C&P Exam for TBI — 10 Facets VA Uses to Rate Traumatic Brain Injury

If you're facing a TBI C&P exam, you already know the stakes are high.

The VA uses a complex 10-facet system to rate traumatic brain injury that most veterans don't understand. Miss describing symptoms in even one facet, and you could lose thousands in benefits.

In this guide, I'll show you exactly how the VA rates TBI using these 10 specific symptom areas — and how to prepare for each one.

Specifically, you'll learn:

• The 10 TBI facets the VA must evaluate (many examiners skip them)
• What symptoms to emphasize for each facet
• How the VA converts facet scores into your disability rating
• Red flags that signal an inadequate TBI exam
• Your rights during the C&P exam process

The 10 TBI Facets VA Uses for Rating

The VA rates TBI using 10 separate symptom categories called "facets" under 38 CFR 4.124a.

Each facet gets scored from 0 to 3 (or "total" for complete impairment). Your highest facet score determines your overall TBI rating.

Here's why this matters:

Many C&P examiners don't properly evaluate all 10 facets. In our analysis of 1,051 TBI cases, inadequate examination was the 4th most common reason for denial at 23.2%.

The examiner must assess every facet — even ones that seem normal. If they skip facets or use a "checklist approach" without evaluating your overall functional impairment, that's grounds for a new exam.

Let me break down each facet and what you need to know.

Facet #1: Memory, Attention & Concentration

This is the most commonly affected facet after TBI. The VA scores it like this:

• 0 points: No complaints of impairment
• 1 point: Mild memory loss, attention, or concentration issues but no objective evidence on testing
• 2 points: Objective evidence on testing of mild impairment
• 3 points: Moderately severe impairment with objective evidence
• Total: Severely impaired

The key word here is "objective evidence." The examiner should perform neurocognitive testing, not just ask if you have memory problems.

Describe these specific symptoms:

• Forgetting conversations within hours
• Getting lost in familiar places
• Word-finding problems (knowing what you want to say but can't find the words)
• Inability to follow multi-step instructions
• Losing track mid-conversation
• Missing appointments despite writing them down

Don't minimize by saying "I've learned to cope." The VA needs to know your actual functional limitations.

Facet #2: Judgment

This facet evaluates your decision-making ability:

• 0 points: Normal judgment
• 1 point: Mildly impaired
• 2 points: Moderately severely impaired
• 3 points: Severely impaired

Examples of impaired judgment after TBI:

• Making impulsive financial decisions
• Poor safety awareness (walking into traffic, not checking blind spots)
• Inability to assess social situations appropriately
• Taking unnecessary risks
• Difficulty planning ahead or considering consequences

Here's the deal:

Many veterans don't realize their judgment is impaired because it feels "normal" to them. Ask family members what decisions concern them about your behavior.

Facet #3: Social Interaction

This measures how appropriately you interact with others:

• 0 points: Always appropriate
• 1 point: Occasionally inappropriate
• 2 points: Frequently inappropriate
• 3 points: Totally or near-totally inappropriate

TBI can cause significant social problems that weren't present before your injury. Be specific about:

• Interrupting others or talking over them
• Saying things that are rude or tactless without realizing it
• Missing social cues (not recognizing when someone is upset)
• Inappropriate emotional responses (laughing at serious topics)
• Difficulty maintaining friendships or relationships
• Avoiding social situations because they're overwhelming

Facet #4: Orientation

Orientation measures awareness of person, place, time, and situation:

• 0 points: Always oriented to all 4 aspects
• 1 point: Occasionally disoriented to one aspect
• 2 points: Often disoriented to two or more aspects
• 3 points: Consistently disoriented

Even mild disorientation counts. Examples include:

• Losing track of what day it is
• Getting confused about your location when you wake up
• Difficulty following the sequence of events
• Confusion about time (thinking it's morning when it's evening)

Don't dismiss these as "normal aging." If they started or worsened after your TBI, they count.

