RESIDUALS OF TRAUMATIC BRAIN INJURY (TBI)

Summary

The veteran, who served from October 1994 to December 1998, appeals the denial of entitlement to a separate rating for TBI residuals not included in his PTSD rating, and entitlement to a rating in excess of 70 percent for PTSD with TBI residuals from July 22, 2013. The Board granted entitlement to a separate rating for TBI residuals, finding that the visual spatial impairment noted in VA examinations was not compensated by his current PTSD rating. The Board determined that the Veteran's TBI residuals, specifically mild visual spatial impairment, more closely approximated the criteria for a 40 percent rating under DC 8045. Regarding the PTSD claim, the Board reviewed multiple examinations from 2016 to 2025. While some symptoms aligned with a 70 percent rating, the Board found that the Veteran's overall symptomatology, including hallucinations, grossly inappropriate behavior, intermittent inability to perform daily living activities, and impaired impulse control, rose to the level of total occupational and social impairment, warranting a 100 percent rating. The Board noted the Veteran's reported difficulties with coworkers and strained relationships due to paranoia, despite also reporting employment and a relationship with his wife. The Board concluded that the Veteran's PTSD symptoms most closely approximated total occupational and social impairment, thus granting a 100 percent rating.

Rationale

Visual spatial impairment not compensated by PTSD rating; Mild impairment approximated Level 2 criteria for 40% rating

Full Decision Text

Citation Nr: 26005054
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 14-43 958
DATE: April 29, 2026

ORDER

Entitlement to a separate rating for traumatic brain injury (TBI) residuals not included in the posttraumatic stress disorder (PTSD) rating is granted.

Entitlement a rating in excess of 70 percent for PTSD with TBI residuals from July 22, 2013, is granted.

FINDINGS OF FACT

1. The evidence reflects that the Veteran's TBI residuals include moderate impairment of visual spatial orientation. The Veteran's visual spatial impairment are not compensated by any of the Veteran's current ratings, including his rating for PTSD with TBI residuals under the code for PTSD (DC 9411).

2. The evidence reflects that the Veteran's PTSD symptoms produced total occupational and social impairment.

CONCLUSIONS OF LAW

1. The criteria for a separate rating of 40 percent for residuals of a TBI are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8045.

2. The criteria for an rating in excess of 70 percent for PTSD from July 22, 2013 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.130, Diagnostic Code 9411.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 1994 to December 1998.

This case was previously before the Board of Veterans' Appeals (Board) in July

2021. At that time, the Board remanded the matters for additional development

pursuant to the March 2021 United States Court of Appeals for Veterans Claims

(CAVC) Order.

After development was completed, the Agency of Original Jurisdiction (AOJ)

issued a Supplemental Statement of the Case (SSOC) in October 2025 based upon

the new evidence and denied entitlement to a separate rating for TBI residuals not

included in the rating for PTSD, entitlement to a rating in excess of 70 percent for

PTSD with TBI from July 22, 2013, to the present, and entitlement to TDIU. 

The matters were returned to the Board, and in January 2026, the Board remanded the matters for additional development consistent with the previous July 2021 Board decision under Stegall v. West, 11 Vet. App. 268 (1998).  After development was complete, the AOJ issued an SSOC in March 2026 based upon the new evidence and denied entitlement to a separate rating for TBI residuals not included in the rating for PTSD and entitlement to a rating in excess of 70 percent for PTSD with TBI from July 22, 2013.  The matters are now back before the Board.

Entitlement to a separate rating for TBI residuals not included in the PTSD rating

The Veteran's service-connected TBI residuals are currently subsumed within his 70 percent rating for PTSD, as "PTSD with TBI." See, e.g., January 2019 Rating Decision.

The Veteran contends that his TBI residuals warrant a separate rating for those which are not compensated by his PTSD rating. The Board notes the Veteran is separately rated for his migraines, including migraine variants and post concussive headaches due to TBI and for obstructive sleep apnea due to TBI.  See January 2026 Rating Decision - Codesheet.

TBI residuals are evaluated under diagnostic code (DC) 8045, which enumerates "three main areas of dysfunction that may result from TBI"-cognitive, emotional/behavioral, and physical. 38 C.F.R. § 4.124a. Separate impairment (e.g. cognitive versus physical) may receive separate ratings under the DC, though all cognitive impairment is to be assigned only one rating based on the most severe "facet" of impairment, and the rule against pyramiding prevents evaluating the same impairment more than once in situations where it may come under the purview of more than one area of dysfunction (e.g., cognitive impairment which is also noted as an emotional/behavioral symptom).

Here, the May 2025 VA TBI examination noted mild cognitive impairment under the facets of memory, judgment, social interaction, visual spatial orientation, subjective, neurobehavioral, and cognitive symptoms. Except for visual spatial orientation, all noted symptoms also appear on examinations evaluating the Veteran's service-connected PTSD, migraines, and OSA. See examinations dated May 2025, October 2018, January 2018, June 2017, and July 
 "facet" of impairment, and the rule against pyramiding prevents evaluating the same impairment more than once in situations where it may come under the purview of more than one area of dysfunction (e.g., cognitive impairment which is also noted as an emotional/behavioral symptom).

Here, the May 2025 VA TBI examination noted mild cognitive impairment under the facets of memory, judgment, social interaction, visual spatial orientation, subjective, neurobehavioral, and cognitive symptoms. Except for visual spatial orientation, all noted symptoms also appear on examinations evaluating the Veteran's service-connected PTSD, migraines, and OSA. See examinations dated May 2025, October 2018, January 2018, June 2017, and July 2016.

The Board finds the noted visual spatial impairment is not compensated by any of the Veteran's current ratings, including his rating for PTSD with TBI residuals under the code for PTSD (DC 9411).

The October 2018 and May 2025 TBI examination notes specifically that the Veteran has mildly impaired visual spatial orientation due to getting lost easily, forgetting directions, inability to drive on freeways, visual spatial deficits, and inability to recognize proper distance.  The January 2018 examination found the Veteran has mild impairment of visual spatial orientation due to running into things.  The February 2026 VA examiner indicated the overlapping symptoms between the Veteran's PTSD and TBI were memory issues, headaches, insomnia, and mental health.  The Board finds that none of those incorporate the impaired visual spatial orientation symptoms noted in the TBI examinations as such were not delineated in the PTSD examinations.

Under DC 8045, "mildly impaired" visual spatial orientation and judgment are assigned a level 1, which corresponds to a 10 percent rating. However, the May 2025 VA examination contains evidence indicating impairment more closely approximating the criteria for level 2 impairment: "Moderately impaired. Usually gets lost in unfamiliar surroundings, has difficulty reading maps, following directions, and judging distance. Has difficulty using assistive devices such as GPS (global positioning system)." Indeed, the examination specifically noted that the Veteran does not recognize proper distance and forgets directions and the January 2018 examination noted the Veteran would run into things.

A level 2 corresponds to a 40 percent rating.  Accordingly, the Board finds that a separate rating of 40 percent, and no higher, is warranted for residuals of a TBI, to include impairment of visual spatial orientation.

Entitlement to a rating in excess of 70 percent for PTSD with TBI residuals from July 22, 2013

The Veteran contends that he is entitled to a rating in excess of 70 percent for his PTSD with TBI residuals from July 22, 2013, to the present.

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as "staged" ratings." Hart v. Mansfield, 21 Vet. App. 505 (2007). The relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability for the time period beginning one year before the claim was filed until VA makes a final decision on the claim. Id.

The Veteran's PTSD is rated under Diagnostic Code (DC) 9411.  A 70 percent evaluation is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relationships, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. Id.

A 100 percent evaluation is warranted for total occupational and social impairment, due to such symptoms as
 percent evaluation is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relationships, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. Id.

A 100 percent evaluation is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id.

When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely based on social impairment. 38 C.F.R. § 4.126.

The symptoms listed in the rating schedule are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Nevertheless, all ratings in the general rating formula are associated with objectively observable symptomatology, and in Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013), the United States Court of Appeals for the Federal Circuit (Federal Circuit) stated that "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." The Federal Circuit further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." Id. Thus, "[a]lthough the veteran's symptomatology is the primary consideration, the regulation also requires an ultimate factual conclusion as to the veteran's level of impairment in 'most areas.'" Id. at 118. As such, the Board will consider both the Veteran's specific symptomatology as well as the occupational and social impairment described in the general rating formula to determine whether an increased evaluation is warranted.

In this regard, while the diagnostic criteria sets forth multiple symptoms indicative of the 70 percent level, the Court held in Bankhead v. Shulkin that "the language of the regulation indicates that the presence of suicidal ideation alone, that is, a veteran's thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment with deficiencies in most areas." See 29 Vet. App. 10, 20 (2017).

In the September 2014 examination, the examiner confirmed the diagnosis of PTSD and found the Veteran had the following symptoms: depressed mood, anxiety, suspiciousness, chronic sleep impairment, difficulty in understanding complex commands, disturbances of mood and motivation, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, and impaired impulse control.  The Veteran appeared appropriately groomed on examination and no evidence of delusions were noted.

In the December 2015 VA examination, the examiner found the Veteran had symptoms of anxiety, suspiciousness, chronic sleep impairment, mild memory loss, impairment of short and long term memory, circumstantial, circumlocutory, or stereotyped speech, difficulty in understanding complex commands, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, and impaired impulse control.  On examination delusions were denied and he appeared well groomed.

In the June 2017 PTSD examination, the examiner confirmed the diagnosis of PTSD and found the Veteran has an occupational and social impairment in most areas.  The examiner noted symptoms of depressed mood, anxiety, suspiciousness, panic attacks more than once a week, near continuous panic or depression affecting ability to function independently, chronic sleep impairment mild memory loss, impairment of short and long
 loss, impairment of short and long term memory, circumstantial, circumlocutory, or stereotyped speech, difficulty in understanding complex commands, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, and impaired impulse control.  On examination delusions were denied and he appeared well groomed.

In the June 2017 PTSD examination, the examiner confirmed the diagnosis of PTSD and found the Veteran has an occupational and social impairment in most areas.  The examiner noted symptoms of depressed mood, anxiety, suspiciousness, panic attacks more than once a week, near continuous panic or depression affecting ability to function independently, chronic sleep impairment mild memory loss, impairment of short and long term memory, flattened affect, difficulty in understanding complex commands, impaired judgment, impaired abstract thinking, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, inability to establish and maintain effective relationships, impaired impulse control, and neglect of personal appearance and hygiene.

In the August 2018 PTSD examination, the examiner confirmed the diagnosis of PTSD and noted symptoms of depressed mood, anxiety, suspiciousness, panic attacks occurring weekly or less often, chronic sleep impairment, mild memory loss, impairment of short and long term memory, flattened affect, circumstances, circumlocutory or stereotyped speech, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, inability to establish and maintain effective relationships, persistent delusions or hallucinations, and grossly inappropriate behavior.

In the May 2025 VA examination, the VA examiner confirmed the diagnosis of PTSD and noted symptoms of persistent negative emotional state, markedly diminished interest or participation in significant activities, feelings of detachment, irritable behavior and angry outbursts, depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, and difficulty adapting to stressful circumstances, including work or a work like setting.

The Board recognizes that some of the symptoms detailed in the examinations above correspond to a 100 percent disability rating, specifically hallucinations, grossly inappropriate behavior, and inability to maintain hygiene, and some correspond to a 70 percent rating, including near continuous panic or depression, impaired impulse control, neglect of personal appearance and hygiene, difficulty in adapt to stressful circumstances, and inability to establish and maintain effective relationships.

Based on the evidence, the Board finds that a rating in excess of 70 percent for PTSD is warranted. The symptomatology described demonstrates issues with depressed mood, anxiety, suspiciousness, panic attacks of once per week or less, near continuous panic, delusions or hallucinations, intermittent inability to perform activities of daily living, chronic sleep impairment, mild memory loss, flattened affect, circumstantial, circumlocutory or stereotypical speech, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, inability to establish and maintain effective relationships, impaired impulse control, and neglect of personal hygiene, which more closely approximate the 100 percent criteria.

The evidence of record shows that the Veteran has reported having a relationship with his wife, as well as employment during the relevant period in consulting and writing books.  However, the Board notes difficulty with coworkers were reported as well as working from home with the help of his wife.  He has reported suspiciousness of those and strained relationships with others due to paranoia, viewing people as a threat.

Thus, the Veteran's PTSD symptoms do rise to the level of total occupational and social impairment, as required for a 100 percent disability rating. The Board has considered all of the Veteran's symptoms, as he himself has described them, and finds that the Veteran's overall functioning most closely approximates total occupational and social impairment.  The nature and severity of the Veteran's symptoms and their resultant occupational and social impairment is contemplated by the 100 percent rating assigned.

The Board finds that a persuasive weight of the evidence is in favor of a rating in excess of 70 percent, the benefit of the doubt doctrine does not apply, and the claim for a 100 percent rating for PTSD with TBI residuals is warranted.

 

 

Ardie A. Bland

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Huber, C.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.