What is a TBI?

TBI is short for traumatic brain injury that occurs from sudden trauma, causing damage to the brain. TBI can occur when your head suddenly and violently hits an object or when an object penetrates the skull and enters your brain tissue. The definition of TBI covers its general causes. Yet, here are some more specifics. A TBI can be caused by a blow, bump, or jolt to the head or a hit to your body, causing your head and brain to move quickly back and forth.

Such sudden movements can cause the following:

• Chemical changes in your brain
• Brain cells are stretched and damaged
• Your brain bounces around or twists in the skull

Some common activities that create TBI include things such as falling, motor vehicle accidents, assault, contact sports, or firearm-related injuries. The most common cause of TBI-related deaths in the United States is fire-arm-related suicides.

TBI and Veterans

Veterans are prone to TBI due to the nature of their work and time in service. TBIs are impacting an increasing number of veterans due to:

• Roadside Improvised Explosive Device (IED) attacks
• Firebombs
• Other explosives creating skull piercing injuries
• Shrapnel and blast injuries

Other situations where Veterans are prone to TBI would be blasts that jolt their body, head, and brain, causing it to twist or move inside the cranial cavity and the sides of the skull.

Prevalence of TBI

According to the National Institute of Health, millions of people in the US suffer brain injuries every year, and the treatment and ongoing care required for TBIs have a rather large economic and societal toll. For example, the estimated cost of treating TBI was $76.5 billion in 2010. The cost of fatal TBIs and TBIs requiring hospitalization amount to approximately 90% of total TBI-related medical costs.

According to data from the Traumatic Brain Injury Model Systems National Database (TBIMS NDB), five-year outcomes of people with TBI (aged 16 and older who received inpatient rehab services with a primary diagnosis of TBI) are as follows:

• 22% died
• 30% experienced worse symptomology such as TBI Headaches
• 22% stayed the same (did not experience any changes in terms of improvement or worsening symptomology)
• 26% improved with experienced symptomology and Activities of Daily Living (ADL)

Prevalence of TBI in Veterans

TBIs are becoming increasingly prevalent among Veterans in recent service times. The VA estimates 22% of all combat-related casualties sustained by Veterans from Iraq and Afghanistan are caused by TBIs. This is a 10% increase from Vietnam War Veteran rates.

Nearly 4,000 more Veterans from 9/11 died in the past 20 years than projected, and these are the highest number of deaths attributed to TBI in United States history.

Additional statistics regarding TBI and Veterans:

• 17.5% of post-9/11 Veterans have been diagnosed with mild TBI
• 3% additional Veterans experience moderate to severe TBI

Statistics such as these raise awareness of veterans’ needs for proper treatment and compensation so that access to treatment can be received.

Types of TBI

One type of TBI is a concussion. They are the most common type of TBI documented in the United States. A concussion involves a short loss of normal brain functioning following a hit to your head or body, causing your head and brain to move back and forth rapidly. Concussions should be taken seriously and vary in level of severity.

Since a concussion falls under the category of TBI, TBIs are also classified in the following manner:

• Mild
• Moderate
• Severe

Mild TBI or concussions are the most frequent type that occurs annually in the United States. While these are not typically life-threatening, they should receive proper attention and medical care to minimize their short-term and long-term impacts on your brain and body.

Moderate and severe level injury may lead to long-term or life-long health issues impacting many areas of your life and can be equivalent to the effects of chronic disease.

Other TBI Headaches

The following are all complications or components of TBI that can occur and that contribute to TBI headaches. Headaches can vary and range from mild, dull pain that persists all day to severe shooting pain that is very brief in duration. If you are experiencing TBI headaches due to these conditions, you must reach out to your medical provider or seek proper medical attention quickly.

Cerebral Contusion

A cerebral Contusion is a scattered area of bleeding on the surface of the brain. It most commonly occurs along the undersurface and poles of the temporal and frontal lobes. A cerebral contusion occurs as a result of the brain striking a fold in the dura matter (the brain’s tough outer covering) or a ridge on the skull.

Cerebral Laceration

A cerebral Laceration is a tear in the brain tissue. It is caused by a foreign object or pushed-in bone fragment resulting from a skull fracture. Blows to the head or motor vehicle crashes are common causes of tears and bruising of brain tissue.

Cerebral Edema

Cerebral edema is defined as the swelling of the brain. This can occur as a complication of TBI or concussion.

Cerebral Hematoma

A hematoma is a pool of mostly clotted blood that forms in a body space, tissue, or organ. So, a Cerebral Hematoma is a hematoma that occurs in your brain. Cerebral Hematoma can occur when blood vessels burst between your brain and your dura mater. The dura mater is the outermost of three protective layers of your brain (the other two are the pia mater-innermost- and the arachnoid mater-middle layer).

The leaking blood from the blood vessels that burst forms a hematoma that presses on your brain tissue. If a hematoma continues to enlarge, it can cause a gradual loss of consciousness (LOC) and potentially death. Hematomas can also burst, which is also a life-threatening situation.

Brain Abscess

Brain abscess is a result of a collection of pus that develops in the brain due to an infection. Although rare, it can occur as a complication of a TBI, especially if the TBI includes a foreign object penetrating the skull. If the foreign object that penetrated the skull was shrapnel or something like rusty metal or if it did not receive proper medical treatment quickly and in a sterile environment, an infection could occur.

