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Nexus Letters for Traumatic Brain Injury
Licensed Physician, MD | Patriot Path Medical Team
Specializing in VA neurological evaluations and independent medical opinions • Last updated: June 2026
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TBI is a signature wound of the post-9/11 wars, and one of the hardest to prove on paper. A blast, an IED, a vehicle rollover, a hard fall in training. The hit may have seemed minor at the time, and the records often say nothing. Years later the memory gaps, the headaches, and the short fuse are still there.
A nexus letter ties it together. Our physicians connect your brain injury, and the symptoms that came with it, to your service, in the language the VA expects. One flat fee of $1,500, and the first consultation is free.
How VA Rates TBI
The VA rates TBI under 38 C.F.R. § 4.124a, Diagnostic Code 8045. An exam scores how the injury affects ten areas of how your brain works, from memory to judgment to consciousness. Your single worst area sets the rating. The levels line up like this:
| Rating | What it generally takes | Monthly pay (approx) |
|---|---|---|
| 100% | A 'total' level in any one area. For example, you are not oriented to person, place, time, or situation, or you cannot communicate at all. | ~$3,939/mo |
| 70% | Your worst area is at level 3. For example, near-constant trouble with memory, judgment, or getting along with people. | ~$1,808/mo |
| 40% | Your worst area is at level 2. For example, frequent memory or attention problems that get in the way of daily tasks. | ~$796/mo |
| 10% | Your worst area is at level 1. For example, mild but real trouble with memory or focus. | ~$180/mo |
| 0% | All areas at level 0. A diagnosed TBI, but no measurable loss of function yet. Still service-connected. | $0/mo |
Two things make TBI different. First, your rating comes from your single worst area, not the total of all ten. Second, any TBI symptom that has its own diagnosis is rated under its own code and added on top, not folded into the TBI score. Migraines (DC 8100), a mental health condition like PTSD or depression (38 C.F.R. § 4.130), seizures, and hearing loss or tinnitus from the same blast are each rated separately and combined. That is why a TBI claim is often several ratings, not one. The 'mild', 'moderate', or 'severe' label from the day you were injured does not set your rating.
Pay figures are approximate 2026 rates (effective December 1, 2025) for a single veteran with no dependents. Check VA.gov for current amounts.
How the VA scores a TBI
The TBI exam, and the rating, work through ten areas of how your brain functions. Each one gets a level. Here is the short version.
- 1
Ten areas get scored
Memory and attention, judgment, social interaction, orientation, motor activity, visual-spatial sense, subjective symptoms (like headaches or dizziness), neurobehavioral effects (like irritability), communication, and consciousness.
- 2
Each area gets a level from 0 to 3, or 'total'
Level 0 means normal. Level 3 means severe. 'Total' is the worst, and it is only used for the most serious areas.
- 3
Your highest single area sets the rating
Level 0 is 0%, level 1 is 10%, level 2 is 40%, level 3 is 70%, and a 'total' in any area is 100%. The areas are not added up.
- 4
Separate diagnoses are rated on their own
If a symptom has its own diagnosis, like migraines or PTSD, it is rated under its own code and combined with the TBI rating. That usually raises your combined rating.
Get tested. A neuropsychological exam documents these areas far better than a short office visit, and the rating turns on what is in the record.
Making a VA Disability Claim for TBI
A VA disability claim for a TBI needs three things to line up:
A current diagnosis
A TBI diagnosis, ideally backed by neurology and neuropsychological testing that documents the ten areas the rating uses.
A service connection
An in-service head injury or blast exposure, even if it was written off as minor at the time.
A medical nexus
A qualified opinion that your TBI is 'at least as likely as not' connected to that in-service event.
The nexus is where TBI claims fall apart, because the original injury was so often undocumented. A blast that rang your bell on patrol rarely made it into your medical record. A nexus letter supplies the link: a written medical opinion connecting your brain injury, and the symptoms you live with, to your service. The 'at least as likely as not' standard (a 50% or better chance) comes from the benefit-of-the-doubt rule in 38 U.S.C. § 5107(b), carried out in 38 C.F.R. § 3.102.
How to Connect TBI to Service
A TBI claim is almost always a direct claim, tied to a head injury in service. The bigger payoff is usually in the conditions the brain injury caused.
Direct connection
A head injury happened in service.
- Blast exposure. An IED, RPG, mortar, or breaching blast, even with no visible wound.
- Impact injuries. A vehicle rollover, a fall, a training accident, or a sports or combatives injury.
Secondary connection
A service-connected condition led to the head injury (38 C.F.R. § 3.310). This path is less common, but real.
- A fall or blackout. A service-connected condition that caused a fall, a seizure, or a blackout that led to a head injury.
Aggravation
You had a head injury before service, and service made the residuals permanently worse.
- Worsened by service. An old head injury whose symptoms got worse after an in-service blast or impact.
Secondary Conditions
TBI rarely shows up alone. The same blast or impact, and the brain injury itself, drive a long list of other conditions. Each one is rated on its own and added to your combined rating, so this is where a TBI claim grows.
A TBI claim is usually direct, but it can be secondary to
- A service-connected fall or seizure. If a service-connected condition caused the accident that injured your head.
- Blast exposure already on file. If the same in-service blast is already tied to your tinnitus or hearing loss, that record supports the TBI too.
Conditions often secondary to a TBI
- Migraines. Post-traumatic headaches are a common TBI residual, rated under DC 8100.
- PTSD, depression, or anxiety. Mood and behavior changes after a brain injury are common, and rated under their own codes.
- Seizures. A brain injury can lead to post-traumatic epilepsy.
- Tinnitus and hearing loss. The blast that caused the TBI often damaged hearing at the same time.
What to Gather - Evidence Checklist
Gather these before you file or ask for a letter. For TBI, the testing and the proof of the in-service event do the heavy lifting.
Frequently Asked Questions
How does the VA rate a TBI?
Under 38 C.F.R. 4.124a, Diagnostic Code 8045. An exam scores ten areas of how your brain works, from memory to consciousness. Your single worst area sets the rating: level 0 is 0%, level 1 is 10%, level 2 is 40%, level 3 is 70%, and a 'total' in any area is 100%. The areas are not added together.
Can I be rated for my TBI and my migraines and PTSD?
Yes, and you usually should. Symptoms with their own diagnosis, like migraines (DC 8100) or PTSD (rated under 4.130), are rated under their own codes and combined with the TBI rating. That is why a TBI claim is often several ratings, not one.
My head injury is not in my records. Can I still claim it?
Often, yes. Many blasts and falls were never written up. Buddy statements, incident reports, deployment history, and a current diagnosis can together show the injury happened. A nexus letter ties them to your TBI.
Does the 'mild TBI' label hurt my claim?
No. 'Mild', 'moderate', and 'severe' describe the injury on the day it happened. They do not set your VA rating. The rating is based on how the injury affects you now, across those ten areas.
Do I need a nexus letter for a TBI?
Often, yes, especially when the original injury was not documented. The VA needs a medical opinion linking your current TBI to the in-service event. A nexus letter, backed by testing, is usually what decides the claim.
What does it cost, and how do we start?
Patriot Path charges $1,500 flat for a nexus letter, and the first consultation is free. Book a consultation and a clinician will tell you straight whether a letter can help your TBI claim.
The injury was real, even if the paperwork missed it.
Let our physicians prepare a TBI nexus letter that meets the VA's evidence standards and supports the benefits you earned.
Sources & Regulatory References
- VA disability compensation (VA.gov) https://www.va.gov/disability/
- 2026 VA disability compensation rates (VA.gov) https://www.va.gov/disability/compensation-rates/veteran-rates/
- 38 CFR 4.124a, Schedule of ratings, neurological conditions, including DC 8045 TBI (eCFR) https://www.ecfr.gov/current/title-38/section-4.124a
- 38 CFR 3.310, Secondary service connection (eCFR) https://www.ecfr.gov/current/title-38/section-3.310
- 38 CFR 3.303, Principles relating to service connection (eCFR) https://www.ecfr.gov/current/title-38/section-3.303
- 38 U.S.C. 5107, Benefit of the doubt (Cornell LII) https://www.law.cornell.edu/uscode/text/38/5107