TBI (Traumatic Brain Injury) in Military: Symptoms, Treatment & VA Disability

Bottom Line Up Front: 20-30% of OEF/OIF veterans have TBI (blast exposure, vehicle accidents, impacts). Symptoms: Headaches, memory problems, irritability, light/noise sensitivity, sleep issues. Often misdiagnosed as PTSD (many have both). Treatment: Cognitive therapy, medication for symptoms, vestibular therapy (balance), vision therapy. VA disability: 0-100% rating ($0-$3,900/month). Document ALL head injuries (even "minor") - symptoms appear months/years later. MRI usually normal (TBI is functional injury, not structural).

What is TBI?

Definition

Traumatic Brain Injury: Brain function disruption from external force (blast, impact, acceleration/deceleration)

Military-specific causes:

• IED blasts (most common in Iraq/Afghanistan)
• Vehicle rollovers (Humvee, MRAP)
• Mortars/rockets (pressure wave)
• Falls (helicopter, building, training accidents)
• Fights/assaults
• Repeated subconcussive impacts (breaching, heavy weapons, parachute landings)

TBI Severity Levels

Mild TBI (mTBI) / Concussion:

• Loss of consciousness: <30 minutes (or none)
• Memory loss: <24 hours
• 80-90% of military TBI = mild
• Symptoms: Headaches, dizziness, confusion, sensitivity

Moderate TBI:

• Loss of consciousness: 30 minutes - 24 hours
• Memory loss: >24 hours
• Symptoms: Cognitive issues, mood changes, physical symptoms

Severe TBI:

• Loss of consciousness: >24 hours
• Permanent disability common
• Symptoms: Major cognitive/physical impairment

Reality: Even "mild" TBI causes long-term problems if untreated

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TBI Symptoms (What to Watch For)

Physical Symptoms

Headaches:

• Constant or frequent
• Worse with physical activity, stress, bright lights
• Different from pre-injury headaches

Dizziness/Balance problems:

• Room spinning
• Unsteady on feet
• Worse in crowds, busy environments

Light/Noise sensitivity:

• Sunglasses needed indoors
• Can't tolerate loud environments (restaurants, malls)
• Fluorescent lights trigger headaches

Vision problems:

• Blurry vision
• Double vision
• Difficulty tracking moving objects (reading = eyes jump)

Tinnitus (ringing in ears):

• Constant or intermittent
• Often accompanies TBI from blast

Cognitive Symptoms

Memory problems:

• Forget appointments, conversations
• Can't remember where you parked car
• Lose track of daily tasks

Concentration issues:

• Can't focus on work/reading for >10 minutes
• Easily distracted
• "Brain fog" (thoughts feel slow/thick)

Processing speed:

• Takes longer to understand instructions
• Need things repeated
• Struggle with multitasking

Executive function:

• Planning/organizing difficult
• Can't prioritize tasks
• Difficulty making decisions

Emotional/Behavioral Symptoms

Irritability:

• Quick to anger (rage over small things)
• Low frustration tolerance
• Yelling at spouse/kids

Depression:

• Loss of interest in hobbies
• Fatigue
• Hopelessness

Anxiety:

• Constant worry
• Panic attacks
• Avoidance of crowds/noise

Personality changes:

• "Not the same person anymore"
• Impulsive (spending, risky behavior)
• Social withdrawal

Sleep Symptoms

Insomnia:

• Can't fall asleep
• Wake frequently
• Never feel rested

Hypersomnia:

• Sleep 10-14 hours, still tired
• Naps daily

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TBI vs. PTSD (Often Both)

Symptom Overlap

Both TBI and PTSD cause:

• Irritability
• Sleep problems
• Concentration issues
• Memory problems
• Social withdrawal

How to Tell the Difference

TBI-specific:

• ✅ Headaches (physical)
• ✅ Dizziness, balance problems
• ✅ Light/noise sensitivity
• ✅ Vision problems
• ✅ Symptoms started AFTER head injury event

PTSD-specific:

• ✅ Nightmares (combat, trauma)
• ✅ Flashbacks
• ✅ Hypervigilance (scanning for threats)
• ✅ Avoidance (places, people, reminders)
• ✅ Symptoms started AFTER traumatic event (may not involve head injury)

Many veterans have BOTH:

• IED blast = TBI (head injury) + PTSD (trauma)
• Treatment for both often needed

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Diagnosis & Testing

Clinical Evaluation

What to expect at TBI clinic:

• Medical history (head injuries, symptoms timeline)
• Neurological exam (reflexes, coordination, balance)
• Cognitive testing (memory, attention, processing speed)

Imaging (Usually Normal!)

MRI/CT scan:

• Often normal in mild TBI
• Normal scan does NOT mean "no TBI"
• TBI is functional injury (brain cells damaged but structure intact)

Advanced imaging (research settings):

• DTI (Diffusion Tensor Imaging) - shows white matter damage
• Not widely available for clinical use yet

Cognitive Testing

Common tests:

• ANAM (Automated Neuropsychological Assessment Metrics)
• MACE (Military Acute Concussion Evaluation)
• Full neuropsych battery (4-6 hours of testing)

What they measure:

• Memory (short-term, long-term)
• Attention/concentration
• Processing speed
• Executive function (planning, problem-solving)

Self-Report Questionnaires

NSI (Neurobehavioral Symptom Inventory):

• 22-item checklist
• Rate symptoms 0-4 (none to very severe)
• Track symptoms over time

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Treatment Options

Cognitive Rehabilitation

What it is:

