If you've been hit, blasted, or knocked out — read this.

What counts as TBI

The VA recognizes traumatic brain injury at three severity levels:

• Mild (concussion) — loss of consciousness 0-30 min, or being dazed for less than 24 hours. Can have lasting symptoms even after a single mild TBI. Most blast/fall/MVA injuries fall here.
• Moderate — loss of consciousness 30 min to 24 hours, post-traumatic amnesia 1-7 days.
• Severe — loss of consciousness over 24 hours, post-traumatic amnesia over 7 days.

Repeat blast or impact exposure matters. Even without any single severe event, repeated exposure (door breachers, mortar crews, recoilless rifle gunners, combat engineers, repeat IED proximity) is recognized as causing chronic neurological symptoms.

Common symptoms

TBI symptoms overlap heavily with PTSD and depression — that's why so many veterans get the wrong diagnosis. Look for:

• Headaches (especially post-exertional)
• Memory problems · word-finding difficulty
• Irritability · "short fuse"
• Sleep disruption · insomnia
• Light/noise sensitivity
• Balance issues · dizziness
• Anxiety · depression
• Fatigue · cognitive slowing

VA care — what's actually available

Every VA medical center has a polytrauma/TBI program. Available treatments:

• Cognitive rehabilitation therapy — speech-language pathology, occupational therapy
• Headache management — neurology, often with newer CGRP-class meds
• Sleep medicine — sleep studies, CPAP if indicated, behavioral interventions
• Vestibular rehab — balance and dizziness
• Mental health integration — TBI/PTSD overlap requires combined treatment
• Caregiver support (PCAFC) — for moderate to severe TBI see caregiver guide

Polytrauma centers (Tampa, Richmond, Minneapolis, Palo Alto, San Antonio) are the top-tier centers for severe cases. Most veterans are managed at their local VA.

Filing a TBI disability claim

VA TBI ratings range 0-100% based on impairment in 10 facets (memory, orientation, language, social interaction, etc.). The C&P exam is critical — request a TBI-trained examiner, not a general medical examiner.

• Document the original injury or exposure (incident reports, awards, statements from buddies)
• Track symptoms over time — a journal is gold
• Get a private neuropsychological evaluation if you can — it's usually more thorough than the C&P
• Have a buddy statement if your behavior changed after the event

TBI is often rated alongside PTSD. They can be rated separately or under a combined diagnosis depending on which produces a higher rating.

Blast exposure without diagnosis — Project ENDURE / clinical trials

VA, DoD, and Walter Reed are running large studies on subclinical blast exposure (gunners, breachers, mortar crews) — chronic symptoms without a clear single TBI event. Ask your VA neurologist about referral to a Brain Health Center or a research protocol.

Specific situations

"I never got knocked out, but I was around a lot of blast"

You may still qualify. The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act and DoD Brain Health initiatives now recognize chronic effects from repeat blast. File anyway — describe the exposure (frequency, distance, type of weapon system).

"I was diagnosed with PTSD but symptoms don't fit"

Headaches that don't respond to PTSD meds, light sensitivity, balance issues, or word-finding problems point toward TBI rather than (or in addition to) PTSD. Ask for a neuropsychological evaluation.

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