If the VA already service-connected your traumatic brain injury (also called TBI, concussion, post-concussion syndrome, blast injury), it can cause or worsen other conditions that are ratable on their own. These "secondary" claims are where many veterans leave money on the table. Below is what a service-connected traumatic brain injury commonly leads to, why, and what evidence each one takes.
TBI residuals are rated under 38 CFR 4.124a, DC 8045, across three areas: cognitive, emotional/behavioral, and physical. Cognitive problems and subjective symptoms go through a table of 10 facets (such as memory and attention, judgment, social interaction, and orientation), each scored 0, 1, 2, 3, or "total."
| Highest level on any facet | Rating |
|---|---|
| Total | 100% |
| 3 | 70% |
| 2 | 40% |
| 1 | 10% |
| 0 | 0% |
Only the single highest facet sets this rating; facets are not added together. Physical residuals and diagnosed mental health conditions can be rated separately, as long as the same symptoms are not counted twice.
A secondary claim only works if the primary condition (traumatic brain injury) is already service-connected, and you have a nexus — a doctor's opinion that it is "at least as likely as not" the cause. Nexus letter sample and template →
Post-traumatic headaches are among the most common TBI residuals and the medical literature strongly supports the link. They can be rated separately under the migraine code, often higher than if bundled into the TBI rating.
What you'd need: A headache diagnosis with a documented pattern of prostrating attacks and a note linking them to the TBI. The VA should apply whichever of DC 8045 or DC 8100 gives the higher rating.
TBI frequently causes emotional and behavioral changes. DC 8045 instructs the VA to separately rate any residual with a distinct diagnosis, so a mental health condition gets its own rating.
What you'd need: A mental health diagnosis and documentation linking the mood/behavioral changes to the service-connected TBI.
TBI commonly disrupts sleep. As a distinct residual, a sleep disorder can be separately evaluated from the core TBI rating.
What you'd need: A documented sleep disorder (sleep study if apnea is suspected) and a nexus opinion tying it to the TBI.
Blast and head trauma that cause TBI often also damage the auditory system, producing tinnitus.
What you'd need: A statement of ringing plus audiology; a nexus opinion tying tinnitus to the same head-injury event/TBI.