Facet #5: Motor Activity

This evaluates physical movement and coordination:

• 0 points: Normal motor activity
• 1 point: Mildly decreased
• 2 points: Moderately decreased
• 3 points: Severely decreased

TBI can affect motor function in subtle ways:

• Balance problems or dizziness
• Hand-eye coordination issues
• Slower reaction times
• Tremors or fine motor control problems
• Fatigue affecting physical activity

But here's the kicker:

The examiner should test your coordination, not just ask about it. If they don't perform any physical tests for balance or coordination, note this as inadequate.

Facet #6: Visual-Spatial Orientation

This measures your ability to understand spatial relationships:

• 0 points: Normal
• 1 point: Mildly impaired
• 2 points: Moderately impaired
• 3 points: Severely impaired

Visual-spatial problems after TBI include:

• Difficulty judging distances (misjudging curbs, stairs)
• Problems with depth perception
• Getting lost even with GPS
• Trouble reading maps or following directions
• Difficulty parking or judging space between objects
• Problems with visual tracking (losing your place while reading)

Facet #7: Subjective Symptoms

These are symptoms you feel that others can't observe:

• 0 points: Subjective symptoms that don't interfere with work or daily activities
• 1 point: 3 or more subjective symptoms that mildly interfere
• 2 points: 3 or more that moderately interfere

Common subjective symptoms include:

• Headaches (frequency and severity)
• Light or noise sensitivity
• Dizziness or vertigo
• Tinnitus (ringing in ears)
• Fatigue
• Sleep disturbances
• Nausea
• Mood changes

Facet #8: Neurobehavioral Effects

These are observable behavioral changes:

• 0 points: 1+ neurobehavioral effects that don't interfere with activities
• 1 point: 1+ that occasionally interfere
• 2 points: 1+ that frequently interfere
• 3 points: 1+ that interfere with or preclude normal activities

Neurobehavioral effects include:

• Irritability or quick temper
• Impulsiveness
• Disinhibition (saying or doing inappropriate things)
• Emotional lability (mood swings)
• Apathy or lack of motivation
• Anxiety in social situations
• Depression

It gets better:

These behavioral changes often overlap with mental health conditions. The VA should evaluate them separately under both TBI and mental health criteria. You can receive ratings for both.

Facet #9: Communication

This measures your ability to express and understand language:

• 0 points: Able to communicate
• 1 point: Able to communicate with some difficulty
• 2 points: Unable to communicate by spoken/written word more than occasionally but can comprehend
• 3 points: Completely unable to communicate

Communication problems after TBI:

• Word-finding difficulties (tip-of-the-tongue phenomenon)
• Slurred or slow speech
• Difficulty understanding complex instructions
• Problems with reading comprehension
• Trouble following conversations in groups
• Writing difficulties

Facet #10: Consciousness

This facet is scored as either normal or "total" (100% rating):

• Normal: Alert and aware
• Total: Persistently altered state of consciousness (coma, persistent vegetative state)

Most veterans reading this won't have consciousness issues, but the examiner should still document your level of alertness and awareness.

How VA Converts Facets to Your Rating

The VA takes your highest facet score and converts it to a percentage:

For example, if you score:

• Memory: Level 2 (40%)
• Judgment: Level 1 (10%)
• Social interaction: Level 2 (40%)
• All other facets: Level 0 (0%)

Your TBI rating would be 40% because that's your highest facet score.

Now, you might be wondering:

What if multiple facets are severely affected? Unfortunately, the VA doesn't add them together. You get the highest single facet rating.

However, TBI often causes secondary conditions that can be rated separately:

• Headaches secondary to TBI
• Sleep disorders secondary to TBI
• Depression/anxiety secondary to TBI
• Tinnitus secondary to TBI

These secondary conditions can significantly increase your overall combined rating. Learn more about TBI secondary conditions for VA benefits.

How to Prepare for Your TBI C&P Exam

Your TBI C&P exam should last 60-90 minutes. Shorter exams are often inadequate for the complexity of TBI evaluation.

