PTSD and TBI Combined

Veterans, especially those who served in combat, often find they have lingering effects from the mental and physical effects of service. Brain injuries and emotional trauma both have an impact on veterans’ health for years after their time in the military.

The CDC estimates that more than 430,000 service members and veterans have been diagnosed with traumatic brain injuries (TBI) between 2000 and 2020. In addition, as many as 15% of combat veterans return from duty with post-traumatic stress disorder (PTSD). For some, the two conditions are linked. The injury that leads to TBI can also cause lasting PTSD.

Veterans with TBI and PTSD caused by military services are eligible for disability payments from the VA if the conditions are service-connected. They may also be eligible for special monthly compensation in addition. Learn more about how the VA addresses paying benefits to veterans with multiple diagnoses.

What Is Traumatic Brain Injury?

According to the CDC, traumatic brain injury (TBI) is an injury to the brain that affects how it works. TBI is common among military personnel and leads to a range of long-term issues. TBI can cause changes to mental abilities, as well as lead to physical disabilities.

The most common cause of TBI is a significant blow to the head or jolt to the body that damages the tissue of the brain. An injury that penetrates the skull, such as a bullet or shrapnel wound, can lead to TBI, as can bone fragments from a skull injury.

In some cases, TBI effects are short-lived, and people recover fully. In other instances, the damage to brain tissue, nerves, and blood vessels in the brain may be significant. Damage from TBI can be permanent and result in life-long complications.

The long-term effects of TBI vary from person to person. Some of the common complications from a traumatic brain injury include:

• Headaches
• Dizziness or vertigo
• Seizures
• Blood vessel damage that increases the risk of stroke
• Sensory issues, such as:
  • Loss of or altered sense of smell or taste
  • Vision changes
  • Swallowing problems
  • Dizziness
  • Ringing in the ear
  • Hearing loss
• Memory problems
• Difficulty with learning and reasoning
• Impaired judgment
• Problems with attention or concentration
• Executive functioning (difficulties with problem-solving, multitasking, organization, planning, decision-making, beginning or completing tasks)
• Communication problems may include:
  • Difficulty understanding speech or writing
  • Difficulty speaking or writing
  • Inability to organize thoughts and ideas
  • Trouble following and participating in conversations

TBI can also result in changes to behavior such as loss of impulse control, poor understanding of social cues, and sudden outbursts. In addition, people with TBI may experience mood changes such as depression, anxiety, anger, and mood swings.

In addition, damage to the brain might lead to loss of physical abilities. Paralysis, bladder and bowel control problems, loss of balance or mobility, and other dysfunctions might arise due to nerve damage.

TBI often requires life-long treatment, including medication, physical therapy, occupational therapy, and potentially full-time nursing care.

What Is PTSD?

The Mayo Clinic defines Post Traumatic Stress Disorder (PTSD) as a mental condition that develops after experiencing or witnessing a terrifying event. To be considered PTSD, the symptoms must be present for one month or longer, get worse over time, and/or interfere with daily life.

Traumatizing events vary widely. Many of the episodes veterans face in combat contribute to PTSD. Sustaining an injury may trigger PTSD. Sexual assault is also a common reason for PTSD.

Common emotional and mental symptoms of PTSD include:

• Flashbacks
• Intrusive memories of the event
• Nightmares
• Avoidance of anything that might lead to memories of the event
• Negative thoughts about yourself, other people, or the world
• Memory problems, including not remembering important aspects of the traumatic event
• Difficulty maintaining close relationships
• Lack of interest in activities you once enjoyed
• Difficulty experiencing positive emotions
• Feeling emotionally numb

In addition, people experiencing PTSD may have behavior changes such as:

• Being easily startled or frightened
• Always being on guard for danger
• Self-destructive behavior, such as drinking too much or driving too fast
• Trouble sleeping
• Trouble concentrating
• Irritability, angry outbursts, or aggressive behavior
• Overwhelming guilt or shame

PTSD can lead to veterans unable to participate in work and other daily activities. They may have periods where symptoms recede only to return and disrupt their lives. Some veterans require long-term treatment, including therapy or medications to manage symptoms.

TBI and PTSD Together

It is common for PTSD and TBI to occur together, particularly in veterans who may have been injured during combat or training. A veteran who was injured due to an explosion, gunfire, or physical combat will likely suffer mental effects from the incident. Injuries caused by vehicle accidents, dive injuries, or a jump from an airplane are similarly traumatizing. Any incident where a veteran was hurt and also saw others injured or killed will add more trauma to the overall situation.

It’s not always possible to distinguish symptoms of TBI from symptoms of PTSD because they can be so similar. Both conditions can lead to depression, trouble sleeping, and memory problems. Some behavior changes like sudden outbursts, mood swings, impulsive behavior, and inappropriate social behavior.

Veterans with service-related PTSD and TBI may be eligible for benefits related to both conditions. Disability payments for each condition are based on the veteran’s symptoms and how they interfere with daily life.

The VA is not allowed to pay benefits twice for the same symptom. For example, even though a veteran may have two conditions that cause headaches, they can only receive benefits for one of the headache-causing conditions. By law, the VA must pay the higher of the two possible benefits in cases like that.

How the VA Rates TBI and PTSD Together

The VA has separate rating scales for PTSD and TBI. PTSD is considered a mental health disorder and is rated on the scale called “General Rating Formula for Mental Health Disorder.” Benefits are assigned based on what symptoms a veteran displays and the degree of “occupational and social impairment” they cause. Total impairment entitles the veteran to 100% disability. Lower levels of impairment can qualify the veteran for a rating of 10-70%.

Ratings for TBI are more complicated. A veteran with TBI needs to be evaluated to see what effect the injury has on three types of functions: cognitive, emotional/behavioral, and physical. Many of the cognitive and emotional effects of TBI are rated according to a VA scale titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” This scale includes an assessment of issues such as social behavior, memory function, judgment, and communication.

Some symptoms of TBI are classified as mental conditions and are rated according to the criteria on the general mental health rating scale. TBI-induced depression or anxiety would be rated this way. Likewise, any physical symptoms such as loss of mobility, sensory deficits, loss of bladder or bowel function, or seizures would each be rated as discrete physiological symptoms.

The final amount of disability compensation for a veteran will account for a combination of all the symptoms associated with PTSD and TBI. If a symptom is present due to more than one diagnosis, the VA must assign a higher rating for the symptom.

Qualifying for VA Benefits

To begin the process of getting benefits, veterans need to apply to the VA and show that they have a disability and that the disability was directly caused by military service.

The veteran must provide evidence of their current disability. This is the current disability requirement.

Second, the veteran must present evidence of a nexus or linkage between his service event and his current disability. So-called “buddy letters” from spouses, friends, or colleagues can help describe the ways that the disability has changed the veteran’s life and can help to establish a continuous chain of symptoms since discharge from the service.

Finally, veterans need to show a connection between military service and their present disability. Veterans must have evidence establishing that a disabling incident, disease, or injury was “incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein.”

Records of traumatic brain injury that happened during service should be accessible in their active-duty military records. Any medical records detailing treatment related to the TBI after military service will also be relevant to the claim.

When events or injuries caused PTSD during active duty, personnel records may contain information about the pertinent events. The veteran may need to provide evidence of personality and mood changes after the traumatic event. Medical and psychological treatment records and reports from friends, family, and coworkers can support the claim that PTSD directly caused mental health changes.