Traumatic Brain Injury: A Guide for Caregivers

of Service Members and Veterans

Caregiver’s 

Companion
	 	

“I would just say that this experience has shown all of us 

that there’s hope at every turn. We have found that through 

the doctors, through case managers, and through our family 

and friends who have supported us. We found it in the small 

changes in Tim’s abilities.

There has always been that sense of hope, and even at the 

bleakest moment, there was always something that you could 

look back on or look forward to that could give you that hope. 

I wish that every caregiver could see that and hope that they 

do. I think most of them do. I think most caregivers are just 

amazingly resilient people themselves, and they thrive off the 

strength of their wounded warrior.”

	 	 	 	 	 	 	 - Shannon M.

ii
Caregiver’s Companion i

Introduction

Glossary of Medical Terms

U.S. Military Ranks

Military Terms

Diagrams of the Brain

Contact Information of the Health Care Team Members

Medication Log

Caregiver Support Worksheet

Home Care Team Volunteer Form

An electronic version of this Guide can be found at the following Web address: 

www.traumaticbraininjuryatoz.org

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Table of Contents

This Caregiver’s Companion to Traumatic Brain Injury: A Guide for 

Caregivers of Service Members and Veterans has information and forms that

can help you in your caregiving journey. Use this binder to keep yourse

organized. You may want to carry it with you to keep track of importa

information. You may need to start a new binder as this one gets ful

The Companion includes:

•	A glossary of terms that you’re likely to come across time and time again

•	A table of military ranks to help you understand the ranks of the

service members and officers that you may meet

•	A list of acronyms (e.g., DoD for the Department of Defense) to make

sense of the alphabet soup within government agencies

•	Blank diagrams of the brain that you can use when talking to your

health care provider about where the injury occured

•	Master forms to use for writing down key information. The mast

forms in the Companion are meant to be duplicated. Make sever

copies of each to use over time or download the forms from

www.traumaticbraininjuryatoz.org.

The master forms inc

-	contact information for members of the health care team

-	medication log to keep track of medications, dosage, timing, and

side effects

-	home care team volunteer form to keep track of those who

volunteer to help

-	caregiver support worksheet, to help you list the members of your

home care team - the people who can help you take care of all the

responsibilities you may not have time for.

•	Plastic sleeves to keep business cards of medical professionals and

others you want to be able to contact later for more information

•	Plastic sleeves for compact disks (CDs) of medical scans and tests you

will want to keep. You may need to purchase more plastic sleeve

May your caregiving journey be one that brings you hope, love, pride,

and peace.

Introduction

Caregiver’s Companion 1
	 	

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Absence Seizures – A non-convulsive generalized seizure when a person

may appear to be staring into space with or without jerking or twitching

movements of the eye muscles. These seizures may last for second

or even tens of seconds, with full recovery of consciousness and no

confusion. People experiencing absence seizures sometimes move fr

one location to another without any purpose.

Abstract Thinking – Being able to apply abstract concepts to new

situations and surroundings.

Acceleration – To increase speed and/or change velocity.

Amnesia – A loss of memory. Amnesia can be caused by brain injur

shock, fatigue, repression, illness, and sometimes anesthesia.

Angiogram – A procedure in which a dye is injected through a thin tube

into a blood vessel. Special x-ray pictures are taken, allowing your heal

care provider to view the blood vessels of the brain, heart, or other part

of the body. Also called an arteriogram for arteries or venogram for vein

Anorexia – A loss of appetite, especially when prolonged over time.

Anosmia – The decrease or loss of the sense of smell.

Anoxia – Absence of oxygen supply to an organ.

Anoxic Brain Injury – Injury to the brain due to severe lack of oxygen.

This usually happens when blood is unable to flow to the brain due to

certain injuries, bleeding, or cardiac arrest.

Apraxia – The loss or impairment of the ability to perform complex

coordinated movements despite having the desire and the physical

ability to perform the movements.

Arthralgia – Joint pain or stiffness in a joint.

Ataxia – The inability to coordinate the movement of muscles.

Ataxia may affect the fingers, hands, arms, legs, body, speech, or eye

movements.

Axons – Also known as nerve fibers, an axon is a long, slender projection

of a nerve cell, or neuron, that conducts electrical impulses away from the

neuron’s cell body or soma. Axons are the primary transmission lines 

the nervous system.

Basal Ganglia – The deep brain structures that help start and control

voluntary movements and postures.

Blast Injuries – Injuries that result from the complex pressure wave

generated by an explosion. The explosion causes an instantaneous rise 

Glossary of Medical and TBI Terms

Glossary of Medical and TBI Terms
Caregiver’s Companion 3

pressure over atmospheric pressure that creates a blast over pressurization

wave. Injuries to organs surrounded by fluid, such as the brain, and airfilled organs, such as the ear, lung, and gastrointestinal tract are commo

Brain – The main organ of the central nervous system (CNS). It is divided

into the cerebrum, brainstem, and cerebellum. The brain regulat

virtually all human activity.

Brainstem – The lower extension of the brain where it connects to the

spinal cord. Neurological functions located in the brainstem include those

necessary for survival (breathing, heart rate) and for arousal (being awake

and alert).

Cerebellum – The portion of the brain (located in the back) that helps

coordinate movement.

Cerebral Hypoxia – Inadequate oxygen supply to brain tissue. Mild

or moderate cerebral hypoxia is sometimes known as diffuse cerebral

hypoxia. It can cause confusion and fainting, but its effects are usual

reversible.

Cerebrospinal Fluid (CSF) – A colorless fluid that is found around and

inside the brain and spinal cord, offering some protection and cushioning

the brain.

Cerebrum – The largest part of the brain. It is divided into two

hemispheres, or halves. It controls motor, sensory, and higher ment

functions, such as thought, reason, emotion, and memory.

Chronic Subdural Hematoma – An “old” collection of blood and

blood breakdown products between the surface of the brain and its

outermost covering (the dura).

Closed Head Injury – Injury to structures within the skull or the brain that

do not result in an opening in the skull, such as a direct blow to the head

or a blast. Injuries may range from a mild concussion to potentially fata

Coma – A state of unconsciousness in which the person is not aware of

the environment nor able to perform voluntary actions.

Computed Tomography (formerly known as Computerized 

Axial Tomography) – A painless procedure in which x-rays are passed

through the affected area at different angles, detected by a scanner,

and analyzed by a computer. CT scan images show bones and blo

collections more clearly than conventional x-rays. The computer c

combine individual images to produce a three-dimensional view.
	 	

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Concussion – involves a disruption of brain function caused by

trauma. This disruption is characterized by, but not limited to, a loss 

consciousness for less than thirty minutes, post-traumatic amnesia lasting

for less than 24 hours, and a Glasgow Coma Scale of 13-15. Also referr

to as a mild traumatic brain injury.

Consciousness – The state of awareness of the self and the environment.

Contusion – A bruise. In terms of brain injury, a contusion refers to

bruising of the brain tissues.

Coup-Contrecoup – An injury to the brain that occurs when an impact

or violent motion brings the head to a sudden stop, causing injury to the

impact site and the opposite side of the brain. This is also known as 

acceleration/deceleration injury.

Cranium – Skull.

Deceleration – To reduce speed or go more slowly.

Diffuse – Widely spread.

Diffuse Axonal Injury, or DAI – Widespread injury of large nerve fibers

(axons covered with myelin).

Diffuse Brain Injury – Injury to cells in many areas of the brain rather

than in one specific location.

Diplopia – Seeing two images of a single object; double vision.

Dura Mater – The outermost of three membranes protecting the brain

and spinal cord. It is tough and leather-like.

Dysarthria – Difficulty in forming words or speaking them because

of weakness of the muscles used in speaking. Tongue movements a

usually labored and the rate of speaking may be very slow. Voice quali

may be abnormal, usually excessively nasal; volume may be weak;

drooling may occur.

Dyskinesia – Involuntary movements most often seen in the arms or legs.

Electroencephalograph, or EEG – A test that measures electrical

activity of the brain that is recorded from electrodes placed on the scalp.

Epidural Hematoma – Bleeding into the area between the skull and the

dura mater.

Euphoria – An exaggerated or abnormal sense of well-being not based

on reality.

Glossary of Medical and TBI Terms
Caregiver’s Companion 5

Executive Functions – The ability to formulate and carry out plans

effectively. These functions are essential for independent, creative, a

socially constructive behavior.

Expressive Aphasia – Also known as Broca’s aphasia. A difficulty 

expressing oneself in speech and writing. Characterized by knowi

what one wants to say but being unable to find the words to say what

is being thought. There is lack of spontaneous speech, words are oft

labored over, and sentences are short and incomplete.

Focal Brain Injury – Damage confined to a small area of the brain. T

focal damage is most often at the point where the head hits an object or

where an object, such as a bullet, enters the brain.

Frontal Lobe – The front part of the brain; involved in planning,

organizing, problem solving, selective attention, personality, and a variety

of “higher cognitive functions.”

Generalized Tonic-Clonic Seizures – A seizure involving the entire

body. It is also called a grand mal seizure. Such seizures usually inv

muscle rigidity, violent muscle contractions, and loss of consciousness.

Glasgow Coma Scale – A scale used for measuring level of consciousness.

Scoring is determined by three factors: eye opening ability, verbal

responsiveness, and motor responsiveness. The scores range from lowe

level of responsiveness (a 3) to highest level of responsiveness (a 15).

Hematoma – A collection of blood caused by the rupture or tearing of 	 	

blood vessels.

Herniation/Herniated – Compression of brain tissue caused by high

pressure inside the skull that can lead to death if not aggressively treated.

Hypertension – The medical term for high blood pressure.

Hypotension – The medical term for low blood pressure.

Hypoxia – Decreased oxygen levels in an organ, such as the brain.

Impaired Initiation – The diminished ability to take the first step in

beginning an action.

Improvised Explosive Devices, or IEDs – An IED can be almost

anything with any type of material and initiator. It is a “homemad

device that is designed to cause death or injury by using explosives alone

or in combination with toxic chemicals, biological toxins, or radiological

material. IEDs can be produced in varying sizes, functioning method
	 	

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containers, and delivery methods. IEDs can utilize commercial or milita

explosives, homemade explosives, or military ordinance and ordinance

components.

Intracerebral Hemorrhage – A subtype of intracranial hemorrhage

that occurs within the brain tissue itself. Intracerebral hemorrha

can be caused by brain trauma, or it can occur spontaneously in

hemorrhagic stroke.

Intracranial Pressure, or ICP – The amount of pressure inside the skull

resulting from the brain tissue, cerebrospinal fluid, and blood volume.

This pressure normally ranges from 0-10 mm Hg.

Intracranial Pressure (ICP) Monitor – A monitoring device used to

determine the pressure within the brain. It is used to assess potenti

complications resulting from increased pressure exerted on the brain.

Limbic System – A group of structures deep within the brain that are

associated with emotion and motivation.

Lobe – A part of the brain located in each of the two hemispheres. Ea

hemisphere of the cerebrum is divided into four sections known as the

frontal lobe, the parietal lobe, the occipital lobe, and the temporal lobe.

Magnetic Resonance Imaging, or MRI – A test that uses a powerful

magnet linked to a computer to make detailed pictures of soft tissues

inside the body.

Meninges –The covering of the brain that consists of three layers:

the dura mater, the arachnoid mater, and the pia mater. The prima

function of the meninges and of the cerebrospinal fluid is to protect the

central nervous system.

Mild Traumatic Brain Injury, or mTBI – Also referred to as a

concussion, mTBI involves a disruption of brain function caused by

trauma. This disruption is characterized by, but not limited to, a loss 

consciousness for less than thirty minutes, post-traumatic amnesia lasting

for less than 24 hours, and a Glasgow Coma Scale of 13-15.

Military Acute Concussion Evaluation, or MACE – A standardized

mental status exam that is used to evaluate concussion in theater. Th

screening tool was developed to evaluate a person with a suspected

concussion.

Myalgia – Pain in one or more muscles.

Neurocognitive – Of, relating to, or involving the brain and the ability

to think, remember, or process thoughts.

Glossary of Medical and TBI Terms
Caregiver’s Companion 7

Neuron – A nerve cell that can receive and send information by way of

connections with other nerve cells.

Neuropsychology – A science that combines the study of the brain’s

structures and functions with psychological processes and human

behaviors.

Neuroradiological Tests – Tests using computer-assisted brain scans.

These tests allow providers to visualize the brain. Tests may include: 

Scan, MRI, Angiogram, EEG, SPECT Scan, PET Scan, DTI Scan.

Neurotransmitters – Chemicals found within the brain that are

released from a neuron which transmit signals from neuron to neuron

across gaps called synapses. These chemicals either excite or inhib

specific reactions; e.g., in motor neurons, the neurotransmitter causes

contraction of muscles through stimulation of muscle fibers.

Nystagmus – Involuntary, usually rapid movement of the eyeballs 	 	

(side to side or up and down).

Occipital Lobe – The occipital lobe is found at the back of the brain.

This lobe receives signals from the eyes, processes those signals, allows

people to understand what they are seeing, and influences how people

process colors 	and shapes.

Ocular – Relating to the eye.

Open Head Injury – Trauma to the brain that occurs from a skull

fracture or penetrating injury.

Parietal Lobe – The part of the brain that is involved with movement,

and with the processing of signals received from other areas of the brain

such as vision, hearing, motor, sensory, and memory.

Penetrating Head Injury – A brain injury in which an object pierces

the skull and enters the brain tissue.

Perseveration – The repeated and uncontrollable use of the same words

or actions regardless of the situation.

Photophobia – An intolerance to light or a painful sensitivity to

strong light.

Positron Emission Tomography, or PET Scan – A specialized

imaging technique that uses an injection of a short-lived radioactive

substance and special CT scans. PET scanning provides informati

about the body’s chemistry not available through other procedures.

Unlike other imaging techniques that look at structures of the brain, PET

looks at the energy use of different parts of the brain.
	 	

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Post-Deployment Health Assessment, or PDHA – The military’s

global health screening that occurs when a unit or service member

returns from an overseas deployment. The purpose of this screeni

is to review each service member’s current health, mental health, or

psychosocial issues commonly associated with deployments, special

medications taken during the deployment, possible deployment-related

occupational/environmental exposures, and to discuss deploymentrelated health concerns.

Post-Deployment Health Reassessment, or PDHRA – A second

assessment used 3-6 months following re-deployment or return of service

members from overseas deployment. PDHRA extends the continu

of care for deployment-related heath concerns and provides education,

screening, assessment, and access to care.

Post-Traumatic Amnesia (PTA) – The inability to acquire new

memories. For example, a person with TBI may not be able to rememb

what he or she had for breakfast. Long-term memories, such as tho

from childhood, are not affected. PTA may range from a period of just

few minutes to a more permanent condition.

Post-Traumatic Stress (PTS) – Anxiety that can develop if you are

exposed to or witness a traumatic event (like combat) that threatened or

caused great physical harm to self or others.

Rancho Los Amigos Level of Cognitive Functioning – A scale used

to follow the recovery of the TBI survivor and to determine when he or

she is ready to begin a structured rehabilitation program.

Receptive Aphasia – Also known as Wernicke’s aphasia; characterized

by difficulty understanding spoken words. Aphasic individuals ha

difficulty interpreting and categorizing sounds, and speak in what

is referred to as a “word salad” with random words put together

unintelligibly to form sentences.

Seizure – Uncontrolled electrical activity in the brain, which may

produce a physical convulsion, minor physical signs, thought

disturbances, or a combination of symptoms. Seizures fall into two ma

groups. Focal seizures, also called partial seizures, happen in just o

part of the brain. Generalized seizures are a result of abnormal activi

throughout the brain.

Glossary of Medical and TBI Terms
Caregiver’s Companion 9

Single-photon Emission Computed Tomography, or SPECT Scan

– Test that uses the injection of a weak radioactive substance into a vein,

followed by pictures taken with special cameras. This test is similar to

PET scan and provides information on the energy being used by the brain.

Skull Fracture – A break, split, or crack in the skull.

Subdural Hematoma – Bleeding confined to the area between the

outermost covering of the brain (dura) and the brain.

Temporal Lobe – The temporal lobe is located at about ear level, and

is the main memory center of the brain, contributing to both longterm and short-term memories. The temporal lobe is also involved wi

understanding what is heard and with the ability to speak. An area on t

right side is involved in visual memory and helps people recognize objects

and faces. An area on the left side is involved in verbal memory a

helps people remember and understand language. The back area of t

temporal lobe helps people interpret the emotions and reactions of others.

Thalamus – A part of the brain that is primarily responsible for relaying

sensory information from other parts of the brain to the cerebral cortex.

Tinnitus – “Ringing in the ears” or another noise that seems to originate

in the ears or head.

Traumatic Brain Injury, or TBI – An injury to the brain as the result of

trauma to the head.

Whiplash – An injury to the neck caused when the head is violently

thrown back and forth, such as in a rear end car collision.
	 	

Navy and 

Coast Guard Army Air Force Marines Pay

Scale

Enlisted Personnel

Master Chief Petty

Officer of the Navy

Command Master

Chief Petty Officer

Master Chief Petty

Officer

Senior Chief Petty

Officer

Chief Petty Officer

Petty Officer First Class

Sergeant Major of

the Marine Corps

Sergeant Major

Master Gunnery

Sergeant

First Sergeant

Master Sergeant

Gunnery Sergeant

Staff Sergeant

Chief Master Sergeant

of the Air Force

First Sergeant (Chief

Master Sergeant)

Chief Master

Sergeant

First Sergeant (Senior

Master Sergeant)

Senior Master

Sergeant

First Sergeant

(Master Sergeant)

Master Sergeant

Technical Sergeant

Sergeant Major of

the Army

Command Sergeant

Major

Sergeant Major

First Sergeant

Master Sergeant

Sergeant First Class

Staff Sergeant

Special

E-9

E-9

E-8

E-7

E-6

U.S. Military Ranks 

10 U.S. Military Ranks
Caregiver’s Companion

Corporal

Specialist

Private First Class

Private

Private (Recruit)

Senior Airman

Airman First Class

Airman

Airman Basic

Corporal

Lance Corporal

Private First Class

Private

Petty Officer

Third Class

Seaman

Seaman Apprentice

Seaman Recruit

E-4

E-3

E-2

E-1

Sergeant Staff Sergeant Sergeant Petty Officer

Second Class

E-5

Navy and 

Coast Guard Army Air Force Marines Pay

Scale

Enlisted Personnel

Blank indicates there is no rank at that pay grade.

** Ranks used infrequently, during wartime.

Commissioned Officers

General of the Army

General

General of the

Air Force

General General

Fleet Admiral

Admiral

Special**

O-10

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Vice Admiral

Rear Admiral

(Upper Half)

Rear Admiral

(Lower Half)

Captain

Commander

Lieutenant

Commander

Lieutenant

Lieutenant,

Junior Grade

Ensign

Lieutenant General

Major General

Brigadier General

Colonel

Lieutenant Colonel

Major

Captain

1st Lieutenant

2nd Lieutenant

Lieutenant General

Major General

Brigadier General

Colonel

Lieutenant Colonel

Major

Captain

1st Lieutenant

2nd Lieutenant

Lieutenant General

Major General

Brigadier General

Colonel

Lieutenant Colonel

Major

Captain

1st Lieutenant

2nd Lieutenant

Navy and 

Coast Guard Army Air Force Marines Pay

Scale

Commissioned Officers

O-9

O-8

O-7

O-6

O-5

O-4

O-3

O-2

O-1

U.S. Military Ranks 

12 U.S. Military Ranks
Caregiver’s Companion

Chief Warrant

Officer 5

Chief Warrant

Officer 4

Chief Warrant

Officer 3

Chief Warrant

Officer 2

Warrant Officer 1

Chief Warrant

Officer 5

Chief Warrant

Officer 4

Chief Warrant

Officer 3

Chief Warrant

Officer 2

Warrant Officer 1

Chief Warrant

Officer 5

Chief Warrant

Officer 4

Chief Warrant

Officer 3

Chief Warrant

Officer 2

Warrant Officer 1

Navy and 

Coast Guard Army Air Force Marines Pay

Scale

W-5

W-4

W-3

W-2

W-1

Warrant Officers

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Here are terms that you may hear when you are on a military base or

military hospital.

Terms related to injuries and treatment:

• BI – Battlefield Injury

• CASEVAC – Casualty Evacuation

• MTF – Medical Treatment Facility; for example:

- NNMC – National Naval Medical Center, commonly called “Bethesda”

- NMCSD – Naval Medical Center San Diego, commonly called “Balboa”

- BAMC – Brooke Army Medical Center

- WRAMC – Walter Reed Army Medical Center

• OT – Occupational Therapy

• PT – Physical Therapy

• PTSD – Post-Traumatic Stress Disorder

• SCI – Spinal Cord Injury

• TBI – Traumatic Brain Injury

• VSI, SI, SPECAT – Very Seriously Injured, Seriously Injured, 	 	

Special Category

• WII – Wounded, Ill, and Injured

Terms related to Medical Review Boards:

• COAD – Continuation on Active Duty

• COAR – Continuation on Active Reserve

• DES – Disability Evaluation System

• EPTE – Existed Prior to Entry

• HAO – Home Awaiting Orders

• MEB – Medical Evaluation Board

• MMRB – MOS Medical Retention Board

• MOS – Medical Occupational Specialty

• PEB – Physical Evaluation Board

• PDRL – Permanent Disability Retirement List

• PLD – Permanent Limited Duty

• TDRL – Temporary Disability Retirement List

• VASRD – Veterans Affairs Schedule for Rating Disabilities

Military Terms

14 Military Terms
Caregiver’s Companion

Other terms:

• AW2 – U.S. Army Wounded Warrior Program, formerly called DS3

• BAH – Basic Allowance for Housing

• BAS – Basic Allowance for Subsistance

• CACO – Casualty Assistance Call Officer

• CONUS – Continental U.S. (OCONUS is Outside the Continental U.S.)

• DoD – Department of Defense

• FMLA – Family and Medical Leave Act

• IED – Improvised Explosive Device

• ITOs – Invitational Travel Orders

• M4L – Marine For Life

• MLO – Marine Liaison Office

• NMA – Non-Medical Attendant

• OEF – Operation Enduring Freedom

• OIF – Operation Iraqi Freedom

• PNOK – Primary Next of Kin

• SSN – Social Security Number

• TSGLI – Traumatic Servicemembers’ Group Life Insurance

• VA – Department of Veterans Affairs 	 	 	 	

(formerly called Veterans Administration)

• VBA – Veterans Benefits Administration

• VSO – Veteran Service Officer

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Diagrams of the Brain

These drawings of the brain may be used by the health care team to

show you the area of injury in your service member/veteran.

Diagrams of the Brain
Caregiver’s Companion 17
	 	

Forms

Contact Information of the Health Care Team Members

PROFESSIONAL - NAME CONTACT INFORMATION

Audiologist

Cardiologist

Case Manager(s)

Chaplain Services

MEB/PEB Case Manager

Neurologist

Neuropsychologist

Neurosurgery Specialist

Nurse

Occupational Therapist (OT)

Ophthalmologist

Optometrist

Department of Defense Military

Liaison

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Caregiver’s Companion

Orthopedic Specialist

Physical Therapist (PT)

Plastic Surgeon

Primary Care Provider

Recreational Therapist

Registered Dietitian

Rehabilitation Nurse

Rehabilitation Psychologist

Speech/Language Pathologist

Social Worker

Urologist

Physiatrist (Physical Medicine and

Rehabilitation Specialist)

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PROFESSIONAL - NAME CONTACT INFORMATION

Contact Information of the Health Care Team Members
	 	

20 Forms

Contact Information of the Health Care Team Members

PROFESSIONAL - NAME CONTACT INFORMATION
Caregiver’s Companion 21

Medication Log

Allergies:

Pharmacy Phone #:

Name:

Name/dose

Date

Purpose Prescribed

by

Times

Taken daily

Comments/Side Effects

Methylphenidate 7 12 noon Stimulant Dr. K Loss of Appettite

Medication
	 	

22 Forms

Medication Log

Allergies:

Pharmacy Phone #:

Name:

Name/dose

Date

Purpose Prescribed

by

Times

Taken daily

Comments/Side Effects

Methylphenidate 7 12 noon Stimulant Dr. K Loss of Appettite

Medication
Caregiver’s Companion 23

Caregiver Support Worksheet

Caregiving Task Who Can Help Contact Information

Everyday Tasks:

Meal Planning

Lawn Care

Grocery Shopping

Meal Preparation

Light Housekeeping

Transportation for:

Other Family Mem

Shopping & Err

Child Care

Pet Care

Care Tasks:

Coordinating Home Care Team

In-home Supervision/Companionship

Transportation for:

Medical Appointm

Support Group/Counse

Care Team Meetings/Dinner

Personal Hygiene:

Ba

Other, e.g. hair, nails,

Hands-on Medical Treatments/Exercise/Therapy

Scheduling Medical Appointments

Managing Medications
	 	

Forms

Recreation Activities

For the Service Member/Veteran

For the Family Caregiver

For Other Family Members

Finances/Legal

Banking

Paying Bills

Managing Military/VA Benefits

Managing Insurance Claims

Handling Legal Matters

Finding Community Services

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Caregiver Support Worksheet

Caregiving Task Who Can Help Contact Information
Caregiver’s Companion 25

Home Care Team Volunteer Form

Name Contact Information What he or she would like to do
	 	

26
Caregiver’s Companion
www.DVBIC.org

Version: 1-2010 | www.traumaticbraininjuryatoz.org

This guide was produced in collaboration with

The Defense Health Board

The Defense and Veterans Brain Injury Center

and

The Department of Veterans Affairs
Traumatic Brain Injury: A Guide for Caregivers

of Service Members and Veterans

Module 1

Introduction to Traumatic 

Brain Injury (TBI)
	 	
Introduction to Traumatic Brain Injury

Table of Contents

i

Module 1 Summary

Chapter 1: The Basics of TBI

Chapter 2: Learning about the Bra

What are the Parts of the Brain? How Do They Wor

What is the Anatomy of the Brain?

Chapter 3: Causes and Types of T

What Types of TBI are There?

What Injuries Co-Occur with TBI?

Chapter 4: Diagnosis and Treatment of T

How is a Traumatic Brain Injury Diagnosed?

How are Traumatic Brain Injuries Medically Treated?

Chapter 5: Potential Complications Following T

Are There Common Complications Following Severe TBI?

Chapter 6: Recovery Proce

What are the Stages of Recovery?

Appendix A: Glasgow Coma Sca

Appendix B: Rancho Los Amigos Leve

References/Credits

An electronic version of this Guide can be found at the following Web address: 

www.traumaticbraininjuryatoz.org

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Introduction to Traumatic Brain Injury

In this section, you can find basic information about:

• the parts of the brain and what they do

• the causes of traumatic brain injury (TBI)

• how the brain changes after TBI

• how the brain begins to recover.

You can use this information to understand:

• how the brain works

• what you might see during recovery

• why you might see changes in how your service member/veteran

thinks and acts due to a TBI.

TBIs are classified by how severe or serious they are at the time of injury.

TBIs range from mild (concussion) to moderate to severe.

This module provides information on moderate to severe TBI. Doctor

nurses, and other health care providers who work with TBI guided

the content.

As you read through this document, ask your health care providers to

explain what you don’t understand.

Some key points are:

• The brain is the body’s control center.

• The parts of the brain work together to help us think, feel, move, and talk.

• A TBI is caused by a penetrating injury or by blunt force trauma to

the head.

• TBI is very common in both civilian and military populations.

• Many different health care providers will help diagnose and treat your

service member/veteran with TBI.

• It is the goal of health care providers to minimize complications, the

things that can go wrong after the injury.

• Many service members/veterans with TBI go through common stages

of recovery. Each person, however, progresses at his or her own pac

• Recovery from a TBI may be measured in weeks, months, or years.

• Promising new research is showing the brain’s capacity for healing.

• There are many ways you can support your service member/veteran

with TBI throughout his or her recovery.

Be hopeful. The brain is very good at repairing itsel

Module 1 Summary

iii
What is a TBI?

 A traumatic brain injury (TBI) is:

• A direct blow or jolt to the head

• A penetrating head injury, or

• Exposure to external forces such as blast waves

that disrupt the function of the brain.

Not all blows to the head or exposure to external 

forces result in a TBI. The severity of TBI may range 

from “mild”— a brief change in mental status or 

consciousness—to “severe,” an extended period of 

unconsciousness or confusion after the injury. 

Source: DVBIC (2007). Fact Sheet.
Introduction to Traumatic Brain Injury

What is a Traumatic Brain Injury?

A traumatic brain injury (TBI) happens when something outside the body

hits the head with a lot of force. This could happen when a head hi

a windshield during a car accident. It could happen when a piece 

shrapnel enters the brain. Or it could happen during an explosion of 

IED (improvised explosive device). There are many causes of traumat

brain injury (TBI).

How Long Does It Take to Recover from a TBI?

No two brain injuries are exactly alike. Some people who have a T

recover quickly, others take much longer. Some will have very few longterm effects. Others will face lifelong challenges. The effects va

person to person.

Recovery from a TBI may be measured in weeks, months, or years.

What Happens Right After the Injury?

In the days and weeks right after the injury, the tissue in the brain may swell

or bleed. There may also be changes in the brain’s neurochemistry syste

Sometimes there is so much blood that doctors have to remove it during

surgery. This surgery reduces swelling and pressure within the brain.

helps the brain’s blood flow and neurochemistry system to recover. Th

usually helps the brain to work better.

1

The Basics of TBI

An IED is an 

improvised 

explosive device. 

They are also 

called roadside 

bombs. They are 

placed on the side 

of the road and 

explode when 

someone drives 

by. IEDS are a 

leading cause of 

TBI in Iraq and 

Afghanistan.

“Neuro” means 

the body’s nervous 

system.

Chapter 1

“He actually ended up being in a coma for about three months 

after the brain injury.”

	 	 	 	 	 	 	 - Pam E.

“He really won’t tell me the whole story because I think he 

doesn’t want to scare me. But, he brought me a piece of metal 

back home that was embedded in the wall right behind him. 

He said it missed his head by a few inches. He said that he 

thanks God every day that he’s still alive, and that’s why he 

brought the piece of metal home, to show me that that’s how

close he had come to dying.”

	 	 	 	 	 	 	 - Lynn C-S.
	 	

How Does the Brain Recover Over Time?

No one completely knows what happens in the brain during long-term

recovery from a TBI:

•	Some researchers think that the healthy brain tissue learns over time

how to do what the damaged brain cells used to do.

•	Others think that connections between brain cells rearrange

themselves or become more efficient.

The brain can repair itself more than people used to think was possible.

Different things influence a person’s ability to recover. They includ

•	His or her age (younger brains often recover faster)

•	How severe the TBI is

•	Where the TBI is located.

Recovery, however, is a very individual process.

What Else Affects Recovery?

Often, a person with a severe brain injury also has serious injuries in

other parts of the body. These injuries can cause bleeding, swellin

and damage to internal organs, blood vessels, bones, limbs, the sensory

system, and nerves.

For example, think about a service member/veteran who was close to

a blast from an IED. He or she may have a couple of fractures, lo

an arm or leg, or lost some hearing. He or she may also have intern

injuries. All of these injuries together can make recovery take longe

They may even cause more damage to the brain. Prompt treatment 

these other injuries will help limit damage to the brain.

What Kind of Treatment Will My Service Member/

Veteran Receive?

Depending on the nature of the brain injury and other injuries, some

service members/veterans may need only regular follow-up appointments

with their doctor.

Others may receive therapy, tests, and monitoring on an outpatient basis.

Others may begin treatment in an intensive care unit or general hospital.

They may transfer later to a rehabilitation unit. They may also ne

outpatient therapy for a long time.

How much and what rehabilitation therapy your service member/

veteran needs depends on many things.

Chapter 1 - The Basics of TBI

Outpatient means 

living elsewhere 

and going to the 

doctor’s office or 

hospital for care.

A fracture is a 

broken bone.

2

Rehabilitation 

means re-learning 

skills needed for 

everyday life.
Introduction to Traumatic Brain Injury

No matter where your service member/veteran receives care, he or she is

being treated with the most up-to-date methods based on what doctors

know about the recovery process.

How Common is TBI?

TBI is the leading injury among U.S. forces serving in Afghanistan (Operation

Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]).

The frequent use of IEDs in these wars increases the chance that service

members will be exposed to blasts and other injuries that can cause a TBI.

Among service members evacuated from OEF/OIF to Walter Reed Army

Medical Center in 2003-2007 because of injuries, 30 percent had a TBI.

In 2008, the Department of Defense (DoD) reported that:

•	Seven out of 10 TBI injuries were due to a blast

•	More than 1 in 10 were due to a fall

•	More than 1 in 20 were due to a vehicular incident

•	One in 20 were due to fragments

•	The rest were due to other causes.

The Army reported that 88 percent of TBIs among soldiers were mild.

Six percent were moderate and another six percent were severe.

How Are TBIs Rated?

Traumatic brain injuries (TBIs) range from mild to severe. Injuries a

rated on the basis of their severity at the time of the injury.

How severe the TBI is when the injury first happens does not always

predict how bad the later symptoms are. In other words, those who we

severely hurt sometimes make very good recoveries. Others who seem 

have mild injuries can experience symptoms for months to years.

It’s impossible to accurately predict at the time of the injury who will

recover rapidly and who will go on to experience symptoms. That’s w

the military tries to screen and diagnose anyone even remotely suspected

of TBI. That way, they can receive the care and help they nee

Mild TBI (Concussion)

Most injuries to the brain sustained in Iraq and Afghanistan are mild.

Another term for mild TBI (mTBI) is concussion.

3

mTBI stands 

for mild TBI, 

also called a 

concussion.
	 	

A TBI is rated as mild when the service member/veteran:

•	Has brief or no loss of consciousness

•	Is momentarily dazed or has confusion lasting an hour or less, and

•	Has an initial Glasgow Coma Scale (GCS) score of 13-15.

In most cases of mTBI:

•	The service member/veteran will complain of having	 	 	

“his or her bell rung”

•	Thinking may be slow

•	Memory and concentration may be affected

•	Headaches, dizziness, and fatigue (tiredness) are common.

Most service member/veterans will feel much better and be back to

normal within a couple of weeks to months.

Others with more complex mTBI may experience symptoms for several

months or even longer.

Moderate to Severe TBI

A TBI is rated as moderate to severe when the service member/veteran:

•	Has loss of consciousness for more than 30 minutes

•	Confusion lasting for hours, days, or weeks

•	A Glasgow Coma Scale (GCS) score ranging from 3-12.

Computed Tomography (formerly known as Computerized Axial

Tomography [CAT]) scans of the brain often reveal bruising or bleeding

inside and/or outside of the brain.

The service member/veteran with this level of injury often spends weeks

to months in hospital and rehabilitation settings.

Chapter 1 - The Basics of TBI

Glasgow Coma 

Scale is used to 

rate someone’s 

symptoms after 

a head injury. 

You can find the 

Glasgow Coma 

Scale in 

Appendix A.

In Computed 

Tomography (CT), 

a computer creates 

cross-sectional 

images of the 

inside of the body, 

based on x-ray 

pictures.

4
Introduction to Traumatic Brain Injury

Learning about the Brain

The more you understand about the brain, the easier it is to understand

how TBI affects your service member/veteran.

Chapter 2

“Basically, they walked me through the process every 

day, because I had a lot of questions. I asked a lot of the 

same questions, and they were patient with me. I was very 

overwhelmed.

So I asked a lot of questions. They kept explaining to me 

that this is what happened, that they can fix it but that it’s a 

long process. The doctors themselves were the best source of 

information.”

	 	 	 	 	 	 	 - Emily S.

What Are the Parts of the Brain?

How Do They Work?

The brain is the body’s control center. The brain has billions of ner

cells. The cells are arranged in sections that work together to control a

of our movements, breathing, thoughts, behaviors, and emotions.

The brain is constantly sending and receiving signals from all parts of the

body. The body uses these signals to think, move, talk, and see. 

brain controls our personalities, the way we behave, and the way we

understand the world around us.

Each part of the brain has a specific job. Each part links with other par

of the brain to perform tasks.

5

“In the very beginning, I didn’t want to know anything 

because I was so scared. But a little while later... the doctors 

would throw out tidbits to me, like he might never speak again 

and he might never walk again... but I couldn’t understand 

why. So then I wanted to understand the part of the brain 

that was injured and why he was having these symptoms or 

why he was having this diagnosis.”

	 	 	 	 	 	 	 - Patty H.
	 	

What is the Anatomy of the Brain?

A healthy adult brain weighs about 2.5 to 3 pounds. It is located insi

the skull.

The underside of the skull (referred to as the base of the skull) is rough,

with many bony ridges. Forceful injuries to the head cause the brain 

bounce rapidly around the inside of the skull. This bouncing results 

brain damage in the area of these ridges.

Just inside the skull, the brain is covered by three thin membranes

called the meninges. They are the dura mater, arachnoid layer, and t

pia mater.

You may hear doctors and nurses mention these membranes when

they describe where a hematoma is located. For example, a subd

hematoma is blood that collects right below the dura mater. 

subarachnoid hemorrhage is located just below the arachnoid layer.

Cerebrospinal fluid (CSF) is a clear liquid that surrounds the brain and

spinal cord. It is produced within the ventricles of the brain. CSF al

the brain to float within the skull and cushions the brain.

The outermost and largest part of the brain itself is called the cerebrum.

The cerebrum controls thoughts and actions. It has a wrinkled surfa

and a deep crease that divides it into two halves, known as the left and

right hemispheres.

Chapter 2 - Learning About the Brain

The ventricles

are butterflyshaped spaces in 

the center of the 

brain.

Skull

Dura mater

Arachnoid layer

Pia mater

Brain

Figure 1. The Meninges

6

The skull is the 

bony part of the 

head that protects 

the brain.

A membrane is a 

thin sheet of tissue.

A hematoma is 

a collection of 

blood. It is also 

called a blood 

clot.
Introduction to Traumatic Brain Injury

Figure 2. The Cerebral Hemispheres

Figure 3. The brain controls movement on 

the opposite side of the body.

Cerebral Hemispheres

Right hemisphere 

These halves look nearly the same. But they differ in what they do. 

most people, the left half of the brain controls:

•	language (speaking, listening, reading, writing)

•	thought and memory involving words.

The right half is involved in:

•	nonverbal processes

•	recognizing the differences in visual

patterns and designs

•	reading maps

•	enjoying music and art

•	expressing and understanding

emotions.

The left side of the brain controls

movement on the right side of the

body. The right side of the brain contro

movement on the left side of the body. Th

is just the opposite of what you might think.

Damage to the right half of the brain may

cause movement problems or weakness on the

left side of the body. Damage on the left hal

of the brain may cause movement problems or

weakness on the right side.

7

The cerebral 

hemisphere means 

half the brain.
	 	

The Lobes of the Brain

The brain is divided into four sections called lobes. These lobes a

known as the:

•	frontal lobe

•	temporal lobe

•	parietal lobe

•	occipital lobe.

Although it is easier to learn about each lobe separately, keep in mind

that the lobes of the brain work together.

8 Chapter 2 - Learning About the Brain

Frontal Lobe

Temporal Lobe

Parietal Lobe

Occipital Lobe

Figure 4. Lobes of the Cerebrum

The Frontal Lobe

•	Problem solving

•	Planning and anticipation

•	Organizing and sequencing

•	Understanding abstract concepts

•	Attention and concentration

•	Memory

•	Judgment

•	Impulse control

•	Social and sexual behaviors

•	Initiation

•	Personality and behavior

•	Awareness and self-monitoring

Figure 5. The Frontal Lobe
Introduction to Traumatic Brain Injury

•	Emotions

•	Language/speaking

•	Movement.

The frontal lobe is the largest of the four lobes. It is responsible f

many important cognitive (thinking) processes.

You may hear doctors using the term executive functions. This refe

to the higher-level, more complex thinking activities performed by the

brain. The ability to form concepts, socialize, and think abstractly a

executive functions.

Executive functions allow us to be creative, solve problems, and function

independently. The frontal lobe is easily injured 1) because it is locat

towards the front of the head; and 2) because of where it sits inside the

skull near several bony ridges.

The Temporal Lobe

• Memory

• Organization, categorization

• Learning

• Concept of time

• Understanding verbal language

• Emotion

• Hearing

• Some visual perception.

The temporal lobe is also easily injured because of its location. It is ne

several bony ridges on the underside of the skull.

The Parietal Lobe

• Sense of touch

• Identification of sizes, shapes, colors

• Spatial perception

• Visual attention

• Integration of senses

• Manipulation of objects.

The parietal lobe is more protected from

traumatic injury. But it can also be injure

9

Figure 6. The Temporal Lobe

Figure 7. The Parietal Lobe
	 	

The Occipital Lobe

• Vision

• Visual recognition.

The occipital lobe is more protected

from traumatic injury because of its

location at the back of the brain.

Deeper Parts of the Brain

The most basic functions of the brain

are controlled at the deepest level,

called the brainstem (see Figure 9).

This primitive part of the brain controls

automatic functions such as:

•	breathing

•	heart rate

•	blood pressure

•	consciousness and alertness

•	sleep/wake cycles

•	sweating

•	temperature regulation

•	swallowing

•	sense of balance.

The deeper structures of the brain include the brainstem, thalamus, and

hypothalamus.

The thalamus is near the top of the brainstem and nearly all information

from our senses (taste, touch, etc.) passes through it to the outer levels of

the brain.

The hypothalamus sits under the thalamus. It produces so

hormones. It helps control many critical functions, includin

•	body temperature

•	hunger

•	thirst

•	emotional and behavior responses.

Directly beneath the cerebrum is the limbic system. This part of t

brain is involved with human emotions and memories.

10 Chapter 2 - Learning About the Brain

Figure 8. The Occipital Lobe
Introduction to Traumatic Brain Injury

Located at the back of the brain, beneath the occipital lobes, is the

cerebellum. The main job of the cerebellum is to control, regulate, a

coordinate movement, posture, and balance.

These deeper structures also help to regulate alertness and attention and

share information among the parts of the brain.

Understanding the various parts of the brain and what each part controls

allows you to understand why your service member/veteran is having

certain kinds of effects. Where the injury happened influences the effec

you are seeing.

11

“We agreed that the resident doctor could present Jason’s case 

to a conference of doctors at the University of Maryland. Of 

course, she wouldn’t use his name. She asked if we would 

come too, and we said yes. 

So we’re in front of this whole room of doctors and she finishes 

her presentation, and the doctors start asking questions. 

And this one doctor raised his hand, and he said, ‘I was the 

surgeon who treated him when he was first injured in Balad. 

I remember him.’ And he said that seeing how far Jason has 

come and how responsive Jason is from when he saw him, from 

when they brought him off the field... he said that the brain is 

a lot more repairable than they even anticipated was possible.”

	 	 	 	 	 	 	 - Pam E.

Figure 9. Deeper Brain Structures

Limbic System

Thalamus

Hypothalamus Brainstem

Cerebellum
	 	

12
Introduction to Traumatic Brain Injury

Causes and Types of TBI

What Types of TBI are There?

There are two types of traumatic brain injury:

Penetrating Head Injury

Penetrating head injury happens when an object goes through the skull

and enters the brain. These injuries are easy to identify. They are c

for right away. Items that may enter the brain ar

• bullets

• knives

• debris from an explosion

• bone or metal fragments.

Closed Head Injury 

Closed head injury occurs from any force that causes violent shaking of the

brain inside of the skull. A closed head injury can happen in many way

• exposure to blast waves during an explosion

• motor vehicle crash where the head hits the windshield

• a fall

• when a blunt object, such as a fist or weapon, strikes the head.

Chapter 3

13

Sometimes, when the front of the head is struck by something, the

whiplash motion set into place causes the brain to rock back and forth

inside the skull. This leads to damage to both the front and back of t

brain. This rocking motion with damage to opposite sides of the bra

can also happen in a side-to-side manner or in a diagonal manner. This 

called a coup-contrecoup injury.
	 	

Chapter 3 - Causes and Types of TBI

For service members in Iraq and Afghanistan, attacks involving explosions

or blast by rocket-propelled grenades, improvised explosive devices

(IEDs), and land mines are common causes of TBIs. Gunshot wound

falls, and motor vehicle crashes also cause TBI in combat. Over 

percent of combat-related TBIs are closed head injuries.

Sometimes, in the case of mild TBI (concussion), there may be no visible

sign of injury.

The brain is quite fragile. It has the consistency of firm gelatin. Ima

that the brain is like gelatin in a bowl. When you tilt the bowl, you c

move the gelatin around. If you shake the bowl more forcefully or dr

the bowl, you can cause tiny or even large cracks in the gelatin. Th

is similar to what happens to the brain when it is exposed to external

forces. When the head is severely jarred, the brain moves rapidly arou

the rough bony interior of the skull. The brain can be ripped, twiste

torn, and bruised. The brain is somewhat protected by the skull, but c

still be injured if enough force is applied.

When the head is injured, many things can happen:

•	skull fractures

•	bleeding on the outside or inside of the brain (hemorrhage,

hematoma)

•	bruising of the brain tissue itself (contusion)

•	widespread stretching and straining of the brain cells 	 	 	

(diffuse brain injury).

14

“I had no idea really what kind of injury he suffered. They said 

there was brain shearing. What’s brain shearing? Because I 

think if I understood what the medical terms meant, it would 

have educated me to ask more questions.”

	 	 	 	 	 	 	 - Pam E.
Introduction to Traumatic Brain Injury

What Injuries Co-Occur With TBI?

What is a Skull Fracture?

There are several types of skull fracture:

• Simple fracture: A break in a skull resembli

a thin line or crack that does not splinter, cave in,

or change the shape of the skull. No surgery 

usually required for simple fractures. They te

to heal on their own.

• Compound fracture: A break in or crushi

of a part of the skull. Bone fragments 

remain on the outside of the dura or may splinter

off and penetrate the dura. This is known 

a depressed skull fracture. Depressed sku

fractures may require surgery. During surger

small screws are used to hold the bones in place.

If there is a tear in the dura, doctors will work to

prevent an infection in the brain.

• Basal skull fracture: Fractures at the ba

(underside) of the skull can injure nerves, blood

vessels, or other parts of the brain. So

fractures may cause cerebrospinal fluid

(CSF) to leak. A sign of a CSF leak 

clear fluid dripping from the nose or ears.

Doctors and nurses will closely monitor

any leaks. Most leaks stop on their ow

but sometimes surgery is necessary.

What about Bleeding?

Bleeding can occur on either the outside

or inside of the brain. Another term f

bleeding is hemorrhage. You may also he

the term hematoma.

Sometimes the bleeding is very small and simply requires close

monitoring. Sometimes blood builds up and pushes against t

surrounding brain tissue. If this happens, the blood needs to be remov

by surgery. The neurosurgeon is the specialist on the team who wi

make this decision.

15

A fracture is a 

break in a bone.

Simple

Fracture

Compound

Fracture

Basal Skull

Fracture

CSF is fluid that 

allows the brain 

to float within 

the skull and 

cushions the 

brain. 

Figure 10. Skull Fractures
	 	

There are several types of bleeding. Types of bleeding are described 

terms of where the blood lies in relation to the skull, dura, and brain:

• Epidural hematoma: A blood clot outside the brain and the du

but under the skull. This blood clot can cause fast changes in t

pressure inside the brain and may need to be removed surgically.

When the brain tissue is compressed, it can quickly change the brain’s

normal functions.

• Subdural hematoma: A blood clot between the brain and t

dura. The clot may cause increased pressure and may need to 

removed surgically.

• Subarachnoid hemorrhage: Bleeding within the layers of the dur

specifically under the arachnoid layer.

• Intracerebral hematoma: Bleeding within the brain tissue itse

caused by the rupture of a blood vessel within the brain.

• Intraventricular hemorrhage: Bleeding into the ventricl

(butterfly-shaped spaces) of the brain.

16 Chapter 3 - Causes and Types of TBI

Subdural Hematoma

Epidural Hematoma

Intracerebral

Hematoma

Intraventricular

Hemorrhage

Subarachnoid

Hemorrhage

Figure 11. Types of Brain Bleeding

The dura is the 

tough covering of 

the brain. 

A hematoma is 

an accumulation 

of blood. It’s also 

called a blood 

clot.

Hemorrhage 

means bleeding.
Introduction to Traumatic Brain Injury

What about Bruising?

Along with bleeding on the inside or outside of the brain, the brain tissue

itself may be bruised. This is a contusion and can occur througho

the brain. Sometimes severely bruised brain tissue needs to be surgical

removed. You may be surprised to know that many people who ha

small portions of the brain removed in order to save their lives still have

the potential to make a meaningful recovery.

What is a Diffuse Brain Injury?

A diffuse (widespread) brain injury is one of the most common and

potentially severe types of TBI. In this injury, damage to the brain occu

over a large area. It is one of the major causes of unconsciousness a

long-term coma after a TBI occurs.

Brain cells are made up of neurons (the body of the cell) and axons (the

long tail of the cell). Axons are important as they are the informatio

highway on which signals travel in the brain. Axons allow cells 

communicate with each other in order to carry out the many processes of

the brain.

Diffuse axonal injury (DAI) is the result of stretching, twisting,

and shearing (tearing) of axons. DAI is often caused when the he

violently starts or stops, which commonly happens when it is exposed

to external forces.

The diagrams below illustrate the differences between a healthy axon and

injured ones.

17

Figure 12. Healthy and Injured Axons

Healthy

Axon

Stretched

Axon

Twisted

Axon

Sheared

Axon

A contusion is 

another word for 

a bruise.

A coma is when 

someone is unable 

to be awakened.

Diffuse axonal 

injury is 

widespread injury 

to the axons, the 

long tails of brain 

cells.
	 	

18

Changes in Neurochemistry

Along with straining and stretching of brain cells, the chemistry

system in the brain is often affected with TBI. The brain has a delica

neurochemistry system. Chemicals called neurotransmitters help bra

cells communicate with each other. This allows the brain to carry out i

many jobs. TBI disrupts this communication system. It can take week

months for the neurochemistry system to return to a normal state.

Chapter 3 - Causes and Types of TBI
Introduction to Traumatic Brain Injury

Diagnosis and Treatment of TBI

There are many health care providers involved in the diagnosis and

treatment of service members/veterans with TBI. These providers a

experts in disorders of the brain and how these disorders affect a person’s

ability to function.

Some of these specialists work in the acute care hospital setting where

diagnosis and early medical treatment are priorities. Others work in t

rehabilitation setting where treatment focuses on restoring function and

adapting to residual effects of the TBI.

Treatment for severe TBI can last weeks to months, and sometimes longer.

How is a Traumatic Brain Injury Diagnosed?

With a severe TBI--especially in cases of penetrating injury--doctors can

usually make a diagnosis immediately. A closed head injury could 

overlooked when the service member has other life-threatening or serious

physical injuries. However, a closed head TBI will be detected later wh

more detailed evaluation is possible.

A detailed neurological exam is helpful in detecting TBI. This ex

usually includes a series of questions and simple commands to see if the

service member/veteran can open his or her eyes, move, speak, and

understand what is going on around him or her.

What is the Glasgow Coma Scale and How is it Used?

You may have heard about the Glasgow Coma Scale (GCS). The G

is used to evaluate brain function and the severity of the TBI.

The GCS rates three things:

•	the ability to open eyes

•	the ability to respond to a command to move

•	the ability to speak.

A score of 3 is the lowest score possible and means the person is in a

coma. A score of 15 is the highest score and means the person is ful

awake and understands what is going on around him or her.

GCS scores can be affected by other things. For example, being sedat

or having a breathing tube inserted affects GCS scores.

What is Post-Traumatic Amnesia (PTA)?

Another measure of how serious a TBI may be is severity and depth of

confusion, also known as post-traumatic amnesia (PTA). The long

someone is confused, the more serious the damage to the brain.

Health care 

providers are all 

the people on the 

medical treatment 

team. They 

include doctors 

and nurses, 

along with many 

other medical 

specialists. You 

can find out 

more about the 

members of the 

health care team 

in Module 2.

You can find 

a copy of the 

Glasgow Coma 

Scale in 

Appendix A.

A coma is when 

someone is unable 

to be awakened.

Chapter 4

19
	 	

Chapter 4 - Diagnosis and Treatment of TBI

What is a CT Scan? Why is it Used?

If your service member/veteran was knocked unconscious or was very

confused following his or her injury, doctors probably used a Computed 

Tomography (CT) (formerly known as Computerized Axial Tomography

[CAT]) scan of the brain to look for signs of TBI.

Why Did the Doctor Order an MRI? What is it?

Sometimes, when a CT scan is negative for obvious injury but the service

member/veteran is still showing signs and symptoms of TBI, a Magnetic 

Resonance Image (MRI) may be ordered.

What Other Tests are Used to Diagnose TBI?

An electroencephalograph (EEG) may also be ordered. An E

measures electrical activity in the brain. Special patches are applied 

the head to measure activity. EEG is one way to detect seizure activi

and to look for an increased risk for seizures in the future.

Elevated intracranial pressure (ICP), the pressure inside of the

brain, can indicate the presence of TBI. An ICP monitor may be plac

through a small hole in the skull to measure the pressure inside the brain.

How are Traumatic Brain Injuries Medically 

Treated? 

Early medical treatment for TBI seeks to:

• stop any bleeding

• prevent and control increased pressure in the brain

A CT scan is a 

computerized 

x-ray that doctors 

use to view areas 

of the brain and 

to look for areas 

of bleeding and 

bruising. 

An MRI scan 

provides detailed 

images of the 

brain using 

magnetic energy 

rather than x-ray 

technology.

Intracranial 

means within the 

skull.

“Something that was really helpful for me was the list of the 

Glasgow Coma Scale because they used that a lot and I didn’t 

understand what it meant. People would throw out these 

numbers—’Oh, he’s at number 4 or 5’—well, what does 

that mean?

When I read the list, it’s up to 15. I could watch Pat’s recovery, 

too, because at the beginning he was 3, and then I could say, 

okay, now he’s a 4 or 5, he’s making progress.”

	 	 	 	 	 	 	 - Patty H.

20
Introduction to Traumatic Brain Injury

• maintain adequate blood flow to the brain

• remove large blood clots as necessary.

Treatments vary with the type of injury. The doctors and nurses wi

decide which ones will be used. Some common treatments ar

Positioning

The head of the bed will be elevated and the neck kept straight. Th

position may decrease pressure inside the brain.

Fluid Restriction

Your service member/veteran’s intake of fluids may be limited. The bra

may be swollen and limiting extra fluids can help control the swelling.

Medications

There are many possible medications that doctors may use to treat TBI.

Medications can:

• decrease the amount of fluid in the body and brain

• prevent seizures

• prevent and treat infections

• maintain blood pressure

• control pain.

Sometimes medications are given to purposefully keep your service

member/veteran asleep while his or her injuries are being identified

and treated.

“My son had a closed head injury. Initially, he was in a coma. 

If you’re not in the medical field, it’s pretty horrendous to see 

your son on a vent and a ventriculostomy coming out of the 

brain to measure the intracranial pressure. They had to control 

the intracranial pressure. If it kept going up, they would have 

to do a cranioplasty. It is horrendous to walk in and see all the 

tubes and not be able to communicate with him.”

	 	 	 	 	 	 	 - Cindy P.

21
	 	

Ventricular Drain (Ventriculostomy)

A small tube may need to be placed in one of the ventricles of the

brain. (See page 6 for a description of ventricles.) This tube drai

cerebrospinal fluid (CSF) if there is more than there should be.

Too much CSF causes unwanted pressure on the brain.

Ventilator

A ventilator is a machine used to support someone’s breathing or to

provide breaths. This is also sometimes called a respirator. Strong regul

breathing provides good oxygen flow to the brain.

When is Surgery Needed?

There are different kinds of surgery that your service member/veteran

may need:

• A craniotomy involves opening the skull to relieve the causes of

increased pressure inside the skull. The causes may be fractur

bones, blood clots, or bruised brain tissue.

• Burr hole surgery involves a small opening into the skull to remove a

pool of blood.

• Craniectomy involves removing a piece of bone from the skull to

relieve pressure caused by swollen brain tissue.

It can be quite a shock to see your service member/veteran for the

first time after a craniectomy because his or her head will not be its

normal shape. Craniectomy allows the brain to swell upward instead 

downward. This is very important as downward swelling in a closed vau

like the skull can be fatal. Without a complete skull to protect the brai

the service member/veteran may be required to wear a protective helmet

until the bone can be replaced.

• A cranioplasty will follow a craniectomy. In this surgery, t

bone piece (also called bone flap) that was removed during the

craniectomy is replaced, after the risk of brain swelling is gone.

Cranioplasty may involve placement of screws or small plates to keep

the bone flap in place. If the original bone was too damaged to 

replaced, artificial materials may be used during cranioplasty.

Cranioplasty is also performed in cases of penetrating injury or complex

skull fractures.

22 Chapter 4 - Diagnosis and Treatment of TBI

CSF is fluid that 

allows the brain 

to float within the 

skull and cushions 

the brain. 
Introduction to Traumatic Brain Injury

What are All These Tubes?

Various tubes may be used in the early treatment phase following TBI.

These tubes have different purposes:

• Some are in place to provide nutrition. A nasogastric tube (NG tub

passes through the nose into the stomach. It is a short-term source f

nutrition. If the service member/veteran is unable to swallow for ma

days to weeks, a per cutaneous gastronomy tube (PEG tube) will be

placed directly into his or her stomach.

• Other tubes help with breathing. If a ventilator is needed to assist

with breathing, the short-term option is an endotracheal tube. 

is inserted through the nose or mouth. If a longer option is needed,

tracheostomy tube may be placed directly into the trachea.

• Intravenous tubes (IVs) may also be used for several days or weeks

to provide medications and nutrition.

• A tube may be placed in the bladder to drain urine (urinary catheter).

Seeing your service member/veteran with many tubes can be scary. T

good news is that tubes are almost always temporary measures used in

early treatment. Rarely are any of these tubes permanen

The trachea is 

the main airway 

that runs from the 

base of the throat 

down to the lungs.

“Intravenous” 

refers to veins.

23
	 	

24
Introduction to Traumatic Brain Injury

Potential Complications Following TBI

Doctors and nurses work very hard to prevent complications after a TBI.

During the first several days to weeks after the injury, the risk of further

damage from complications is high. So the health care team takes all t

steps it can to control complications.

Are There Common Complications Following 

Severe TBI? 

Some complications are a direct result of injury to the brain. Othe

come from being bedridden for many days or weeks. Some result fr

the overall shock the body is experiencing.

Here are some common complications that happen in the days or weeks

after the injury:

•	Increased intracranial pressure (ICP): The pressure inside t

brain can increase to dangerous levels. Sometimes, the pressu

is life-threatening. An ICP monitor alerts doctors to the pressur

Medications can prevent or treat high pressure.

•	Edema: Swelling that occurs when the brain contains more fluid th

normal. When swelling happens within the brain, there is no pla

for the tissue to expand. This is because the brain is encased in t

skull. Swelling can cause pressure to build up. This results in da

to brain cells. It also interrupts blood flow. Medications and f

restrictions often help. Sometimes, surgery is neede

•	Hydrocephalus: Also known as “water on the brain,” hydrocephal

happens when cerebrospinal fluid (CSF) collects in the ventricles. Th

condition may occur during the initial period after TBI or develop later

(usually within the first year). If hydrocephalus is severe, doctors m

place a shunt in the brain. The shunt drains the extra fluid from t

brain to other places in the body.

• Low blood pressure: Blood carries oxygen to the brain. The b

needs oxygen. Doctors and nurses work hard to keep blood pressu

from getting too low. This helps increase blood flow to the brai

•	Fever: Some parts of the brain regulate temperature. Injur

these parts may cause high fevers. This is especially true during t

first hours or days after an injury. Fever is also a sign of infectio

Medications and/or cooling blankets can bring the fever down.

•	Pneumonia: Being in bed and not able to move around increases t

risk of pneumonia. The health care team will carefully monitor your fami

member’s breathing and lung status. They may take frequent chest x-ra

A complication is 

a secondary injury 

that can hamper 

the recovery 

process.

Intracranial 

means within the 

skull.

Edema is another 

word for swelling.

A shunt is a tube.

Pneumonia is an 

infection in the 

lungs.

Chapter 5

25
	 	

Chapter 5 - Potential Complications Following TBI

to look for pneumonia. Fever is also a sign of pneumonia, a comm

complication. Fortunately, antibiotics usually work to treat pneumoni

•	Brain infection: Infections may occur on the outside of the dur

below the dura, in the membranes surrounding the brain (meningitis),

or within the brain itself (abscess). Depressed skull fractures 

penetrating brain injuries can cause brain infections. Antibiotics tre

brain infection. Sometimes, surgery is neede

•	Other infections: To treat TBI, your service member/veteran m

have one or more tubes (see page 23). These tubes are needed. 

they may cause infection. Body temperature readings and blood tes

are ways to monitor for infection. Antibiotics control infection

•	Blood clots: Not being able to move around leads to slower blo

flow throughout the body. Slower blood flow can lead to blood clo

in the legs or arms. These are known as deep vein thrombose

(DVT). Signs of a clot include a leg or arm that is warm, red, a

swollen.

If a DVT travels to the lungs, it is known as a pulmonary embolus 

(PE). A PE can be very dangerous. It requires immediate treatm

A tiny filter may be placed in a large vein called the vena cava. Th

keeps DVTs from reaching the lungs. This filter is usually removed

later. Medication to thin the blood is often used to prevent and tre

blood clots.

•	Skin breakdown: Being in bed all the time and having oth

injuries may cause the skin to break down (bedsores). Nurses wo

hard to prevent bedsores by changing the person’s position often

and inspecting all areas of the skin. Various treatments or topic

applications may be used.

The dura is the 

tough outer 

membrane around 

the brain.

An abscess is an 

inflammation that 

contains pus.

The veins carry 

blood to the 

heart.

Pulmonary refers 

to the lungs.

An embolism is a 

mass that blocks 

the flow of blood 

in the vein.

Bedsores are ulcers 

on the skin.

You are an important part of the team. You know your

servicemember/veteranbetterthan anyone. If you noti

any of these signs or symptoms, tell the health care team

what you are seeing or thinking. Do this even if y

simply feel as if “something is wrong,” even though you

can’t quite put your finger on what it is. Family membe

may notice small changes before anyone else. The earli

a complication is detected, the sooner it can be treated.

26
Introduction to Traumatic Brain Injury 27

It is hard to predict a person’s long-term recovery from a TBI. You wa

to know if your service member/veteran will fully recover. But docto

may not be able to give you a definite answer.

Recovery Process

Chapter 6

“When my son was hurt, I said, ‘What can I expect? What’s 

going to happen to my son?’ The doctor looked at me, and 

said, ‘Even we don’t know. The injuries that these guys are 

coming home with now are new to us. Five years ago, an 

injury like this would have killed him. He would never survive 

it. These are young people. They now get better and they 

survive it. We are re-writing the medical books.’”

	 	 	 	 	 	 	 - Nellie B.

After a TBI, the body begins to repair itself. In most cases, brain swelli

begins to go down within a few weeks. The pressure inside the skull lessen

The brain’s chemical balance returns to normal within several months.

For most people with moderate to severe TBI, the most rapid recovery

will happen in the first six months following injury. But there is rea

to stay hopeful. Most will also continue to improve for years after injur

Recovery is individual. Everyone progresses at his or her own pac

It takes time for people to “wake up” after a severe TBI. It is a process.

does not happen overnight. Most people with severe TBI will “wake u

and “clear up” over the course of several days or weeks. Sometimes, th

takes months. The extent to which someone fully wakes up and clears 

is not fully known by anyone. However, it becomes clearer as time passe

Here are some ways that the brain repairs itself over time:

•	New connections may develop between damaged cells.

•	Existing connections may also be used in new ways to make up for

damaged ones.

•	Other parts of the brain may slowly learn to assume functions of

damaged brain tissue.

•	The body may even be able to replace damaged brain tissue.

Sometimes, the term “brain plasticity” is used to describe the brain’s

ability to bounce back and recover after TBI.
	 	

People with milder injuries tend to recover sooner. But this is not alwa

true. People with more severe injuries usually take longer to recove

Some recover fairly well over time. Some will need help for the rest 

their lives.

Moderate to severe TBI may involve a coma that lasts days, weeks, or

months. Very rarely, a coma lasts even longer. In general, the long

person remains in a coma, the more challenging recovery may be.

Recovery from a moderate to severe brain injury is also affected by:

•	How severe the damage is

•	The areas of the brain affected

•	The areas of the brain not affected

•	Age at the time of injury

•	The early pattern of recovery

•	The length of time the person is very confused

•	Other injuries to the body

•	The overall health of the person before this injury.

There is no way to speed the process of recovery. Good medic

care gives your service member/veteran the best chance of recovery.

Rehabilitation by specialists in TBI helps your family member re-learn

how to do things. Most people return to their homes, families, a

communities. This is true even for people with severe TB

Rehabilitation 

means re-learning 

how to do things. 

A rehabilitation 

specialist might 

be a physical 

therapist, an 

occupational 

therapist, or a 

speech-language 

pathologist.

Chapter 6 - Recovery Process

A coma is when 

someone is unable 

to be awakened.

“It had been 15 months and he had slowly improved. But he 

couldn’t talk. He’d kind of start trying to mouth words, but 

he just couldn’t talk. And so, on October 21st, 2005, I’ll never 

forget that morning. I came in to the bedroom and I said, 

‘Fred, how are you doing?’ And he said, ‘Fine.’ Okay. I think 

he just talked to me. So I just turned around and went back 

into the kitchen, got his breakfast, came back in and thought, 

okay, let me try this again. I said, ‘Fred, how are you doing?’ 

And he said, ‘Fine.’ It wasn’t a lot at first, but he could talk.”

 - Denise G.

28
Introduction to Traumatic Brain Injury

As a caregiver, keep hope alive as you support the recovery process of

your family member with TBI. Waiting for your service member/veter

to become more awake and aware can make you feel sad and frustrated.

(See Module 3 to read about caring for yourself during this time.)

On the positive side, you are likely to see progress. Remember, progre

is progress, even if it’s slower than you would like to see.

Keeping a journal and writing down what is happening during your

service member/veteran’s recovery may help you track recovery

milestones. Months from now, you may look back on earlier journ

pages and be amazed at how far he or she has come.

Using a journal to record your own feelings may also help you cope

with stress and anxiety. Most people have these feelings when a fami

member has been injured.

What are the Stages of Recovery?

As your service member/veteran recovers from TBI, he or she often moves

through stages known as the Rancho Los Amigos Levels. The Ranch

Los Amigos Levels of Cognitive Functioning describe the stages of

recovery from TBI. The levels are based on the person’s behavior

You can find 

a copy of the 

Rancho Los 

Amigos Levels in 

Appendix B.

Key Points to Keep in Mind:

• There is no accurate way to predict exactly how

recovery will progress or what the final outcome

will be.

• Many service members/veterans with severe TBI go

through similar stages and patterns of recovery but

at their own pace.

• Most service members/veterans will make progress.

• Progress is still progress!

29

The Rancho Los Amigos Levels help you understand what point your

service member/veteran has reached in his or her recovery. On t

folllowing pages are the four broad stages of recovery and how you can

help during each stage.
	 	

Emergence from Coma (Rancho Levels II and III)

Unlike the dramatic reawakening you may have seen on television,

waking up from a coma is usually very gradual after a severe TBI.

Although the term “coma” suggests closed eyes, your service member/

veteran’s eyes may open before other signs of consciousness appear.

Consciousness is judged by a person’s ability to pay attention to or

interact with the world around him. It is usually tested by how well t

person can follow commands and respond to stimulation.

It may be helpful to understand the medical terms commonly used to

describe a service member/veteran with TBI who is very sleepy:

• Coma – unconscious, no sleep/wake cycles, does not respond at all to

the world around him or her, does not show emotion

• Vegetative State – sleep/wake cycles are apparent, may startle, may

occasionally “track” with his or her eyes

• Minimally Conscious State – partly awake and conscious, may

reach for objects, more often “tracks” with the eyes, might be able to

occasionally talk or make noises, can show emotion.

Some individuals with TBI may remain in a minimally conscious state.

Most, however, will progress to greater awareness. As people co

out of a coma, they typically move from inconsistent responses with

only certain people to responses that are more consistent. Your servi

member/veteran’s sleep/wake cycle improves and he or she begins to

follow objects with his or her eyes (tracking). Other signs of awakeni

30 Chapter 6 - Recovery Process

“My brother was in a minimally conscious state. You hear 

all these miracle stories and you start getting your hopes up. 

But then day after day goes by, week after week, month after 

month, and no sign of major improvements. Meanwhile, 

you watch as others on the same ward or whom you’ve met 

continue to improve. You want to be happy for them--and 

you are, but why is your loved one not improving at the same 

rate? During these times, take comfort and support from those 

around you. At my most cynical of times, I would continue to 

be inspired by the generosity and strength of others.”

	 	 	 	 	 	 	 - Liza B.
Introduction to Traumatic Brain Injury

may appear before your service member/veteran begins consistently

responding to commands. These signs could be assisting in therapy 

showing facial expressions or emotions.

During this time, the health care team looks for purposeful responses and

encourages these responses by stimulating the person. Stimulati

techniques include:

•	range-of-motion exercises

•	stimulating taste and smell

•	using sounds to reach the person

•	providing visual stimulation

•	using touch

•	encouraging frequent position changes.

Families and friends are often uncomfortable about interacting with a

person with a brain injury. This is particularly true when the individual 

in a coma or minimally conscious, in an ICU, and full of tubes.

The odds are that your family member will recognize you when he or she

begins to awaken. The incidence of true “amnesia” is almost unhea

of after a TBI. As early confusion clears, most people with TBI keep the

long-term memories and recognize their family and friends.

What Can I Do To Help?

•	No one knows for certain if people in a coma can hear. But th

doesn’t really matter. What matters is they “might” hear. Hea

your voice and knowing you are there can be very comforting.

•	Watch doctors and nurses as they try to stimulate the person. T

doing what they do.

•	Do simple activities for short periods of time. Describe what you a

doing (“I am holding your hand now.”).

•	Ask your service member/veteran to look at you and others in the

room when his or her eyes are open.

•	Present one simple direction at a time. Allow ample time for a respons

•	Touch is very important and stimulating. If you are uncomfortab

touching your service member/veteran, ask about ways to effectively

touch, pat, or massage the person in reassuring ways.

•	Bring in tape recordings of familiar music, the family dog barking,

messages from friends, and other sounds that might be stimulating.

Stimulation 

means prodding 

the person to get 

him or her more 

active, aware, or 

involved with the 

world.

An ICU is an 

Intensive Care 

Unit where people 

with the most 

serious illness or 

injury are treated.

Post-traumatic 

amnesia (PTA) 

is the inability 

to acquire new 

memories. For 

example, a person 

with TBI may 

not be able to 

remember what 

he or she had for 

breakfast. Longterm memories, 

such as those from 

childhood, are 

not affected. PTA 

may range from 

a period of just a 

few minutes to a 

more permanent 

condition.

31
	 	

•	Move back and forth between stimulating activities and periods of

rest, quiet music, or soothing touch.

•	Each time you are in the room, tell your service member/veteran

the date and where he or she is. The more your family memb

hears accurate information about where he or she is and what has

happened, the more that information will begin to stick.

•	Calendars, pictures of the family, friends, home, and favorite things

are helpful.

•	Encourage visitors and the health care team to not talk about the

person as if he or she is not there. Everyone should introdu

themselves when they enter the room, explain why they are there, and

say when they plan to leave.

•	You don’t need to always talk to your service member/veteran. It is al

fine to just be with your family member and spend quiet time together.

•	Setbacks, such as pneumonia, are not unusual in the early days.

These can be scary. The health care team knows how to mana

complications.

•	As his or her responses to commands become more consistent, keep

asking your service member/veteran to follow simple commands.

•	Ask questions in a “yes” or “no” format. These are easier 

respond to.

•	If you are concerned about how much stimulation is appropriate for

your family member, please ask for guidance from the doctor or other

team members.

Chapter 6 - Recovery Process

Inconsistency throughoutrecovery fromTBI is expected.

Don’t be alarmed if your service member/veteran does

something (follows a command, opens his or her eyes,

speaks) one day, but not the next. The capacity is sti

there. He or she will again show the behavior. I

usually just a matter of “when.”

People recovering from TBI have good days and bad

days. Fatigue and impaired memory contribute 

inconsistency. Many families learn to embrace t

good days and tolerate the bad days.

32
Introduction to Traumatic Brain Injury

Agitated State (Rancho Level IV)

A phase of restless, agitated, or aggressive behavior can occur in your

service member/veteran as he or she progresses. He or she will also sh

confusion during this period.

In any case of severe TBI, the injured person will probably not remember

much, if anything, about:

• what happened

• how he or she was transported

• the early days in the ICU

• his or her early interactions with doctors and nurses.

Agitated refers 

to a lot of 

movement, 

sometimes violent 

movement.

“In the beginning, he thought he was captured. On that kind 

of heavy medication, he was super-disoriented. Plus, he was 

injured and he didn’t know about losing his eye. He didn’t 

know where he was. He couldn’t see. He was strapped down 

to the bed, and it took eight doctors at different points in time 

to restrain him because he kept trying to leave.

I had to seriously get down next to him and just explain to him 

that he was at Walter Reed, because he kept fighting these 

doctors. He punched out a nurse. It was really bad because they 

had to restrain him and that’s really sad to see, when you’re all 

bandaged up like that, to have to be restrained on top of it.”

	 	 	 	 	 	 	 - Emily S.

33

Your service member/veteran may perform routine activities such as

sitting up and reaching out without much sense of purpose. He or s

may be very focused on basic needs: going to the bathroom, eating, and

going back to bed.

Behavior may seem bizarre and out of character. The person’s respons

may seem out of proportion to what he or she is seeing and hearing or

being asked to do. Yelling is not uncommon, nor is pulling at tube

Try not to let this overwhelm you as a caregiver. Doctors and nurses w

work with TBI are very familiar with this stage of recovery. They will he

you and your family member through it.
	 	

Safety and “riding out the storm” are the primary goals. The va

majority of people with TBI pass through this stage in a number of days

to weeks. The odds of remaining in this state forever are very lo

The inability to store new information and memories is called posttraumatic amnesia (PTA). PTA often goes hand-in-hand with extre

confusion. Signs that someone is in PTA ar

•	inability to recall if he or she just spoke to you

•	the use of repetitive statements and questions

•	confusion about where he or she is.

These behaviors are part of the recovery process. Your service membe

veteran will probably not exhibit them over the long term.

During this time of restlessness and confusion, the health care team will

take steps like these:

•	reduce distracting stimuli (i.e., television, radio, noise level)

•	try to establish normal sleep/wake patterns

•	create a safe environment.

Protection may include the use of mats or a specially-designed bed

to allow your service member/veteran to move freely without harm.

Behavior management strategies and medications are also helpful for

some individuals.

What Can I Do To Help?

•	Be aware of and reduce anything that promotes agitation.

•	Being overstimulated and overtired contribute greatly to fatigue.

Work with the health care team to set up a schedule that promotes rest.

•	Most people with TBI respond best to a regular schedule. Try 

maintain the schedule set up by the health care team.

•	Continue to seek responses to commands and questions. But speak 

gentle, low tones. Move about quietly and slowl

•	Explain in simple language what happened to cause the injury.

•	Speak slowly. Use simple language when speakin

•	Talk about familiar things: family members, pets, places, and even

the individual has experienced.

•	Unusual behaviors, including swearing, are common. Be patien

These behaviors tend to go away over time.

•	Complex tasks are difficult to complete. Break tasks down into simp

steps. Offer step-by-step instruction

Chapter 6 - Recovery Process

Fatigue is 

weariness and 

exhaustion.

34

Post-traumatic 

refers to after a 

trauma or injury. 

Amnesia means 

forgetting.
Introduction to Traumatic Brain Injury

•	Don’t get into long explanations or arguments. Simple instructions 

conversations are best.

•	Distraction is a powerful tool. Change the topic often if you find t

person is becoming upset over a certain topic.

•	Reassure the person that everything is being done to provide the care

and treatment needed to restore health and well-being.

•	Move the person to another type of activity if he or she becomes

“stuck” on a certain topic or behavior.

•	Give accurate information. But don’t argue. It is best for your ser

member/veteran to hear correct information and not believe things

that are not true.

•	You can set limits on very inappropriate behavior. But do not expe

to control your service member/veteran into “normal” behavior.

•	It is often wise to limit visitors during this stage of recovery. G

directions from the health care team about how to do this.

•	If visitors are allowed, have only 1-2 in the room at a time. Have on

one person speak at a time.

It is important to remember that the agitated stage is a

step forward in the recovery process. Agitated behavio

may be difficult to watch and respond to. But they a

often signs of improvement. This is a stage that requir

a great deal of open-mindedness and understanding

by everyone. The health care team is very familiar wi

this stage of recovery. They are not embarrassed 

taken aback by any behaviors. Safety for everyone is t

primary goal.

35

Confused State (Rancho Levels V and VI)

Most individuals with severe TBI pass through a period of confusion and

lingering restlessness. They have a hard time keeping a coherent line 

thought. They often mix up past and present event

In this stage, your service member/veteran with TBI may not recall

new information and may not know where he or she is, what has
	 	

happened, the time of day, or time of year. People in this stage oft

have a hard time remembering the names and roles of their health care

providers. They often do not understand why they are in the hospital 

rehabilitation unit.

The ability to pay attention is often very short at first. Sometimes, it 

only a few minutes. There is usually a gradual improvement in the abili

to pay attention. Learning begins to take place during this stag

As your service member/veteran becomes less confused, the ability to

focus on and complete simple tasks improves. So does the ability to reca

the events of the day (for example, what he or she had to eat, who visited,

what he or she worked on in therapy). The health care team often begi

to use calendar or memory notebook systems at this time. These too

remind the person with TBI of important facts and the daily schedule.

Many individuals know when they need to use the bathroom and are

beginning to eat by now. Awareness of physical problems usually com

before awareness of thinking or behavioral problems.

As recovery continues, you will find more meaningful ways to interact with

your service member/veteran. Your service member/veteran is probab

becoming less passive and able to do much more.

Once equipment such as feeding tubes is no longer needed, there is more

opportunity to be out of bed. Then, your family member can go to thera

and other activities. This promotes recovery and brings pleasure to al

What Can I Do To Help?

•	Ask simple questions that encourage memory.

•	Offer generous words of encouragement and praise for attempts	 	

to respond.

•	Create steady routines to develop greater organization.

•	Learn the calendar and memory notebook systems put into place

by health care providers. Reinforce their use by your servi

member/veteran.

•	Learn how to best cue the person (see Module 2). A consiste

cueing approach between the health care team and family members

is very useful.

•	Do not treat your service member/veteran as a child because his or her

thinking is muddy. Do continue to be as honest and direct as possibl

•	As he or she progresses through this stage, help with organization to

perform simple daily tasks.

Chapter 6 - Recovery Process

Cueing means to 

give a signal to 

begin a specific 

action.

36
Introduction to Traumatic Brain Injury

•	Build greater independence by offering only occasional support to

complete tasks.

•	Ask health care providers how you can be involved:

- Ask the physical therapist (PT) how to safely transfer your service

member/veteran in and out of the wheelchair or bed.

- Ask the nurse to show you how to assist with toileting.

- Ask the occupational therapist (OT) how to correctly perform rangeof-motion exercises and how to help with meals or dressing.

- Ask the speech and language pathologist (SLP) how to communicate

best with the person.

•	Do not bring in food or offer snacks without checking with the health

care team. Eating the wrong kinds of foods can cause problems f

your service member/veteran.

•	Tape record all family conferences with the health care team. This c

benefit family members who cannot attend. It can also give you

valuable review of information and progress.

•	Your service member/veteran is likely processing information very

slowly. It takes time for messages to be processed and mot

responses to be carried out. Allow extra time for responding. 

Repeat your request after allowing time.

•	Memory is often weak during early recovery from TBI. Check wi

health care providers to learn what restrictions your service member/

veteran has (for example, not getting out of bed alone, not leaving the

premises, smoking restrictions, diet restrictions).

• Confabulation is not uncommon. Talk with health care provide

about how to manage confabulation.

•	Keep in mind that repetition is important in order for the person to

learn and remember.

•	Your service member/veteran’s tolerance levels for activities will still be

low. Try to be patient and maintain realistic expectation

•	Limit visitors during this stage of recovery so as not to overstimulate

the person.

•	Encourage your family member to participate in all therapy sessions.

Confabulation 

means that the 

person tries to fill 

in memory gaps 

by making 

things up.

37
	 	

High Functional Level (Rancho Levels VII and VIII)

Although most people with TBI are medically stable when they reach this

stage, they may continue to have physical, thinking, and behavior problems.

They are probably able to follow a schedule with little assistance.

Memory for day-to-day events has improved. But activities that ne

higher-level thinking (solving complex problems, making hard decisions,

doing more than one thing at a time) are probably still challenging.

The ability to participate in therapy full-time has improved. So h

awareness of the need for therapy. Your service member/veteran m

know what he or she needs to do, but has some trouble carrying it

out. He or she will likely still feel overwhelmed when under stress or 

emergency situations.

Physical recovery has often continued to the point that others think the

person looks “back to normal.”

Treatment seeks to help your service member/veteran recognize these

difficulties and learn how to compensate for them. Ongoing goals a

to develop independence and begin to make plans to move from the

hospital or rehabilitation setting to home.

Your service member/veteran may be anxious about returning to family,

community, school, and/or active duty. This may come across 

ambivalence or disinterest in the future. Psychological counseling c

help you and your service member/veteran to develop coping skills and

better understand how his or her levels of functioning have changed.

In this stage, you may need to encourage full participation in daily

activities. Your service member/veteran should begin taking responsibili

for his or her personal care. He or she should begin to use ways that wi

help compensate for thinking and/or physical problems.

What Can I Do To Help?

•	Do not promise your service member/veteran that life will return to

normal. Time will settle those issues for you. Then you won’t have 

feel guilty about making false promises.

•	No two brain injuries are the same, just as no two people are the

same. Comparisons with others may be disappointing and misleadin

•	All discussions should take place with the person with TBI present.

These discussions may seem harsh when there is talk of long-term

effects and the future impact they will have on the life of your service

member/veteran. Still, it is best to have full disclosure. This h

38 Chapter 6 - Recovery Process
Introduction to Traumatic Brain Injury

develop plans that everyone agrees with. Open honest discussion al

develops trust and coping.

•	While your service member/veteran is still in the hospital or rehabilitation

setting, learn as much as you can about how to help your family member

apply the skills he or she is learning back in the home setting.

•	Hospitals and rehabilitation units are very structured, just like the

military. Routines have been set up that you can continue at hom

Practice as soon as you get home. Without structure and routine, skil

may seem to be lost and confusion may increase. But with a go

family support system and practice, these skills often quickly reappear.

•	Discourage your service member/veteran from using alcohol or drugs

(see Module 3).

•	After your service member/veteran is settled into a comfortable and

workable home routine, begin to practice activities outside the home

(grocery shopping, going to a movie, seeing friends). See Module 

•	Be sure you fully understand restrictions on your service member/

veteran. These might limit driving, working, being left alone, usi

power equipment, and climbing.

•	Be sure you fully understand the plan for outpatient therapy and

follow up with all members of the health care team.

•	Treat your service member/veteran as an adult. Provide guidance, cue

and assist with decision making. But always respect his or her opinion

39
	 	

40 Chapter 6 - Recovery Process

“The doctor said to both of us, do you believe in miracles? 

And I said yes. And he said, then you need to pray for a big 

one. You need to pray for a real big miracle because your 

son—we don’t know if he’s going to make it. And he said if I 

were you, I would let him go. I’ll give him my assistance, but 

he’s not going to make it.

And I said to him, you don’t make those decisions, you don’t 

tell me he’s not going to make it. That’s not up to you. You 

go back in there and you do what you said you can do, now, 

to keep my son alive. 

And two weeks later, my son opened his eyes for the first time. 

Three weeks later, he was taken off the ventilator and has 

never been on another one.

We were looking at my son three years ago to now. You don’t 

even think it’s the same person.”

	 	 	 	 	 	 	 - Nellie 
Introduction to Traumatic Brain Injury 41

The questions below can help you reflect on your experience as a caregiver. 

You can write your thoughts here, copy this page and add it to your 

journal if you keep one, or reflect on these questions in your journal. 

What have the doctors told me about my service member/veteran’s injury? 

Describe the injury as best you can, in your own words.

What are my strongest fears or concerns at this moment in time?

What do I feel joyful or optimistic about?

Journal
	 	

42
Introduction to Traumatic Brain Injury 43

The Glasgow Coma Scale is used to assess the consciousness and neurological

functioning of a person who has just received a TBI. The total score is the sum 

the scores in three categories: eye-opening response, verbal response, and mot

response. The Scale provides a score in the range 3-15. A score of 3-8 indicat

severe TBI; a score of 9-12, a moderate TBI; and a score of 13-15, a mild TBI.

For adults, the scores are as follows:

Glasgow Coma Scale

Appendix A

Eye Opening 

Response 

Verbal 

Response

Motor 

Response

Spontaneous--open with blinking at baseline

Opens to verbal command, speech, or shout

Opens to pain, not applied to face

None	

Oriented

Confused conversation, but able to answer questions

Inappropriate responses, words discernible

Incomprehensible speech

None

Obeys commands for movement

Purposeful movement to painful stimulus

Withdraws from pain

Abnormal (spastic) flexion, decorticate posture

Extensor (rigid) response, decerebrate posture

None

4 points

3 points

2 points

1 point

5 points

4 points

3 points

2 points

1 point

6 points

5 points

4 points

3 points

2 points

1 point
	 	

44
Introduction to Traumatic Brain Injury

Family Guide to the Rancho Los Amigos 

Levels of Cognitive Functioning

Cognition refers to a person’s thinking and memory skills. Cogniti

skills include paying attention, being aware of one’s surroundings,

organizing, planning, following through on decisions, solving

problems, judgment, reasoning, and awareness of problems. Memory

skills include the ability to remember things before and after the brain

injury. Because of the damage caused by a brain injury, some or all 

these skills will be changed.

The Levels of Cognitive Functioning is an evaluation tool used by

the rehabilitation team. The eight levels describe the pattern 

stages of recovery typically seen after a brain injury. This helps t

team understand and focus on the person’s abilities and design an

appropriate treatment program. Each person will progress at his or h

own rate, depending on a variety of factors, including the severity of

the brain damage, the location of the injury in the brain, and length of

time since the brain injury. Some individuals will pass through each 

the eight levels, while others may progress only to a certain level and

no farther.

It is important to remember that each person is an individual and there

are many factors that need to be considered when assigning a level of

cognition. There is a range of abilities within each of the levels and yo

family member may exhibit some or all of the behaviors listed below.

Cognitive Level I: No Response

A person at this level:

•	does not respond to sounds, sights, touch, or movement.

Cognitive Level II: Generalized Response

A person at this level will:

•	begin to respond to sounds, sights, touch, or movement;

•	respond slowly, inconsistently, or after a delay;

•	respond in the same way to what he or she hears, sees, or feels.

Responses may include chewing, sweating, breathing faster, moaning,

moving, and/or increasing blood pressure.

Rancho Los Amigos Levels

Appendix B

45
	 	

Cognitive Level III: Localized Response

A person at this level will:

•	be awake on and off during the day:

•	make more movements than before;

•	react more specifically to what he or she sees, hears, or feels. F

example, he or she may turn towards a sound, withdraw from pain,

and attempt to watch a person move around the room;

•	react slowly and inconsistently;

•	begin to recognize family and friends;

•	follow some simple directions such as “Look at me” or “Squeeze

my hand”;

•	begin to respond inconsistently to simple questions with “yes” and

“no” head nods.

What family/friends can do at Cognitive Levels I, II, and III

•	Explain to the individual what you are about to do. For example, “I

going to move your leg.”

•	Talk in a normal tone of voice.

•	Keep comments and questions short and simple. For example, instead

of “Can you turn your head towards me?”, say, “Look at me.”

•	Tell the person who you are, where he or she is, why he or she is in the

hospital, and what day it is.

•	Limit the number of visitors to 2-3 people at a time.

•	Keep the room calm and quiet.

•	Bring in favorite belongings and pictures of family members and

close friends.

•	Allow the person extra time to respond, but don’t expect responses to

be correct. Sometimes the person may not respond at al

•	Give him or her rest periods. He or she will tire easily.

•	Engage him or her in familiar activities, such as listening to his or her

favorite music, talking about family and friends, reading out loud to him

or her, watching TV, combing his or her hair, putting on lotion, etc.

•	He or she may understand parts of what you are saying. Therefore, 

careful what you say in front of the individual.

46 Appendix B - Rancho Los Amigos Levels
Introduction to Traumatic Brain Injury

Cognitive Level IV: Confused And Agitated

A person at this level may:

•	be very confused and frightened;

•	not understand what he or she feels or what is happening around him

or her;

•	overreact to what he or she sees, hears, or feels by hitting, screaming,

using abusive language, or thrashing about. This is because of t

confusion;

•	be highly focused on his or her basic needs, i.e., eating, relieving pain,

going back to bed, going to the bathroom, or going home;

•	not understand that people are trying to help him or her;

•	not pay attention or be able to concentrate for a few seconds;

•	have difficulty following directions;

•	recognize family/friends some of the time;

•	with help, be able to do simple routine activities such as feeding him/

herself, dressing, or talking.

What family/friends can do at Cognitive Level IV:

•	Tell the person where he or she is and reassure him or her that he or

she is safe.

•	Bring in family pictures and personal items from home, to make him or

her feel more comfortable.

•	Allow him or her as much movement as is safe.

•	Take him or her for rides in a wheelchair, when this has been approved

by the treating team.

•	Experiment to find familiar activities that are calming to him or her

such as listening to music, eating, etc.

•	Do not force him or her to do things. Instead, listen to what he or she

wants to do and follow his or her lead, within safety limits.

•	Since he or she often becomes distracted, restless, or agitated, you

may need to give him or her breaks and change activities frequently.

•	Keep the room quiet and calm. For example, turn off the TV and radio,

don’t talk too much, and use a calm voice.

•	Limit the number of visitors to 2-3 people at a time.

47
	 	

Cognitive Level V: Confused and Inappropriate

A person at this level may:

•	be able to pay attention for only a few minutes;

•	be confused and have difficulty making sense of things outside him/

herself;

•	not know the date, where he or she is, or why he or she is in the

hospital;

•	not be able to start or complete everyday activities, such as brushing

his or her teeth, even when physically able. He or she may ne

step-by-step instructions;

•	become overloaded and restless when tired or when there are too

many people around;

•	have a very poor memory. (He or she will remember past events from

before the accident better than new information he or she has been

told since the injury.);

•	appear to “make things up” to try to fill in gaps in memory;

•	may get stuck on an idea or activity (perseveration) and need help

switching to the next part of the activity;

•	focus on basic needs such as eating, relieving pain, going back to bed,

going to the bathroom, or going home.

What family/friends can do at Cognitive Level V:

•	Repeat things as needed. Don’t assume that he or she will rememb

what you tell him or her.

•	Tell him or her the day, date, name and location of the hospital,

and why he or she is in the hospital when you first arrive and before

you leave.

•	Keep comments and questions short and simple.

•	Help him or her organize and get started on an activity.

•	Bring in family pictures and personal items from home.

•	Limit the number of visitors to 2-3 at a time.

•	Give him or her frequent rest periods when he or she has problems

paying attention.

48 Appendix B - Rancho Los Amigos Levels
Introduction to Traumatic Brain Injury

Cognitive Level VI: Confused And Appropriate 

A person at this level may:

•	be somewhat confused because of memory and thinking problems.

He or she will remember the main points from a conversation, but

forget and confuse the details. For example, he or she may rememb

he or she had visitors in the morning, but forget what they talked about;

•	follow a schedule with some assistance, but becomes confused by

changes in the routine;

•	know the month and year, unless there is a severe memory problem;

•	pay attention for about 30 minutes, but has trouble concentrating

when it is noisy or when the activity involves many steps. For exampl

at an intersection, he or she may be unable to step off the curb, watch

for cars, watch the traffic light, walk, and talk at the same time;

•	brush his or her teeth, get dressed, feed him/herself etc., with help;

•	know when he or she needs to use the bathroom;

•	do or say things too fast, without thinking first;

•	know that he or she is hospitalized because of an injury, but will not

understand all of the problems he or she is having;

•	be more aware of physical problems than thinking problems;

•	associate his or her problems with being in the hospital and think that

he or she will be fine as soon as he or she goes home.

What family/friends can do at Cognitive Level VI:

•	You will need to repeat things. Discuss things that have happen

during the day to help the individual remember recent events and

activities.

•	He or she may need help starting and continuing activities.

•	Encourage the individual to participate in all therapies. He or she wi

not fully understand the extent of his or her problems and the benefits

of therapy.

Cognitive Level VII: Automatic and Appropriate

A person at this level may:

•	follow a set schedule;

•	be able to do routine self care without help, if physically able. F

example, he or she can dress or feed him/herself independently, have

problems in new situations, and may become frustrated or act without

thinking first;

49
	 	

•	have problems planning, starting, and following through with activities;

•	have trouble paying attention in distracting or stressful situations. For

example, family gatherings, work, school, church, or sports events;

•	not realize how his or her thinking and memory problems may affect

future plans and goals. Therefore, he or she may expect to return 

his or her previous lifestyle or work;

•	continue to need supervision because of decreased safety awareness

and judgment. He or she still does not fully understand the impact 

his or her physical or thinking problems;

•	think more slowly in stressful situations;

•	be inflexible or rigid, and he or she may seem stubborn. However, h

or her behaviors are related to the brain injury;

•	be able to talk about doing something, but will have problems actually

doing it.

Cognitive Level VIII: Purposeful and Appropriate

A person at this level may:

•	realize that he or she has problems with his or her thinking and memory;

•	begin to compensate for his or her problems;

•	be more flexible and less rigid in his or her thinking. For example, 

or she may be able to come up with several solutions to a problem;

•	be ready for driving or job training evaluation;

•	be able to learn new things at a slower rate;

•	still become overloaded with difficult, stressful, or emergency

situations;

•	show poor judgment in new situations and may require assistance;

•	need some guidance to make decisions;

•	have thinking problems that may not be noticeable to people who did

not know the person before the injury.

What family/friends can do at Cognitive Levels VII/VIII:

•	Treat the person as an adult; show respect for his or her opinion when

attempting to provide guidance and assistance in decision making.

•	Talk with the individual as an adult. There is no need to try to u

simple words or sentences.

50 Appendix B - Rancho Los Amigos Levels
Introduction to Traumatic Brain Injury

•	Because the individual may misunderstand joking, teasing, or slang

language, be careful to check for understanding when using humor or

other abstract language.

•	Encourage the individual to be as independent as is safe. Help h

or her with activities when he or she shows problems with thinking,

problem solving, and memory. Talk to him or her about the

problems without criticizing. Reassure him or her that the proble

are because of the brain injury.

•	Strongly encourage the individual to continue with therapy to increase

his or her thinking, memory, and physical abilities. He or she m

feel he or she is completely normal. However, he or she is still maki

progress and may possibly benefit from continued treatment.

•	Be sure to check with the physician on the individual’s restrictions

concerning driving, working, and other activities. Do not rely on t

brain injured individual for information, since he or she may feel ready

to go back to his or her previous lifestyle.

•	Discourage him or her from drinking or using drugs, due to medical

complications.

•	Encourage him or her to use note taking as a way to help with

memory problems.

•	Encourage him or her to carry out his/her self care as independently as

possible.

•	Discuss what kinds of situations make him or her angry and what he or

she can do in these situations.

•	Talk with him or her about his or her feelings.

•	Learning to live with a brain injury is difficult and it may take a long

time for the individual and family to adjust. The social worker and/

psychologist will provide family members and friends with information

regarding counseling, resources, and support organizations.

– Los Amigos Research and Educational Institute (LAREI), 1990

Disclaimer: Information presented on this page is for specific health 

education purposes only. Persons should consult qualified health professionals 

regarding specific medical concerns or treatment. Each clinician caring for 

the patient is responsible for determining the most appropriate care.

51
	 	

References/Credits

Chapter 1: The Basics of TBI

Definition of TBI: Defense and Veterans Brain Injury Center, “OIF/OEF Fact

Sheet” (Washington, D.C., June 2007).

New research on factors affecting recovery: Novak, T. and Bushnik, T.

(2008). Understanding TBI. Part 3: The Recovery Process. Seattle,

TBI Model Systems Knowledge Translation Center. (DRAF

Statistics on TBI in OEF/OIF: CRS (Congressional Research Service) Report

for Congress. “United States Military Casualty Statistics: Operation Iraqi

Freedom and Operation Enduring Freedom.” The Library of Congres

Order Code RS22452. September 9, 200

References/Credits

52
Introduction to Traumatic Brain Injury
www.DVBIC.org

Version: 1-2010 | www.traumaticbraininjuryatoz.org

This guide was produced in collaboration with

The Defense Health Board

The Defense and Veterans Brain Injury Center

and

The Department of Veterans Affairs
Traumatic Brain Injury: A Guide for Caregivers

of Service Members and Veterans

Module 2

Understanding the Effects of

Traumatic Brain Injury and What

You Can Do To Help

Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

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Table of Contents

i

Module 2 Summary

Chapter 1: TBI Effects and Treatment

What are the Phases of Treatment?

What is the DoD System of Care?

What is the VA Polytrauma System of Care?

Who is on the Health Care Team?

Chapter 2: Physical Effects

What are Common Physical Effects of TBI?

Headaches

Sleep Changes

Fatigue/Loss of Stamina

Dizziness

Balance Problems (Tendency to Fall)

Sensory Changes

What Physical Effects May Be Less Common?

Spasticity

Hemiparesis, Hemiplegia

Bladder/Bowel Changes

Changes in Swallowing and Appetite; Weight Loss or Gain

Visual Spatial Problems

Apraxia

Seizures

Heterotrophic Ossification

Chapter 3: Cognitive Effects

What are Common Cognitive Effects?

Confusion

Slowed Speed of Processing

Attention Problems

Difficulties with Memory
ii

Planning and Organization Problems

Difficulty with Decision Making and Problem Solving

Confabulation

How Can You Help to Build Thinking Skills?

Compensation Strategies

Cueing

5W Strategy

Feedback

Problem Solving

Chapter 4: Communication Effects

What are Common Communication Effects?

Does Not Speak Clearly

Problems Starting a Conversation

Word Finding Problems

Problems Following a Conversation

Reading Comprehension Problems

What Communication Effects Are Less Common?

Dysarthria

Interrupting or Having a Hard Time Taking Turns in Conversation

Topic Selection Problems

Writing Problems

Nonverbal Communication Issues

Chapter 5: Behavioral and Emotional Effects

What Are Common Behavioral Effects?

Frustration, Increased Anger/Aggressiveness

Impulsivity or Difficulties in Self-Control

Poor Judgment

Reduced or Lack of Initiation

Repetitive Behaviors (Perseveration)

Less Effective Social Skills

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Table of Contents
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help iii

Changes in Sexual Behaviors

Lack of Self-Awareness

What Are Common Emotional Effects?

Depression

Increased Anxiety

Mood Swings (Emotional Lability)

Changes in Self-Esteem

Should I Stay in Touch with the Health Care Team?

Appendix A: Frequently-Asked Questions

Appendix B: Resources

References/Credits

An electronic version of this Guide can be found at the following Web address: 

www.traumaticbraininjuryatoz.org

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iv
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

This module is about the ways that a moderate to severe traumatic brain 

injury (TBI) may change a person’s body, thinking, acting, and feelings. 

Some of the information you will read may be true for your service 

member/veteran. But some of it will not. Each person is unique and 

each person’s effects from TBI will also be unique. 

Many people with TBI have similar patterns of recovery. But everyone 

recovers at a different pace. There is no way to “hurry up” the recovery 

from TBI. 

There are, however, many things you and the health care providers can 

do to create the best possible recovery. 

Remember, you are not alone. There are thousands of other military 

families who are struggling to cope with many of the same changes from 

TBI that you and your service member/veteran are experiencing. 

Doctors at the Departments of Defense (DoD) and Veterans Affairs (VA) 

are learning more every day about how to effectively treat the effects 

of TBI. Your service member/veteran will benefit from new medical 

knowledge based on other service members’ experiences. His or her 

experience will add to doctors’ knowledge about how to treat TBI.

Most effects of TBI fade over time. Keep hope in your heart as you move 

forward into the future. 

v

Module 2 Summary

Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

This module is about all the effects that people with TBI may experience. 

You may notice some of these changes in your service member/veteran 

with TBI. 

The module explains what you can do to help your service member/

veteran manage these effects. This information will be especially helpful 

when he or she comes home from the hospital.

Please keep in mind—your service member/veteran is likely to 

experience some--but not all--of these effects. Many effects are 

common right after the injury. Many are likely to improve over time. 

Though we know more now about TBI than ever before, no one can say 

with certainty just what effects each injured person will have. 

We do know that most people with TBI can and will make improvements. 

Proper diagnosis, treatment, and follow-up care helps. So do a 

supportive family and community. 

You Are Not Alone

TBI is the “signature” injury of the conflicts in Iraq and Afghanistan. As 

many as one in five service members with injuries returning from these 

war zones have been diagnosed with a TBI. 

Blasts from grenades, improvised explosive devices (IEDs), and land 

mines caused most of these TBIs. Gunshot wounds, falls, and motor 

vehicle accidents also cause TBI. 

Because TBIs from blast injuries are common, the DoD and VA are 

focused on how to help the injured and their families manage the effects 

of TBI. More is learned every day about how to do so.

The good news is that you are not alone. There are skilled health care 

providers and excellent resources to help you and your service member/

veteran with TBI manage the effects of TBI. 

There are things you can learn to do to manage these effects at home. 

There are other caregivers who are learning about the effects of TBI too, 

and who can share their experiences and ideas with you (see Module 3).

Learning about Effects

The very first effect of a TBI could be loss of consciousness or a dazed feeling. 

Some effects are most visible just after the injury. For most people, these 

effects will generally fade as time goes by.

A blast is an 

explosion. There 

is often a loud 

noise, waves of air 

pressure, shaking, 

and flying objects. 

People in a blast 

may get thrown 

out of their 

vehicles. 

Chapter 1

TBI Effects and Treatment

1
The kind of effects that your service 

member/veteran with TBI will have 

depends on what part of his or her brain 

was injured. (You can learn more about the 

parts of the brain in Module 1.) 

Understanding the brain injury can help 

you make sense of what doctors tell you. 

It can also help you cope with changes you 

observe.

Service members sometimes have several 

injuries, including TBI. It is often hard to 

sort out which effects are due to TBI alone, 

and which result from other injuries. 

Emotional conditions like post-traumatic 

stress (PTS), post-traumatic stress disorder 

(PTSD), and depression also make it hard 

to tell if an effect is due to TBI.

The health care team is familiar with all of 

these conditions. They will develop the 

proper treatment plan. They will also teach you about how you can help.

You will see sections in this module about physical effects, cognitive 

effects, communication effects, and so on. It’s important to remember 

that many effects of TBI are inter-connected. For example:

• Sleep problems can affect how quickly someone thinks.

• Sensory 

changes can 

affect how 

someone 

focuses and 

learns. 

• Fatigue can 

make it hard 

to safely move 

about. 

• Memory problems can make it hard to communicate with others. 

• Visual problems can make it hard to learn. 

Post-traumatic 

stress (PTS) is 

anxiety that 

can develop if 

you are exposed 

to or witness a 

traumatic event 

(like combat) 

that threatened 

or caused great 

physical harm to 

self or others.

What is a TBI?

A traumatic brain injury (TBI) is 

a direct blow or jolt to the head, 

penetrating head injury, or exposure 

to external forces such as blast waves 

that disrupts the function of the 

brain. Not all blows to the head or 

exposure to external forces results 

in a TBI. The severity of TBI may 

range from “mild”— a brief change 

in mental status or consciousness—

to “severe,” an extended period of 

unconsciousness or confusion after 

the injury. 

The changes that result from TBI are 

the direct result of the injury, and not 

a result of your loved one intentionally 

trying to act or think in a way that may 

be different from how he or she used 

to act and think. 

2 Chapter 1 - TBI Effects and Treatment
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

What are the Phases of Treatment?

If your injured family member was deployed, treatment began 

immediately. The military health care team stabilized your service 

member so he or she could be moved to the next level of care. 

From Iraq and/or Afghanistan, most service members go to Landstuhl 

Army Regional Medical Center in Germany for acute care. Those 

stationed outside of the United States may return to their home base. 

Others may go directly to a military hospital in the United States. 

You will be informed about where your service member is and when he 

or she will return to the United States. If your family member is going to 

be in Landstuhl for awhile, you may receive Invitational Travel Orders to 

pay for you to fly to Germany.

Once the service member’s injuries are under control, he or she is 

transported back to the United States for continued inpatient care and 

rehabilitation. 

Medical treatment and rehabilitation may continue for several months 

in a military treatment facility (MTF), such as Walter Reed Army Medical 

Center, National Naval Medical Center, or Brooke Army Medical Center. 

Rehabilitation may continue at a VA Polytrauma Rehabilitation Center or 

Polytrauma Network Site. 

The final phase of treatment is often at home and in the community. In 

this phase, you may be the primary caregiver for your service member/

veteran with TBI. Therapy often continues on an outpatient basis in a 

hospital or clinic closer to home.

Each injured service member will have his or her own pattern of care. 

Those stationed outside the United States may not return stateside for 

care. Some service members will have injuries that require care in a 

military hospital; others will not. Some will need months of inpatient care 

in the VA system; others will not. 

The health care team will tell you the type of care your family member 

needs. They will explain when it is time to move to another level of care, 

and why. 

Throughout treatment, you are an important member of your service 

member/veteran’s team. The more you know about TBI, the more easily 

you can work with the health care team. The more you know, the better 

able you will be to help your service member/veteran recover from TBI. 

Acute care is 

short-term 

treatment for a 

serious injury or 

illness.

Inpatient care is 

care provided to a 

person staying in 

a hospital.

Rehabilitation 

means re-learning 

old skills.

A military 

treatment facility 

(MTF) is a military 

hospital. You can 

find a list of MTFs 

in Appendix B.

Outpatient care 

means living at 

home and going 

to appointments 

at the hospital or 

doctor’s office.

3
What is the DoD System of Care?

There is a network of military treatment facilities (MTFs) across the 

country. They are operated by the Department of Defense (DoD). The 

DoD and the Department of Veterans Affairs (VA) Polytrauma Centers 

work together to manage the care of injured service members.

Check www.tricare.mil/mtf to locate the military treatment facilities. 

DoD also provides health care through TRICARE (see Module 4). 

4

Department of Defense Medical Centers

(source: www.tricare.mil/mtf)

Chapter 1 - TBI Effects and Treatment

Fort Lewis, WA

Travis AFB, CA

NMC, San Diego-Balboa, CA

MCLB, Barstow, CA

Fort Carson, CO

Fort Hood, TX

Lackland AFB, TX

Fort Bliss, TX

Fort Sam Houston, TX

Kessler AFB, MS

Fort Campbell, KY

Walter Reed AMC, DC

National NMC, Bethesda, MD

Fort Bragg, NC

NMC, Portsmouth, VA

Fort Gordon, GA

Andrews AFB, MD

VAMC − Buffalo, NY

Tripler AMC, HI

Wright-Patterson AFB, OH 
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

What is the VA Polytrauma System of Care?

If your service member/veteran needs long-term care and rehabilitation, 

he or she may go to a center that is part of the Department of Veterans 

Affairs (VA) Polytrauma System of Care (PSC).

The PSC is a comprehensive, integrated system of rehabilitation care for 

veterans and service members with polytrauma and TBI.

The PSC is a tiered system of care which includes:

• Four TBI/Polytrauma Rehabilitation Centers (PRC) located in 

Richmond, VA; Tampa, FL; Minneapolis, MN; Palo Alto, CA (a fifth PRC 

in San Antonio, TX is scheduled to open in 2011). The PRCs provide 

the most intensive specialized care and comprehensive acute, inpatient 

TBI rehabilitation care.

• 22 Polytrauma Network Sites (PNS) which provide a full range of inpatient 

and outpatient TBI rehabilitation care in regional areas closer to home. 

• 81 Polytrauma Support Clinic Teams (PSCT) which provide local 

outpatient, specialty rehabilitation care, and long-term TBI management. 

• 49 Polytrauma Points of Contact (PPOC) located at VA medical centers 

across the country. PPOCs coordinate case management and referral 

within the PSC and provide referrals for local community services.

VA is the 

Department of 

Veterans Affairs.

Polytrauma 

means more than 

one injury.

Learn more about 

the VA Polytrauma 

System of Care at 

www.polytrauma.

va.gov. 

5

Department of Veterans Affairs PRCs and PNSs

Richmond

Tampa

Minneapolis

Palo Alto

Seattle

West Los Angeles

Polytrauma Rehabilitation Centers

Polytrauma Network Sites

St. Louis

Boston

Hines

Philadelphia Indianapolis

Lexington

Augusta

Syracuse

Bronx Cleveland

Washington DC Denver

Tucson

Houston

Dallas

San Juan, PR
Polytrauma Rehabilitation Centers (PRCs)

Your service member/veteran may transfer from a military hospital to a VA 

PRC for additional inpatient care and TBI rehabilitation. The health care 

teams at the military hospital and PRC work together to plan the move.

At the PRC, your family member will receive specialized medical and 

rehabilitation treatment for all the effects of TBI (and other serious 

injuries) that you will read about here. 

The PRC offers a program where injured service members/veterans learn 

how to live as independently as possible after TBI. Each PRC also has 

military liaisons on site. Through regular meetings, the liaison helps your 

family member stay connected with his or her military community and 

makes sure that all service-related needs (e.g., orders) are addressed.

Polytrauma Transitional Rehabilitation. For those who have completed 

inpatient care but are not yet able to live independently, Transitional 

Rehabilitation offers a progressive return through a structured program 

focused on restoring home, community, and vocational skills in a 

controlled, therapeutic setting. A transitional rehabilitation program for 

veterans and active duty service members with TBI is located at each of 

the four PRCs. 

Case management is an integral part of PSC services. A clinical case 

manager works with your service member/veteran to help with:

• Transition from military hospital to VA medical center

• Communication between service member/veteran, family, and the VA 

rehabilitation team

• Identification of various VA, DoD, and community resources.

There are also VBA counselors to help you find and apply for 

VA benefits.

Case management 

is the coordination 

of services to 

meet the patient’s 

needs.

VBA stands for 

Veterans Benefits 

Administration. It is the 

government 

agency that offers 

insurance and 

other benefits 

to veterans and 

eligible service 

members.

6

The DOD and VA systems of care have many levels of 

service. That’s because your family member’s need for 

care will change as he or she gets better over time. 

There are also services to give you the education and 

support you need as a caregiver.

Chapter 1 - TBI Effects and Treatment
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

Family Support Services

Families are valued members of the treatment team at the PRC and 

throughout the VA Polytrauma System of Care. VA rehabilitation team 

members work with family members and caregivers to provide education, 

training, and information on: 

• Caregiver role and caregiver tasks

• TBI rehabilitation process and recovery

• VA and community support services

• How to take care of yourself and stay well.

Each PRC has a Voluntary Services office. This office can help you find 

resources near the PRC, including places of worship, shopping centers, 

and other local services.

All four PRCs have a Fisher House on site that offers housing for family 

members while their service member/veteran is receiving care.

Learn more about 

Fisher House at 

www.fisherhouse.

org.

“My goal—and I’ve made this clear to the team—is for Mike 

to go to the transition program, where they have to live 

basically on their own. They have to be able to take care of 

all their living skills, and be able to get in and out of their 

bed, and to and from therapy, and that kind of thing. I would 

really like for him to get to that point because I would like for 

him to prove to himself that he’s able to stay alone and take 

care of himself and prove to me that he’s able to stay alone 

and take care for himself for a short time.”

 - Meredith H.

7
Who is on the Health Care Team?

Your service member/veteran’s health care team includes members with 

different skills and training. The team may include:

• Your service member/veteran with TBI—the most important 

member of the team: Participating in the rehabilitation process 

and setting goals helps your family member feel in control. It also 

drives recovery.

• You, the caregiver—the one who knows your service 

member/veteran best!: Your role is to pay attention to what your 

family member is experiencing. Report problems to the health care 

team. This helps the team develop the best treatment plan.

• Audiologist: A team member who evaluates and treats hearing loss 

and related disorders, including balance (vestibular) disorders and 

tinnitus (ringing in the ears).

An audiologist fits and dispenses hearing aids and other assistive 

devices for hearing.

• Case Manager/Care Coordinator: A case manager may be a social 

worker or Registered Nurse (RN) who works at the MTF or VA center. 

He or she is the family’s Point of Contact (see Module 4). This is the 

person who will be the liaison between you and the health care team.

The case manager learns about the needs (medical, financial, 

emotional) of your service member/veteran and your family. Then, he 

or she plans for your family member’s move to the next level of care. 

The case manager is available throughout treatment. She or he can 

share information to help your family manage the challenges you 

experience.

• Chaplain: The chaplain is a member of the clergy. He or she can 

counsel you and your family member about how to accept and cope 

with the changes that a TBI may bring. The chaplain also offers 

spiritual comfort.

• Department of Defense Military Liaison: The team member 

who helps with questions about benefits and other military–related 

issues. (See Module 4 to learn about benefits.)

• Dietitian: This team member reviews your family member’s diet and 

develops a nutritional plan based on his or her medical needs. 

• Neurologist: A doctor who treats disorders of the brain, spinal cord, 

nerves, and muscles. Neurologists are often called upon to manage 

seizures and headaches. 

8 Chapter 1 - TBI Effects and Treatment
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

• Neuro-opthalmologist: A doctor who treats visual problems related 

to the nervous system (that is, vision problems that do not come from 

the eyes themselves). He or she tracks changes in vision, perception, 

and the need for lenses.

• Neuropsychologist: A licensed clinical psychologist with special 

training in how the brain affects a person’s behavior. 

This team member gives and evaluates certain types of cognitive and 

emotional tests. 

Neuropsychologists may serve as the rehabilitation team leader. They 

can help both service members/veterans and family members cope 

with life after TBI.

• Neurosurgeon: A doctor who performs surgery on the nerves, brain, 

and/or spine.

• Occupational Therapist (OT): A therapist who helps with 

“activities of daily living,” like eating, grooming, dressing, and bathing.

OTs also help injured people to re-learn or adapt skills they need to 

return to work or school. This may include skills such as shopping, 

cooking, and money management. 

OTs provide adaptive equipment and make suggestions for changes in 

the home. 

OTs provide cognitive rehabilitation. They also may help treat 

swallowing problems. 

• Physiatrist (Physical Medicine and Rehabilitation Specialist): 

A doctor who is often the leader of the health care team. As the 

leader, he or she directs and coordinates rehabilitation care. 

Physiatrists treat problems of all the major systems in the body. 

“The whole team would come in almost every morning to 

discuss the day and how he was and what was going on. Then 

they’d have a big weekly meeting. So I felt very involved with 

his care and I felt like I understood what was going on, on a 

daily basis. That gave me a lot of comfort.”

 - Patty H.

9
• Physical Therapist (PT): A team member who provides services 

that help restore body function, improve mobility, relieve pain, and 

prevent or limit permanent physical disabilities from injury. 

PTs also determine the patient’s level of independence and ability to 

re-enter the community or workplace after injury. 

They teach service members/veterans to use assistive and adaptive devices, 

such as crutches, prosthetics, wheelchairs, and specialized equipment.

• Primary Care Provider: The team member who coordinates the 

ongoing care of all your family member’s general medical needs. Primary 

care providers may include Family Practice Physicians, Internal Medicine 

Physicians, Clinical Nurse Practitioners, and Physician Assistants.

• Recreational Therapist (RT): A team member who helps service 

members/veterans become independent in leisure activities and with 

social reintegration. RTs help with re-entering the community by 

applying practical skills to real-life situations.

• Rehabilitation Nurse: A nurse who specializes in rehabilitation. 

Rehabilitation nurses educate service members/veterans and their 

families about TBI and safety, skin care, toileting, medication, and 

other issues. They reinforce the skills being learned in therapy and 

help carry out the treatment plan.

• Rehabilitation Psychologist: A licensed clinical psychologist 

who has been specially trained to assess and treat the many issues 

facing service members/veterans and their families (i.e., coping and 

adjustment problems related to chronic or traumatic injury). They 

work to help achieve the highest level of functioning after injury. 

• Social Worker: A team member who may help patients and families 

find resources they need during treatment. A Licensed Clinical Social 

Worker (LCSW) is trained in psychotherapy and helps individuals deal 

with mental health and daily living problems. 

• Speech Language Pathologist (SLP): Also called a speech 

therapist, a team member who specializes in evaluating and treating 

both expressive and receptive speech and language problems. SLPs 

may be involved with evaluating and treating swallowing problems. 

Cognitive rehabilitation is another area of assessment and treatment 

for SLPs. 

• Vocational Rehabilitation Counselor: This team member 

may help your service member/veteran prepare for or retrain for 

employment.

10 Chapter 1 - TBI Effects and Treatment
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

“A really super thing for us in terms of communicating with 

the hospital staff—and the hospital already had this installed 

in the room—is a big dry erase board. Some people use it and 

some people don’t. We use it to make a list of all the things 

we want to talk about with the doctors. That way, if I’m 

not in the room when the doctors come by on their rotation, 

they’ve got the big list right there and they can see it clearly. 

That helps keep the communication going.”

 - Anna E.

11

The next chapters describe many possible effects of TBI. 

These include physical, cognitive, communication, and 

behavioral/emotional effects

If you notice any change in any effects of TBI in your 

service member/veteran, alert the health care team 

immediately.
12

“He was plateauing on a therapy level. We realized that 

what the therapists were doing—you know, they had a book 

and they were going through checklists—was like being 

in school to him. So we suggested that the therapists try 

working with him on something he wants to learn. They said 

fine, tell us what he wants to do. So I asked him one night. I 

said, ‘Jason, what would you want to learn first if you had to 

prioritize?’ Well, he wanted to learn to use the telephone and 

he wanted to learn to use the remote control on the TV. We 

told the therapists. They got him an adaptive remote control 

and we got him a phone. He learned to use them both within 

a week. So the therapists were good. They said, ‘We’ll work 

with you. What do you think is going to help him?’ They 

didn’t know him before the brain injury, so they relied on 

us to give them as much information as we could on the 

kind of person he was so they could determine what would 

work for him through the therapy. You have to educate the 

professionals on what he was like.” 

 - Pam E.

Chapter 1 - TBI Effects and Treatment
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

This chapter is about possible physical effects from TBI. 

Module 1 is about how the brain works. It explains that there are areas in 

the brain that control our ability to perform physical tasks. 

After a TBI, the nerve cells in the brain may no longer send information to 

each other the way they normally do. This is why people with a TBI may 

have changes in their physical abilities. 

A brain injury can affect physical abilities, such as:

• balance 

• mobility

• coordination

• muscle strength, tone, and control. 

It may also affect the body’s senses, including:

• hearing

• vision 

• smell

• touch

• taste. 

A TBI can cause fatigue and conditions such as seizures, spasticity, and 

bladder, bowel, and swallowing difficulties. 

Some of these effects will get better quickly, others will take time, and still 

others may become a lasting problem. 

Every person with TBI has a unique set of physical effects. Each person 

has a unique pace of recovery. 

This chapter describes many physical effects that people with a TBI may 

experience. Some information in this chapter may apply to your 

service member/veteran, but other information may not. Some 

information may apply now, but not in the future.

With the help of the health care team, many physical effects can be 

treated or managed with positive results. 

You can help your service member/veteran with TBI by following through 

on treatment plans from the health care team. You can also use the 

suggestions in this chapter. But first, check these ideas out with the 

health care team. 

The health care team will have many more suggestions and treatments 

than are listed here. Talk to the team members about “what to do” if 

Fatigue is being 

very tired or 

weary.

Spasticity is 

increased tension 

or tightness in 

a muscle. When 

such a muscle 

is stretched, the 

increased tension 

causes it to pull 

back (resist).

Physical Effects

Chapter 2

13
Chapter 2 - Physical Effects

“He deals with migraines right now on a daily basis, and I 

think that stress plays along with it. He can’t deal with too 

much at one time. He’s overwhelmed. But he deals with the 

fatigue factor. He’s on limited hours right now, so he can only 

work four hours out of the day. It’s very light duty. That’s 

where we’re at, right now.”

 - Meaghan L.

your service member/veteran begins to have new symptoms or problems, 

or reacts differently to treatments than he or she has been. 

What are Common Physical Effects of TBI?

Headaches

Headaches are common following TBI. Some people have a headache all 

the time, and some people’s headaches come and go. 

Fatigue, stress, and a history of migraines make these headaches worse.

Fortunately, post-TBI headaches usually improve over time. 

Treatment Options

Medication: It can take some trial and error to find the right medicine 

to treat post-TBI headaches. Your family member should take all 

medications exactly as the doctor directs. He or she should talk with 

the doctor before changing how much medicine he or she takes, or 

how often.

Other options: Stretching and strengthening exercises may help. 

Follow the directions of the health care team on these. Exercise, such 

as swimming in warm water, can help loosen the muscles that cause 

headaches. Acupuncture, occipital nerve blocks, biofeedback, Botox®, 

and physical therapy are possible treatments.

How you can help:

• Ask your service member/veteran to lie down in a dark and quiet 

place; sleep can relieve a headache. 

• Use heat or ice as directed by the doctor.

14
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

• Encourage your family member to:

- Avoid bright sunlight, especially going from a dark building into 

bright sunlight (may need to wear very dark sunglasses).

- Avoid alcohol.

- Avoid foods that trigger headaches. These include cold foods, aged 

hard cheeses, or chocolate. 

- Manage stress. Take breaks during activities, practice deep breathing 

exercises, exercise, and have some fun.

- Keep track of headaches in a journal. Note the time of day, the activity, 

and intensity of the pain. Share this information with the doctor.

- Take medications at the same time every day.

If headaches do not improve or worsen, call the doctor. Your service 

member/veteran does not need to suffer. New treatment options can be 

tried. Your family member may be referred to a headache specialist (such 

as a neurologist) if headaches do not improve with standard treatment. 

Sleep Changes

Altered sleep patterns are very common after TBI. This problem is usually 

worst in the first several weeks to months after injury. 

Many people with TBI sleep during the day and are awake at night. They 

may nap now, when before they did not. 

Stay hopeful. Most people with TBI do usually resume a more normal 

sleep routine similar to the one they had before the injury. 

Time, patience, and some creative problem-solving help. Developing a 

consistent routine, using medications on a temporary basis, and changing 

the bedroom can improve sleep. 

What you might see:

• Difficulty falling or staying asleep (insomnia)

• Awake at night, sleeping during the day

• Frequent naps

• Sleeping too much or too little.

How you can help:

• Work with the health care team to establish healthy sleeping patterns. 

• Encourage your service member/veteran to:

- Limit daytime naps (talk to the health care team first).

15
- Avoid caffeine (coffee, tea, energy drinks, dark soda) after the 

morning. 

- Exercise during the day; avoid exercise too close to bed time. 

- Avoid fluids two hours prior to bedtime.

- Try to eat the last meal of the day four hours before bedtime.

- Go to bed at the same time every night and get up at the same time 

every morning. 

- Avoid use of bed for activities other than sleep and sex 

(e.g., watching TV).

• If worrying or nightmares are contributing to poor sleep, consult a 

doctor or nurse.

• Monitor the bedroom: turn the clock away from the bed, use room 

darkening shades. Most people sleep better in a cooler environment.

• If your service member/veteran simply cannot fall or stay asleep, have 

him or her get out of bed and watch TV or read (if easy to do without 

assistance) until he or she feels tired and is ready to try again.

• Talk with your service member/veteran’s doctor about temporarily 

using sleep medication or complementary/alternative therapies to help 

establish a sleep schedule.

• Make sure to tell your doctor if your service member/veteran is taking 

an over-the-counter medication.

Chapter 2 - Physical Effects

“He had tremendous sleep problems, which is extremely 

common. He met other people who were in similar situations. 

They’d all be up on the computers or watching TV in the 

middle of the night, doing things that make their symptoms 

worse. We went for 25 years with no TV in our home so we’re 

not TV watchers. He would sit and channel surf. And the 

reason he channel surfed, he said, was because he couldn’t 

concentrate long enough to watch anything very long. He 

was just going from one thing to another.”

 - Caroline M.

16
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

Stamina is having 

the physical 

strength to keep 

on going.

Central fatigue 

is fatigue of the 

central nervous 

system. 

Fatigue/Loss of Stamina

Fatigue is a common complaint among people with TBI. The body needs 

a vast amount of energy for healing after traumatic injuries. Sleep is often 

disrupted in the hospital. 

Usual patterns of rest and activity are often very different for many weeks 

to months after TBI. Confusion can make fatigue worse. 

Central fatigue is the major type of fatigue in TBI patients. Central 

fatigue affects thinking. Working harder to learn and stay focused can 

make your family member mentally tired. In some people, central fatigue 

causes them to be irritable or have headaches. 

“Sleep and fatigue were probably the biggest, most constant 

problems, with the other things sort of waxing and waning. 

And the neuropsychologist explained to me about the fatigue, 

that when you have cognitive deficits, your brain has to work 

so hard just to process something that’s just routine for the 

normal person that it causes a great deal of fatigue.

So it took him a very long time to get over that fatigue, and 

he still has it at times. But when we first got home, he would 

be completely wiped out when he came home from work, 

and every single weekend was a wipe-out. And then that 

improved, and it was just Saturday that was the wipe-out. 

Now, most days are pretty normal. Most weekends are pretty 

normal. Every now and then we hit a time where he just kind 

of crashes.”

 - Caroline M.

Peripheral fatigue is also reported by many. Peripheral fatigue is 

physical. It can make pain, thinking, and mood worse. 

Fatigue reduces the speed and quality of rehabilitation. Fatigue can also 

slow down the return to normal life activities, such as school or work. 

For most people, fatigue gradually lessens over time. Stamina and 

endurance improve. However, some people with TBI say that for the rest 

of their lives, their endurance is just not what it used to be. They have to 

pace themselves more than they used to. 

Peripheral fatigue 

is muscle fatigue.

17
What you might see:

• Frequent comments about being tired 

• Need for sleep after a short activity, lack of energy

• Poor stamina

• Extreme fatigue after a busy stretch of hours

• Slurred speech

• Irritability

• Slower thinking speed.

How you can help: 

• Set up a daily schedule for your family member. Make sure it includes 

enough rest/sleep. Use a calendar to help your service member/

veteran follow the schedule.

• Reduce family and social demands. 

• Help your family member to pace him or herself. 

• Ask your family member to conserve energy for important tasks in the day. 

• Help your family member to have an active lifestyle. Regular exercise 

increases stamina. The physical therapist can develop a safe exercise 

program. 

• Allow time for undisturbed rest during the day. A nap is usually 30-60 

minutes.

• Schedule important appointments for times of the day when your 

family member is most awake. 

• Learn the signs of fatigue in your service member/veteran. Ask him or 

her to do the same. Make a list of the signs and keep it in his or her 

calendar/memory notebook. 

• Inform the health care team about changes in sleep patterns or stamina. 

• Ask the health care team to rule out other causes of fatigue. Common 

causes of fatigue are endocrine abnormalities, sleep disorders, mood 

disorders, diabetes, substance abuse, electrolyte imbalances, and 

nutrition deficits. 

Dizziness 

Dizziness is a term used to describe everything from feeling faint or 

lightheaded to feeling weak or unsteady. 

Under normal circumstances, your sense of balance is controlled by a 

number of signals that your brain receives from several locations. A TBI 

can disrupt this. 

18 Chapter 2 - Physical Effects
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

The greatest concern about dizziness is the increased tendency to fall 

when dizzy or lightheaded. 

Dizziness is often an early effect. It frequently goes away during the first 

weeks following injury. 

“He had severe dizzy spells and vertigo from the head injury. 

Driving in a car was really hard for him. The dizziness in 

the car went on for three or four months. It slowly started to 

go away.”

 - Emily S.

If dizziness does not go away on its own, there are therapies and 

medications that may help. These must be used under the supervision of 

the health care team.

What you might see:

• Complaints that the surroundings are spinning or moving (vertigo) 

• Loss of balance, unsteadiness

• Nausea 

• Wooziness, lightheadedness

• Blurred vision during quick or sudden head movements. 

How you can help:

• Be aware of the possible loss of balance. This can lead to falling and 

serious injury. 

• Fall-proof your home: Remove area rugs and electrical cords that 

someone could slip on. Use non-slip mats on your bath and shower 

floors. 

• Have your service member/veteran:

- Sit for a few minutes before walking. This gives the brain time to adjust.

- Sit or lie down as soon as he or she feels dizzy. 

- Avoid driving a car if frequent dizziness or lightheadedness is present. 

- Use good lighting when getting out of bed at night. 

- Walk with a cane, walker, or other assistive device for stability.

- Avoid sudden movements or bending over. 

19
• Work closely with the health care team to manage symptoms effectively.

• Talk with the doctor about therapies or medications that improve 

symptoms. 

Balance Problems (Tendency to Fall)

The brain controls our physical movement and our balance. A TBI can 

affect balance. 

Balance problems are often an early effect after TBI. They go away over 

time and with physical therapy. 

What you might see:

• Unsteadiness when walking

• Inability to walk or sit without assistance

• Falls

• Holding onto furniture, walls, other objects when walking.

How you can help:

• Encourage proper use of aids such as walkers or canes, if prescribed, in 

all settings (community and home). 

• Remove throw rugs from your home.

• Work with the physical therapist to learn how to assist your service 

member/veteran while he or she is sitting or walking. 

• Falls are the leading cause of non-combat TBI. Provide or arrange for 

supervision once you are home to prevent falls and another TBI. 

Chapter 2 - Physical Effects

“He was dizzy. He had balance problems. In the first four 

months, maybe six months after the injury, we just never knew 

what was going to happen from one moment to the next, and it 

was like a light switch going on and off. One minute he would 

be pretty normal, and the next minute it was like somebody 

flipped a switch and he was dizzy and losing his balance and 

nauseated and couldn’t remember things, and he was confused. 

It was the darndest thing.”

 - Caroline M.

20
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

Sensory Changes

The brain is the center for all five of our senses: sight, hearing, taste, 

smell, and touch. 

When the brain is injured, each of the senses is at risk for change. There is 

often not much to be done about these changes in the first year after injury. 

Doctors often use a “wait and see” approach with the hope that sensory 

changes will go away on their own. 

For some sensory changes that don’t go away over time, surgery may help. 

For others, therapy and learning to live with the effect will be in order. 

What you might see:

• Vision changes, such as blurry vision, double vision, or sensitivity to light

• Hearing changes, including muffled hearing or ringing in the ears 

(tinnitus) in one or both ears

• Changes in taste and smell. This could be a complete lack of taste and 

smell or an altered taste, such as a metallic flavor in the mouth.

How you can help:

• A neuro-ophthalmologist can evaluate visual changes. A neurologist 

can evaluate other sensory changes.

• Reinforce wearing of an eye patch or special glasses if ordered for 

double vision.

• Ask your service member/veteran to avoid alcohol. It may increase 

sensitivity to light and noise.

• Seek professional advice about whether or not it is safe for your family 

member to drive if he or she is having a change in vision. 

• Have his or her hearing checked. Use hearing aids, if needed.

• Ask a dietitian about tips for eating if taste and smell are lost or altered.

“He had visual field deficits right after the injury. They’ve 

since gotten a little bit better, but he still has visual field 

deficits. He lost hearing in his right ear, so he can’t hear 

sometimes when I’m trying to talk to him.”

 - Aimee W.

21
• Make sure you have a working smoke alarm in the house if his or her 

sense of smell has been lost. 

• Try to be patient. Sensory changes can improve over the first several 

months or years after TBI. Work with the health care team to track 

how the senses are working. Seek further evaluation and treatment 

options as needed. 

What Physical Effects May Be Less Common?

Spasticity 

An injury to the brain can cause an abnormal increase in muscle tone 

called spasticity. A spastic muscle does not easily relax the way a 

normal muscle does. 

This effect is most common with a severe and/or penetrating head injury. 

Regular stretching, splints to keep limbs in proper position, and 

medications are common treatments. 

Severe spasticity can be painful so pain management may be in order. 

What you might see:

• Involuntary muscle tightness and stiffness

• Muscle contractions 

• Decreased range of movement and abnormal posture.

How you can help:

• The physical therapist will develop a stretching program for your 

family member. Ask the physical therapist to teach you this program.

• Post diagrams of the stretches. Help your family member do the 

recommended stretches.

• If splints are used, learn how to apply them. Find out how long they 

are to be worn each day.

Chapter 2 - Physical Effects

Spasticity is 

increased tension 

or tightness in 

a muscle. When 

the spastic muscle 

is stretched, the 

increased tension 

causes it to resist, 

pull back.

“He’s getting a laptop and he’ll be using a special program 

on it, which the vision therapy here has provided for him. It 

magnifies everything.”

 - Meredith H.

22
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

“My son’s biggest problem was the spasms. My son was very 

tight. All his muscles were contracted. He slept with his foot 

on the floor, because his leg would not stretch out. His arm 

was contracted to him, against his body. You couldn’t pull 

it apart from his body. His fingers were tight and closed. He 

could not open his hands. 

They gave him a muscle relaxer. My son’s legs now move. He’s 

completely relaxed, completely relaxed. It’s amazing what it 

does for my son.”

 - Nellie B.

• Monitor your family member’s skin for pressure points from the splints. 

Alert nurses to areas of redness and breakdown.

• Tell the health care team if the spasticity gets worse. This could be a 

sign of an underlying problem.

• If spasticity is so severe that it interferes with comfort, positioning, and 

general functioning, ask the doctor about treatment options. These 

include implanting a muscle relaxant pump. 

Hemiparesis, Hemiplegia 

Muscle movement originates in the brain. A TBI can affect movement. 

You may remember from Module 1 that movement of the right side of 

the body is controlled by the left side of the brain, and movement of the 

left side of the body is controlled by the right side of the brain.

What you might see:

• Muscle weakness on only one side of the body (hemiparesis).

• Total paralysis of the arm, leg, and trunk on one side of the body 

(hemiplegia).

How you can help:

• Your service member/veteran’s physical therapist and occupational 

therapist will develop leg and arm exercises. Ask to learn these 

exercises. 

• Realize that your family member may take longer to move around. 

Allow extra time to get places.

The “hemi” in 

hemiparesis and 

hemiplegia refers 

to the hemispheres 

of the brain.

23
• Encourage use of prescribed assistive devices, such as a walker or cane. 

They help your family member stay safe and independent.

• You may notice decreased sensation in affected limbs. Monitor skin 

for pressure points from the splints. Alert the team to areas of redness 

and breakdown. 

• Therapists may recommend certain sleeping positions that are best for 

the affected limb(s). Follow their suggestions.

Bladder/Bowel Changes

Even bowel and bladder functions are controlled by the brain. For many 

people with TBI, bowel and bladder functions are impaired in the early 

days to weeks following injury. Health care providers expect this and 

are prepared to help. Urinary catheters and use of diapers or pads may 

be needed. Bowel and bladder retraining is part of the rehabilitation 

process. Fortunately, with time and practice, most people with TBI regain 

control of these body functions. 

What you might see: 

• Loss of bladder or bowel control

• Increased urgency to urinate

• Incomplete bladder or bowel emptying

• Increased bladder infections

• Constipation

• Memory and cognitive problems such that the person does not 

recognize the need to urinate/defecate or recall when he or she last 

did so

• Skin problems due to incontinence.

How you can help:

• Indwelling urinary catheters followed by the use of pads or diapers are 

common early on. Reassure your service member/veteran that these 

are nearly always temporary. 

• The rehabilitation nurse will teach bladder “training” which often 

includes a specific fluid schedule, limiting fluids in the evening, and 

timed attempts to empty the bladder. Help your service member/

veteran adhere to the recommended schedule and interventions.

• Bowel “training” often includes scheduled attempts, a high fiber diet, 

adequate fluids, physical activity, eating meals at regular times, and 

possible use of medications, including suppositories. Help your service 

24 Chapter 2 - Physical Effects
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

member/veteran to adhere to the recommended schedule 

and interventions.

• Monitor for skin breakdown and report it to health care providers.

“He had to learn bladder continence all over again, and that 

was really tough. I bought a bunch of pants that snapped 

down the side, the kind the basketball players wear. So he’d 

be sitting in his wheelchair and right there was the urinal. It 

was very accessible—those snap pants were a lifesaver. It 

took a lot of time and patience. Every so often we’ll have an 

accident, and it’s just like, okay, things happen.”

 - Anonymous

Changes in Swallowing and Appetite; Weight Loss or Gain

Many people with traumatic injuries do not drink or eat for a period of 

time. As a result, they lose weight. 

Once the person is fully awake and able to follow directions, swallowing 

can be evaluated. It is important to fully evaluate swallowing before the 

injured person drinks or eats. 

The purpose of evaluating the person’s ability to swallow is to make 

sure that what he or she eats goes into the stomach, not into the lungs. 

When food or fluid slips into the lungs, it often results in pneumonia. 

A speech or occupational therapist evaluates swallowing. This may be 

done in the person’s hospital room. 

If not, the therapist may escort your family member to the x-ray 

department for a video fluoroscopy. Your family member will consume a 

barium-laced liquid or food that will light up on an x-ray. The x-ray helps 

the therapist to see precisely where it is going. 

Once your service member/veteran is cleared to drink or eat, he or she 

may only be able to consume certain types of liquids and foods. Most 

people do best with medium consistencies, rather than thin fluid or very 

chewy, tough foods. 

With practice, most people will return to a normal diet. 

25
Appetite can be affected. Some people with TBI complain of a reduced 

appetite. Others gain weight due to boredom, memory problems, and an 

increased appetite. 

Work with the health care team to learn how to help your service 

member/veteran have a healthy diet and a healthy weight. 

What you might see: 

• Choking or coughing during meals

• Pocketing of food inside the mouth and/or drooling

• Decreased interest in eating

• Weight loss, without trying to lose weight (possibly due to loss of taste 

and smell)

• Overeating, resulting in weight gain

• Memory problems: failure to remember when to eat or when last ate.

How you can help:

• Do not offer fluids or food until your service member/veteran has been 

cleared to drink and eat.

• If on a special diet with restricted fluids and foods, work with the 

therapists and dietitians to learn what foods are allowed. Learn how 

to assist your family member to drink and eat if special strategies are 

needed (i.e., eat slowly, chin tuck during swallow, double swallow, 

follow every bite of food with fluid). 

• Short term changes in appetite are common. Don’t worry about early 

weight loss. Most often, the weight is regained once the person is home.

• Monitor your service member/veteran’s body weight and learn what 

his or her ideal weight range is from the dietitian.

• Report appetite changes to the health care team. These may be a sign 

of depression, general emotional distress, medication problems, or 

other medical conditions.

• Ask for a dietitian to review dietary intake and to learn more about 

meal preparation and a balanced diet.

• It is common to have reduced taste and smell following TBI. Talk with 

the dietitian about how to use spices and flavorings to perk up the 

taste of food.

• Weight gain following TBI is common. It is usually due to lack of 

physical activity. But sometimes it is due to boredom. Work with 

your service member/veteran to remain physically active and engaged 

26 Chapter 2 - Physical Effects
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

in outside activities. Establish set meal times. Discourage overeating 

or too many snacks.

• Encourage your service member/veteran to be involved, as able, in 

grocery shopping and meal planning/preparation. 

• Write meal times in the planner/memory book. Check off meals when 

finished.

Visual Spatial Problems

Visual spatial abilities begin in the brain. They include blind spots and/

or changes in the brain’s ability to understand what the eyes see. 

The ability to perceive where you are in space and in relation to other 

items in the environment may also be affected by TBI. This is called 

spatial awareness. 

Injury to the right side of the brain in particular can lead to difficulties in 

these areas. 

What you might see: 

• Tendency to ignore things on one side of the body

• Bumping into things on the affected side

• Difficulty finding his or her way around, especially in new places

• Difficulty recognizing shapes and telling the difference between shapes

• Turning head towards the unaffected side

• When reading, cutting words in half or beginning to read in the 

middle of the sentence or page

• Mistaking the location of a chair when sitting down

• Misjudging distance; for example, missing the cup when pouring

• Standing too close or too far from others in social situations

• Confusion between right and left

• Reports of impaired vision. 

How you can help:

• Ask for a neuro-ophthalmologist to identify your service member/

veteran’s specific visual and/or visual spatial problems.

• Stand on and place objects on the affected side. Encourage your service 

member/veteran to look to that side (this is called visual cueing).

• Remind your service member/veteran to frequently look around the 

environment, especially toward the affected side 

(this is called visual scanning).

Spatial refers to 

understanding 

where you are in 

the space around 

you.

27
• Use visual cues (e.g., a dark line) on one side of a page to encourage 

visual scanning of the entire page. 

• Arrange your house to make tasks easier. For example, have items to 

accomplish a task organized in one place.

• Show your service member/veteran around new places several times. 

Avoid sending him or her to new places alone.

• Limit clutter in the house. Try not to move items around.

• Remind your service member/veteran to use handrails when available.

• Provide gentle reminders that he or she is standing too close or far 

away during social encounters.

• Seek professional advice about whether or not it is safe for your service 

member/veteran to drive (see Module 3).

Apraxia 

A person with apraxia can often understand what to do and has the 

physical ability to do the task. However, his or her body simply has 

trouble cooperating with his or her best intentions. 

This is a direct result of injury to the brain, often to the parietal lobe 

(see Module 1). 

People with apraxia may have trouble using items correctly. 

What you may see:

• Trying to use a toothbrush to comb hair or a fork to eat soup

• Unable to follow spoken directions accurately. For example, he or she 

may not give “thumbs up” when asked.

• Putting clothes on backwards, upside down, inside out.

Chapter 2 - Physical Effects

“As far as training him for his left side neglect, when we would 

eat, he would put everything on the right side, and I would 

move everything to the left side to help him learn that. In the 

bathroom, I moved everything to the left side of the counter. 

So that was definitely a suggestion from the staff, to get 

everything to the left side so that he’s using that training.”

 - Sandy M.

Apraxia is the 

reduced ability to 

perform complex 

movements.

28
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

How you can help:

• Guide the person to complete the task the right way. For example: 

Place your hand over your family member’s hand and move it through 

the correct motions to perform a specific task.

• Redirect your service member/veteran to perform other common tasks 

in the correct order, one step at a time.

• Write down instructions for your service member/veteran.

• Post a daily routine or schedule for hygiene and other daily tasks (e.g., 

dressing) and write the routine down in your service member/veteran’s 

calendar/memory notebook.

Seizures 

Seizures happen when the electrical system in the brain misfires. 

Seizures can be frightening to watch. 

Two kinds of seizures may occur following a severe TBI:

• Early seizures—also called “generalized seizures” or “Grand Mal 

seizures”—typically happen during the first week after an injury. 

• Later seizures usually occur after the first week of injury in individuals 

who have never had a seizure before. People who have late-onset 

seizures are more likely to have a penetrating injury or one that causes 

a large amount of bleeding in the brain. 

Seizures can be temporary or chronic. Late-onset seizures carry a greater 

risk of future seizures than do early seizures.

29

Chronic means 

ongoing.

“He has what they call apraxia, which is one of many 

cognitive deficits that have occurred. He has issues with 

sequencing; for example, if he were going to make a sandwich, 

he wouldn’t know how to put these things in order like you 

and I would, he would get confused. He wouldn’t know what 

to do first, what to do second, like when to cut a sandwich in 

half and how to pick it up... the sequencing.”

 - Cindy P.
Chapter 2 - Physical Effects

A neurologist is the member of the health care team who usually 

diagnoses seizures. He or she will treat seizures with medications. 

What you may see:

• Generalized shaking or jerking of the arms and legs

• Loss of consciousness

• Altered attention, emotion, sensation, or movement

• Strange odors or sensations.

Late-onset seizures can also cause changes in smell, behavior, or 

personality. Sometimes, people mistake a seizure as a psychiatric 

disorder. 

Ask your doctor early on about how to recognize a seizure and what to 

do if one occurs.

How you can help:

• For a first seizure, call your doctor as soon as possible.

• If not a first seizure, alert the doctor. Make an appointment to have 

anti-seizure medication and blood levels checked.

• Talk to the doctor before adding or stopping medications or herbal 

treatments. These can change the blood level of the anti-seizure 

medication and make it ineffective.

• During a seizure:

- Keep calm.

- Don’t hold your family member down or try to stop his or her 

movements.

- Loosen ties or anything around the neck that makes breathing 

hard to do.

- Clear anything hard or sharp from the surrounding area.

- Put something flat and soft under the head.

- Turn the person gently onto one side. This helps keep the 

airway clear.

- Do not try to force the mouth open.

- Stay with the person until the seizure ends.

• CALL 911 if your service member/veteran experiences:

- Difficulty breathing during or after a seizure

- Seizure lasting more than five minutes

30
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

- Second seizure that happens immediately after the first seizure

- Difficulty waking up from the seizure or a second seizure without 

waking up in between.

Some things are triggers for seizures. These include:

• Stress

• Overuse of alcohol and/or other drugs

• Being overworked and/or tired.

Help your service member/veteran to avoid these triggers.

“I wish the doctors had educated me about seizures early on, 

because the likelihood of him having seizures was pretty high 

given the type of injury he had, and I had no education. And 

the first seizure he had, I thought he was dying. I had no idea 

what was going on.

There are some things--like if you lack sleep or if you have too 

much caffeine or if you drink alcohol--that may be triggers for 

some people. I think there should be education, too, about 

the different kinds of seizures, like what they are and what 

they look like... for me, it was very scary the night Pat had 

a seizure. Everyone has a seizure threshold, but, for some 

people, once you have a a brain injury it can drop way down. 

They’re more concerned about seizures in the first three weeks 

because those can be more dangerous. It’s important for 

family members to know you’re not out of the woods even 

after the first few weeks. Pat’s was at four months and the 

husband of one of my friends developed seizures almost a year 

after his injury.” 

 - Patty H.

31
Chapter 2 - Physical Effects

Driving laws for people with seizures vary from state to state. Check with 

your Department of Motor Vehicles to find out what the rules are for your 

family member if he or she has a seizure disorder.

Heterotrophic Ossification

Heterotrophic ossification (HO) happens when bone forms in an 

unnatural location, such as in soft tissue or muscle.

What you may see:

• Swelling, warmth, limited range of motion, pain in soft tissue areas or 

a muscle.

How you can help:

• Rest the arm or leg where the pain is. Ask for physical therapy to 

maintain range of motion.

With the health care team’s help, many physical effects 

can be treated or managed with positive results.

32
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

The questions below can help you reflect on your experience as a caregiver. 

You can write your thoughts here, copy this page and add it to your 

journal if you keep one, or reflect on these questions in your journal. 

What physical effects have you observed in your service member/veteran? 

How severe is the effect?

Is there one particular instance that stands out for you? Describe what 

happened and how you reacted.

What impact have these physical effects had on you? On other members of 

the family?

33

Journal
What strategies have you tried to use to help your service member/veteran 

cope with physical effects? How well have they worked?

What strategies do you plan to try in the future?

34 Journal
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

Cognition is another term for how we think and learn. 

Cognitive changes—changes in thinking--are very common after a TBI. 

Thinking takes place in the brain. When the brain is injured, thinking is 

affected. Thinking may be different and harder than it used to be. 

In most cases, cognitive problems improve over time. Time, rehabilitation, 

and the natural healing of the brain all help thinking to improve. 

Cognitive recovery often takes longer than physical recovery. Try to be 

patient. Remember that it is an injury to a specific part or parts of the 

brain that causes cognitive problems. 

This chapter reviews cognitive changes your family member with TBI 

may experience. Strategies are listed that may help you and your service 

member/veteran with TBI to make up for the loss of some thinking skills.

Just as with physical problems, not everyone with a TBI has the same 

cognitive problems. The neuropsychologist, OT, and speech language 

pathologist are the health care team members who identify and treat 

cognitive problems. 

What is a Neuropsychological Evaluation?

Module 1 described tests—like MRIs and CTs—that doctors use to 

examine the brain and its physical injuries. 

There is a different test to figure out how well the brain is working, i.e., 

how well the person is thinking. This test is called a neuropsychological 

evaluation. A neuropsychologist conducts this test.

First, the neuropsychologist will learn as much as possible about the 

person and what he or she was like before the injury. He or she may ask 

you questions about your family member. 

Next, the neuropsychologist will use a number of different tests to see how 

the person’s brain is working and where there are cognitive problems.

Testing may measure:

• attention span

• orientation

• memory

• concentration

• language (receptive and expressive)

• new learning

Cognitive Effects

Chapter 3

35
• mathematical reasoning

• spatial perception

• abstract and organizational thinking

• problem solving

• social judgment

• motor abilities

• sensory awareness

• emotional characteristics

• general psychological adjustment.

These tests can take several hours to complete.

Based on what the tests show, the health care team will develop 

treatment plans to improve cognitive problems. Occupational therapists 

(OTs) and speech language therapists are the members of the health care 

team who do this work.

What are Common Cognitive Effects?

Confusion

Most people with severe TBI experience some confusion after their injury. 

It is expected. 

Sometimes confusion only lasts minutes. Other times, it can last days or 

even weeks. 

Keeping your family member safe, reminding him or her about what’s 

going on, and offering reassurance are important during this stage of 

recovery. 

What you might see:

• Disorientation (not sure of where he or she is, time of day, what has 

happened)

• Seems in a fog, staring blankly

• Confusing times/tasks in schedule of activities

• Confusing past and present events

• Making up convincing stories to fill memory gaps (This is called 

confabulation. See page 43 to learn more.) 

36 Chapter 3 - Cognitive Effects 
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

How you can help:

• Keep your family member oriented. Put calendars, clocks, family 

pictures, and/or a sign about where he or she is and what has 

happened, in his or her room. A list of health care team members and 

what each one does may also be useful. 

• Use a notebook to plan for and log events. Have your family member 

refer to it for details of daily events.

• Frequently remind your service member/veteran of correct details of 

past and present events.

• Limit changes and provide structure in a daily routine.

Slowed Speed of Processing

Many people with TBI complain that their thinking and processing of 

information is much slower than it used to be. 

This problem improves over time. It can be frustrating in today’s fastpaced world. 

Slowed speed of processing can add to confusion.

What you might see:

• Taking longer to answer questions

• Taking longer to understand things that were easily understood before

• Taking a long time to react and respond.

How you can help:

• Slow down and simplify information. 

• Break complex tasks and activities down into smaller steps.

• Allow extra time to respond to questions and to comprehend and 

learn new information.

37

“Processing is very slow, just taking things in—he would repeat 

things over and over.

You try to do everything for them. They’re trying to do things and 

you’re tired... then you start over again trying to do everything for 

them to speed things up, which doesn’t help. They need to do things 

for themselves as much as possible. Rehab is the main thing.”

 - Denise G.
• Avoid situations that are overstimulating (e.g., noise, crowds).

• Suggest a different activity or topic of conversation to help the person 

remain on task.

• Encourage your service member/veteran to ask others to slow down 

and repeat information.

Attention Problems

The ability to focus, to pay attention for a long time, and to do more than 

one thing at a time is controlled by the brain. 

TBI can and often does affect all forms of attention. 

Attention is important because paying attention is the first step to 

learning and remembering. 

It is not uncommon for a person with a severe TBI to only be able to 

attend for a few minutes at a time in the beginning. 

What you might see:

• Short attention span, sometimes only minutes in duration 

• Easily distracted

• Difficulty in attending to one or more things at a time

• Inability to shift attention from one task or person to the next

• Difficulty completing tasks.

How you can help:

• Focus on one task at a time.

• Be sure you have your service member/veteran’s attention before 

beginning a discussion or task.

• Reduce clutter at home and in the work environment.

• Perform tasks in a quiet environment.

• Remove distractions and noises that you don’t need. As best as 

possible, use timers (watches, PDAs, or other devices) and checklists in 

the calendar/memory notebook to help with completion of tasks.

• Refocus attention to the task at hand.

• Expect a short attention span. Schedule rest breaks and/or stop an 

activity when you notice drifting attention.

• When signs of distraction arise, insert a rest break (“Let’s do this for 

another 5 minutes and then take a 15 minute break.”).

• Present verbal or visual information in limited amounts.

38 Chapter 3 - Cognitive Effects 
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

Compensation 

means finding 

another way to do 

something. For 

example, if you 

can’t remember 

something in your 

head, write it 

down.

Difficulties with Memory

Memory problems happen often after a TBI. Past memories or longterm memory is nearly always intact. Recent memory, called short-term 

memory, is much more often affected. 

Short-term memory often gets worse as fatigue increases.

Short-term memory usually improves over time. 

Memory compensation means learning to use memory tools, such as a 

calendar, planner, organizer, or memory notebook. 

Signs with instructions, lists, and notes are other effective memory 

compensation tools. 

Ask the health care team about which memory tools would be helpful for 

your family member. 

“He has severe memory issues. He has a PDA to keep him 

straight on what appointments he has, what medications he 

needs to take, things like that. That’s helped him a lot.” 

 - Meaghan L.

These tools may also help you remember everything you need to do!

What you might see:

• Can’t remember information from day to day about people, 

conversations, places, events, appointments, dates, and telephone 

numbers

• Keys, wallet, etc. are frequently lost or misplaced 

• Repeating questions or the same story over and over again

• Can’t learn new information and use it in everyday life.

How you can help:

• Get the person’s attention when you are trying to teach, do, or discuss 

something.

• Break new information down into categories or “chunks.” List and 

review them in order.

• Set up a routine of daily tasks and follow it. 

39
• Help your family member use memory aids on a regular basis. Write 

down tasks on a calendar or notebook. Check tasks off when done. 

• Explore use of “high tech” memory aids. Personal digital 

assistants (PDA), wristwatch alarms, and cell phones can 

remind your family member when to do a task, such as 

taking medication. Before spending money on these 

devices, ask the OT or speech pathologist whether your 

family member can learn to use the technology.

• Buy a pill box and label each compartment with the 

time and day that medication should be taken. Write 

the names of medications and when to take them into 

the calendar/memory notebook.

• Keep personal and household items in the 

same place.

• Try to pair new information with 

things the person is able to 

recall.

• Provide verbal cues for recall 

and help fill in memory gaps. 

• Talk to your service member/

veteran about the activities and 

events of the day to help build 

memory.

• Have your service member/veteran review plans for the following day. 

• Learn and use a cueing system (see section on cueing at the end of 

this chapter).

• Present information in more than one way, including hearing, seeing, 

and doing. Each person has a different learning style. Ask the 

neuropsychologist how your family member learns best. 

• Role play in order to reinforce new learning.

Planning and Organization Problems

Organization and planning skills are often affected by TBI. 

These skills improve over time. The health care team will work with your 

family member to develop better organization and planning skills. 

You may need to remind your family member again and again to use the 

skills he or she learns in therapy until they become a habit.

Chapter 3 - Cognitive Effects 

To cue is to 

instruct or prompt 

someone to do 

something.

40
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

What you might see: 

• Problems organizing time to get things done

• Problems understanding which tools are needed to complete a task 

and getting them together

• Problems breaking down complex tasks into smaller steps

• Having a hard time getting ready for work, school, and appointments

• Being late for appointments and work or school

• Having a hard time starting a task

• Problems making plans and completing them 

• Problems setting goals

• Trouble prioritizing

• Looking disorganized.

“His biggest problem is naming. He has a hard time naming 

anything. So we have picture cards. We go through the cards 

all the time, just to get him to name an object. We can even 

go through the house or if we take a walk, I ask him to name 

things... what is this? This is a sidewalk. What is this? This is 

a tree. What sort of tree?”

 - Patty H.

“He has a PDA, and he does make lists, but that’s a battle in 

itself. Early on I had sticky notes everywhere and lists of things 

that he needed to do when he got up in the morning, things 

that he would need to get before he left for his therapy, that 

kind of thing.

And over time I see that we’re regressing in that department, 

so I’m actually in the process of getting those lists back out 

because he definitely has a memory issue, even with taking his 

medication every day. There will be times that he forgets.”

 - Sandy M.

41
How you can help:

• Begin with small, realistic tasks.

• Work with your family member to get organized at home. Keep a 

family calendar posted on a wall. Use reminder notes and cue cards 

(example at the end of the chapter).

• Have a place for everything and keep everything in its place. In particular, 

keep your service member/veteran’s belongings in certain places.

• Turn off the radio/TV or other distractions when tasks need to be done.

• Use memory aids such as 

calendars and notebooks to 

plan, write down, and check 

off tasks when done. 

• Use a tote bag or backpack 

to organize needed items for 

the day.

• Work with your service 

member/veteran to decide 

which information or activity has the highest priority.

Chapter 3 - Cognitive Effects 

“He has his talking watch because he has some issues with his 

vision. So his watch tells the date and the time. And he also 

has a beeper that’s preset by speech therapy, and it goes off 

five minutes before he has an event, like therapy or something 

scheduled. The beeping, the auditory cue, lets him know to 

look at his book, which is just a three-ring binder notebook. 

It has his schedule, like Monday through Friday and a time 

on one side. So he picks the day and then looks at the time 

according to what his watch says, and then he knows where 

he’s supposed to be.”

 - Meredith H.

Difficulty with Decision Making and Problem Solving

Making decisions and solving problems take a lot of thinking. Both can 

be hard for people with TBI. 

42
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

Simple decision making and problem solving are easier than more 

complicated decision making and problem solving. 

What you may see:

• Taking a long time to make a decision

• Making inappropriate and/or potentially harmful decisions

• Problems reasoning

• Responding impulsively to situations

• Having a hard time recognizing problems 

• Slow to think of alternate solutions to problems

• Tendency to be “concrete” in terms of problem solving, that is, 

difficulty making inferences

• Taking things literally.

How you can help:

• Avoid having your service member/veteran make decisions when tired, 

hungry, or under stress.

• Help your family member to weigh options and consequences of a 

decision.

• Give your service member/veteran time to make a decision. Be patient 

and talk him or her through the possible options.

• Limit the number of possible choices. Two or three choices is best. 

Too many are often overwhelming and can increase indecisiveness.

• Avoid making last minute decisions.

• Practice identifying a problem and following through with evaluating 

the options (see tips for problem solving at the end of the chapter).

Confabulation

Confabulation is a memory problem. It happens when a person with a 

brain injury makes up false memories.

These memories could be about past events that never happened. Or 

they could be memories of actual events that the person puts in the 

wrong time or place.

Sometimes these memories are very detailed and the person honestly 

believes the events happened.

Confabulation is the direct result of injury to the brain. It may go away 

on its own. 

43
Each person is unique. A compensation approach that 

works for one person might not work for another. What 

works during structured inpatient rehabilitation may 

not work in the same manner at home. Try approaches 

out with your service member/veteran with help from 

your health care team. If an approach does not work 

well, review it with a provider and try other strategies. 

Continue to use your health care team as experts in 

designing compensation approaches most likely to 

work for your service member/veteran with TBI.

Chapter 3 - Cognitive Effects 

The health care team will work with your service member/veteran to 

reduce the effect by helping him or her to become more aware of it.

What you may see:

• Making up convincing stories to fill memory gaps.

How you can help:

• Don’t accuse your family member of lying.

• Gently help your family member become aware that this memory is 

not accurate.

How Can You Help to Build Thinking Skills?

Occupational therapists (OTs) and speech language therapists are the 

members of the health care team who teach cognitive skills. 

They teach memory compensation skills. They also develop systems for 

cueing and providing feedback to your service member/veteran. 

You can learn a lot from these therapists about how to use these 

techniques. The more everyone uses these techniques, the more benefit 

to your family member.

Compensation Strategies 

Compensation strategies are ways to help your family member manage 

cognitive changes. They build on the person’s strengths. At the same 

time, they make up for deficits in thinking caused by the TBI. 

44
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

The OT, PT, and speech language pathologist are the health care team 

members who assess how well your family member is thinking. They will 

develop a cognitive rehabilitation program for your family member. Their 

assessments will pave the way for return to the community and will help 

decide if your family member can return to duty, work, or school.

Cueing

Cueing means to give a signal to begin a specific action. Cueing prompts 

your service member/veteran to stop and think before acting. 

Cueing strategies are best learned from the therapists working with your 

service member/veteran. Attend therapy and observe how they cue the 

person. The goal of progressive cueing is to move your service member/

veteran from having to be “told what to do” by you and rehabilitation 

team members to being able to independently cue, or remind, him or 

herself what he or she needs to do. Learning how to self-cue increases 

self-reliance. Consistency in approach increases the odds of success. 

Try the following methods for cueing your service member/veteran with TBI:

• Guide your service member/veteran by asking questions.

- Ask questions that will help the person find a solution, such as “What 

could you do to help yourself next time?”

“We would play Trouble, where you have to count how many 

squares you move. We would play Connect 4. We played 

Phase 10, Skippo, Uno, and sequence games. We played 

board games where you have to count your spaces. In the 

beginning, one of the things we did was we got the little 

children’s blocks where four blocks make a picture, and then 

another four blocks make another picture. In the beginning, 

he couldn’t put the four blocks together to make a picture. 

He couldn’t figure out what picture went with what. I mean, 

he’d have an airplane with a ladybug. He also had trouble 

putting the shapes into the right size hole. When you think 

about it, you’re thinking this is very easy, but it definitely was 

a challenge for him.”

 - Sandy M.

45
- Avoid asking questions that do not help solve the problem, such as 

“Why did you do that?” 

• Provide verbal or nonverbal cues.

- An example of a verbal cue is to say “Stop and think, what else could 

you do?”

- An example of a nonverbal cue is pausing or not acting immediately 

to help the person recognize the need to use a strategy such as “stop 

and think.”

- Use a signal you have agreed upon ahead of time, such as a raised 

finger or a head nod.

• Types of cues:

- Direct Cue – a specific prompt. 

For example: “Did you look in 

your calendar?”

- Indirect Cue – a general 

prompt: For example: 

“Where could you find that 

information?”

- Self Cue – “Where could I find 

that information?” 

Chapter 3 - Cognitive Effects 

CUE CARD - Thinking Strategies

• Slow down, pause, STOP and THINK

• Take my time

• Don’t assume

• Check things off as I go along

• Ask questions to make sure I understand

• Repeat back what I heard

• Take notes

• Underline important information

• Double check my work

• Write down information in my own words

• Ask myself, “Do I want to be quick or accurate?”

• When I get bored – stretch, take a short break, walk around

• When I get angry – doodle, take a break, and then come back

CUE CARD - Preparing a Meal

• Decide on a menu

• Count number of people eating

• Look at the needed ingredients

• Look in the pantry for what you have

• Prepare shopping list and shop

• Follow recipe instructions and organize time

• Serve and eat meal

• Clean up

46
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

5W Strategy

Therapists may also teach the 5W strategy to help your service member/

veteran learn more efficiently. Learning in the face of a short-term 

memory deficit can be challenging. This technique will help as it allows 

the person to save time. Instead of reading information over and over 

again, the person is taught to focus and pick out the main points of what 

he or she is reading. 

Read and Remember

• Who

• What

• Where

• When

• Why

Why 5W Strategy Works:

Writing out or saying something out loud reinforces accurate memory. The

5W strategy also simplifies the information so main points can be recalled. 

Your service member/veteran may have difficulty at first but practice helps. 

Example of the 5W strategy:

Making/taking a message – write down all 5 points (W’s) of the message

Who: Mom

What: Call about lunch

Where: Meet at our favorite restaurant

When: Friday at noon

Why: To talk about vacation plans

Feedback

Feedback means giving information to your family member about how 

he or she is doing. A brain injury can make it hard for a person to fully 

understand how he or she is behaving. Feedback from others can help 

the person see what is going on. 

The best time to give feedback is right away, just after the situation 

happened. If your family member has memory problems, it can be hard 

for him or her to remember what happened for very long. So prompt 

feedback is best.

47
You need to give feedback in a firm but gentle manner. This may be hard 

at first, but keep practicing. It will get easier. A direct and supportive 

approach works best. 

Consistency is another key. Attend therapy as much as you can to learn 

how to provide feedback to your service member/veteran. You can also 

learn how your service member/veteran tends to respond to different 

types of feedback. The more consistent the approach, the more likely the 

feedback will have a positive impact on the thinking and behavior of your 

service member/veteran. 

Problem Solving

Learning how to be a good problem solver can help you and your 

service member/veteran cope with stress and reduce anxiety. Therapists 

will often work closely with your service member/veteran to improve 

problem-solving skills. The following simple problem-solving steps 

can be effective in helping to break down problem solving into a more 

manageable task. Writing down the answers can be helpful and allow 

the person to better “see” options. Reinforcing use of this technique is 

one way you can help with problem solving, both in the rehabilitation 

setting and when you get home.

• Identify the problem. If the problem has many parts, break it down 

into one problem at a time.

• Brainstorm solutions. Think of as many possibilities as you can.

• Evaluate the alternatives. Consider the pros and cons of each 

possibility.

• Choose a solution, the one that seems to fit best for you.

• Try the solution out.

• Evaluate the solution. If it didn’t work, try another solution until you 

find the one that works.

48 Chapter 3 - Cognitive Effects 
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

Here are some examples of problem solving. Fill in the worksheet with 

examples from your own experience.

The Problem Potential Solution How It Worked

Sallie has to be at

school at 8:15 and

Don’s medical 

appointment is at

8:30 across town. I 

can’t be in both places.

Ask Terry’s mom if I 

could drop off Sallie 

at her house early and 

she could drive Sallie 

and Terry to school 

together.

Worked great!

I can’t remember what 

the doctor told me 

to do about John’s 

memory problems.

Ask again at the next 

appointment.

I still forgot—he’s 

not the only one with 

memory problems!

Nothing’s changed—I 

still can’t remember 

what to do.

Next appointment, I 

will take a notebook 

with me and write 

down his answer.

Now I can refer to my 

notes and don’t feel so 

worried about it.

49

Problem Solving Worksheet
Chapter 3 - Cognitive Effects 

“The most important piece of equipment he has is his cell 

phone. I said, ‘How are you going to have a phone if you can’t 

read and you can’t do the numbers?’ And he said, ‘Mom, you 

use call voice command.’ I’m thinking, gee, who has the brain 

injury here?

He had to tell me, and I thought, oh, my gosh, you’re absolutely 

right, Shane. He’s the one that came up with that. Not even 

the doctors brought that up. 

We do have to key in the phone numbers. If he wants a friend’s 

number or asks for that, he’ll say, ‘Okay, here’s my phone 

number. Call me. When you call me, I’ll know that’s you and 

then I’ll have my mom key in your name. Or here’s my phone, 

put in your name and key in your number so I can call you.’ 

And it works. 

And that is our safety net because whenever he is away with 

someone that I’m not really sure about, I make sure that I call 

or he calls so that we keep that open line of communication.”

 - Cindy P.

50
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help 51

The questions below can help you reflect on your experience as a caregiver. 

You can write your thoughts here, copy this page and add it to your 

journal if you keep one, or reflect on these questions in your journal. 

What cognitive effects have you observed in your service member/veteran? 

How severe is the effect?

Is there one particular instance that stands out for you? Describe what 

happened and how you reacted.

What impact have these cognitive effects had on you? On other members of 

the family?

Journal
52 Journal

What strategies have you tried to use to help your service member/veteran 

cope with cognitive effects? How well have they worked?

What strategies do you plan to try in the future?
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

A TBI can cause changes in a person’s communication skills. These 

changes vary from person to person.

How severe the injury is and its location affect these changes. 

Factors that play a role in communication problems include:

• behavior 

• memory, attention, and other thinking skills

• judgment 

• social skills

• self-awareness.

Communication skills are very important in everyday life. Your family 

member may not be able to use words to express him or herself well. 

This can be very frustrating. Many people with TBI do well speaking in 

non-stressful situations. But your service member/veteran may not be 

able to use these speaking skills during a stressful situation at school, 

work, home, or in the community. 

Language problems can lead to miscommunication and confusion. 

This may make it harder than it used to be to make new friends and 

maintain old relationships. A positive note: Most people with a TBI do, 

in fact, speak again. Most make notable progress in the other areas of 

communication over time. 

A speech language pathologist (SLP) is the team member who treats 

communication problems. Your service member/veteran may be able to 

speak, but may need training to:

• understand and remember what is being said

• express needs, wants, and ideas clearly to others. 

The SLP treats problems with speech, voice, and memory.

What are Common Communication Effects?

Language and thinking are linked. Language involves understanding, 

talking, reading, and writing. 

In this chapter, you will read about some common communication effects 

from a TBI. You will also learn about ways that you can help your family 

member with these effects.

Each person with a TBI will have different communication problems. 

Some are more severe than others.

Communication Effects 

Chapter 4

53
Communication problems occur when the frontal and temporal lobes of 

the brain are injured. 

Hearing or vision loss make it harder to communicate well. If your family 

member is having communication problems, his or her hearing and vision 

should be checked. 

Use this chapter as a guide. Talk to the speech language pathologist, 

neuropsychologist, and doctor about the specific areas that are hardest 

for your family member. 

Feedback is important to help improve your family member’s 

communication. 

Chapter 4 - Communication Effects

“When he started to speak again, his speech was impaired, 

wasn’t good. The first time he said a word, one day, like a 

Friday, he was saying a word. On Saturday, he was doing 

phrases. And on Sunday, he was doing sentences.

To me, he does not sound like he did before the brain injury. 

He’s clear. He can carry on a conversation with you. If you 

talked to him, you would probably think he was just fine. I 

know there’s a difference in his speech, but it’s not enough that 

an average person would know he’s got a brain injury.”

 - Pam E.

Does Not Speak Clearly

What you might see:

• Slurred speech

• Speaking too loudly or softly

• Speaking too rapidly.

How you can help:

• Tell your family member that you did not understand what he or she 

said. Ask him or her to say it again more slowly.

• Use a consistent cue or gesture to let him or her know you did not 

understand. For example, cup your hand over your ear as a reminder 

to speak louder.

• Allow time for your service member/veteran to express him or herself. 

54
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

Problems Starting a Conversation

What you might see:

• Unable to start or is slow to start conversations

• Long pauses

• Problems explaining what he or she means

• Does not respond to another’s questions or comments.

How you can help:

• Help your service member/veteran start a conversation by asking a 

leading question such as, “What do you think about ...?”

• Encourage your service member/veteran to talk about topics of interest 

or familiar topics.

• Ask open-ended questions (e.g., questions that cannot be answered 

with a “yes” or “no”), such as, “Tell me more about your day.”

• Give your service member/veteran with TBI your full attention.

• Give your service member/veteran time to organize his or her 

thoughts.

• Use redirection, if necessary (e.g., “So what do you think about....?”)

• Reinforce all efforts to start a conversation. Show that you value what 

your service member/veteran has to contribute to conversations.

“One and a half years later—he can speak now. He can have 

a conversation. He is just starting to spell now, which is still 

improving. His comprehension is very good. In the beginning, 

he couldn’t even understand language. He’s still having a lot 

of trouble reading, so we’re still working on that. He can’t 

read at this point.

He’s never been embarrassed about his speech. One thing 

I did early on was to buy him a cell phone and I got him to 

call a lot of his friends. I think that has helped, to be able to 

call people and talk to them. Some of them saved the first 

message he left them—they were just crazy. But I think that 

helps, just being able to stay in touch with people that are 

familiar and being able to communicate with them.”

 - Patty H.

55
Word Finding Problems

What you might see:

• Problems finding the right word to describe what he or she is trying 

to say.

How you can help:

• Give your family member time to locate the word he or she is 

looking for.

• If he or she still cannot locate the word after some time, guess at what 

he or she might mean. Or ask him or her to write it down.

• Try to be patient. It can be very frustrating for your service member/

veteran when he or she knows what he or she wants to say but cannot 

locate the right word or phrase.

• Encourage him or her to use another word that is close in meaning.

• Suggest that he or she use many words (or a description) instead of 

using a single word. (This is called circumlocution, a strategy speech 

language pathologists will often teach.)

Chapter 4 - Communication Effects

“The children wanted to be involved in his recovery. They 

wanted to help read stories, help him with the word finding. 

One of the things we did was write the words on little sticky 

notes, and we put them on all his different things. He was 

really having trouble naming his workshop tools, so we labeled 

all of his tools. It was something the kids could quiz him on.”

 - Shannon M.

Problems Following a Conversation

What you might see:

• Difficulty paying attention to what is said

• Misinterpreting what is said

• Being “off topic” compared to the rest of the people in the 

conversation.

How you can help:

• Get your service member/veteran’s attention before speaking.

• Be clear and to the point. Keep it simple.

56
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

• Reduce distractions.

• Every so often, stop and ask your family member to restate what he or 

she heard to ensure understanding.

• Reduce your rate of speech and pause frequently to allow the person 

time to process and respond.

• Avoid abrupt topic changes.

• In group conversations, help set a slower pace of conversation.

“To improve our communication, I had to learn to make 

shorter sentences. I ramble a lot. So I had to learn not to 

ramble... to ask myself, what am I thinking? I had to really 

consolidate my thoughts before I approached him on a 

subject. That has helped our communication a lot because 

he’s not way out there in left field zoning out because I already 

lost him at sentence two.”

 - Shannon M.

Reading Comprehension Problems

What you might see:

• Problems understanding what is read

• Trouble stating the main idea or main point.

How you can help:

• Read with your service member/veteran.

• Review the reading material, using the 5W strategy – Who, What, 

Where, When, Why: 

- Who are the characters?

- What happened to the characters in the book? What did they do 

about it? 

- Where did it happen? 

- When did it happen? 

- Why did it happen?

• The 5W’s should be related, that is, they should refer to the same 

characters or portion of the story.

57
Chapter 4 - Communication Effects

“I used to have him sit in his wheelchair once he started 

talking and read articles from the newspaper to me while I 

put on my makeup. Getting him to learn how to read and 

follow the line was important. If it didn’t make sense to me, 

I’d say, ‘Oh, wait, wait, wait, I think you missed something.’ 

And he’d go, ‘Oh, yeah, yeah,’ and he’d go back up.

We probably did that for at least a year. Every time I’d put 

on makeup, he would come in and sit down and read an 

article to me.”

 - Denise G.

“He couldn’t read or write. He can now, after two years of 

therapy--it’s a very slow process, but he can recognize signs, 

and in time he was able to write his name and his Social 

Security number and his phone number. Now, mind you, if you 

show him a sign and it has numbers on it, it takes him a while 

to even understand what that is. He learns with repetition 

and sometimes those signs have no meaning to him, especially 

if there are words with the pictures.

Now, he can see that’s the McDonald’s sign, that’s a Wendy’s 

sign, and he surprises me sometimes. He’ll say, ‘Well, that’s so 

and so.’ ‘Now, how did you know that?’ And he says, ‘Well, 

it just looks like it is.’”

 - Cindy P.

• Your service member/veteran can write out important information or 

say it out loud; this uses other senses to increase comprehension.

• Emphasize important information in the text.

58
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

What Communication Effects Are Less Common?

Dysarthria 

Dysarthia means having a hard time using the muscles needed to form 

words and produce sounds.

What you might see:

• Speech is often slow, slurred, and garbled

• Problems with intonation or inflection.

How you can help:

• The speech language pathologist will prescribe exercises to improve 

the muscles used in speaking. Over time, these exercises will make 

your family member’s speech more clear. Help him or her to do these 

exercises properly and regularly.

• Allow ample time for your service member/veteran to express him or 

herself.

• Encourage him or her to take time to speak.

• Inform those around your service member/veteran about the diagnosis 

so they too allow the person time to express him or herself.

59

“While in the hospital, he stuttered when he would get angry 

or frustrated. He would often forget his thoughts. He would be 

on a train of thought and he’d just forget where he was going, 

which caused him to be frustrated. So you really couldn’t have a 

two-sided conversation with him early on because he’d want to 

be talking the whole time, and God forbid he loses his thought.”

 - Kristen S.

Interrupting or Having a Hard Time Taking Turns in 

Conversation

What you might see:

• Talking non-stop

• Not allowing the listener a turn to speak

• Frequent interruptions
• Inability to adjust communication style for the situation

• Bringing up the same topic over and over again (perseveration).

How you can help:

• Politely interrupt and ask for a chance to speak. Tell your service 

member/veteran you would like to say something.

• Ask your service member/veteran to please make it brief.

• Develop a hand signal which indicates to the service member/veteran 

that he or she may be monopolizing the conversation.

• Gently alert him or her to the fact that the topic change was too 

abrupt or that he or she has interrupted and will be given a chance to 

say his or her piece in a moment.

• Use positive reinforcement for all attempts at listening rather 

than talking.

• Your service member/veteran may be interrupting because he or she is 

“lost” in the conversation. Encourage him or her to let you know if he 

or she doesn’t understand what is being said.

Topic Selection Problems

What you might see:

• Problems finding good topics for conversation

• Problems keeping up when topics change

• Introducing a new topic abruptly

• Problems staying on topic.

How you can help:

• Pick topics that your service member/veteran enjoys. Ask about his or 

her interests and opinions.

• Clarify new topics as they come up.

• Ask how his or her comment relates to the topic: “How does the price 

of gas relate to what you ate for lunch?”

• Tell your service member/veteran you are confused or getting lost in 

the conversation.

• Gently but firmly alert your service member/veteran if he or she is 

bringing up a topic that may be offensive to others.

60 Chapter 4 - Communication Effects
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

Writing Problems

What you might see:

• Problems expressing thoughts in writing

• Problems getting started writing

• Writing the same words or phrase over and over (perseveration).

How you can help:

• Practice writing with your service member/veteran. For example, write 

letters to friends or relatives.

• Make a list of openings (i.e., Dear, Hello, Hi, etc.) and closings (i.e., 

Thank You, Sincerely, Yours Truly) and the reasons for selecting them.

• Suggest saying words out loud before writing them.

• Suggest reading what is written to make sure it makes sense.

Nonverbal Communication Issues 

What you might see:

• Having a hard time understanding common nonverbal cues 

(e.g., facial expressions, hand gestures)

• Standing too close or too far from those he or she is speaking to

• Uncomfortable number/type of physical contacts

• Body language that doesn’t “match” what is said

• Facial expressions that don’t “match” what is said

• Poor eye contact

• Staring at others during conversation.

How you can help:

• Politely ask your service member/veteran to stand closer or 

further away.

• Explain the behavior is making you feel uncomfortable.

• Tell your service member/veteran you are confused by the difference 

in body language and spoken message. Briefly explain what you saw 

and heard.

• Ask him or her to stop any distracting motions.

• Role play the right way to behave in a particular setting. Work with 

the health care team to practice appropriate behavior. This will help 

decrease behavior that causes problems.

61
62 Chapter 4 - Communication Effects

• Talk to your family member about how to act in certain situations, 

before he or she is in those situations.

• Give feedback on the right amount of eye contact to keep with 

another person. Praise all improvements.

• Decide on a signal to indicate problematic behavior.
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help 63

The questions below can help you reflect on your experience as a caregiver. 

You can write your thoughts here, copy this page and add it to your 

journal if you keep one, or reflect on these questions in your journal. 

What communication effects have you observed in your service member/

veteran? How severe is the effect?

Is there one particular instance that stands out for you? Describe what 

happened and how you reacted.

What impact have these communication effects had on you? On other 

members of the family?

Journal
64 Journal

What strategies have you tried to use to help your service member/veteran 

cope with communication effects? How well have they worked?

What strategies do you plan to try in the future?
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

Behavioral and Emotional Effects

You may notice changes in the way your family member acts. People 

with a TBI may have many emotional and behavioral effects.

That’s because our brain controls the way we act and feel. An injury to the 

brain—usually an injury to the frontal lobe—causes changes in emotion 

and behavior. The life changes that happen after a TBI also affect how 

people act and feel.

Changes in behavior may include:

• frustration, increased anger/aggressiveness

• impulsivity or difficulties in self-control

• faulty or poor judgment

• decreased ability to initiate conversation or activity

• repetitive behaviors (perseveration)

• less effective social skills

• changes in sexual behaviors 

• impaired self awareness about how TBI impacts him/herself and others.

Emotional effects may include:

• depression

• increased anxiety 

• mood swings (emotional lability)

• changes in self-esteem.

Pay attention to changes in how your family member acts and feels. Ask 

the health care team for advice. They can help your family member 

manage these changes through counseling, medication, and healthy 

coping behaviors. 

Chapter 5

65

“He’s very blessed that he has retained his personality and 

his speech. He does have anxiety--with the anxiety comes 

a little depression. He also has a short fuse and frustration. 

Sometimes we still see some PTSD mixed in there, and that kind 

of intertwines with the TBI. Some of those symptoms kind of 

intertwine.”

 - Cindy P.
What Are Common Behavioral Effects? 

Frustration, Increased Anger/Aggressiveness

After a TBI, many people become frustrated more easily than before. Your 

family member may not be able to do things as easily as he or she once 

did. Sometimes, he or she may not know what others expect. This can 

be frustrating.

You may notice a quicker temper or a tendency to fly off the handle 

more easily.

Loss of independence, fatigue, overstimulation, or cognitive problems can 

also lead to feelings of frustration and anger.

What you might see:

• Strong reaction to minor annoyances or sources of frustration

• General lack of patience (e.g., when others don’t understand the 

changes resulting from the injury)

• Low tolerance for change 

• Unexpected outbursts of anger

• Increased irritability

• Verbal or physical demonstrations of anger

• Increased tendency towards anger when tired, in new situations, and 

during high levels of stress.

How you can help:

• Develop a plan to manage frustration or anger. This might mean 

taking a walk or going to another room and turning on the television. 

Chapter 5 - Behavioral and Emotional Effects

“If I try to talk to him about issues with our family or the 

relationship or whatever, he can’t handle it. Emotionally, he 

just can’t deal with that kind of stuff. He does have mood 

swings occasionally, some of which have not been so pretty. I 

think sometimes the fight or flight kind of thing kicks in, and 

then sometimes he has actually left the house. Little things 

that might sit normally and not aggravate someone will 

aggravate him and he’ll get upset about it.”

 - Aimee W.

66
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

This can be a good signal to others in the family that your family 

member needs to be alone for awhile.

• Remain calm. Encourage your family member to recognize when he 

or she is becoming angry or frustrated. Help him or her learn to ask 

for a break or some space to calm down. 

• Reinforce all efforts to use effective anger management strategies.

• Prepare your service member/veteran for challenging situations when 

possible. 

• Simplify tasks and provide a consistent, structured environment.

• Try to avoid surprises. People with TBI do better when they are 

prepared and can anticipate a change in plans. 

• Try to consistently react to certain behaviors in a certain way. Often, a 

consistent approach helps to manage difficult behaviors. 

• Rehearse and role play specific situations to boost confidence in 

managing life outside the home.

• Approach challenges calmly and allow yourself to take a break when 

necessary.

• If your family member is often angry, ask the health care team 

to develop a plan to manage this behavior. The rehabilitation 

psychologist or neuropsychologist is the team member who will work 

on this plan.

67

“As time went on—probably about two years after the injury—

we started seeing the anger coming in. I think he started to 

understand the frustrations he was having... the troubles.

The anger got bad. Unfortunately, what I tried to do was keep 

it behind closed doors. The anger accelerated. Instead of 

trying to get help right off the bat to keep it tame, it probably 

took us at least a year to get it under control. He still flares 

up, but it’s nothing like it was before.

A strategy that was suggested for dealing with his anger was 

to keep him abreast of everything that was going on. He 

couldn’t tell me he felt out of control, and still to this day he 

has trouble telling me what his feelings are. So I’m trying to 

make sure that he’s aware of everything that’s going to go on, 

(continued)
and we try to keep a routine. Routine is very important.....it 

keeps him soothed. Trying to talk to him in a calm voice helps, 

but it’s not always easy, you know, because if you accelerate, of 

course they do too.

The anger has gotten better over time. And now what we have 

is... more like frustration outbursts.”

 - Denise G.

Chapter 5 - Behavioral and Emotional Effects

Tell the health care team if anger increases or your 

family member is violent. You do not have to tolerate 

verbal or physical attacks. 

Your family member is no more comfortable with this 

behavior than you are. Get help. There are effective 

medications and behavior management approaches to 

help manage angry outbursts.

68

Impulsivity or Difficulties in Self-Control

Many individuals with TBI react before thinking. “Stop and think” is a 

good way to help a person make up for various cognitive problems. It 

allows the person to stop, slow down, pause, and take the needed time 

to think about something before doing it. This allows time to develop a 

reasonable plan or response. 

What you might see:

• Saying whatever comes to mind without thinking about how it might 

affect the person him/herself or someone else 

• Acting without thinking about potential consequences (e.g., crossing 

the street without checking traffic)

• Inappropriate comments to or about others.

How you can help:

• Use redirection (e.g., suggest a different activity or topic of conversation).

Impulsivity means 

responding 

quickly, without 

thinking the 

situation through.
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help 69

“People just don’t know a lot about brain injury, and I try 

to educate them in the sense that there’s a lot of things 

emotionally that Jason doesn’t have control over, and you have 

to learn to not take it personally because it’s not a personal 

attack. It is what it is. Not that it’s excusable or that it is 

acceptable, but Jason is also learning good public behavior: 

what’s okay to say, what’s not okay to say, and when enough is 

enough. That’s definitely where I come in with the cueing.”

 - Sandy M.

• Develop a special “stop and think” signal that you can use to alert 

your family member when he/she is doing or saying something 

inappropriate (e.g., raising your finger, saying a special word).

• Suggest that your family member stop and think, slow down, and 

consider options.

• Praise and reward desired behaviors; discuss consequences in private, 

after the fact.

• Avoid comparing past and present behaviors.

Poor Judgment 

Sometimes it’s hard for a person with TBI to analyze a situation and 

understand what could happen. 

What you might see:

• Inappropriate decisions; potentially harmful decisions

• Difficulty reasoning

• Ineffective problem solving.

How you can help:

• Help your service member to use effective problem-solving skills:

- Identify the problem. If the problem has many parts, break it down 

into one problem at a time.

- Brainstorm possible solutions together. Think of as many possibilities 

as you can.
Chapter 5 - Behavioral and Emotional Effects

- Evaluate the alternatives. Consider the pros and cons of each 

possibility.

- Choose a solution, the one that seems to fit best.

- Role play with your service member/veteran to prepare him or her 

for various situations.

- Have him or her try the solution out.

- Evaluate the solution. If it didn’t work, try another solution until he 

or she finds the one that works.

70

“I think that early in his injury--especially with severe TBI--to 

me, watching him go through his recovery was like watching 

a child go through a really rapid growth phase. He went 

through that toddler phase when he was just learning his 

ADLs (Activities of Daily Living). Then he went through the 

adolescent phase where he was gaining some independence 

and learning his bounds. Then he went through that teenage 

phase where he was trying to take control of his life and 

impulsivity became a real issue. Finally, now we are in the 

adult phase where things have begun to balance out. There 

are still good days and bad days, but more good days as we 

move forward.”

 - Shannon M.

Reduced or Lack of Initiation

Your family member may seem to have lost interest in activities he or she 

used to enjoy. You may find yourself offering frequent reminders to do 

simple tasks, like brushing teeth or taking a bath. 

Your service member/veteran may not begin activities on his or her own. 

This is not laziness. Injury to the brain is the reason. 

What you might see:

• Remaining in bed until encouraged to get up

• Spending much of the day sitting around, not actively engaged in 

activities

• Not speaking unless spoken to

Initiation means 

“get up and go.” 

A person who 

initiates is a selfstarter.
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help 71

• Problems completing tasks without a lot of supervision

• Agreeing to do something, but then not following through.

How you can help:

• Set up a regular schedule for your service member/veteran to follow. 

The goal is to learn a routine so well that it becomes automatic.

• Post the schedule. Make sure it is in the person’s calendar or memory 

notebook. 

• Work with your service member/veteran to develop a list of goals or 

tasks to be completed. Help your family member check off completed 

tasks so he or she can see progress.

• Encourage your service member/veteran to become involved. Having 

purpose along with structure can help. 

Repetitive Behaviors (Perseveration)

Perseveration means getting stuck on one idea or one behavior and 

repeating it again and again. Injury to the frontal lobe of the brain is 

the cause.

What you might see:

• Writing the same letters or words or repeating the same word or 

phrase over and over

• Repeating physical movements or tasks

• Getting “stuck” on one topic or theme (e.g., “when can I drive?”, 

“when can I go home?”, “I need a cigarette.”).

How you can help:

• Use redirection (i.e., try to change the topic or focus of interest to 

something else).

• Try engaging the person in a physical task if he or she is verbally 

“stuck” on a topic.

• Try engaging the person in a conversation or thinking task if he or she 

is physically “stuck” on a task.

Less Effective Social Skills

Social skills are all of the things we do and say in order to fit in, get along 

with others, and read and understand the people and situations around us. 

Social skills form the foundation for relationships with others. They include:

• Thinking of topics for a conversation
Chapter 5 - Behavioral and Emotional Effects

• Listening to the other person without interruption

• Keeping the conversation going

• Reading the facial and verbal cues that the other person sends and 

responding to them

• Knowing when and how to end a conversation.

What you might see:

• Lack of awareness of personal space and boundaries (e.g., talking 

about private family matters, asking questions that are too personal, 

flirting with a married person)

• Reduced sensitivity for the feelings of others

• Possible disregard for acceptable standards of conduct at home or out 

in public

• Use of vulgar language or behavior.

How you can help:

• React calmly.

• Role play or rehearse responses to social situations.

• Use an agreed-upon signal to let your service member/veteran know 

that he/she may be saying something inappropriate. 

• Use redirection (i.e., try to change the topic or focus of interest to 

something else).

• Praise and reinforce appropriate behavior.

Changes in Sexual Behaviors 

Many people with TBI change how they act during intimate moments. 

Those with moderate to severe TBI may sometimes act in sexually 

inappropriate ways. These behaviors can often be managed over time. It 

takes patience, feedback, and a consistent approach. 

What you might see:

• Hypersexuality (thinking about or wanting frequent sexual activity, 

e.g., masturbation)

• Hyposexuality, or a lack of interest in sex

• Discomfort with intimacy

• Trying to kiss or touch strangers 

• Making suggestive or flirtatious comments to or about others

• Disrobing or engaging in masturbation in front of others. 

72
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help 73

How you can help:

• Develop a “stop and think” signal to let your family member know 

that he/she is saying something inappropriate. 

• Use redirection (i.e., try to change the topic or focus of interest to 

something else).

• Talk to your family member about what are and are not acceptable 

ways to act in public. 

• Tell your family member that having sexual feelings is normal. Sexual 

behavior, however, is a private matter. 

• Find a way for your family member to express his or her sexual needs 

(i.e., in the privacy of his or her room).

• Emotional changes and physical symptoms can affect desire for 

intimacy and sex. Ask your family member to discuss concerns with 

the doctor or counselor. (See Module 3.)

Lack of Self-Awareness

Your family member may not be aware of how the TBI has affected him 

or her. He or she may also not understand how it affects others.

Self-awareness means understanding our own strengths and weaknesses. 

Our sense of self-awareness is housed in the frontal lobe of the brain.

A reduced sense of self-awareness is a hallmark effect of TBI. Your family 

member may say very little has changed. He or she is not deliberately 

denying there is a problem. People with TBI simply do not understand 

that they are having problems.

Self-awareness usually improves with time and feedback from others. 

People with TBI learn from their successes and failures, just as we all do.

What you might see:

• Underestimating the problem areas related to TBI

• Not understanding why rehabilitation therapies are needed

• Not following the recommendations of the health care team 

(i.e., driving restrictions, no alcohol)

• Unrealistic expectations about future plans or abilities

• Inaccurate self-perception or self-image.

How you can help:

• Learn how to use safe, “supported risk taking” techniques from the health 

care team. This method allows the person to try to do something that he 
Chapter 5 - Behavioral and Emotional Effects

thinks he can do but that may be beyond his capabilities. The goal is to 

raise the person’s awareness through real trial and error situations. 

• Work with your service member/veteran to use effective problemsolving techniques. 

• Give realistic and supportive feedback.

• Help to set realistic goals. Develop plans to take steps towards larger goals. 

• Use a memory notebook to track progress and setbacks. 

What Are Common Emotional Effects?

Emotions start in the brain. Emotional self-control may be more difficult 

following a TBI. TBI can affect the complex neurochemistry system in the 

brain. This can lead to changes in emotional functioning. 

Depression

Many people with TBI become depressed. This depression comes 

from both the physical changes in the brain due to the injury and the 

emotional reactions to it. 

It is sometimes hard to tell the difference between symptoms of 

depression and effects of the TBI. For example, depressed people and 

people with TBI may have:

• low activity level

• sleep problems

“It’s hard to describe the things we take for granted day in 

and day out, just being able to take care of our own selves, 

like brushing our teeth, washing our hair, knowing how to do 

those things and when they need to be done. We take that for 

granted, but that’s something I’ve seen that Mike has really 

been able to master again. It has improved tremendously. At 

first, he knew what a toothbrush was for and what a hairbrush 

was for, but he would never have remembered, ‘Oh, I need to 

brush my teeth.’ He would never have thought about that. 

But recently, that’s something he knows. After he eats, he’ll say, 

‘Oh, I need to brush my teeth.’ He’s more self-aware.”

 - Meredith H.

74
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help 75

• difficulty controlling emotions

• lack of initiation.

Men and women often have different symptoms of depression. They also 

have different ways of coping with the symptoms. 

Men often report symptoms of:

• fatigue

• irritability/anger

• loss of interest in pleasurable activities

• sleep disturbances. 

Men are more likely than women to use alcohol or drugs when they are 

depressed. They may engage in reckless, risky behavior. Men also tend 

to avoid talking about their feelings of depression with family or friends. 

Women are more likely to talk about depressive symptoms to others. 

They often report feelings of:

• persistent sadness

• anxiety

• excessive crying

• feelings of guilt/worthlessness

• decreased energy

• increased appetite

• sleep problems

• weight gain. 

In severe cases, both men and women may experience thoughts of suicide. 

If you suspect that your family member is depressed, ask your health care 

team to evaluate his or her mental health. This is very important.

Depression can be treated with counseling and medication. If the 

depression is affecting the family, marriage and/or family therapy can help. 

What you might see:

• Persistent sad, anxious, or “empty” feelings 

• Feelings of hopelessness and/or pessimism 

• Feelings of guilt, worthlessness, and/or helplessness 

• Irritability, anger, restlessness 

• Loss of interest in activities or hobbies once pleasurable, including sex 

• Fatigue and decreased energy 
Chapter 5 - Behavioral and Emotional Effects

• Problems concentrating, remembering details, and making decisions 

• Insomnia, early morning wakefulness, or excessive sleeping 

• Overeating, or appetite loss 

• Persistent aches or pains, headaches, cramps, or digestive problems 

that do not ease even with treatment 

• Less attention paid to grooming and personal appearance

• Thoughts of suicide, suicide attempts. 

How you can help:

• Offer emotional support, understanding, patience, and 

encouragement. Remind your family member that depression usually 

fades with time and treatment. 

• Talk to your family member and listen carefully. 

• Acknowledge feelings, point out realities, and offer hope. 

• Get your family member involved in activities outside the house 

(e.g., walks, shopping, movies, church services, volunteering). If he or 

she declines, keep making gentle suggestions but don’t insist. 

Module 4, Chapter 5 provides information on suicide prevention resources.

Remember, depression is common as a person struggles to adjust to 

the temporary or lasting effects of TBI. Being depressed is not a sign of 

weakness. It is not anyone’s fault. Help is available...do not wait to call 

someone if you think your family member needs help.

76

Know the signs of a person thinking of suicide: 

• making a will

• taking steps to get affairs in order

• giving away personal possessions

• sudden requests to visit friends or other service 

members/veterans 

• purchasing a gun or stockpiling medications

• a sudden and significant decline or improvement in 

mood

• writing a suicide note.
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help 77

“I know that there were times in my husband’s recovery 

that he and I both wrestled with a number of emotions. We 

definitely went through all the phases of grieving because you 

grieve for the loss of those characteristics and those dreams 

that you had before, and that’s all normal.

At one point he said to me that it would have been easier had 

he passed away, and there were times when I went there too, 

but it’s not something that you want. It’s not something that 

you’re wishing for. But, these are feelings that I think any 

couple, any person that’s gone through a traumatic event like 

this, any caregiver that’s watching a loved one suffer like that 

and feeling this state of entrapment or loss of control, would 

normally have in this situation.

You need to acknowledge that you have these feelings. Not 

that you want to fulfill them but just that you’re not going 

crazy and you’re not a bad person for having them.

Just stay open and know that these feelings, and that feeling 

of being trapped in this sort of hopeless, hopeless place, will 

go away. Know that there are a lot of blessings to be found 

through this recovery process.” 

 - Anonymous

Call 911 immediately or bring your family member to 

the closest hospital if you have any suspicion about 

suicide. It is perfectly fine to directly ask the person if 

he or she has been having suicidal thoughts. If yes, ask 

if he or has a specific plan in mind. Having a plan for 

killing oneself is a serious sign to get help quickly.

Always take a person’s threats of suicide seriously. 

Get immediate help. Call the health care team or 

an emergency hotline (DoD/VA: 1-800-273-TALK) 

right away. Make sure to remove or secure any 

available firearms.
Chapter 5 - Behavioral and Emotional Effects

Increased Anxiety

People with TBI often become anxious. Anxiety sometimes goes hand in 

hand with depression. 

What you might see:

• Constant physical tension

• Excessive worry, racing thoughts

• Feeling jumpy, irritable, restless

• Racing heart, dry mouth, excess sweating, shakiness, or feeling 

short of breath 

• Feeling panic or having a sense that something bad is going to happen.

How you can help:

• Work with your family member to recognize problems that he or she 

may be worried about. Use problem-solving techniques (page 48) to 

address them. This can help put the issue into perspective. 

• Suggest that your service member/veteran write things down or keep 

a journal. Sometimes this alone can be calming and can slow down 

racing and nervous thoughts.

• Use redirection (i.e., try to change the topic or focus of interest to 

something else). 

78

“You know what? I think that a big key in rehabilitation is to 

keep him busy because what happens when he’s not, he gets 

very down. He sometimes feels hopelessness because he can’t 

drive and he can’t just get in the car and go. 

These guys are used to being on the go 24/7, being in the 

Army and part of the war itself, and to come back and have to 

sit in a wheelchair and have to depend on your mom or your 

spouse to take you everywhere--you know, you can’t just go in 

the car and get a hamburger. 

It’s very difficult. What keeps him sane and keeps him going is 

sports. He’s on a sled hockey team, the San Antonio Rampage, 

and he travels. Sports have been a huge, huge outlet.”

 - Cindy P.
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help 79

• Ask your family member to talk with the doctor about medications for 

anxiety. Counseling may also help.

• The health care team may suggest other ways to reduce anxiety. These 

could include relaxation training, controlled breathing, and other coping 

strategies. If they do, practice these strategies with your family member. 

Mood Swings (Emotional Lability)

It can be frustrating and embarrassing when you can’t control your 

emotions. It can make it hard to participate in social situations.

What you might see:

• Laughing one minute, and feeling sad or crying the next

• An emotional response that does not “fit” the situation (i.e., crying 

when others are laughing, laughing when receiving news about the 

death of a loved one)

• Frequent, unexpected shows of emotion.

How you can help:

• Reassure your family member that you understand that his or her 

display of emotion may not match the situation. Be nonjudgmental.

• Help family and friends understand sudden shifts in your family 

member’s mood.

• Distract your family member. Use redirection (i.e., try to change the 

topic or focus of interest to something else). 

• If the mood swings are interfering with your family member’s everyday 

life, ask him/her to talk with the doctor. Medications may be helpful in 

managing mood swings. 

“He was very emotional, and still is when he stops and thinks 

too much about stuff. But he was very, very emotional. He 

would hear a song and just cry for no apparent reason.

That was kind of hard to deal with because all you can do is 

comfort. “

 - Sandy M.

Emotional lability 

is a term for 

sudden mood 

swings. 
Chapter 5 - Behavioral and Emotional Effects

Self-esteem is 

feeling confidence 

and pride in who 

you are.

Changes in Self-Esteem

A person’s view of him or herself can be negatively affected by TBI. 

Feelings of low self-esteem go hand in hand with depression. 

What you might see:

• Negative self statements: “I am worthless,” “I’ll never be normal 

again,” “How can you love me like this?”

• Less interest in personal appearance

• Social withdrawal. 

How you can help

• Encourage your family member to express his or her feelings. Try to 

redirect the person to more positive thoughts.

• Encourage your family member to spend time with others. Encourage 

him or her to take part in independent activities.

• Help your family member to set realistic, attainable goals. Help him or 

her to choose activities that he or she can successfully complete.

Should I Stay in Touch with the Health Care 

Team?

Your health care team is your best resource for support and education. 

It is important that you tell the health care team about the emotional 

and behavioral effects that you observe. This is particularly true as these 

effects change over time.

Remember, many TBI effects improve over time. Until they do, the health 

care team can help manage the challenges that your family member is 

facing. Rehabilitation, counseling, and medication are tools that the 

team can use.

80
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help 81

“Ultimately, you will end up being the therapist. You will 

end up being the caregiver. But they do make improvements 

and you will see plateaus, and then all of a sudden you’ll see 

improvements again and then plateaus.

When they’re making a lot of improvements, work it. Work 

it hard. Just do whatever you have to do, if it’s physical or 

mental. I mean, work it. And then when they plateau off, 

don’t get discouraged and think, oh my God, everything’s 

gone again. You might take a couple of steps backward, but 

you will hopefully, eventually make some more steps forward.

The brain is just amazing.”

 - Denise G.

After reading this module, you may be feeling relieved 

that your service member/veteran is experiencing only 

a few effects from his or her TBI. Or you may be feeling 

overwhelmed by the number and complexity of effects 

that you are learning to address.

Remember, you are not alone. There are thousands 

of other military families who are struggling to 

understand and cope with the same cognitive, physical, 

behavioral, and emotional changes that you and your 

service member/veteran are encountering. Healthcare 

providers are learning more every day about how to 

effectively treat these consequences of TBI. Your service 

member/veteran is the beneficiary of new medical 

knowledge gleaned from other service members’ 

experiences. In turn, his or her experience will add to 

the wealth of knowledge about how to treat TBI.

Most effects of TBI fade over time. Keep hope in your 

heart as you move forward into the future.
82
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

The questions below can help you reflect on your experience as a caregiver. 

You can write your thoughts here, copy this page and add it to your 

journal if you keep one, or reflect on these questions in your journal. 

What emotional and/or behavioral effects have you observed in your service 

member/veteran?

Is there one particular instance that stands out for you? Describe what 

happened and how you reacted.

What impact have these emotional and/or behavioral effects had on you? 

On other members of the family?

Journal

83
What strategies have you tried to use to help your service member/veteran 

cope with emotional or behavioral effects? How well have they worked?

What strategies do you plan to try in the future?

84 Journal
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

1. Why is my service member/veteran with TBI so tired all the time? 

People with TBI tire easily for good reasons. First, all thinking takes 

mental energy. 

In a person with a brain injury, thinking activities take two to three times 

more energy than they do for someone without a brain injury. This is a 

major reason for fatigue.

After a TBI, a person’s natural day/night cycle may be disturbed. Your 

service member/veteran with TBI may not be able to achieve the 

necessary deep sleep that allows someone to wake up feeling refreshed. 

He or she may also wake up many times during the night. 

Help your family member to organize the day through the use of a 

calendar or notebook. This helps him or her avoid mental fatigue. (See 

Chapter 3 to learn more.) Keep daily activities on a regular schedule. 

Encourage your service member/veteran to make important decisions in 

the morning when mental energy is highest.

Finally, set up a sleep routine that includes going to bed and getting up 

at the same time every day. If fatigue persists, talk to the health care 

team. Medication can help regulate sleep patterns.

2. Why is my service member/veteran with TBI angry much the time?

During recovery, your family member will learn about how TBI has 

changed his or her life. 

He or she may feel frustrated and angry about these changes. Remain 

calm. Help your family member to recognize when he or she is 

becoming angry or frustrated. Encourage him or her to ask for a break 

or some space to calm down. Praise your family member when he or she 

uses anger management strategies. 

3. Why is my service member/veteran more emotional?

Neurons in the frontal lobe of the brain control the expression of 

emotion. These are often damaged during a TBI. Your service member/

veteran may start laughing or crying, and be unable to stop easily. 

Likewise he or she may feel emotions, but be unable to express them. 

These symptoms usually lessen over time as the brain heals.

Frequently-Asked Questions

Appendix A

85
4. Why does my service member/veteran seem so insensitive 

and hurtful?

Your family member may seem insensitive and hurtful at times because he 

or she has less self-control over thoughts and behaviors. 

This self-control is located in the frontal lobe of the brain. Damage to 

the frontal lobe may cause someone to just say things, without thinking 

about their effect on other people. 

People with frontal lobe damage have a hard time understanding another 

person’s point of view. They also have a hard time multi-tasking. For 

example, it’s hard for people with TBI to respond to conversation and 

monitor what they are saying at the same time. 

People with injury to the parietal lobe may have visual-spatial problems. 

This can make it hard to “read” the nonverbal feedback they are receiving 

from others.

You can help your family member learn to be more aware of the feelings 

of others. First, let your service member/veteran know what you are 

feeling; don’t expect him or her to read your expressions. Second, if your 

service member/veteran blurts out an unkind statement, suggest to him 

or her: “That’s an inside thought, not an outside one.” Finally, work with 

your health care team to help your service member/veteran learn how to 

conduct simple negotiations.

Remember, it’s the injury, not you, that is causing this behavior. If you 

find that it is having an effect on your self-esteem, please seek help 

through support groups, counseling, etc.

5. My service member/veteran used to have a lot of “get up and go.” 

Why is he or she so passive now, just sitting around unless I tell 

him or her what to do?

Both fatigue and damage to the frontal lobe of the brain affect a person’s 

“get up and go.” (See Lack of Initiation on page 70.) You can help your 

family member by setting a regular daily routine. Organize larger tasks 

into a series of smaller ones. Provide choices for activities from which your 

family member can choose. This can increase motivation and initiation.

86 Appendix A - Frequently-Asked Questions
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

6. I no longer have a spouse; I have another child in the family. How 

can I restore my marriage?

A spouse’s role after his or her partner has a TBI will often change. 

See Module 3 for suggestions about how to make the caregiving role an 

easier one.

Help your spouse with TBI become as independent and active as 

possible. See a marriage counselor if there are sexual problems. Talk to 

the doctor about medication to address physical problems that get in the 

way of intimacy.

7. Will our lives ever get back to normal?

The course of recovery after TBI depends on several factors. Your lives 

may return to “normal” or you may need to learn to adjust to a “new 

normal.” It can take time to adapt to the life changes after TBI. Although 

many problems will improve in time, some symptoms may persist 

throughout the person’s lifetime. Research has shown that many people 

who experience TBI do lead a life they find satisfying, even if it is not 

exactly the life they had prior to the injury. 

8. How long is the psychological recovery going to take?

There are two recoveries to consider: the physical and the psychological. 

Physical recovery (spontaneous healing of the brain) usually occurs in the 

first few years after the injury, depending on many factors. 

The psychological recovery from TBI—learning to feel good about 

oneself and one’s life--takes time as well. It may take longer than the 

physical recovery. 

There are members of the health care team who will see you both 

through the recovery process and can guide you. 

In addition, some people find that it is helpful to talk with others who are 

sharing some of the same experiences. 

87
88
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

Injured service members/veterans may be treated at a VA Polytrauma 

Center, a VA Polytrauma Network Site, or a military hospital:

VA Polytrauma Rehabilitation Centers

• Richmond Polytrauma Rehabilitation Center (McGuire VA Medical 

Center) – Richmond, VA

• Tampa Polytrauma Rehabilitation Center (James A. Haley VA Medical 

Center) – Tampa, FL

• Minneapolis Polytrauma Rehabilitation Center (Minneapolis VA 

Medical Center) – Minneapolis, MN

• Palo Alto Polytrauma Rehabilitation Center (VA Palo Alto Health Care 

System) – Palo Alto, CA

A complete list of the VA Polytrauma Network Sites may be found at 

www.polytrauma.va.gov.

Military Medical Centers

• Walter Reed Army Medical Center, Washington, DC

• Blanchfield Army Community Hospital, Fort Campbell, KY

• Malcolm Grow Medical Center, Andrews Air Force Base, MD 

• National Naval Medical Center, Bethesda, MD

• VAMC – Buffalo, NY

• Womack Army Medical Center, Fort Bragg, NC

• Wright-Patterson Air Force Base Medical Center, OH 

• Naval Medical Center, Portsmouth, VA

• Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA

• Keesler Medical Center, Keesler Air Force Base, MS

• Carl R. Darnall Army Medical Center, Fort Hood, TX

• Brooke Army Medical Center, Fort Sam Houston, TX

• Wilford Hall Medical Center, Lackland Air Force Base, TX

• Branch Medical Clinic, Marine Corps Logistics Base, Barstow, CA 

• Naval Medical Center, San Diego-Balboa, CA 

• David Grant USAF Medical Center, Travis Air Force Base, CA

• Tripler Army Medical Center, Oahu, HI

• William Beaumont Army Medical Center, Fort Bliss, El Paso, TX

• Madigan Army Medical Center, Fort Lewis, Tacoma, WA

Resources

Appendix B

89
Learn more about the effects of TBI:

TBI Model Systems Centers 

Visit the Web sites of the TBI Model Systems Centers. The Centers are a 

network of academic centers across the country dedicated to improving 

the delivery of services for people with TBI. They are funded from 2007-

2012 by the National Institute of Disability and Rehabilitation Research 

(NIDRR). Many offer useful information for consumers about the effects 

of TBI.

Alabama

UAB TBI Model System

http://main.uab.edu/tbi

Spain Rehabilitation Center - University of Alabama at Birmingham

1717 6th Ave S

Birmingham, Alabama 35233-7330 

Project Director: Tom Novack 

205-934-3454 or e-mail: tbi@uab.edu

California

Northern California Traumatic Brain Injury Model System of Care

http://www.tbi-sci.org

Santa Clara Valley Medical Center

751 South Bascom Avenue

San Jose, California 95128

Project Director: Tamara Bushnik, PhD

408-793-6433 or e-mail: jerry.wright@hhs.sccgov.org

Colorado

The Rocky Mountain Regional Brain Injury System (RMRBIS)

www.craighospital.org/research/Abstracts%5CTBIMS.asp

Craig Hospital

3425 S. Clarkson St.

Englewood, Colorado 80113

Project Director: Gale Whiteneck, PhD

303-789-8204 or e-mail: gale@craig-hospital.org

90 Appendix B - Resources
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

Illinois

Mid-West Regional Traumatic Brain Injury Center

http://www.ric.org 

Rehabilitation Institute of Chicago

345 E. Superior St

Chicago, Il 60611

312-238-4087 

Michigan

Southeastern Michigan Traumatic Brain Injury System

http://www.semTBIs.org 

Rehabilitation Institute of Michigan

261 Mack Boulevard Room 520

Detroit, MI 48201

Project Coordinator: Carole Koviak

313-745-9737 or e-mail: ckoviak@dmc.org

Minnesota

Mayo TBI Model System

http://mayoresearch.mayo.edu/mayo/research/tbims/index.cfm

200 1st Street SW

Rochester, Minnesota 55905

Project Director: James Malec, PhD

507-255-3116 or e-mail: malec.james@mayo.edu

New Jersey 

New Jersey TBI Model System

http://www.njrehab.org/tbims

JFK-Johnson Rehab Institute

65 James Street

Edison, New Jersey 08820-3947

Project Director: Keith Cicerone, PhD

732-906-2645 or e-mail: kcicerone@solarishs.org

Northern New Jersey Traumatic Brain Injury System (NNJTBIS)

http://www.kesslerfoundation.org/research/lab/modelsys.php?lab=nnjtbis

Kessler Medical Rehabilitation Research and Education Corporation (KMRREC)

1199 Pleasant Valley Way

West Orange, NJ 07052

Project Director: Elie P. Elovic, MD

973-243-2015 or e-mail: tbi@kmrrec.org 

91
New York

New York TBI Model System

http://www.mssm.edu/tbicentral/

Mount Sinai School of Medicine

Department of Rehabilitation Medicine, Box 1240

1425 Madison Avenue

New York, New York 10029

Project Director: Wayne Gordon, PhD

212-659-9372 or e-mail: wayne.gordon@mssm.edu

North Carolina

Carolinas TBI Rehabilitation and Research System (CTBIRRS)

http://www.carolinas.org/services/rehab/CIR/brain_system.cfm

Charlotte Institute of Rehabilitation

1100 Blythe Boulevard

Charlotte, NC 28203

Project Director: Flora Hammond, MD

704-355-4330 or e-mail: flora.hammond@carolinashealthcare.org

Ohio

Ohio Valley TBI Model System

http://www.ohiovalley.org/about/tbimodel.html

Ohio State University

855 Grandview Ave

Columbus, Ohio 43215

Project Director: John Corrigan, PhD

614-293-3830 or e-mail: corrigan.1@osu.edu

Pennsylvania 

MossRehab TBI Model System of Care 

http://www.mossrehab.com/content/view/8909/170

1200 West Tabor Road

Philadelphia, PA 19141

Project Director: Tessa Hart, PhD

215-456-6544 or e-mail: thart@einstein.edu

92 Appendix B - Resources
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help

Texas

North Texas TBI Model System (NT-TBIMS)

http://www.utsouthwestern.edu/utsw/home/research/neurology/tbi/

index.htm

University of Texas, Southwestern Medical Center

5323 Harry Hines Blvd.

Dallas, Texas 75390

Project Director: Ramon Diaz-Arrastia, MD 

214-648-7613 or e-mail: ramon.diaz-arrastia@UTSouthwestern.edu

Texas Traumatic Brain Injury Model System of TIRR

http://www.memorialhermann.org/locations/tirr/forhealthprofessionals/

content.aspx?id=1162

The Institute for Rehabilitation and Research (TIRR)

1333 Moursund Avenue

Houston, TX 77030 

Project Director: Mark Sherer, PhD

713-799-7007 or e-mail: Mark.Sherer@memorialhermann.org

Virginia

Virginia Commonwealth University TBIMS

http://www.tbi.pmr.vcu.edu

Medical College of Virginia

1200 East Broad St., Rm. 3-102

Box 980542

Richmond, VA 23298-0542

Project Director: Jeffrey Kreutzer, PhD

804-838-9055 or e-mail: jskreutz@hsc.vuc.edu

Washington

Univ of Washington TBIMS

http://depts.washington.edu/uwtbi

University of Washington

Rehabilitation Medicine, Box 356490

Seattle, WA 98195

Project Director: Kathleen Bell, MD

206-685-0935 or e-mail: krbell@u.washington.edu

Resources

93
94

Chapter 1 

Prevalence of TBI in OIF/OEF Combat Zones

Cited in a March 2007 letter to the House Appropriations Committee 

from Rep. Bill Pascrell (D-NJ) and Rep. Todd Platts (R-PA), both Co-Chairs 

of the Congressional Brain Injury Task Force.

References/Credits

References/Credits
Understanding the Effects of Traumatic Brain Injury and What You Can Do To Help 95
www.DVBIC.org

Version: 1-2010 | www.traumaticbraininjuryatoz.org

This guide was produced in collaboration with

The Defense Health Board

The Defense and Veterans Brain Injury Center

and

The Department of Veterans Affairs
Traumatic Brain Injury: A Guide for Caregivers

of Service Members and Veterans

Module 3

Becoming a Family Caregiver for a 

Service Member/Veteran with TBI

Becoming a Family Caregiver for a Service Member/Veteran with TBI

Module 3 Summary

Chapter 1: Starting Your Caregiving Journey

What is the Course of Recovery?

How Important is My Caregiving?

Chapter 2: Keeping Important Paperwork Together

How Should I Organize Medical and Military Records?

Chapter 3: Becoming an Advocate

How Do I Advocate to the Health Care Team?

How Do I Advocate to Employers and Others?

How Can I Advocate to the Broader Community?

How Can I Advocate to Policy Makers?

What Are the Basics of Speaking Up for My Family Member?

Chapter 4: Taking Care of Yourself

Whose Care Comes First?

How Can I Stay Emotionally Healthy?

How Can I Stay Physically Healthy?

What Are Strategies for Self-Care?

Chapter 5: Helping Your Children Cope with TBI

How Can I Tell My Child about TBI?

What Are Specific Ways to Explain TBI to a Child?

How Can I Communicate with My Child about TBI?

What Are Some Tips for Helping Children Cope?

How Can I Build Stronger Family Ties?

Chapter 6: Addressing Family Needs

How Can I Build on My Family’s Strengths?

How Can I Preserve My Marriage or Relationship?

What Are Other Ways TBI May Affect My Family?

What Can I Do If Caregiving is Just Too Much?

Table of Contents

i

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ii

Chapter 7: Transitioning to Home

How Do I Manage Care at Home?

How Can I Organize to Get Help with Caregiving?

Chapter 8: Moving Forward

What Can I Expect When My Family Member Comes Home?

How Can I Protect the Safety of My Service Member/Veteran 

with TBI?

Can My Family Member with TBI Drive?

Should I Be Concerned about Alcohol and/or Drug Use?

How Can My Family Member Avoid Another TBI?

Chapter 9: Addressing Everyday Issues

What is the Family and Medical Leave Act?

Can I Receive Public Benefits if I Lose My Job?

Can I Get Help in Finding a Job?

How Can I Balance Work and Caregiving?

Chapter 10: Planning for the Future

What is Guardianship?

What is Power of Attorney (POA)?

What is a Medical Power of Attorney?

What is an Advanced Medical Directive/Living Will?

What Do I Need to Know about Wills?

What Do I Need to Know about Trusts?

What Military Resources Can Help Me?

Chapter 11: Finding Meaning in Caregiving

Appendix A: Resources

References/Credits

An electronic version of this Guide can be found at the following Web address: 

www.traumaticbraininjuryatoz.org

Table of Contents

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.............................................................................. 108
Becoming a Family Caregiver for a Service Member/Veteran with TBI

You play an important role in the recovery of your service member/

veteran with TBI. 

You may be a spouse, parent, sibling, or friend. Your job as a caregiver 

may include being a:

• case manager

• advocate

• benefits coordinator

• health care provider. 

All of these roles may be new to you. 

This module focuses on helping you, the caregiver. It offers tips on how 

to get organized and get help. It also suggests ways to take care of 

yourself while caring for your family member.

Some of the main ideas in this module are:

• Get to know the members of the health care team and the case 

managers. They can and will help you during the hospital stay, during 

recovery, and when your service member/veteran comes home.

• Keep health care and military information about your service member/

veteran in a notebook. Being organized helps you feel less stressed.

• Talk about your needs and the needs of your service member/veteran 

to others (advocacy).

• Take care of yourself first, so you can take care of your service 

member/veteran.

• Take time and be honest when helping children and other family 

members cope with TBI.

• Allow your friends and family to build a support network to help you. 

Ask for help. No one can do it alone.

• Plan for some time off. Respite care and day care programs are 

valuable resources to you and your service member/veteran.

• There are ways to balance work and caregiving through Family and 

Medical Leave and other means.

• There are key legal issues to address to protect your family and 

your service member/veteran. 

Much of the information in this module was guided by family caregivers 

of service members who suffered a TBI.

Module 3 Summary

iii
iv

You are an important team 

player in the active recovery 

of your service member/

veteran with a TBI.
Becoming a Family Caregiver for a Service Member/Veteran with TBI

You are starting out on an important journey in your life--becoming a 

family caregiver to someone who has a traumatic brain injury (TBI). A 

caregiver like you can help your service member/veteran recover as fully 

as possible. 

Few families know 

what to expect 

after a service 

member/veteran 

receives a brain 

injury.

The information 

in this Guide will 

help you cope 

with your new role 

as a caregiver.

1

Chapter 1

Starting Your Caregiving Journey

Caregiver: Any family or support person(s) relied 

upon by the service member or veteran with traumatic 

brain injury (TBI) who assumes primary responsibility 

for ensuring the needed level of care and overall wellbeing of that service member or veteran. 

For the purposes of this Guide, “family” or “family 

caregiver” will include spouse, parents, children, other 

extended family members, as well as significant others 

and friends.

You may be feeling overwhelmed, angry, or scared. You may also feel 

alone and worn out by your new role. 

Please learn about TBI. Take good care of yourself while caring for your 

service member/veteran. Keep hope alive during your journey toward 

recovery.

What is the Course of Recovery?

Recovery from TBI is a gradual process. It may take weeks, months, or 

even years. Those with a TBI may need assistance for weeks to months. 

Some will need help for the rest of their lives. For those in a minimally 

conscious state, some may need long-term care outside of your home. 

Each TBI is different. Each person needs different help and support from 

his or her caregiver. 

How Important is My Caregiving?

Caregivers play an important role in recovery. In fact, many people 

who work with TBI patients believe that having a caregiver just like you 

is one of the most important aids to recovery. Your job is to actively 

follow the treatment plan and offer guidance and help to your injured 

family member.
Chapter 1 - Starting Your Caregiving Journey

“You’re the person who knows your family member best. 

That’s what my neurologist told me. He said you’re going to 

have to help us here because you know him best. You have to 

let us know if he’s hurting, if he’s not hurting, if he’s waking 

up, because you know him best. So you’re going to really have 

to help us here to know what’s going on with him because he 

can’t tell us.”

 - Denise G.

Learn all you can about TBI. The following suggestions may help you:

• Use this Guide. It provides tips on how to be a good caregiver. 

• Ask questions of the doctors, nurses, and other health care providers.

• Classes or online discussion groups may be helpful.

2
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Chapter 2 Keeping

Important Paperwork Together

“Try never to despair. I know that everybody has moments 

and walls or the black day that you feel is the end of the 

world. The truth is that each day is a new day and you can 

look for the little moments.” 

- Lee Woodruff, wife to newscaster Bob Woodruff who sustained a 

TBI while covering Operation Iraqi Freedom. Co-author with her 

husband of In an Instant: A Family’s Journey of Love and Healing

Rehabilitation isn’t necessarily about getting back to “normal.” It may 

be about creating a new “normal.” 

You are providing a very important service to someone you care about. 

This chapter is about organizing your service member/veteran’s medical 

and military records to make your caregiving job easier. You are not alone. 

Health care providers and other professionals are there to help you every 

step of the way. 

How Should I Organize Medical and 

Military Records?

The more organized you are, the better. Being organized will help you:

• have more control

- making decisions 

- having access to accurate information

• reduce your stress

• have all the care-related information you need in one place

• keep all the important documents needed for the Medical Evaluation Board 

(MEB) and Physical Evaluation Board (PEB) (see Module 4, Chapter 12).

Organizing Information

A notebook helps a family member with TBI and his or her caregivers 

keep information they need together in one place. See the Caregiver’s 

Companion provided with this Guide. The Companion will help you get 

started organizing your paperwork. 

You may end up with several notebooks or folders like this. You should 

keep all medical information. You may even want to enter information 

into a computer file.

Rehabilitation 

means re-learning 

how to do 

everyday things.

Keeping a 

notebook about 

your family 

member’s health 

care helps you 

stay organized.

3
Chapter 2 - Keeping Important Paperwork Together

The notebook could include sections for:

• Personal information – This includes important facts, such as your 

service member/veteran’s Social Security number, military service 

record, emergency contacts, and allergic reaction to medications.

• Military service papers – Keep copies of military service records, etc.

• Medication log – Write down all the drugs taken, dosages, dates, 

side effects, and problems. There is a blank form at the end of this 

chapter that you can use.

• Medical reports, tests, scans – Ask for copies of all reports, scans, 

and tests, and file them in this section of the notebook. Put CT and 

MRI scans of the brain on a compact disk (CD). Keep these to share 

with future providers. 

• Notes and questions – Include a three-hole punched notepad in 

your notebook. You can use it to take notes and then insert the sheets 

in the right sections.

“I developed my own filing system. Every time Jason gets a 

new medication, they give you a medication list that tells you 

the side effects and all of that. That goes in the medication 

information slot. Every time he had surgery, that information 

went into the surgery history slot. I actually took it upon 

myself to create a file on the computer of every surgery that 

he’s had, what they’ve done, and the date. I documented 

every seizure that he’s had. I carry that with me so that when 

someone says, ‘Well, what are his surgeries? We need a list of 

his surgeries. We need a list of his seizure history’--it’s right 

there. I give it to them. 

I have a filing system for his orders. I have a file for his profile. 

Definitely keeping everything organized early on is helpful, 

and keeping a daily journal of what’s happening, who you’re 

talking to, whether he had a good day or a bad day, he 

started eating today, he took 10 steps today. I have a list of 

every single appointment that he’s gone to from day one, and 

I just keep everything. He has his own file cabinet.”

 - Sandy M.

4
Becoming a Family Caregiver for a Service Member/Veteran with TBI

• Resources and information – This is the place to keep all the forms 

and information you have received at appointments.

• Calendar of appointments – Use a calendar with enough room to 

write all of your appointments.

You may want to keep another notebook or file with the records needed 

to apply for medical and family benefits or the Medical Evaluation Board/

Physical Evaluation Board (MEB/PEB). (See Module 4 for more information 

about the MEB/PEB.) 

This file will help when you apply for financial aid, a job, or more 

medical care. When you are not using this file, keep it in a locked place 

to keep it safe.

This file could include:

• Social Security card, military records, and insurance cards 

• Power of Attorney

• driver’s license, birth certificate, marriage certificate

• school and work records

• tax returns and assets.

Paying Bills 

If your family member with TBI can no longer handle paying the bills:

• Consider changing the contact name on financial accounts to your 

name or the name of a person who has Power of Attorney. 

• When accounts are in joint names or in the name of the person with 

TBI, it may not be easy to change names on financial accounts. 

You may need to obtain legal guardianship. (See Chapter 9.)

• Consider online banking and bill paying.

5
6 Chapter 2 - Taking Care of Your Service Member/Veteran with TBI

“I observed another wife... she had binders that were for the 

medical stuff or for things like the Power of Attorney or different 

documents that you would need. Then there were different 

binders for therapy, because you do get worksheets, especially 

for speech therapy. I’ll usually carry one binder if I travel. I’ll 

bring all the special information with me on the airplane. 

Also, the list of medicines is really important. A lot of 

information is sent on e-mail. I keep a separate folder for Army 

e-mails in my e-mail account so I can always go back and look.

In the beginning, I bought a book to put business cards in. You 

meet so many people. People hand you a card, in case you 

need anything, and some of those people I’ve actually called 

because I do need things. You can buy the book at an office 

supply store that holds up to 100 business cards. I have three 

of them full now, after a year and a half.

I carry these little books with me so I always have phone 

numbers. I’ve also put phone numbers in my e-mail contact 

list—I try to put them in two different places, so I don’t lose 

things.”

 - Patty H.
Becoming a Family Caregiver for a Service Member/Veteran with TBI 7

Medication Log

Allergies:

Pharmacy Phone #:

Name:

Name/dose

Date

Purpose Prescribed

by

Times

Taken daily

Comments/Side Effects

Methylphenidate 7 12 noon Stimulant Dr. K Loss of Appettite

Medication
8
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Chapter 3

Becoming an Advocate

“As caregivers for my brother, my family and I were his voice 

when he could not speak. This could be anything from hanging 

signs in his room that reminded nurses and therapists where 

Ethan was missing his skull, to helping with rehab, to filling out 

paperwork, to going to JAG officers to discuss Power of Attorney 

issues. Every day, seven days a week, it became our lives. It’s 

easy to fall into a groove. Sometimes that groove is comforting, 

but sometimes it makes you complacent. It’s important to stay 

on top of the situation and not take things for granted.

As a caregiver, you know your loved one and his or her 

treatment plan the best. You can easily recognize when 

something is working well or when something is wrong. Never 

hesitate to acknowledge improvement or voice a concern, 

always ask questions about a procedure with which you are 

unfamiliar, and continually seek out benefits to which your 

loved one is entitled. Information is not always volunteered to 

you; if you don’t ask, you might not receive.

Being a caregiver means being an advocate. You’ve already 

committed yourself to caring for your loved one; it comes 

naturally that standing up for him or her should be part of 

that care.”

 - Liza B.

As a caregiver, you may find yourself in situations where you need to 

advocate for your service member/veteran with TBI or for yourself.

But you may be saying to yourself,

• “What me? Advocate? I’ve always been the quiet type. I’m not 

comfortable demanding anything from anybody,” or 

• “I don’t have the education or authority to talk back to those who hold 

positions of authority,” or

• “I’d rather be dead than have to speak in public.”

Advocacy involves basic communication skills: 

• listening to what other people have to say, and 

• talking about what is important to you. 

You are an 

advocate when 

you speak out on 

behalf of someone 

or something that 

you believe in. 

9
You can learn to build on the problem-solving skills that you already 

have to become an advocate.

Generally, there are three types of advocacy:

• Self-advocacy – understanding and effectively communicating your 

own needs to others

• Individual advocacy – speaking out on behalf of your service 

member/veteran with TBI

• Systems advocacy – attempting to change government, 

organization or agency policy, rules, or regulations.

Advocacy is all about:

• knowing what you want in a situation

• getting the facts

• planning your strategy

• being firm and persistent

• maintaining your credibility.

Let’s look at situations where your advocacy skills are needed.

How Do I Advocate to the Health Care Team?

Becoming an advocate about TBI begins when you first meet the health 

care team who care for your injured service member/veteran. 

Try to learn as much as you can from them about TBI and the treatment 

plan for your service member/veteran. Try to learn as much as you can 

about the DoD and VA medical systems and how to use these services. 

(See Modules 2 and 4.) 

This is all part of getting the facts. Understanding the facts will make you 

communicate better with everyone. 

Tips for advocating with health care providers:

• If you have problems or concerns with the care your service member/

veteran is receiving, identify what you think is needed. 

• Be specific. 

• Talk about your service member/veteran’s needs directly to the 

members of the health care team. Early morning is when doctors 

make their rounds, visiting patients. This may be the best time to talk 

to them. 

• Be clear and be firm about what you need. 

Learning how to 

talk with health 

care providers is 

part of being a 

good advocate. 

DoD is the 

Department of 

Defense.

VA stands for the 

Department of 

Veterans Affairs.

Chapter 3 - Becoming an Advocate

Advocacy is a 

form of problem 

solving, something 

that you probably 

already do every 

day in your own 

life. 

10
Becoming a Family Caregiver for a Service Member/Veteran with TBI

“Basically you have to take the well-being of your loved one 

into account or you’ll get lost in the shuffle. There’s a bunch 

of people here in the hospital and they’re injured. If you don’t 

keep up with your loved one’s therapy, you will get lost in the 

shuffle because there are so many needs to be taken care of.

You have to be your own advocate and the advocate for your 

loved one, and make sure he’s getting everything he needs.”

 - Emily S.

• Be persistent and firm, but in a cooperative manner. If you don’t get a 

response right away, keep asking. 

• If this approach does not seem to work, contact the Ombudsman or 

Patient Advocate at the service member/veteran’s health care facility.

• Try not to be confrontational. 

• Come prepared with a list of your questions when attending care 

conferences. Take notes during meetings or ask a friend or another 

family member to do this for you. 

• Do not tell someone how to do his or her job. It seldom works. 

Instead, talk to the person as a concerned family member and explain 

your worries calmly. 

• Remember, the health care providers are in charge of your loved one’s 

care. You will be talking with them on a regular basis. 

• Work with the health care providers. Remember, they are well 

intentioned. They might not know the exact needs of your loved one 

yet. You are telling them. 

• Give reasons for health care providers to give special care to your 

family member. Tell them about his or her stories and personality 

traits. If they get to know your loved one, they may be more alert to 

his or her care.

• Often, if you let health care providers get to know you, they will listen 

to your concerns with better understanding.

11
How Do I Advocate to Employers and Others?

You may need to advocate on behalf of your service member/veteran with 

TBI to assure access to employment, transportation, or commercial places. 

The Americans with Disabilities Act (ADA) requires that employers, public 

transportation, and commercial businesses not discriminate against 

people with disabilities. It requires reasonable changes to be made so 

that the person can work, ride on public transportation, and/or use 

commercial places. 

“Try to keep a cool head when you are speaking on behalf of 

yourself or others. Know what you’re talking about. If you 

don’t, then ask questions and be willing to learn. The more 

you sound like you’re angry or ‘just complaining,’ the less 

others will listen. If you are receptive to someone, often he or 

she is receptive back. This is what maintains a level of respect 

and credibility.” 

 - Liza B.

“This is all part of getting the facts. Understanding the facts 

will make you communicate better with everyone. 

If you’re really involved, I think the doctors have more respect, 

they’re more likely to listen to you. They feel like you’re 

concerned. 

You need to set goals for your husband and his life; it’s really 

about what you want to accomplish through therapy. So there 

are times when I don’t think you should be afraid to speak up. 

Maybe they’re the expert—the physical therapist or the speech 

therapist—but you should speak up and tell them what your 

goals are. If they’re not meeting them, then you should not be 

afraid to tell them or—if it’s not working out— request another 

therapist. If it’s just not working out or you feel something’s not 

right, don’t be afraid to ask for another person to work with.”

 - Patty H.

12 Chapter 3 - Becoming an Advocate
Becoming a Family Caregiver for a Service Member/Veteran with TBI

If you think your service member/veteran with TBI is being discriminated 

against, speak up. Get to know your family member’s rights under the 

ADA and how to advocate on his or her behalf by going to 

http://www.ada.gov.

How Can I Advocate to the Broader 

Community?

After you have some practice as a caregiver to a person with TBI, you

will begin to know what life is like with TBI and what families affected by 

TBI need. 

Those who have not lived your experiences may have no idea what you 

have gone through. You can educate others and raise public awareness 

of the impact of TBI on individuals and families... through advocacy. 

When you are ready, you can educate others by sharing your experiences 

with them. You may find it helpful to work with others in the local 

chapter of the Brain Injury Association of America (see Appendix) or the 

Wounded Warrior Project (see Appendix) on more organized efforts to 

raise awareness of TBI. 

Working with others will bring you into contact with other people who 

have also walked in your shoes. It may help bring meaning and a greater 

purpose to your family’s experience.

How Can I Advocate to Policy Makers?

The time may come when you want to broaden your advocacy skills to 

change the policies or laws of local, state, or federal government. 

Systems advocacy uses many of the same skills that you have been 

learning. Join with others to help pass important laws. Veterans and 

military service groups as well as TBI-related groups may be interested in 

advocating for change. 

Laws such as the Americans with Disabilities Act and the 

Family and Medical Leave Act were passed due to the 

advocacy of people just like you.

You may find the idea of being an advocate hard or scary. Most family 

caregivers grow more at ease over time as they practice these skills. 

13
You will have moments of triumph and moments of setbacks. But if you 

keep at it, you will find that your own confidence and skills will grow and 

change you as a person. And, you will have made a difference in the world.

The Brain Injury Resource Center (http://www.headinjury.com/advocacy.htm) 

and the Brain Injury Association of America (http://www.biausa.org/

media.htm) have tool kits, fact sheets, and other materials to help you 

develop your TBI advocacy skills. 

Chapter 3 - Becoming an Advocate

There are groups who can help you speak up for your 

family member. Veterans service organizations and 

military service organizations can also advocate on your 

behalf. See www.disabilityinfo.gov for more information.

“I wish I didn’t have to work a real J-O-B full time so that I could 

really jump up and down and do a lot more than I do. But I’m 

starting to learn the ins and outs politically, and I’ve started 

really pulling on my Congressman’s ears and my Senators’ 

ears. I promised my son, and I promised the two families of his 

best friends, that, until I can’t do it anymore, I wouldn’t stop 

advocating on their behalf, because it’s going to be around 

forever, and I’m not going to be here forever to take care of my 

son. Somebody is going to have to, and it should be our nation 

and our system. These kids were not drafted, they volunteered 

to serve. They deployed, some of them volunteering to go back 

over and over again, and it’s the least we can do. We are not 

doing enough, we are not doing enough. 

This is my niche. This is where it works. This is where all the 

pieces fit together, and this is where I can do the most. People 

say, ‘Well, Adam has been out for a year and a half now, and 

there’s no reason for you to have to devote so much time to 

all this.’ I just think to myself, ‘You just don’t get it. It’s not a 

matter of having to. It’s what needs to be done, and I can do it, 

and I can do it well. I’m going to do it.’”

 - Cyd D.

14
Becoming a Family Caregiver for a Service Member/Veteran with TBI

What Are the Basics of Speaking Up for My Family 

Member?

1. Identify Yourself

State your name and identify yourself as a caregiver/

constituent. 

2. Be Specific

Clearly describe the issue and state your goals. If you are 

advocating on behalf of proposed legislation, include the 

name and number of the relevant bill.

3. Make it Personal

The best thing you can do as an advocate is to give the issue 

your individual voice. Use personal examples and speak in 

your own words.

4. Be Confident

You may also know more about the issue than the person 

to whom you are advocating. That is why it is a good idea 

to offer yourself as a source of information.

5. Be Polite

Always work on the basis that your opponents are open to 

reason and discussion. If you are rude, your message will 

not be received.

6. Be Brief

Communication that focuses strongly on one argument 

is the most effective. Keep it to one issue. Limit written 

documents to one page.

7. Be Timely

Your message is more likely to be considered if it is 

immediately relevant.

8. Be Factual

Use facts and statistics. Make sure the information you 

provide is accurate.

15
16
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Chapter 4

Taking Care of Yourself

The very best 

thing you can 

do to take care 

of your family 

member with TBI 

and others in 

your family who 

depend on you 

is to take care of 

yourself. 

Whose Care Comes First? 

Caregiving requires you to take on new roles. You will need to learn new 

skills to help your family member with TBI. 

Keep in mind, all these new demands happen at the same time that you and 

your family are coming to terms with the impact of TBI on your loved one.

You want to give the best possible care and support for your family 

member’s recovery. You may find yourself spending all your time and 

energy dealing with your family member’s needs. This may leave you 

feeling drained.

You may be tempted to put your own needs on hold. It’s not wise to do 

this. You won’t be able to give the best care or cope with your new tasks.

17

“I went and saw a psychologist and that was probably one of 

the best things I did. It was for two days a week, an hour each 

session, and she was just... a neutral person. I could come in 

and say all this stuff was going on, and she would actually 

help me make decisions as to where to go next or what things 

to do for Pat. She could stand back, look at everything, and 

help me make sense of it. That was a huge help for me. It 

was an hour that was just about me and we could talk about 

what was going on. She could put things in perspective for me 

when I couldn’t. I probably saw her for six months.

We got involved in the community. We found a church, and 

that was a great blessing because the people in the church 

really supported us while we were there. They invited us to do 

things in the community away from the hospital. 

I also joined the women’s soccer team. The hospital provided 

a place for Pat to be on Tuesday night, and I could get away 

and play.

Later on, I needed a reason to go to the gym, so we put 

together a team to run the Army 10-miler for Pat. I had 

a reason to go to the gym because I needed to train. It’s 

something for me--I did it last year, I ran 10 miles! We are 

doing it again this year.”

 - Patty H.
How Can I Stay Emotionally Healthy?

You may move through a series of stages as you come to terms with 

the changes in your family member. In the first couple of months, for 

example, you may be feeling happy that your service member/veteran 

is alive and hopeful that he or she will recover fully and quickly. As 

time goes by, progress may slow and you may feel anxious and scared. 

Sometimes you think that a full recovery might happen faster, if only he 

or she would work harder at it. As recovery progresses, you may find 

yourself feeling discouraged and depressed or even guilty. You just don’t 

know how to help your family member get better.

Feelings of depression may progress into feelings of despair and a sense 

of being trapped, if recovery slows down over time. If your service 

member/veteran has sustained a severe TBI and recovery is difficult, you 

may find yourself experiencing a period of grief and deep mourning. 

Eventually—and this may take up to two years or longer—you may find 

yourself stepping back from the pain, accepting what is, and finding 

peace in your family’s situation.

You may not go through these stages exactly like this. Knowing what 

many caregivers and family members go through as they adjust to life 

after TBI may help you know that your reactions are “normal.” 

18 Chapter 4 - Taking Care of Yourself

“I know you can only tell others so many times about taking a 

break and getting away from the hospital. But I wish I would 

have taken more time at the front end of the whole injury 

because as Mike has improved, he needs me more and more, 

and I want to be with him more and more. I have less and less 

time to go about and do my own stuff, whereas when he was 

lying in the hospital all day with his eyes closed, I should have 

gone and relaxed and researched and taken care of things. 

I know you can only tell people that so many times, but it really 

takes them learning that in order to take care of themselves. It 

is a big thing for caregivers to realize that they don’t have to 

feel guilty about stepping away.”

 - Meredith H. 
Becoming a Family Caregiver for a Service Member/Veteran with TBI 19

Although your reactions are normal, there can be harmful effects if you 

focus all your attention on your service member/veteran: 

• You may experience caregiver burnout. 

• If you do not take care of yourself—emotionally and physically—you 

may end up being harmful to yourself. 

• You may feel listless, isolated, or bottled up. Those who are burned 

out may try to use alcohol to cope. You may have poor hygiene 

or have emotional outbursts. These are signs of burnout and 

compassion fatigue. Compassion fatigue is an outcome of 

chronic, unrelieved stress. 

You can take the Caregiver Assessment at the end of this 

chapter to see whether this is something happening 

to you. 

If you do find yourself suffering from caregiver burnout or compassion 

fatigue, take heart in the knowledge that you are a deeply caring person. 

Here is a list of what you can do:

• Find a friend or family member to talk to about your feelings or join 

a support group with other families affected by TBI. Talking with 

someone can relieve stress and reduce anxiety because you will learn 

you are not alone. 

• State affiliates of the Brain Injury Association of America (see Resources 

in the Appendix) can help you find a support group. 

• If stress, sadness, or anxiety begins to feel out of control, seek 

professional help from a counselor, therapist, religious/spiritual leader, 

or social worker. 

• See Module 4 for information about counseling help for military/

veteran family members.

• The table on page 22 describes many of the common issues that 

caregivers face. Also, the table offers ideas for steps you can take 

to cope.

How Can I Stay Physically Healthy?

Healthy behaviors can keep you well. They can help you cope with the 

stress of caregiving. This section contains some healthy lifestyle tips. 

The more you take care of yourself, the better you will feel. 

Burnout is feeling 

hopelessness 

about your 

situation. 

Take steps to take 

care of yourself

Compassion 

fatigue is the 

stress resulting 

from helping or 

wanting to help a 

suffering person.
Chapter 4 - Taking Care of Yourself

Sleep

If you don’t get enough sleep, you are likely to be tired and irritable 

during the day. You also may find it hard to concentrate. Studies show 

that people who do not get enough sleep are less productive, tend to 

overeat, and are even more likely to get in accidents. 

Try these tips for getting a comfortable night’s sleep:

• Establish a routine for when you go to bed and when you get up every 

day. This can reinforce your body’s sleep-wake cycle. 

“I suppose the most challenging thing is adjusting from 

what was to what is. That transition was really difficult for 

me because of lack of information. You start to feel like, oh 

my gosh, I’m going to have to take care of this person and 

I’m going to be cut off from the world for the rest of my life 

because I’ll just have to be at home with this person 24/7. 

That was really tough, and I wish I would have known before 

how many options are out there and that you’re not going to 

be stuck. There are ways to be able to get away and to feel that 

freedom, and that was a really big challenge for me. It scared 

me a lot. Being a 25-year-old young woman, married for four 

years, I just really didn’t think that’s what I had in my future. 

For me personally, I really had to come to terms with the fact 

that the Mike that I married had changed and that I had a 

new Mike. There were a lot of things that were very similar 

to the old Mike, and a lot of things that reminded me of the 

old Mike, but this is a new person and I have to have new 

expectations and new goals, and everything had to shift 

and change. I think once that all happened for me, I mean, 

I’m really happy. I love Mike and I love that he’s still here 

with me and that we’re able to do things, and part of that 

has to do with our relationship before. What helped was 

just coming to terms with the fact that things had definitely 

changed but not always for the worst. I need to be open to 

the fact that it is a change.” 

 - Meredith H. 

20

Most adults need 

7 to 8 hours of 

sleep per night. 
Becoming a Family Caregiver for a Service Member/Veteran with TBI 21

“Just stay strong and pace yourself, and definitely seek help. 

Seek a support group and have that network for yourself, 

because you’re going to need it. You’re in it for the long haul. 

You’re not going to give them a new brain and everything is 

going to be better and they’re going to learn everything again. 

It’s not like an amputation. There’s no prosthetic, and that’s 

the hard thing to swallow.”

 - Sandy M.

• Establish a relaxing bedtime routine. Take a bath, read a book, or find 

another activity that helps you shift from your busy daytime life to 

restful sleep.

• Go to bed when you’re tired and turn out the lights. If you can’t fall 

asleep, get up and do something else until you’re tired. 

• Do not rely on sleeping pills. Check with your doctor before taking 

any sleep medications, as they can interact with other medications or 

a medical condition. You may have an underlying sleep disorder that 

requires treatment. 

• Don’t exercise close to bedtime. It may make it harder to fall asleep.

• If you are having trouble sleeping, use the tips above to ease your concerns.

• Avoid too much alcohol and caffeine. Too much of either usually 

reduces the quality of sleep.

• Have someone stay over to take over the care duties during the night.

Eat a Healthy Diet

A healthy diet is one that is low in fat, high in fiber from whole grains, 

fruits, and vegetables, and includes lean cuts of meat, poultry, eggs 

and other protein sources. A healthy diet also helps you to maintain a 

healthy weight.

It can be tempting to overeat. Do not use food as a comfort when you 

are stressed and sad. You may gain unwanted weight. 

Use low-calorie versions of comfort foods, e.g., sugar-free hot chocolate, 

or find other ways to comfort yourself, such as a hot bath or a good book.

For information 

on how to eat 

healthfully, 

consult the 

Dietary Guidelines 

for Americans and 

the Food Guide 

Pyramid at http://

www.mypyramid.

gov/guidelines/

index.html.

It’s hard to sleep 

when you’re 

worried about 

your family 

member’s medical 

condition, unpaid 

bills, or legal 

issues.
Chapter 4 - Taking Care of Yourself

Coping with Caregiver Challenges

How to Cope

• Deep breathing and other 

relaxation methods

• Exercise

• Time management

• Meditation

• Respite care to get breaks

• Take help from friends and 

family when it is offered.

• Humor

• Keep some things from your 

previous life that are important 

to you.

• Reward yourself.

• Stay in touch with friends.

• Set limits.

• Join a support group.

• Contact a therapist.

• Read a book.

• Listen to music that lightens 

your mood.

• Talk over your feelings with 

others, e.g., in a support group.

• Keep a journal to explore your 

feelings. Give yourself a break, 

by asking for help in caregiving. 

• Try to rest both your body and 

your mind.

• Find someone who can listen 

without giving advice or making 

comments.

• Focus on positive relationships 

in your life – family, friends, and 

pets.

• Know your limits in caregiving. 

It is okay to seek help from 

others if caregiving becomes too 

much for you. 

• See Chapter 6 for ideas for a 

back-up plan.

Symptoms

• Headaches

• Neck and shoulders tighten

• Fatigue

• Trouble sleeping

• Weight change

• Stomach upsets

• Increased use of alcohol, drugs, 

tobacco

• Fear and worry

• Mood swings 

• Crying spells

• Irritability

• Depression

• Forgetfulness

• Poor concentration

• Low productivity

• Negative attitude

• Confusion

• Weariness

• Boredom

• Feelings of isolation

• High blood pressure

• Feeling blue

• Feeling sad

• Withdrawing

• Irritability

• Constant sad, anxious, or 

“empty” feelings 

• Feelings of hopelessness and/or 

gloom 

• Feelings of guilt, being 

worthless, and/or helpless 

• Bad temper, restless 

• Loss of interest in activities 

or hobbies once enjoyable, 

including sex 

• Tired and decreased energy 

• Trouble concentrating

• Trouble remembering details 

and making decisions 

• Can’t sleep, early–morning 

wakefulness, or too much 

sleeping 

Challenge

Stress

Stress is the mental and 

physical reaction to events 

that upset our balance in 

life.

Chronic stress that doesn’t 

go away can lead to serious 

health problems over time.

Sadness, Depression

Sadness and grieving are 

normal responses to the loss 

of life as you once knew it. 

Sadness and grieving can 

lead to depression. 

Symptoms of depression are 

a combination of symptoms 

that interfere with a person’s 

ability to work, sleep, 

study, eat, and enjoy once 

pleasurable activities. 

Major depression is 

disabling and prevents a 

person from living normally. 

22 Chapter 4 - Taking Care of Yourself
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Coping with Caregiver Challenges

How to Cope

• See Chapter 7 for organizing 

help from family and friends 

(Home Care Team).

• If symptoms persist, seek 

professional help. Counseling 

and/or medications have proven 

effective in treating depression.

• Seek help immediately from 

medical care staff if you have 

thoughts of suicide. Seek 

counseling and/or medications 

from a provider.

• Use problem-solving methods 

(see below).

• Talk to a friend or family 

member.

• Exercise.

• Eat a balanced diet.

• Avoid caffeine.

• Write in your journal.

• If symptoms persist, seek 

professional help. 

• Counseling and/or medications 

can effectively treat anxiety.

Symptoms

• Overeating or appetite loss 

• Having thoughts of wanting to 

be dead rather than living in 

all this pain--“I would rather be 

dead than deal with all this pain 

and suffering.”

• Suicide attempts 

• Constant aches or pains, 

headaches, cramps, or stomach 

problems that do not ease, 

even with treatment

• Ongoing worry and tension

• Viewing problems as 

overwhelming

• Restlessness or a feeling of 

being “edgy”

• Bad temper

• Muscle tension

• Headaches

• Sweating

• Difficulty concentrating

• Nausea

• Needing to go to the bathroom 

often

• Being tired

• Trouble falling or staying asleep

• Trembling

• Being easily startled 

Challenge

Sadness, Depression

Anxiety

Anxiety is excessive worry 

about life. It is a reaction 

to stress and can lead to 

depression.

Exercise

Exercise can relieve stress, reduce depression, make you feel better about 

yourself, help you maintain your weight, and give you some time alone. 

It doesn’t have to be strenuous. A 30-minute walk on most days is usually 

enough to protect your health. You can break the 30 minutes into 

shorter 10-minute segments, if that’s all the time you have.

If you already have an exercise routine in place, try to stick with it. Doing 

things that were important to you before the TBI can help you cope. You 

will be a better caregiver.

23

Exercise is one of 

the single best 

ways to protect 

your health. 
If you are new to exercise, check with your personal health care provider 

and start out slowly. Remember to include stretching and strength 

building in your routine. 

There are many exercise videos that you can use at home. You don’t 

need to find the time or money to go to a gym. 

Tobacco Use

If you don’t use tobacco products, don’t start. Find other ways to cope 

with the stress.

If you use tobacco products, stress may increase your tobacco use. If you 

use tobacco products, it may be difficult to quit during periods of stress, 

such as when you are learning to care for someone with TBI. 

Your goal right now may be simply to not increase the number of 

tobacco products you use each day. 

Later, you may want to start cutting down on the number of tobacco 

products and then quit altogether.

The nicotine in tobacco is addictive. Most smokers find it takes several 

attempts to quit before they are successful. Ask your doctor about 

medications or programs that can help you quit.

Alcohol and Other Drugs

When life is stressful, you may find it difficult to solve problems, make 

decisions, and take care of yourself. 

Using any form of 

tobacco damages 

your health. 

Be realistic. 

Chapter 4 - Taking Care of Yourself

“I didn’t do a very good job of taking care of myself, and 

it didn’t take its toll until about four years later. Now I’m 

paying the consequences. My blood pressure is high. Physical 

things are cropping up. During the first year, I didn’t take 

care of myself. 

I didn’t sleep. When I’d go to bed, things would just run 

through my head. When I finally did go to sleep, I woke up 

in the morning with reality hitting me in the face, like I can’t 

believe this is my life. You get out of bed and you just put one 

foot in front of the other.”

 - Denise G.

24
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Some people turn to alcohol or other drugs to help them relax. Alcohol 

tends to make problems worse. 

Using alcohol or drugs to make you feel better in the short term can be 

dangerous. You can become dependent on these substances. This will 

interfere with your responsibilities to your family. 

If you drink, do so in moderation (i.e., one drink per day for women, two 

drinks per day for men). Find other ways to relieve stress and to reward 

yourself for doing a hard job well.

Routine Medical Care

Remember, you can’t take care of someone else well unless you are 

strong and healthy. 

This includes getting routine medical 

and dental care, such as preventive 

screenings (e.g., mammograms, 

blood pressure checks) and regular 

attention to medical problems that 

you may have. 

It’s okay to have your family 

member with TBI sit in the waiting room while you see the doctor, 

dentist, or other provider if he or she is able, or make plans for care if he 

or she cannot be left alone.

If you become sick, worn down, or burned out, you will not be able to 

provide good care to your family member. 

25

“No, I didn’t take care of myself, and I still haven’t really, two 

years later. Now I’m getting to the point where I’ve realized 

that I’ve neglected myself, just the routine things, like doctor 

appointments, dental appointments, and physicals for myself. 

I’ve ended up with a lot of stomach problems as a result. Now 

I’m trying to play catch-up because I didn’t really take care of 

myself the last couple of years. That’s been kind of a downer, I 

guess you could say.”

 - Aimee W.

You can’t take 

care of yourself 

or someone else 

if you’re drunk or 

high.

Caregivers often 

overlook their own 

health as they 

struggle to cope 

with the medical 

needs of their 

loved ones. 

Take care of yourself first. 

It’s not being selfish. It is 

being realistic and loving 

to you, your loved one, 

and other family members. 
What Are Strategies for Self-Care?

Problem Solving

Learning how to be a good problem solver can help you cope with stress 

and reduce anxiety. Here are some simple problem-solving steps:

• Identify the problem. If the problem has many parts, break it down 

into one problem at a time.

• Brainstorm solutions. Think of as many possibilities as you can.

• Assess options. Consider the pros and cons of each possibility.

• Choose a solution that seems to fit best for you.

• Try the solution out.

• If it didn’t work, try another solution until you find the one that works.

Stress Busters

• Practice deep breathing. Take a deep breath, hold it for a few 

seconds, and then let it out. Continue to breathe deeply until you feel 

yourself calm down.

• Relax your muscles. Lying down, begin by tensing your toes, then 

relaxing them. Then tense your ankles and relax. Continue up your 

body to your forehead, tensing and relaxing each set of muscles. Then 

lie quietly for a few minutes, letting your body melt into the floor.

• Try meditation. Select a quiet spot in the house and a time when you 

can be quiet for 15 minutes. Sit down and rest your hands in your lap. 

Close your eyes. Clear your mind. Breathe in deeply, then let your 

breath out while you say a word such as “one.” Repeat continuously. 

Try to clear all thoughts from your mind as you do this—it takes 

practice, but you’ll find yourself able to do so for longer and longer 

periods of time.

• Manage your time effectively. Plan ahead so that you have enough 

time to arrive at appointments on time. Plan your day or week sensibly, 

so that you are not trying to get too much done in too little time.

• Find time to exercise. Exercise helps your brain release endorphins. 

It also gives you some alone time.

• Try Tai Chi or yoga. Many people find these activities helpful to 

relieve stress.

• Find ways to relax and take your mind off your daily routine: Read a 

book, watch your favorite movie/TV show, or spend time with a friend.

Paying attention 

to your emotional 

and physical 

health is the most 

important thing 

you can do to 

help your family 

member with TBI. 

Endorphins 

are natural 

substances in your 

body that reduce 

stress and make 

you feel better.

26 Chapter 4 - Taking Care of Yourself
Becoming a Family Caregiver for a Service Member/Veteran with TBI

The worksheet below helps you to evaluate your stress level. 

You can ask health care providers to teach you stress reduction strategies 

and to provide you with relaxation tapes.

27

The 13-Item Stress Test

 1. True False I have a lot to do.

 2. True False I have more to do than I can handle.

 3. True False I’m not being productive.

 4. True False I’m trying really hard, but getting 

 nothing done.

5. True False I’m feeling unhealthy.

 6. True False I can’t afford to take breaks or time off.

 7. True False I’m pushing myself too hard.

 8. True False I don’t sleep very well.

 9. True False Too many people are telling me what to do.

10. True False I am not treating people the way I want 

 to be treated.

11. True False I feel totally exhausted.

12. True False Nobody is happy with what I do.

13. True False I can’t stand living like this.

Scoring: The more True responses you circle, the greater the pressure 

you’re feeling. Refer to the Stress Buster ideas on page 26 for suggestions 

to decrease stress.
28 Chapter 4 - Taking Care of Yourself

1. Had trouble keeping my mind 

on what I was doing ...................❑Yes ❑No

2. Felt that I couldn’t leave my 

relative alone................................❑Yes ❑No

3. Had difficulty making 

decisions .....................................❑Yes ❑No 

4. Felt completely overwhelmed.......❑Yes ❑No

5. Felt useful and needed ...............❑Yes ❑No

6. Felt lonely ...................................❑Yes ❑No

7. Been upset that my relative has 

changed so much from his/her 

former self....................................❑Yes ❑No

8. Felt a loss of privacy and/or 

personal time ..............................❑Yes ❑No

9. Been edgy or irritable ..................❑Yes ❑No

10.Had sleep disturbed because 

of caring for my relative ..............❑Yes ❑No

11.Had a crying spell(s) ...................❑Yes ❑No

12.Felt strained between work 

and family responsibilities............❑Yes ❑No

13.Had back pain .............................❑Yes ❑No

14.Felt ill (headaches, stomach 

problems or common cold) .............❑Yes ❑No

15.Been satisfied with the support 

my family has given me ..............❑Yes ❑No

16.Found my relative’s living situation 

to be inconvenient or a barrier 

to care ........................................❑Yes ❑No

17.On a scale of 1 to 10, 

with 1 being “not stressful” to 10 being

“extremely stressful,” please rate your current

level of stress. _______

18.On a scale of 1 to 10, 

with 1 being “very healthy” to 10 being “very

ill,” please rate your current health compared to

what it was this time last year. _______

Comments:

(Please feel free to comment or provide feedback)

______________________________________

______________________________________

______________________________________

______________________________________

______________________________________

______________________________________

______________________________________

______________________________________

Caregiver Self-Assessment 

Questionnaire

How are you?

Caregivers are often so concerned with caring for their relative’s needs that they lose sight 

of their own wellbeing. Please take just a moment to answer the following questions. Once you

have answered the questions, turn the page to do a self-evaluation.

During the past week or so, I have...

American Medical Association

Physicians dedicated to the health of America

515 North State Street

Chicago Illinois 60610

MA

A

A

M

A

ERIC N EDIC L AS OCI S T NOI
Becoming a Family Caregiver for a Service Member/Veteran with TBI 29

Self-evaluation:

To Determine the Score:

1.Reverse score questions 

5 and 15. (For example, 

a “No” response should be

counted as “Yes” and a

“Yes” response should be

counted as “No”) 

2.Total the number 

of “yes” responses.

To Interpret the Score: 

Chances are that you 

are experiencing a high

degree of distress:

• If you answered “Yes” to

either or both Questions

4 and 11; or

• If your total “Yes” score

= 10 or more; or

• If your score on

Question 17 is 6 or

higher; or

• If your score on

Question 18 is 6 or

higher.

Next steps:

• Consider seeing a 

doctor for a check-up

for yourself.

• Consider having some 

relief from caregiving.

(Discuss with the 

doctor or a social worker

the resources available in

your 

community.)

• Consider joining a 

support group

Valuable Resources 

for Caregivers:

Eldercare Locator:

(a national directory of 

community services)

1-800- 677-1116

www.aoa.gov/elderpage/

locator.html

Family Caregiver Alliance

1-415- 434-3388

www.caregiver.org

Medicaid Hotline

Baltimore, MD

1-800-638-6833

National Alliance for

Caregiving

1-301-718-8444

www.caregiving.org

National Family

Caregivers Association

1-800 896-3650

www.nfcacares.org

National Information

Center for Children and

Youth with Disabilities

1-800-695-0285

www.nichcy.org

Local Resources and Contacts:
30

The questions below can help you reflect on your experience as a caregiver. 

You can write your thoughts here, copy this page and add it to your 

journal if you keep one, or reflect on these questions in your journal. 

What are the main sources of stress in my life? How do I handle it? How 

could I handle it better?

Other ideas for emotional self-care that I will try:

Ideas for taking care of myself physically that I plan to do:

Journal

Journal
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Chapter 5

Helping Your Children Cope with TBI

Having a parent with TBI can be frightening for a child who looks to his 

or her parent to provide strength and safety. 

The parent with TBI may no longer act the same as he or she did before the injury. 

Your family member/parent with TBI may be angry, depressed, or uncertain. 

As a result, the special parent-child bond that existed previously has changed. 

Children may be confused and upset about what is going on. This could 

be due to worry about a parent’s condition or concerns about changes 

in their parents’ relationship. It could also be due to financial strains, or 

simply adjusting to the new “normal.” 

It is important to recognize that your children are grieving, just as you 

are. They may withdraw from social activities with peers, have mood 

swings, become withdrawn or disruptive, do poorly in school, and show 

other behavioral problems. 

Children also need time and space to be kids. Communicate with your 

child that he or she is not to blame for the TBI. 

Some children may need to take on some caregiving tasks for the parent 

or for younger children in the family. Children who care for parents or 

other relatives experience considerable conflict over the reversal of roles 

between parent and child. 

Make sure any tasks that your child takes on—household chores, for 

example--are suitable for his or her age. Strive as much as possible to 

Many children 

feel as if they 

have lost both 

parents: one to 

TBI and the other 

to caregiving. 

Remind your 

children that you 

are the caregiver 

and that they can 

rely on you to be 

their parent.

31

“Thankfully, they’re pretty adaptable, but still they’re kids, 

and that’s why we’ve had to seek counseling. My son is 

dealing with secondary post-traumatic stress disorder. He’s 

very terrified that every time my husband goes in the hospital, 

he’s not going to come home. So we deal with that. With my 

daughter, we’re kind of dealing with the teenage issues. Plus 

she’s pretty angry at my husband. 

He’s not who he used to be. You know, I think the key is 

talking, keeping the lines of communication open, letting your 

kids express to you if they’re mad, angry, whatever it is. It’s 

okay. Emotions are okay. Do not hold it in because that’s 

going to make it worse in the long term.”

 - Anonymous
32 Chapter 5 - Helping Your Children Cope with TBI

“When Tim was starting to read and do word finding, those 

games were fun activities for the kids to do with him. They 

took part in his recovery, and I think that involvement was 

probably the key factor that kept the children from getting 

resentful, from being isolated. The kids have told me since 

then that they had wanted to know about things sooner. They 

thought that we kept a lot of things from them.

I still think that there are some things kids at that age don’t 

really need to know and they learned things along the way 

that they were ready for. But they did want to know. They’re 

very intuitive. Sharing age-appropriate information meant 

that they still had a little control in their lives, too. They could 

then process why Mommy and Daddy had to be away and not 

go to the dark side of their imagination thinking their worlds 

were falling apart and not have a clue as to why. I think not 

discussing the issues is probably the worst thing you can do for 

your children. They don’t like being left in the dark.”

 - Shannon M.

find other adults to help you, rather than relying on your children to play 

a major caregiving role.

You can help your children by explaining TBI in a way that they can 

understand (see below). Ask a health care provider to talk with your children. 

Build new family routines, and keep an eye out for signs that your child is 

not coping well. 

The table on page 34 offers some ways to explain TBI to children of 

different ages. If your child appears to be depressed for a long time or he 

or she begins taking on risky behaviors, seek professional help.

Children need 

time to grieve. 

How Can I Tell My Child about TBI?

It is difficult to explain TBI to a child. Yet it is vital to tell your child what 

is going on. Some adults try to protect children from the truth because 

they think they are too young to understand. 

Children of almost any age are aware that something is wrong and they 

want to know what is happening. 
Becoming a Family Caregiver for a Service Member/Veteran with TBI 33

“You know, it’s still a daily thing. TBI is definitely a hard thing 

to grasp. I think the hardest thing, especially for our teenage 

son, because maybe he is older, is that his Dad is 37 on the 

outside, but on the inside he’s younger. Our son is going to 

continue to get older and get more mature and grow up, and 

his Dad is kind of where he’s going to be.

I just think a lot of communication is the key. Ask them: Do you 

have questions? What are you struggling with today? What 

don’t you understand? We also go to therapy. I stressed to our 

son that this isn’t going to go away. This is a lifelong disability. 

We have to learn to deal with it and cope with it, and you can’t 

do it on your own. You cannot do it on your own.

Getting plugged in to support groups that are geared for 

TBI, seeking out counselors that know TBI and can give you 

strategies on how to deal with situations, those things are 

important. That’s what it’s about for us right now. It’s about 

getting the mental help and the feedback that we need and 

realizing that, really, we’re not alone.”

 - Anonymous

Communicate in an age-appropriate way what has happened to your 

family member with TBI. Protecting your children by withholding 

information may backfire. Children have active imaginations that may 

create a scenario worse than reality.

How you tell your child about TBI depends on the age of the child. The 

table on the next page offers strategies that you can use, depending on 

the age of your child. 

What Are Specific Ways to Explain TBI to a Child?

Here are some suggestions for how to explain TBI to a child: 

• The brain is similar to the command station of a space ship. If a 

meteorite hit the command station, the crew would not be able to 

control what the space ship does. If the brain is hurt, it may send out 

the wrong signals to the body or no signals at all. A person with TBI 

may have a hard time walking, talking, hearing, or seeing.
34 Chapter 5 - Helping Your Children Cope with TBI

Communication Techniques for Parents

• Communicate using simple words.

• Use picture books.

• Create simple books with pictures of family 

members and simple objects that the child 

understands (hospital, doctor, bed, rest).

• Offer dolls to play with so they can recreate what 

is happening at home or at the doctor’s office.

• Select books with stories that mirror families like 

yours to help your child relate.

• Familiarize your child with pictures of objects 

and concepts related to medical care and health 

(hospital, gown, doctors, flowers, bed, coming 

home from the hospital).

• Incorporate play with a child’s ‘doctor kit’ to 

familiarize your child and symbolize what is 

happening.

• Use interactive communication—reading books 

and creating stories with your child.

• Help your child create his/her own “this is our 

family” album and talk about the photographs 

and memorabilia.

• Watch movies with story lines similar to what 

your family is experiencing. 

• Listen to your child’s thoughts and opinions.

• Ask questions that go beyond yes and no.

• Depending on your child’s level of development 

and understanding, speak with direct, realitybased explanations that include facts.

• Include the sequence of events involved, and 

what to expect.

Age and Stage of Development

Age 2-3

Can differentiate expressions of 

anger, sorrow, and joy

Age 4-5

More self-secure, can play well 

with others, tests the rules, 

‘magical thinking’

Age 6-7

Capable of following rules, 

enjoys having responsibility 

Uncertain of the relationship 

between cause and effect; 

parent is the primary source of 

self-esteem

Age 8-11

Has a better understanding 

of logic and cause/effect, 

less centered on self, able to 

understand others’ feelings, can 

empathize

How Can I Communicate with My Child about TBI?
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Age and Stage of Development

Age 12-17

Experience puberty and 

physiological changes, seek 

freedom and independence, 

acceptance by peers is 

extremely important, develop 

more intimate relationships, 

more thoughtful and caring

Communication Techniques for Parents

• Speak honestly and realistically.

• Give facts, what is expected to happen including 

the diagnosis, prognosis, treatments, and 

expected outcomes.

• Talk with your children, not to them.

• Check in and offer time to discuss concerns 

frequently.

• Listen attentively.

• Ask questions that can be answered with more 

than ‘yes’ or ‘no.’

• Stay alert for risky behaviors, acting out, or 

noticeably withdrawn (if this is a new behavior).

• If risky behaviors are present, seek professional help.

It can be 

challenging to put 

TBI into simple 

terms that a child 

can understand. 

35

• The brain is the computer for the body. When injured, it doesn’t boot 

up properly, runs slower, has less memory, etc. 

• A broken bone will usually heal and be as good as new. A brain injury 

may not heal as completely. Even though the person with the injury 

may look the same, he or she may still be injured. These injuries might 

include having a hard time paying attention or remembering what you 

told him or her. He or she may get tired easily and need to sleep. He 

or she may say or do things that seem strange or embarrassing. He or 

she may get angry and shout a lot.

• Many people develop anger as a direct effect of the damage to the 

brain. In other words, the parts of the brain that normally stop angry 

flare-ups and feelings have been damaged and do not do their jobs as 

well. The parent with TBI may be mad because he or she can’t do the 

things he or she used to do. His or her feelings may be hurt because 

others treat him or her differently than before the injury.

• A cut may take a few days to heal, a broken bone a few weeks. 

Getting better after a brain injury can take months or even years. 

Sometimes, the person will not get 100 percent better.

• Brain injury changes people. These changes can be confusing. Try 

to remember that the changes you see are caused by the brain injury. 

You can still love and care about the person.

More information 

can be found on 

www.neuro.pmr.

vcu.edu.
What Are Some Tips for Helping Children Cope?

• Provide information to your children about what to expect before 

they are reunited with their parent with TBI. For example, explain in 

advance what they may see in the hospital. Describe how their parent 

will look, behave, and react before he or she comes home.

• Be flexible. Take your cue from your child about when he or she 

wants to resume his or her normal routine. Encourage children to stay 

involved with friends and school activities.

• If your children choose to attend their activities, ask friends or relatives to 

take them. Ask friends to take over caregiving when you need to go to 

watch your son or daughter play basketball or appear in the school play.

• Encourage your children to talk about their fears, hopes, and worries. 

Allow safe and appropriate ways for your children to express their 

emotions.

• Meet with your children’s teachers to explain what has happened and 

the effects on the family.

• Encourage other family members, friends, or other important adults in 

your child’s life to share time with your child and to act as a sounding 

board, if needed.

• Your children may say upsetting things to you. Just listening can be the 

best support for them. 

• Re-establish routine for your children. Consistent dinner and bed 

times may help.

• Encourage your children to talk about what familiar characteristics and 

behaviors of their parent they are starting to see.

• Be easy on yourself and your children. A certain amount of stress is 

normal. 

• Be careful not to set a timeframe with your children for when recovery 

will occur. Children want it all to happen quickly, and it is hard to 

predict recovery after TBI.

• Stay alert for changes in their behavior. Get counseling for your child 

to help him or her cope with grief, especially if the child appears 

depressed or is adopting risky behaviors.

• Recognize that some children may pull away for a while. Others may 

regress to younger behavior, becoming very dependent, demanding 

constant attention, or exploding in temper tantrums. These behaviors 

should return to normal over time as the child adjusts.

Chapter 5 - Helping Your Children Cope with TBI

Listen to your 

children’s 

concerns. 

36
Becoming a Family Caregiver for a Service Member/Veteran with TBI

• Teenagers may be embarrassed about their parent with TBI. Rehearse 

with them how to respond to comments or questions about how their 

parent looks, behaves, and speaks. 

• Sesame Street Workshop has produced videos to help children in 

military families understand issues related to military service and 

to help parents communicate effectively with their children about 

these issues. One video addresses “Changes” that occur when a 

parent has been injured. You can find these videos at http://archive.

sesameworkshop.org/tlc. 

At the same time that you are providing factual information about TBI, 

don’t forget to include reassurance that you are still a family and love 

one another. 

“Once we felt that he was doing well enough and could express 

his needs and I didn’t have to be there for 12 hours a day, we 

had a discussion. We came to the agreement that I would be 

with him when the kids are in school, but it would be fine for us 

not to be there every afternoon afterwards because we wanted 

the kids to have normalcy. We wanted them to go play at the 

park and have activities and things in the afternoon. So that 

really took a load off.”

 - Anna E.

How Can I Build Stronger Family Ties?

Set time aside each week for your family to spend some fun time 

together, and move the family focus away from TBI. Try these ideas with 

your family:

• Have a family meeting. Explain that you plan to hold a family time 

every week, and ask for ideas for when and what to do (if family 

members are old enough to participate). Family members could take 

turns choosing activities.

• Turn off the video, cell phone, e-mail, etc. during family time. Your 

goal is to interact with and enjoy each other.

You may not be 

able to preserve 

all of your 

previous family 

routines, but you 

can create new 

ones. 

37
Chapter 5 - Helping Your Children Cope with TBI

• Try activities that everyone in the family can enjoy. This might include 

doing things like playing board games, taking a walk or run, or baking 

cookies. Find activities where everyone in the family can play a role.

• In addition to family time, schedule some individual time with each 

family member. Children need to have time alone with their parent(s). 

This helps them feel heard and appreciated. Plan an activity with each 

child—a shopping trip, movies, story time—and schedule it in on a 

regular basis.

• To build closer family ties, encourage the children to play simple 

games with their injured parent. Such games may also help the 

injured parent practice skills to help in recovery.

• Think about your family rituals and keep them on the schedule. If you 

plan elaborate holiday decorations, you may need to cut back this year 

but you can still celebrate more simply.

38

“When my husband was first diagnosed with TBI, he realized 

he couldn’t do math anymore. So we had to work on math 

skills. He and the children worked on doing simple math again 

and learning algebra. Working out math problems helped us 

come together again as a family. Doing things together brings 

you close. Even going to all the appointments together helped 

us bond. It is a trying time, but it does help bring you back 

together. We are such a close family now.”

 - Lynn C-S.
Becoming a Family Caregiver for a Service Member/Veteran with TBI

The questions below can help you reflect on your experience as a caregiver. 

You can write your thoughts here, copy this page and add it to your 

journal if you keep one, or reflect on these questions in your journal. 

What questions have your children asked? How are they adjusting to the 

changes in the family? 

What new routines do you think your family would enjoy that would help 

your family adjust to the new normal?

39

Journal
40
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Chapter 6

Addressing Family Needs

Everyone in the family is affected by TBI. As the primary caregiver, your 

role within the family has changed. The role of your family member with 

TBI may also have changed. 

Role changes can be emotionally demanding.

Other challenges include learning how to balance work, family, and your 

own needs, in addition to caring for someone else. Changes in finances, 

social life, and relationships also add stress to the family. 

Conflict among family members regarding the care and treatment of the 

injured family member may also occur.

Addressing family needs means paying attention to 

family members’ emotional needs and addressing them. 

All families have 

strengths and 

weaknesses. 

How Can I Build on My Family’s Strengths?

You can learn to cope with the stress of TBI by finding and building on 

your family’s strengths. No family is perfect. 

As you read this section, think about your family’s strengths. Then think 

about areas that you would like to be stronger. Discuss these with family 

members and choose one area that you can work on together.

Family strengths include:

• Caring and Appreciation

• Commitment: One way to build commitment is to create and 

maintain family traditions. 

• Communication: It’s important to keep lines of communication open. 

Active listening is important. When the other person is telling you 

how he/she feels, try re-stating what he/she just said to see if you 

understand his/her position correctly.

“It hasn’t been done without a lot of crying. The dynamic on 

the family is awful. It will either make you or break you.” 

 - Nellie B.

41
• Community and Family Ties: Keeping close ties with relatives, 

neighbors, and the larger community can provide useful sources of 

strength and help in trying times. 

• Working Together: Sharing tasks and decision making will help 

your home run smoothly. When important decisions need to be 

made, all family members should share their points of view.

• Flexibility and Openness to Change: A TBI in the family means 

that everyone’s roles and responsibilities will shift. Learning to manage 

change can be a challenge, but it can be done.

Chapter 6 - Addressing Family Needs

Use “I” statements to share your feelings, rather than 

“You” statements. For example, if you’re upset because 

your brother didn’t show up to drive you to the hospital 

on time, you might say: “I feel upset when you are late 

to pick me up. I am anxious to get to this important 

medical appointment on time so that I have the doctor’s 

full attention” instead of, “You are always late.” 

The former states your feelings; no one can argue about 

your own feelings. The latter attacks the other person, 

making him or her feel defensive and more inclined to 

argue with you.

“It’s just frustrating to not have the same kind of relationship, 

to have to be more of a caretaker than a partner, or a mother/

son or a mother/daughter. You know, people who are injured 

have all kinds of things going on in their own head, so it’s 

hard for them to relate to you because they’re going through 

their own agony. So the frustration of being that person 

sometimes is just hard.”

 - Anonymous

42
Becoming a Family Caregiver for a Service Member/Veteran with TBI

How Can I Preserve My Marriage or Relationship?

TBI can affect the dating or marital relationship, just as it affects other 

areas of family life. 

In addition to the stress that caregiving may bring, the spouses of people 

with TBI may lose the intimacy with their partner that they once enjoyed. 

There may be 

changes in sexual 

interest and 

activities due to 

TBI.

“You feel very nervous or not so comfortable talking to the 

doctors about sexuality or what’s happening, especially in 

the early stages. But it’s a big concern for a wife. It’s a big 

concern for me, especially because we don’t have any kids yet. 

So it could mean... who knows... no kids, or it could mean...? 

It was just a big concern for me.”

 - Anonymous

Following a TBI, your service member/veteran may experience effects 

of the injury that may affect your relationship. Module 2 describes the 

possible physical, cognitive, emotional, and behavioral effects of TBI. 

Most of these changes improve over time. 

Intimacy is the 

emotional and 

physical closeness 

between partners. 

It consists of both 

emotional and 

physical/sexual 

intimacy.

“Intimacy is something that I think a lot of couples with TBI 

have trouble with. Some too much, some too little – but 

certainly changes from pre-injury. In our case, there were 

periods of more emotional withdrawal, whether from the 

medications or the injury itself. For me personally, helping 

other families has filled that emotional void. Focusing on the 

children and focusing on my husband has filled that emotional 

void in a different way.

Physical touch, I’ve found that massage really helps. When 

I’m feeling like I’m just out there on my own, sometimes if I go 

get a massage, then that sort of relieves that physical tension.”

 - Anonymous

43
“I think that one of the hardest things is that with a brain 

injury, you step into the role of being a caregiver..... I’ve ended 

up feeling like mom pretty much and not so much a wife, if 

that makes sense.

That’s been hard for me, because another issue that we have is 

his judgment sometimes, the things he does. I feel like I end up 

being mom. ‘No, you can’t go spend all your money at once.’ 

I hate that feeling because he views me in that way now. I 

don’t want to be mom to him. So that’s really hard.

Sometimes I just wish he would go get more counseling for 

himself. You know how some of these guys are. It’s like a sign 

of weakness to go talk to somebody about things, especially 

being in the Army. They don’t want to admit something is 

wrong. I’ve tried to tell him, I can’t handle everything myself. 

So that’s been an issue.”

 - Anonymous

Chapter 6 - Addressing Family Needs

People with TBI may lose interest in sex, become impotent, or may not 

be able to have an orgasm. This is often due to biological changes or the 

medications that they may be taking. This is a common effect of TBI, so 

do not hesitate to talk with your provider about this. 

Some people with TBI may show their sexual interest in ways that are 

not socially acceptable. They may misinterpret social or vocal cues and 

therefore behave inappropriately. 

Seek professional counseling, if you need it. All marriages go through ups 

and downs; there is no stigma in seeking help. Military family advocacy 

programs and other on-base support programs provide a resource for 

counseling and help.

See Module 4 for counseling resources available to military families. 

44
Becoming a Family Caregiver for a Service Member/Veteran with TBI

What are Other Ways TBI May Affect My 

Family?

Spouses and in-laws may disagree about who is the best caregiver or 

where care should be provided.

If you are experiencing this kind of family conflict, you may need to 

advocate on behalf of your loved one with TBI to other members of the 

family. (See Chapter 2 to learn more about advocacy skills.) 

Keep in mind that every family member involved in this type of conflict 

loves the family member with TBI and wants the best for him or her. 

Remember that everyone is under a great deal of stress. Try to talk 

openly about each person’s point of view. 

Seek professional guidance if you are unable to resolve the issues yourselves.

Caring for your loved one may make existing family issues worse. If you 

find you are having difficulty with treatment decision making, you can 

get advice from a member of the health care team. 

What Can I Do If Caregiving is Just Too Much?

It is helpful to know yourself and your limits. Your back-up plan may 

include finding temporary or more permanent residential care for your 

family member with TBI. Discuss quality of life issues with your family 

and health care professionals. Your choices may include:

• Give others permission to care for your loved one.

• Seek assisted living facilities and board and care homes—for those who 

have difficulty living alone but do not need daily nursing care.

• Consider nursing homes, also called skilled nursing facilities—for 

individuals who need 24-hour nursing care and help with daily activities. 

Skilled nursing care can also be provided at home by nurses you hire.

Check with your case manager(s), VA liaison, and/or military liaison for 

residential care benefits that may be available to your family member with 

TBI. Also, see Module 4 for benefits available to military/veteran families.

Many organizations will assist service members/veterans and families in 

paying for additional costs. Talk with your case manager to help learn 

more about this.

Learn more about residential facilities from this fact sheet from the Family 

Caregiver Alliance: 

http://caregiver.org/caregiver/jsp/content_node.jsp?nodeid=1742.

Some families 

experience conflict 

over the care and 

treatment of their 

family member 

with TBI. 

If caregiving gets 

too demanding 

or other 

circumstances 

prevent you from 

being a caregiver, 

have a back-up 

plan in place. 

45
46 Chapter 6 - Addressing Family Needs

Disabled American Veterans

Veterans of Foreign Wars

Paralyzed Veterans of 

America

National Resource Directory

Long term Care: Veterans 

Affairs

Residential Care 

 

Vocational Rehabilitation 

and Employment Program: 

Veterans Affairs

Independent Living 

Program: Veterans Affairs

Life Insurance: Veterans 

Affairs

Specialty Adapted Housing 

Program: Veterans Affairs

Traumatic Injury Protection 

Under Servicemembers’ 

Group Life Insurance (TSGLI) 

Army Wounded Warrior 

Program (AW2)

U.S. Marine Corps Wounded 

Warrior Regiment

NAVY SAFE HARBOR-- 

Severely Injured Support

Air Force Wounded Warrior 

AFW2 

National Service Officer: http://www.dav.org

National Service Officer: http://www.vfw.org

http://www.pva.org

 

https://www.nationalresourcedirectory.org

http://www.virec.research.va.gov/

DataSourcesCategory/LongTermCare/LTC.htm

www.dvbic.org: Laurel Highlands NeuroCare, 

Pennsylvania and Lakeview NeuroCare, 

Richmond, VA

http://www.vba.va.gov/bln/vre/index.htm

 

http://www.vba.va.gov/bln/vre/ilp.htm

 

www.insurance.va.gov 

 

http://www.homeloans.va.gov/sah.htm

 

www.insurance.va.gov 

 

www.aw2.army.mil

http://www.woundedwarriorregiment.org

www.npc.navy.mil/safeharbor

http://www.woundedwarrior.af.mil

Sources of Information About Residential Care
Becoming a Family Caregiver for a Service Member/Veteran with TBI

The questions below can help you reflect on your experience as a caregiver. 

You can write your thoughts here, copy this page and add it to your 

journal if you keep one, or reflect on these questions in your journal.

How has your relationship with your service member/veteran with TBI 

changed?

Are you experiencing conflicts with other family members? Describe each 

person’s point of view in the conflict. List strategies that you could use to 

resolve the conflict.

47

Journal
48
Becoming a Family Caregiver for a Service Member/Veteran with TBI

The transition to home can be an exciting step, but it also can be 

stressful. Remember, you do not have to do it all yourself. Plan and 

prepare before your family member comes home. 

If possible, try a practice weekend at home. A practice weekend will alert 

you to how much help you may need. Talk with your health care team 

about the transition to home and make a plan. 

Chapter 7

Transitioning to Home

Your Point of Contact(s), case manager(s), VA liaison, 

and/or military liaison are the point persons for helping 

you transition to home or another facility. They help 

identify available resources of regional and national 

services for which you or your family member with TBI 

may be eligible. (See Module 4 to learn more about 

Points of Contact.)

“We had gotten a pass to come home for a visit. The kids were 

so excited to see their dad. Then when we came home for 

good, they were really excited to have dad back at home.”

 - Aimee W.

You are providing a very important service to someone you care about. 

This chapter will provide information about:

Managing TBI care at home, by:

• tracking treatments, and 

• managing medications. 

Organizing:

• your caregiving tasks 

• supportive family members and friends who can help

• your home life to take care of your service member/veteran with TBI.

Asking others for help is not a sign of weakness and it makes good sense. 

Asking for help is a good way to find resources that will support you and 

your service member/veteran throughout the recovery period.

49
Before your service member/veteran with TBI goes home 

from the hospital: 

• Ask the Point of Contact (POC), case manager(s), VA liaison, and/

or military liaison about resources your family member will qualify 

for from the federal, state, and local government. (Learn more about 

POCs in Module 4.)

• With the help of your health care team, write a master schedule for 

your family member. An example is included on the next page.

• Ask for a written list of all therapy and exercises (diagrams or pictures 

of the exercises) to be done at home. 

• Ask for help. Seek out people who offered to help and ask them to be 

available (See page 54 for more tips.)

• Identify services available in your community you can contact for help. 

The National Resource Directory (www.nationalresourcedirectory.org)

may be helpful. Local brain injury, veterans support groups, and 

chapters of the Brain Injury Association can also be good resources. 

(See Appendix.)

• Prepare yourself and your home before your family member with TBI 

arrives. If your family member has physical disabilities, your health 

care team may be able to do a home safety evaluation. 

• The Department of Veterans Affairs (VA) and some charities have 

programs that will modify your home to accommodate your service 

member/veteran’s needs. 

Chapter 7 - Transitioning to Home

“The biggest challenge? Just the stress of being the only 

person. It’s hard most days. Being everybody’s memory and 

being everybody’s person that does everything, that cooks 

and cleans, and makes sure everybody gets where they need 

to go, and everybody remembers where they need to go. It’s 

overwhelming for the most part. 

You kind of wish that you had more of a partner than 

somebody you’re taking care of, but it’s not their fault. They 

can’t help it. They were just doing their job.”

 - Emily S.

50
Becoming a Family Caregiver for a Service Member/Veteran with TBI

MASTER SCHEDULE 

Sample Weekday Activity Schedule – tailor this for your family 

member’s specific needs

8:00 a.m. – 9:00 a.m. Breakfast, Take Medications

9:00 a.m. – 10:00 a.m. Dressing, Toileting, Grooming

10:00 a.m. – Noon Physical Therapy Activities & Rest

Noon – 1:00 p.m. Lunch, Bathroom, Rest

1:00 p.m. – 4:00 p.m. Communication Therapy/Occupational 

 Therapy/Therapeutic Recreation* & Rest

5:00 p.m. – 6:30 p.m. Dinner, Take Medications

Evening Leisure Activities

9:00 p.m. Bed Time Activities

*Rotate activities as recommended by therapists

• Decide what projects and chores can be put off for a while; give 

yourself permission not to do it all.

• Make a list of the assistive devices your family member is using in the 

hospital. Ask the case manager to make sure you will have the same 

assistive devices at home. Be sure you have prescriptions written for 

devices needed at home.

• Know who on the health care team to call for what and post it at 

home. You may wish to use the form at the end of the chapter 

(page 64) to organize contact information for the health care team.

• Make plans to give yourself a break each day. Have someone come to 

the house, so you can get out for a breather. (See Respite Care, page 60.)

What to Expect 

• Know that your family member with TBI will do best with structure, 

consistency, and a schedule. 

• Stick to your master schedule (see sample below), so you don’t have 

to rely on your memory during this time of transition.

• People with TBI often get more confused. Their behaviors and cognition 

problems may appear worse for a while after a change—even if it’s a good 

change. Your family member will settle in over time, just as you will.

51
How Do I Manage Care at Home?

How Do I Manage Medications?

It is important to keep track of what medications are being taken and when. 

Here are tips to manage medications and prevent mistakes:

• Always inform all members of your health care team of any drug or 

latex allergies.

• When you leave the hospital or treatment facility, be sure you get a 

copy of the discharge instructions. They will include a list of all the 

medications your service member/veteran will be taking.

• When picking up prescriptions from the pharmacy, have the pharmacy 

provide written information about the current prescriptions. 

• When picking up the prescription, make sure the order has your family 

member’s name on it. Make sure it includes the correct pills at the 

right dose.

• Ask the doctor and/or pharmacist 

- what the medication is for, what it does

- what to do if you miss a dose

- when/how to take it (empty or full stomach, day time or bed time)

-what to do if there are side effects.

• Make sure the doctor is aware of all other medications. This includes 

supplements and herbal products that your family member takes. 

There might be possible side effects or harmful interactions.

• Keep an up-to-date medication log with all prescription and nonprescription items. Include over-the-counter medications like antacids, 

pain relievers, supplements, high energy drinks, and herbal products. 

• Carry the medication log (page 7) with you every time you have a 

medical appointment.

• Use a pill box to help you organize the medications and to help your 

family member take them on time.

• It is never a good idea to stop medication on your own; always consult 

a provider first to discuss.

• It can also be dangerous to adjust the dosage of medications on your 

own, without consulting the physician.

• If you are having financial difficulties that make it hard to pay for 

medications, contact your case manager.

Living with a TBI 

usually means 

taking multiple 

medications 

to treat the 

symptoms. 

52 Chapter 7 - Transitioning to Home
Becoming a Family Caregiver for a Service Member/Veteran with TBI

• Your family member with TBI should NEVER take any medication 

without talking to the health care provider first.

Tips for Tracking Treatments and Side Effects

• List side effects of medications (date and time) on the medication log 

at the end of this chapter. Ask the doctor which side effects are serious 

and call immediately if they occur. More information on side effects 

can be found in Module 2.

• Write down results of tests (such as blood pressure, blood sugar, and/

or medication blood levels). If you are checking your family member’s 

blood pressure or blood sugars at home, write down the values.

• Be sure to take these results to appointments with health care 

providers.

Does My Family Member Need an Assistive Device?

For people with TBI, it can be a challenge to accomplish daily tasks such 

as talking with friends, going to school and work, or participating in 

recreational activities. Assistive devices can make it easier for a person 

with a disability to manage these activities.

Assistive devices can be anything from simple to complex devices 

such as:

• a magnifying glass

• a timer to remind the person when to take medications 

• a touch-fastener grip attached to a pen or fork for eating or writing

• a PDA (Personal Data Assistant) 

• a special telephone that helps people with speech and hearing 

problems to communicate

• braces, splints

• canes, walkers, crutches

• calendar or memory notebook for tracking appointments, planning, 

organizing

• medical alert bracelet or emergency call system

• eye patches, prism glasses

• special beds. 

Keep the phone number for equipment companies available for 

emergencies or machine malfunctions.

Assistive devices 

are tools to 

help your 

service member/

veteran be more 

independent.

 

53
Your family member with TBI will be evaluated during rehabilitation 

to see if assistive devices would enhance his or her independence and 

capabilities. 

Find out if the devices being used during inpatient stays should be 

included in the discharge plan. Devices prescribed by a provider are 

more likely to be funded by the military, VA, or insurers.

Does My Home Need to be Modified?

Home modifications may be relatively minor and inexpensive, such as 

installing grab bars, handrails, and lever handles. They may also be major 

and very expensive, such as:

• installing elevators or lifts 

• enlarging doorways to allow wheelchair passage

• modifying kitchens for easier meal preparation 

• installing emergency communication systems.

Don’t rush into major modifications because your service member/

veteran’s needs may change over time. 

Ask the health care team what, if anything, needs to be done to modify 

your home before your family member is discharged. You can plan other 

modifications as his or her rehabilitation continues. 

See Module 4 for resources to assist you with home modification.

How Can I Organize to Get Help with 

Caregiving?

Here are some steps to consider in organizing your home life: 

• Identify family, friends, or those in the community who can assist you 

in the home.

• Ask a friend or adult family 

member to read this section 

and assume the role of 

coordinating the Home 

Care Team. This will take a 

load off your mind, even if it 

is short-term help. You can 

work together to get the 

outside help you need. 

Your Home Care Team

• Family members

• Friends

• Members in the community

 - Faith organizations

 - Local charities

• Home health care providers

A Home Care 

Team are the 

friends, family, 

and others who 

will help you do 

all that needs to 

be done at home 

to care for your 

family member 

with TBI.

Chapter 7 - Transitioning to Home

Your home may 

need to be altered 

to make it more 

livable.

54
Becoming a Family Caregiver for a Service Member/Veteran with TBI

• Outline your tasks. Not just tasks to take care of your service member/

veteran with TBI, but tasks that lighten the load for you and other 

members of the family.

Don’t feel like you need to do everything. 

What Needs to be Done?

Your new “normal” day will now consist of your usual everyday tasks, plus 

the care and treatment tasks for your family member with TBI. These 

care and treatment tasks may take up much of your time. 

Your Home Care Team may be able to help you with many everyday tasks 

and possibly some of your family member’s care tasks. A possible listing 

of tasks appears below. If you ask your children for help, be sure the tasks 

you give them are age-appropriate. 

Creating your Home Care Team

• Bring family members and friends together, and request their help in 

caregiving. 

• It is important to accept help because it’s not likely that you can do it 

all yourself. 

Though it may be 

difficult to ask, 

find people who 

are willing to 

help. 

55

Type of Task

 

Everyday Tasks

Care Tasks

Other 

Specific Task

 

Food Preparation

Housework

Finance/Insurance

Transportation

Medical 

Appointments

Supervision

Personal Hygiene

Medical/Nursing 

Care

Support for 

Recreation/ 

Employment/ 

Education/Legal

Who Can Do This 

Task /Resources

Family members

Neighbors

Friends

Caregiver

Family members

Hired home care aides

Veterans service 

organizations, religious 

organizations, 

workplace, social 

group/clubs

Community Resources

 

http://www.fianationalnetwork.org

www.VFW.org

www.legion.org/veterans/h2h/about

www.ourmilitary.mil

www.purpleheart.org

www.DAV.org
• If you do not have time, have a family member or friend help you 

organize your Home Care Team.

• If possible, ask your family member with TBI which people he or she 

would like involved.

How to Ask for Help

Tips for asking for help from others:

• Write down the names of those who offer. See the Possible Home 

Care Volunteer form at the end of the chapter to keep track of 

possible volunteers. (A copy of this form can also be found in the 

Caregiver’s Companion.)

• Make a list of everyone close to you and your service member/veteran 

who can be part of your caregiving team.

• Make sure word of the injury gets out to any groups, social 

organizations, and faith organizations to which you and your service 

member/veteran belong. 

56 Chapter 7 - Transitioning to Home

“Pat’s family did a lot of research for me as far as different 

things that were available. I really didn’t do a lot of it myself 

because I was at the hospital. They were trying to find ways 

to help.

I just think one of the best things I did for Pat is opening up 

about his injury to everyone and letting everyone support 

us. I know the head injury has a lot of things that can go 

on and maybe things that are embarrassing that you don’t 

want people to know. We started a family Web site—I write 

everything that’s going on as a way for me to keep track of 

his progress and to let people know what we need and how 

he’s doing. It’s been like a record for me.

We still have people involved. I think that’s really important, 

to let your friends in. Let them help you. Let your family help. 

Let them be a part of the recovery, because when you see 

them, you can see it in their eyes. They’ve been as much a part 

of it as you have. I just think that’s really important.”

 - Patty H.
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Some people find it really tough to ask for help. If that’s 

you, put yourself in the shoes of a family who needs help. 

You would most likely be willing to help them if the tables 

were turned. So, tough as it may be, let them help you. 

If you’re too stressed to even think about organizing 

others to help, ask a friend to take on this role.

• Gather lists of names, phone numbers, and e-mail addresses, and add 

these names to your list. 

• Check into organizations that specialize in helping:

- America Supports You/U.S. DoD Community Relations 

 (www.OurMilitary.mil) 

- Faith in Action National Network (www.fianationalnetwork.org) 

- Heroes to Hometowns (www.legion.org/veterans/h2h/about). 

 (See Appendix.)

• Once you have a list of names, call or create an e-mail group based on 

your list of names to invite others to help.

• If you do not have a computer or don’t know how to use one, ask a 

friend who is tech savvy to help you send out a group e-mail.

• Keep a large calendar near the phone. As you schedule others to 

help, jot down their names and the tasks they will do. Do not rely on 

your memory.

• Ask for specific help. For example, ask someone to go grocery 

shopping or come over and spend time with your service member/

veteran while you go out to do something for yourself.

57

“We were fortunate in two regards. One, we have a very close 

family. They were all there for us whenever we needed them. 

Our neighbors would keep our 13-year-old daughter when 

Mike and I had to fly out. So we had a really good support 

group as far as people wanting to help. If it meant bringing a 

meal over, that’s what they did.”

 - Pam E.
Coordinate Your Home Care Team

• Consider holding a meeting for all Home Care Team members to 

discuss the specifics:

- issues regarding the injury and your family member’s needs

- current needs of your family member with TBI and the rest of 

your family

- the roles or tasks each team member can take

- exchange of contact information

- members’ availability and tasks they are willing to do 

(write these down)

- identification of a team leader to make phone calls to team 

members during emergencies or to re-organize schedules.

• Invite potential Home Care Team members to the hospital or 

rehabilitation center to learn more about TBI and your family 

member’s specific needs.

• Manage Home Care Team schedules on a master calendar (keep this in 

your home).

• Have an easily visible list of important information: 

- location of pharmacies

- grocery stores

- medical information

- list of phone numbers of people to contact in an emergency.

• Have some cash available for helpers in case of emergencies, an extra 

set of house keys, and a spare set of vehicle keys.

Create Routine in Tasks 

• Set up chore lists, schedules, meal menus, grocery lists as things run 

out, etc.

• Create and document routines. You relieve yourself of having to 

constantly make decisions that take up time and emotional energy. 

58 Chapter 7 - Transitioning to Home

Suggestions for 

coordinating your 

Home Care Team. 
Becoming a Family Caregiver for a Service Member/Veteran with TBI

You can keep your family, friends, and Home Care 

Team updated on progress by creating a personalized 

Web page at sites such as www.carepages.com or 

www.caringbridge.org. These are free. Web pages 

are easy to set up and give you the ability to provide 

updates on your service member/veteran’s progress, 

get support, coordinate care, and share information—

all in a short e-mail note. Your family and friends can 

send you and your service member/veteran notes of 

inspiration and friendship.

Many families ask someone outside of the immediate 

family to establish the Web page and then this person 

shows the family how to do updates, which is simple. 

Most hospitals/rehab centers have computers for 

families to use to make the updates. These Web sites 

greatly reduce the burden on families in telling the 

same story and updates over and over on the phone, 

which can be emotionally and physically exhausting.

“This is another tool, caringbridge.org. Originally when the 

injury occurred, all the family was calling. It was just too 

overwhelming. I couldn’t call everybody every day. So the 

people at the Fisher House in Landstuhl, Germany told me 

about this Web site. It was great. You could download pictures, 

and set up a Web site for your injured soldier and fill it out.

Every day I went on there to write my daily journal. That was 

the journal that I kept.”

 - Cindy P.

59
Time Management

There may be more to do than you have time and energy for. To help 

manage your time, the following will help you prioritize:

• Decide which tasks need to be done right away and which tasks can 

wait until later.

• Prioritizing allows you to focus on those tasks that absolutely need to 

be done. Delegate others to your Home Care Team members. 

• You can do the urgent and important tasks. Schedule your Home 

Care Team members to do the “not so urgent” important tasks.

Time Off: Respite Care/Day Programs

The demands of being a caregiver may cause many challenges. Respite 

– time off – care helps both the caregiver and service member/veteran in 

living with brain injury. 

Respite care is a valuable resource to you and your family member. 

Respite care offers a break and allows you time for yourself.

A companion or sitter may provide respite at home. 

Respite may be provided outside of the home in an adult day care or 

assisted living or nursing facility. 

It can range from a few hours per day, a week, or short-term placements.

Day Rehabilitation Programs may help your family member remain in 

the home. 

These programs may also provide meaningful, engaging, structured 

activities during the day while you go to work outside the home.

Respite services for persons with TBI are generally supported by 

government grants and contracts, nonprofit agencies, Medicare, 

Medicaid, and through self-pay (most often sliding scale fees). 

Many VA Medical Centers offer respite care and day programs. See 

Module 4 for additional resources.

TRICARE provides respite care for homebound service members on active 

duty who meet the following criteria:

• their conditions or injuries make them unable to leave home without 

taxing effort 

• they need more than two interventions during the eight-hour period 

per day when the primary caregiver would normally be sleeping. 

Respite care

is “planned or 

emergency care 

provided to a 

child or adult with 

a special need in 

order to provide 

temporary relief 

to the family 

caregiver.”

Chapter 7 - Transitioning to Home

Where can you 

find respite 

programs?

60
Becoming a Family Caregiver for a Service Member/Veteran with TBI

For these individuals, TRICARE provides a maximum of eight hours of 

respite per day, five days per week. This benefit is retroactive to January 

1, 2008, and has no cost shares or co-pays. For more information, 

consult www.tricare.mil.

The National Resource Directory (www.nationalresourcedirectory.org) can 

direct you to respite programs. Your religious community, local social 

service agency, local chapters of Easter Seals, the local mental health 

agency, military service organizations, veterans service organizations, 

and Military OneSource’s Wounded Warrior Project (see Appendix) are all 

organizations that can help you find the right respite care for you.

Ask your Point of Contact/case manager about the Exceptional Family 

Member (EFM) Respite Care Program, and how to qualify. More 

information can be found at http://www.MyArmyLifeToo.com and 

http://www.militaryhomefront.dod.mil.

There are many organizations that have respite care. This list may be useful:

Exceptional Family Member (EFM) Respite Care Program

Army

40 hours of respite care per month per EFM

• Family selects respite care worker

• Monthly Respite Care Newsletter: http://www.MyArmyLifeToo.com

Navy 

• Goal to assist sailors by addressing the special needs of their family 

members during the assignment process 

• Navy EFMP Coordinators are located at Navy medical treatment 

facilities. Their role is to refer to the Fleet and Family Support Center 

for community assistance 

- Special medical, dental, mental health, developmental or educational 

requirements, wheelchair accessibility, adaptive equipment, or 

assistive technology devices and services 

http://www.militaryhomefront.dod.mil

Marines

• 40 hours/month 

• Care can be provided by 

- Installation CDC 

- FCC Home

- Visiting Nurse Service

- Family member 

- Neighbor. 

61
• National Association of Child Care Resource & Referral Agencies 

(NACCRRA)

- Partnership Program with Marine Corps EMFP Respite Care 

- 40 hours/month of free respite child care 

- 10 participating bases 

• Air Force Aid Society Respite Care Program

- Respite Certificate issued with number of hours of respite over three 

month period

- Services are re-evaluated quarterly

- 4-6 hours/week – average

- Family identifies care provider

- Will not reimburse for a relative to provide care.

Home Health Care

Home health care is care for your family member with TBI from a qualified 

aide, nurse, and/or therapist in your home. You may be eligible for 

assistance with home health care from TRICARE, the Department of 

Veterans Affairs, or Medicare (see Module 4). If not, you may choose to pay 

out of pocket or use other health insurance your family member may have.

• There are many professional agencies that offer home health aide 

services; if you are eligible for government assistance, you may need to 

use an approved agency.

If you use an agency:

• You may pay more per hour, but the agency assumes the employment 

responsibilities. It bonds and certifies the home health workers. 

• It also provides substitutes for sick days. 

If you choose to hire privately:

• The advantage is that you can usually pay less per hour for help.

• However, this means you are an employer and must adhere to all 

employment laws, including payroll taxes and Workers’ Compensation 

insurance. Your state Employment Development Department will help 

you set up the necessary paperwork. 

On the next pages are forms that you can duplicate and use to record 

information to make caregiving easier. (These forms can also be found in 

the Caregiver’s Companion.)

62 Chapter 7 - Transitioning to Home
Becoming a Family Caregiver for a Service Member/Veteran with TBI 63

Home Care Team Volunteer Form

Name Contact Information What he or she would like to do
Chapter 7 - Transitioning to Home

Contact Information of the Health Care Team Members

PROFESSIONAL - NAME CONTACT INFORMATION

Audiologist

Cardiologist

Case Manager(s)

Chaplain Services

MEB/PEB Case Manager

Neurologist

Neuropsychologist

Neurosurgery Specialist

Nurse

Occupational Therapist (OT)

Ophthalmologist

Optometrist

Department of Defense Military 

Liaison

64
Becoming a Family Caregiver for a Service Member/Veteran with TBI

PROFESSIONAL - NAME CONTACT INFORMATION

Orthopedic Specialist

Physical Therapist (PT)

Plastic Surgeon

Primary Care Provider

Recreational Therapist 

Registered Dietitian

Rehabilitation Nurse 

Rehabilitation Psychologist 

Social Worker

Speech/Language Pathologist 

Urologist

Physiatrist (Physical Medicine and 

Rehabilitation Specialist) 

65
Caregiving Task Who Can Help

Caregiver Support Worksheet

Contact Information

Everyday Tasks:

Meal Planning

Lawn Care

Grocery Shopping

Meal Preparation

Light Housekeeping

Transportation for:

 Other Family Members 

 Shopping & Errands

Child Care 

Pet Care

Care Tasks:

Coordinating Home Care Team

In-home Supervision/Companionship

Transportation for:

 Medical Appointments

 Support Group/Counseling

Care Team Meetings/Dinner

Personal Hygiene:

 Bathing

 Other, e.g. hair, nails, skin

Hands-on Medical Treatments/Exercise/Therapy

Scheduling Medical Appointments

Managing Medications

66 Chapter 7 - Transitioning to Home
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Caregiving Task Who Can Help

Caregiver Support Worksheet

Contact Information

Recreation Activities

For the Service Member/Veteran

For the Family Caregiver

For Other Family Members

Finances/Legal

Banking

Paying Bills

Managing Military/VA Benefits

Managing Insurance Claims

Handling Legal Matters

Finding Community Services

67
68
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Each person’s experience with the effects of TBI is unique. Most effects 

improve with time, although some may linger for a lifetime. Only time 

will tell.

As you are now aware, brain injury presents many challenges for survivors 

and their families. For many, recovery will extend over a lifetime. There is 

no “normal” time frame for recovery. Many family members with severe 

injury surprise doctors with an unexpected degree of improvement. 

Many factors determine the extent of recovery. The more severe the 

damage to the brain, the greater the likelihood of long-term problems. 

Pre-injury history plays a role in how the individual will adapt and accept 

these changes. 

However, with the passage of time, a dose of patience, and a strong support 

system, most individuals will go on to productive and fulfilling lives. 

Returning to the community, to family, and to school or work following a 

TBI can be challenging. It is possible. For most family members with TBI, 

the possibility is what drives family members with TBI to work hard 

in therapy.

Chapter 8

Moving Forward

69

“It does get better. I don’t know if it gets better because you 

get used to it or because they are making improvements. Jason 

has definitely made improvements. We’ve kind of fallen into a 

routine, and I guess when you fall into a routine, then you know 

what to expect. I guess that makes it easier. It does get easier, 

just because they’re getting better, and they do get better.”

 - Pam E.

“He’s been really good. He’s been going to his appointments 

all by himself. He tells me what happened at the appointment, 

and what kind of drugs they give him. I really couldn’t tell you 

exactly what his medications are unless I look in the cupboard. 

He is to the point where he is doing it himself.” 

 - Kristen S.
What Can I Expect When My Family Member 

Comes Home? 

• For most of us, a “normal” and fulfilling life usually includes things like 

living independently, spending time alone, working, attending school, 

volunteering, driving, doing household chores, parenting, dating, and 

participating in social and leisure activities of our choosing. 

• For a person who has recently experienced a TBI, some or all of this 

may not be possible right away. The hope is always there that most 

will be possible, over time. 

• Moving back home is an exciting step in the recovery process! 

Although the transition to home is certainly positive, it is important to 

be aware that it may also be stressful at times. 

• There is no way to prepare yourself for what lies ahead. With time, most 

people with TBI and their families successfully adjust to life at home. 

• Some families report that during the first few days or weeks at home, 

their family member actually seemed to have taken a step or two 

backwards. Your family member with TBI needs more time than he 

or she used to in order to adapt to a new environment, even if it’s a 

familiar one. 

• Returning to the community, to family, to a familiar setting requires 

thoughtful planning to insure that the transition goes smoothly. It 

is important that you work closely with the rehabilitation team to 

prepare a discharge plan. 

• Skills that your service member/veteran acquired or relearned in 

rehabilitation do not easily transfer into a home setting without a 

great deal of support and reinforcement. The therapy team will spend 

weeks to months preparing you and your family member for this step. 

• You will both have many opportunities to practice and to identify what 

the challenges might be BEFORE you go home. 

Those with TBI prefer structure. They adjust better and thrive when 

there is some routine and predictability to their days. It is helpful to add 

structure right away at home by scheduling activities and rest breaks 

much like the schedule observed in rehabilitation. 

• Over time, as everyone adjusts to being home and your service 

member/veteran continues to recover and gain skills, the need for so 

much structure may lessen and more flexibility will be possible. 

Chapter 8 - