the connection. VA decides whether the condition is linked to service.
Seizures without another immediate cause (unprovoked seizures) after moderate or severe TBI linked to service are covered by 38 CFR § 3.310(d), unless clear evidence shows otherwise. Other cases need evidence of the connection.
Under 38 CFR § 3.310(d), depression is covered if it appears within 3 years of moderate or severe TBI, or within 12 months of mild TBI, unless clear evidence shows otherwise.
A diagnosed headache disorder may receive a separate rating under DC 8100 when its effects are not already counted. Migraines are not on the § 3.310(d) presumed list.
The same event may cause TBI and PTSD. That does not mean one caused the other. Check the link from each condition to service and whether the same symptoms are being counted twice.
Ask about this only if sleep apnea is diagnosed and your provider can explain the connection.
The same blast may link both conditions directly to service. Do not assume one condition caused the other.
Choose the related health problems you want to discuss. Your preparation packet will include the notes you select and the full condition guides available for them.