What to expect:

• Multi-faceted evaluation covering all 10 symptom domains
• Memory and cognitive testing
• Assessment of headaches, balance, vision, mood changes
• Review of any neuroimaging if available

What to emphasize:

• Describe cognitive difficulties: forgetting conversations, getting lost, word-finding problems
• Report ALL symptoms even if they seem minor: dizziness, light sensitivity, irritability
• Mention if symptoms have worsened over time — TBI can be progressive
• Describe impact on social and occupational functioning

What NOT to say:

• Don't say "I've learned to cope with it" — this minimizes severity
• Don't skip reporting any of the 10 facets even if you think they're mild
• Don't downplay symptoms because you're having a "good day"

Bring support:

• Ask someone who lives with you to write down symptoms they observe
• Bring a buddy or spouse to observe the exam and take notes
• Consider recording the exam (audio only) if your state allows it

Spotting an Inadequate TBI Exam

Based on our analysis of 1,051 TBI cases, here are red flags that signal an inadequate exam:

• Examiner didn't assess all 10 TBI facets
• No neurocognitive testing performed
• Exam lasted less than 45 minutes
• Examiner attributed TBI symptoms to another condition without explanation
• Examiner used a "symptom checklist approach" instead of evaluating functional impairment
• Examiner made factual errors about your service history or injury

Bottom line?

If your examiner uses phrases like "does not exhibit," "veteran denies," or "no evidence of" without proper testing, that's the "Symptom Checklist Approach" error.

Under Mauerhan v. Principi, symptoms listed in the rating criteria are not exhaustive. Your overall disability level matters more than checking boxes.

Common examiner errors in TBI cases include:

• Bare Conclusion: Examiner provides opinion without supporting reasoning (violates Nieves-Rodriguez v. Peake)
• Ignoring Lay Evidence: Dismissing your testimony about symptoms without explanation (violates Jandreau v. Nicholson)
• Insufficient Exam Time: Complex TBI evaluation in 15-20 minutes (violates Barr v. Nicholson)

Your C&P Exam Rights

You have more rights during C&P exams than most veterans realize:

• You have the right to RECORD your C&P exam (audio only in most states) — inform the examiner at the start
• You can bring a BUDDY or spouse to observe the exam and take notes
• You can request a DIFFERENT EXAMINER if you believe the examiner is biased or hostile
• You can request a copy of the exam report through your VA.gov portal after it's completed
• If the exam feels rushed or inadequate, you can request a NEW EXAM by filing a complaint
• You have the right to review your C-file (claims file) before the exam — request it via VA.gov
• You can submit a WRITTEN REBUTTAL if you disagree with the exam findings
• The examiner MUST review your entire claims file — if they admit they didn't, note this as inadequate
• You can request the exam be rescheduled if you're having a particularly GOOD day and it won't reflect your typical symptoms
• Under 38 CFR § 3.327, you can request a new exam if your condition has WORSENED since the last exam

Want to know the best part?

Most veterans don't exercise these rights. Using them shows you're informed and helps ensure a more thorough examination.

For more details on common exam errors across all conditions, check out our guide on 10 VA C&P exam errors that cost veterans higher ratings.

Your Next Steps After the Exam

After your TBI C&P exam, here's what to do:

Immediately after:

• Write down everything you remember about the exam while it's fresh
• Note any red flags or concerns about the examiner's approach
• Submit any additional evidence you forgot to mention

Within 30 days:

• Request a copy of the exam report through VA.gov
• Review the report for factual errors or missing information
• Submit a written rebuttal if needed
• Consider filing for secondary conditions related to your TBI

If you're denied:

• Analyze the denial reason against our database of 1,051 TBI cases
• File a Higher-Level Review if it's an examiner error
• File a Supplemental Claim if you have new evidence
• Consider getting an independent medical opinion

Remember, TBI cases have a 48.5% remand rate in appeals, meaning the Board often sends cases back to fix errors. Getting it right the first time saves months or years.

Now I'd like to hear from you — which of these 10 facets affects you most, and are you prepared to describe it at your exam?