Also, if you have an underlying immunocompromised condition, an infection may occur because of a weakened immune system to fight its prevention or to fight it once it occurs. Its symptoms vary based on the location of the brain abscess. They may include headaches and nausea due to increased pressure in your brain. Neurological symptoms may also be present, although rare. Treatment includes close monitoring and antibiotics. Some cases may require the abscess to be surgically drained.

It is said that fewer than 20,000 cases of brain abscess are reported in the United States annually.

Symptoms of TBI

Since TBI impacts the brain and can lead to chemical and mechanical alterations, its symptoms tend to affect how you think, feel, learn, sleep, sometimes talk or receive verbal cues, and other such tasks. Generally, the level of severity of your TBI will impact the severity of your symptoms. It is important to note that even a TBI can impact your social, emotional, cognitive, or physical health.

TBI symptoms can be classified into three categories: physical, sensory, and cognitive/behavioral/mental symptoms.

Physical symptoms include:

• Inability to wake from sleep
• Loss of consciousness (LOC) ranging from several minutes to hours
• Repetitive nausea and/or vomiting
• Persistent TBI headaches
• TBI headaches that worsen
• Discharge from nose or ears (clear fluid)
• Seizures or convulsions
• Dilated pupils (one or both eyes)

Sensory symptoms include:

• Light sensitivity
• Sensitivity to sound
• Ringing in the ears (tinnitus)
• Blurred vision
• Altered ability to smell
• Bad Taste in your mouth

Cognitive, Behavioral, or Mental Symptoms

• Difficulty concentrating
• Memory loss (retrograde or anterograde)
• If no LOC, state of disorientation (dazed, confused)
• Mood swings and changes
• Feelings of anxiety and depression
• Difficulty sleeping
• Sleeping more or less than usual

Since TBIs vary in severity and specific causes, everyone experiences symptoms differently. A person experiencing a TBI resulting from concussion blasts in Iraq may experience completely different symptoms than someone experiencing TBI from a collision on the football field or perhaps someone who bumped their head at home performing chores. Effects of TBI also differ based on individual demographics, such as how old you are and whether you have a history of previous TBI. The severity of symptoms may also fluctuate on a daily basis. Some days may be more challenging than others. For example, if you experience light sensitivity, your symptoms may be worse on sunny days than on overcast days.

Residual Symptoms

Residual symptoms are those symptoms that manifest as short-term or long-term physical, behavioral, and cognitive disabilities. They may include any of the above-listed symptoms but are sometimes also referred to as lingering symptoms. This means they continue to persist after the initial injury. They may persist for days, months, or even years.

VA Rating for TBI

The VA rates TBIs at 0%, 10%, 40%, 70%, and 100% levels. The VA also offers a special monthly compensation (SMC) for veterans dealing with severe TBIs. This is because the VA recognizes that there is a possibility your case is so severe it warrants a rating higher than 100%. This is considered if you cannot work due to your TBI. In such a case, the VA will consider unemployability which could lead to the SMC rating. The specific SMC rating for TBI is SMC-T.

SMC-T VA Rating

In order to be eligible for the SMC-T rating, you must show you need aid and attendance, meaning that without in-home aid and attendance, you would require hospitalization, nursing home care, or other such residential/institutionalized care. You do not qualify for a higher level of Aid & Attendance based on 38 USCS § 1114 (R-2), Rates of wartime disability compensation. If you are able to prove all of these factors, you may be eligible for the 100% rating or more through unemployability which would make you eligible for special monthly compensation for your TBI.

What are VA TBI Residuals?

Since TBI severity varies based on several factors, and symptoms vary in length of duration, the VA also rated TBI Residuals. The VA rates residuals of traumatic brain injury with diagnostic code 8045 in the Schedule for Rating Disabilities. The VA rates residual symptoms of your TBI at the same time you are assigned a VA TBI rating. The VA rates TBIs based on residual symptoms. This is also known as lingering symptoms of TBI that persist for months and sometimes even years after the initial injury. The severity of the event that caused the TBI is not rated by the VA.

VA Rating for TBI Residuals

The VA evaluates TBI residual effects based on your current levels of:

• Cognitive or mental function: Defined as lowered memory, attention, concentration, and executive functioning of your brain
• Physical function: These include neurological functions and are evaluated under the specific area of physical dysfunction
• Behavioral or emotional function: The VA uses the General Rating Formula for Mental Disorders in the Schedule for Rating Disabilities. This is found under Title 38, Chapter I, Part 4, Subpart B – Mental Disorders § 4.130.

The VA will evaluate your residual symptoms according to the following 10 categories:

• Consciousness
• Judgment
• Communication
• Social interaction
• Orientation
• Motor activity
• Visual-spatial orientation
• Neurobehavioral effects
• Subjective symptoms
• Memory, attention, concentration, and executive functions

Filing a VA TBI Claim

When you file a claim with the VA for your TBI, you need to prove:

• You have a current TBI medical diagnosis
• Your TBI was caused by a traumatic event during your time served on active duty
• There is a medical nexus linking your TBI to your traumatic event that occurred during your time served on active duty.

It would be beneficial if you have documentation of your in-service event that caused the TBI that you can provide when filing for the claim, along with a nexus letter. For example, if you have medical records from the time of the event or any military records that corroborate the traumatic event that occurred, then that would be helpful. It is recommended to collect the necessary documentation first and then go ahead and file the claim.

If you are a Veteran who experienced TBI during your term of service and need help with an appeal for VA benefits, contact a veteran’s benefits attorney. At Veterans Disability Info, we’re a law firm specializing in helping veterans obtain compensation for disabilities incurred in active military service. Call us today at 888.878.9350 for help with getting the support you need and deserve from the VA.