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NEUROLOGICAL SECTION
Current Section: Neurological Conditions
Table of Contents

Neurological Conditions

Neurological Conditions

Overview of VA Neurological Ratings

Neurological conditions affect the brain, spinal cord, and nerves throughout the body. Military service can lead to neurological conditions through traumatic injuries, exposure to toxins, or the physical demands of service. This section explains how the VA rates neurological conditions and provides detailed guidance for the most common conditions.

General Rating Principles for Neurological Conditions

The VA rates neurological conditions based on several factors:

  • Severity of symptoms: How severely the condition affects your functioning
  • Frequency of symptoms: How often symptoms occur
  • Duration of symptoms: How long symptoms last when they occur
  • Impact on daily activities: How the condition affects your ability to work and perform daily tasks
  • Response to treatment: How well the condition responds to medication or other treatments
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Objective Evidence

While some neurological conditions can be confirmed with objective tests (like MRIs, CT scans, or nerve conduction studies), others rely heavily on your reported symptoms. For conditions without clear objective markers, detailed documentation of symptoms and their impact is crucial.

Traumatic Brain Injury (TBI)

Traumatic Brain Injury (TBI) occurs when a sudden trauma causes damage to the brain. In military settings, TBI commonly results from blast exposures, vehicle accidents, falls, or combat injuries. TBI can range from mild (concussion) to severe and may cause a wide range of physical, cognitive, emotional, and behavioral effects.

Establishing Service Connection for TBI

To establish service connection for TBI, you need:

  1. Diagnosis of TBI by a qualified medical professional
  2. Evidence of an in-service event that could cause TBI (blast exposure, fall, accident, etc.)
  3. Medical nexus linking your current TBI symptoms to the in-service event
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Combat Presumption

If you served in combat and report experiencing a head injury or blast exposure during combat, your testimony alone may be sufficient to establish the in-service event, even without medical documentation from your service period.

VA Rating System for TBI

The VA uses a unique and complex system to rate TBI under Diagnostic Code 8045. This system evaluates TBI across three main areas:

  1. Cognitive impairment: Memory, attention, concentration, executive functions
  2. Emotional/behavioral dysfunction: Psychiatric symptoms
  3. Physical symptoms: Headaches, seizures, balance problems, etc.

Each area is rated separately, and the highest rating among the three becomes your TBI rating.

Cognitive Impairment Rating Scale

Cognitive impairment is rated on a scale from 0 to 3 across 10 facets:

  1. Memory, attention, concentration, executive functions
  2. Judgment
  3. Social interaction
  4. Orientation
  5. Motor activity
  6. Visual spatial orientation
  7. Subjective symptoms
  8. Neurobehavioral effects
  9. Communication
  10. Consciousness

The level of impairment for each facet is rated as:

  • 0: Normal
  • 1: Mild impairment
  • 2: Moderate impairment
  • 3: Severe impairment
  • Total: Total impairment

The highest level of impairment among the 10 facets determines your cognitive impairment rating:

100%
Total impairment in one or more facets

Evidence for 100% Rating:

  • Medical documentation showing total impairment in at least one of the 10 facets
  • Evidence of requiring full-time assistance for basic functions
  • Documentation of inability to work due to cognitive impairment
  • Neuropsychological testing showing severe cognitive deficits
70%
Level 3 impairment in one or more facets

Evidence for 70% Rating:

  • Medical documentation showing level 3 (severe) impairment in at least one of the 10 facets
  • Evidence of significant difficulty with memory, attention, or executive functions
  • Documentation of severe impact on work and daily activities
  • Neuropsychological testing showing moderate to severe cognitive deficits
40%
Level 2 impairment in one or more facets

Evidence for 40% Rating:

  • Medical documentation showing level 2 (moderate) impairment in at least one of the 10 facets
  • Evidence of moderate difficulty with memory, attention, or executive functions
  • Documentation of moderate impact on work and daily activities
  • Neuropsychological testing showing mild to moderate cognitive deficits
10%
Level 1 impairment in one or more facets

Evidence for 10% Rating:

  • Medical documentation showing level 1 (mild) impairment in at least one of the 10 facets
  • Evidence of mild difficulty with memory, attention, or executive functions
  • Documentation of mild impact on work and daily activities
  • Neuropsychological testing showing mild cognitive deficits
0%
Level 0 impairment in all facets

Evidence for 0% Rating:

  • Medical documentation showing normal functioning in all 10 facets
  • History of TBI but with full recovery
  • No current impact on work or daily activities

Emotional/Behavioral Dysfunction

If your TBI causes emotional or behavioral symptoms (such as depression, anxiety, or mood changes), these are evaluated under the General Rating Formula for Mental Disorders. See the Mental Health Conditions section for details.

Physical Symptoms

Physical symptoms of TBI (such as headaches, seizures, or balance problems) are rated under the appropriate diagnostic codes for those conditions. For example, headaches would be rated under the criteria for migraine headaches (Diagnostic Code 8100).

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Separate Ratings

You can receive separate ratings for the cognitive, emotional/behavioral, and physical aspects of TBI. For example, you could have a 40% rating for cognitive impairment under DC 8045, a 50% rating for depression under DC 9434, and a 30% rating for migraine headaches under DC 8100.

Building a Strong TBI Claim

Evidence Checklist for TBI Claims

Required Medical Evidence
Military Records
Supporting Statements
Additional Evidence (if applicable)
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TBI Claim Tip

Request a neuropsychological evaluation specifically for your VA claim. These comprehensive evaluations provide objective measurements of cognitive functioning across multiple domains and are highly valued by the VA when rating TBI claims.

Migraine Headaches

Migraine headaches are a common neurological condition characterized by severe, often debilitating headaches that may be accompanied by nausea, vomiting, and sensitivity to light and sound. Military service can trigger or worsen migraines due to stress, sleep disruption, environmental exposures, or head injuries.

Establishing Service Connection for Migraines

To establish service connection for migraines, you need:

  1. Diagnosis of migraine headaches by a qualified medical professional
  2. Evidence of onset or worsening during service or evidence of a service-connected condition that caused or aggravated your migraines
  3. Medical nexus linking your current migraines to service or to another service-connected condition
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Secondary Service Connection

Migraines are often secondary to other service-connected conditions, including:

  • Traumatic Brain Injury (TBI)
  • PTSD or other mental health conditions
  • Neck injuries
  • Tinnitus
  • Sinusitis

If you have one of these service-connected conditions, you may be able to establish service connection for migraines as secondary to that condition.

VA Rating Criteria for Migraines

Migraines are rated under Diagnostic Code 8100 based on frequency, severity, and economic impact:

50%
Very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability

Evidence for 50% Rating:

  • Medical documentation of very frequent migraines (several times per month)
  • Evidence that migraines are completely prostrating (requiring bed rest, inability to function)
  • Documentation that attacks are prolonged (lasting several hours or days)
  • Evidence of severe economic impact (missed work, inability to maintain employment)
  • Detailed headache journal documenting frequency, duration, and severity
  • Statements from employers about work absences or accommodations
  • Medical records showing multiple treatments and medications
30%
Characteristic prostrating attacks occurring on average once a month over the last several months

Evidence for 30% Rating:

  • Medical documentation of migraines occurring approximately once a month
  • Evidence that migraines are prostrating (requiring bed rest, inability to function)
  • Documentation of consistent pattern over several months
  • Headache journal documenting frequency, duration, and severity
  • Statements about impact on work and daily activities
  • Medical records showing treatments and medications
10%
Characteristic prostrating attacks averaging one in 2 months over the last several months

Evidence for 10% Rating:

  • Medical documentation of migraines occurring every other month on average
  • Evidence that migraines are prostrating (requiring bed rest, inability to function)
  • Documentation of consistent pattern over several months
  • Headache journal documenting frequency, duration, and severity
  • Statements about impact on work and daily activities
0%
Less frequent attacks

Evidence for 0% Rating:

  • Medical diagnosis of migraines
  • Documentation of infrequent attacks (less than one every two months)
  • Migraines that are not prostrating (can still function during attacks)
  • Minimal impact on work and daily activities
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Key Terms

Prostrating: Causing extreme exhaustion, powerlessness, or incapacitation. For VA purposes, a prostrating migraine is one that forces you to stop all activity and seek rest, typically requiring you to lie down in a dark, quiet room.

Severe economic inadaptability: Does not require complete inability to work, but rather that migraines cause significant interference with work capacity. Courts have interpreted this to mean "producing or capable of producing severe economic inadaptability."

Building a Strong Migraine Claim

Evidence Checklist for Migraine Claims

Required Medical Evidence
Military Records
Supporting Statements
Additional Evidence (if applicable)
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Migraine Claim Tip

Keep a detailed headache journal for at least 3-6 months before your C&P exam. Record the date, time, duration, severity (on a scale of 1-10), symptoms, triggers, medications taken, and impact on activities. This journal provides concrete evidence of the frequency and severity of your migraines that is difficult for the VA to dispute.

Case Study: Successful Migraine Claim

Veteran Profile

Navy veteran who served as an aviation mechanic for 8 years, including deployments on aircraft carriers.

Condition

Migraine headaches that began during service and worsened after discharge.

Symptoms & Presentation
  • 4-5 severe migraines per month
  • Each episode lasting 8-24 hours
  • Symptoms including throbbing pain, nausea, vomiting, and sensitivity to light and sound
  • Required complete bed rest in a dark room during attacks
  • Missing 2-3 days of work per month due to migraines
  • Multiple medications with limited effectiveness
Evidence Submitted
  • Service treatment records showing several visits for headaches during service
  • Diagnosis of migraine headaches from VA neurologist
  • Six-month headache journal documenting frequency, duration, and severity
  • Letter from employer documenting work absences due to migraines
  • Statement from spouse describing the veteran's condition during migraine attacks
  • Medical records showing multiple medication trials
  • Detailed personal statement describing the impact on work and daily activities
Outcome

The veteran was initially awarded a 30% rating for migraines. After submitting additional evidence, including the headache journal and employer statement, the rating was increased to 50% based on the frequency of prostrating attacks and evidence of severe economic inadaptability.

Key Takeaways
  1. The headache journal provided concrete evidence of frequency and severity
  2. The employer statement was crucial for establishing economic impact
  3. Documentation of failed treatments helped establish the severity of the condition
  4. The detailed personal statement helped the VA understand the full impact of the condition
  5. Persistence in providing additional evidence after the initial rating led to the appropriate higher rating

See Also

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