Once the TBI diagnosis has been established, the residuals of TBI must be assessed. A veteran submitting a claim for residuals of TBI must first establish a TBI diagnosis by a psychiatrist, physiatrist, neurologist, or neurosurgeon if the veteran did not receive a diagnosis while on active duty ( VA, 2018b). It must also inform the claimant whether the VA or the claimant is responsible for obtaining that evidence. If VBA does not receive a substantially complete application, VBA must give the claimant written notice of the evidence necessary to substantiate the claim. If VBA receives a “substantially complete application,” meaning it includes sufficient information to verify the veteran's service and claimed medical condition, it will begin to process the claim. Disability claims can be filed through the VA's eBenefits, in person with a veterans service organization (VSO), or with a VA representative at a military installation ( health.mil, 2018). At any point after leaving the military, a veteran may file a claim with the VA for a disability. If the service member is being medically discharged from the military because of residuals of TBI that render him or her unfit for duty, the disability evaluation process begins while the service member is still serving in the military. C&P = compensation and pension (more.)īroadly speaking, the VA disability determination process for residuals of TBI involves the following steps, as described in the VA's Compensation and Pension Manual, M21 (see Appendix I for M21 Table of Contents) ( VA, 2018b): 1. NOTES: A veteran may file for an appeal at any step in the process (e.g., service connection, initial decision, a decision for an increased rating). Overview of the VA adjudication process for disability compensation. Table 3-1 shows the number of unique veterans who received VA disability compensation benefits for residuals of TBI, displayed by their overall disability ratings, inclusive of TBI and any other non-TBI rated conditions. In fiscal year 2017, 155,321 veterans received compensation benefits for residuals of TBI. Veterans may also receive disability benefits from SSA while receiving benefits from the VA, although eligibility for one does not necessarily confer eligibility for the other ( VA Law, 2018). While SSA awards disability compensation to individuals who cannot work, the VA awards disability compensation to people who sustain injuries from military service, regardless of their ability to work. SSA, another federal agency that provides disability benefits, views disability compensation as a binary decision where the compensation is awarded based on the claimant's inability to work or perform “substantial gainful activity” by reason of a medical impairment ( SSA, 2017). 2 This can be contrasted with how the Social Security Administration (SSA) views disability. The VA regards disability as an intersection of service connection, diagnosis, and function, and the compensation decision is for the most part not associated with the veteran's ability to work. Finally, the overall disability rating is mapped to a benefits table (see Chapter 1, Table 1-1), which shows the monthly amount paid by VA to the veteran commensurate with the degree of disability and the number of eligible dependents ( VA, 2015a). A veteran who has more than one service-connected disability receives a rating for each condition, and the VA then applies a formula to determine the overall disability rating ( VA, 2018a).
The degree of disability for a given disabling condition depends on a number of factors, including the diagnosis (coded according to the Veterans Affairs Schedule for Rating Disabilities, which provides criteria for translating medical information into a disability rating) associated with the disability and a variety of functional measures.
1 Each disabling, service-connected condition is assigned a rating, ranging from 0 to 100 percent disability, in 10 percent increments. Disability compensation is a monetary benefit awarded to veterans for one or more injuries or illnesses that the VA determines were “service connected,” that is, were incurred during active military service ( VA, 2018a).
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