• Therapy to retrain brain (compensate for deficits)
• Memory strategies (calendars, reminders, routines)
• Attention training
• Problem-solving practice

Effectiveness: 60-70% improvement in daily function

Where to get:

• VA TBI clinic
• TRICARE-covered civilian therapist

Medication (Symptom Management)

For headaches:

• Preventive: Topiramate, propranolol
• Acute: Triptans (for migraines)
• Avoid: Opioids (addictive, don't fix TBI)

For cognitive issues:

• Stimulants: Modafinil, methylphenidate (improve focus)
• Memantine (memory support)

For sleep:

• Melatonin (3-10 mg)
• Prazosin (if nightmares)
• Trazodone (low dose)

For mood:

• SSRIs (sertraline, escitalopram) for depression/anxiety

Vestibular Therapy (Balance/Dizziness)

What it is:

• Physical therapy for inner ear/balance system
• Exercises to retrain balance

Effectiveness: 70-80% reduction in dizziness

Duration: 6-12 weeks

Vision Therapy

For TBI vision problems:

• Eye tracking exercises
• Convergence training (eyes working together)
• Prism glasses (correct double vision)

Effectiveness: 60-80% improvement

Complementary Therapies

May help (some evidence):

• Acupuncture (headaches)
• Massage (muscle tension, headaches)
• Yoga (stress, balance)
• Meditation (cognitive function, stress)

Worth trying: Low risk, may provide relief

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VA Disability Rating for TBI

How TBI Is Rated

Based on 10 symptom areas:

1. Memory, attention, concentration
2. Executive function
3. Judgment, reasoning
4. Social interaction
5. Orientation
6. Communication
7. Mood
8. Motor activity
9. Visual/spatial function
10. Subjective symptoms (headaches, dizziness)

Rating levels:

• 0%: Mild TBI with no current symptoms (still service-connected!)
• 10%: Minimal symptoms, no functional impact
• 40%: Moderate symptoms, some functional impact
• 70%: Severe symptoms, major functional impact
• 100%: Total occupational/social impairment

TBI VA Disability Compensation (2025)

• 0%: $0/month (but service-connected for future increases)
• 10%: $171/month
• 40%: $755/month (with spouse/kids: $850-$950)
• 70%: $1,716/month (with spouse/kids: $1,850-$2,050)
• 100%: $3,900/month (with spouse/kids: $4,100-$4,500)

Secondary Conditions to TBI

Can also claim:

• Migraines secondary to TBI (0-50%)
• Insomnia secondary to TBI (included in TBI rating or separate)
• PTSD (separate condition, can have both)
• Tinnitus (10% flat rate, very common with blast TBI)
• Depression/anxiety secondary to TBI

Many veterans get 70-100% combined (TBI + secondaries)

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Documenting TBI for VA Claims

Critical Documentation

1. Evidence of head injury event:

• Incident report (IED blast, vehicle rollover)
• Medical records (concussion diagnosis, even if "cleared" same day)
• Buddy statements ("I was there when he got blown up")

2. Current diagnosis:

• TBI clinic evaluation
• Neuropsychological testing results
• Neurologist diagnosis

3. Nexus (connection):

• Doctor's statement: "Veteran's TBI symptoms are at least as likely as not related to [IED blast in 2010]"

4. Symptom timeline:

• When symptoms started (right after injury OR months later = both valid)
• How symptoms affect daily life (can't work, can't drive, relationship problems)

Common TBI Claim Mistakes

❌ Mistake #1: "Minor concussion, I was fine"

• Reality: You were "cleared" after 10 minutes, told to return to duty
• Years later: Headaches, memory problems, anger issues
• VA: "No documentation of TBI"

Fix: Document EVERY head injury (even if minor). Symptoms appear later.

❌ Mistake #2: Not getting TBI screening

• Reality: Never got TBI eval during service (symptoms dismissed as stress)
• VA: "No medical evidence of TBI"

Fix: Get TBI screening ASAP (VA offers free TBI evaluations for all OEF/OIF vets)

❌ Mistake #3: Attributing all symptoms to PTSD

• Reality: File PTSD claim, mention memory/sleep issues
• VA: Rates PTSD at 50%, misses TBI
• Could have 70% PTSD + 70% TBI = 90% combined

Fix: File separate TBI claim (can have both)

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Action Steps

If You Think You Have TBI:

This Week:

1. ✅ Call VA TBI screening: 888-860-2072 (free)
2. ✅ Schedule appointment with primary care (document symptoms)

This Month:

1. ✅ TBI clinic evaluation (neurologist, cognitive testing)
2. ✅ Start symptom journal (track headaches, memory issues, mood)

If Filing VA Claim:

1. ✅ Gather evidence (deployment records, incident reports, medical records)
2. ✅ Get buddy statements (people who witnessed injury or saw symptoms)
3. ✅ Get current TBI diagnosis (VA or private doctor)
4. ✅ Submit Intent to File (locks in effective date while gathering evidence)
5. ✅ File full claim (use VSO - Veterans Service Officer for help)

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Related Guides

• PTSD Symptoms, Treatment & VA Disability
• VA Disability Claims Step-by-Step
• Headaches and Migraines VA Rating

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Remember: TBI is real, treatable, and ratable for VA disability. Don't dismiss symptoms as "just stress" or "getting old." Document all head injuries (even minor), get screened, seek treatment. Thousands of veterans with TBI get 40-100% VA disability ($755-$3,900/month). You earned it. File your claim.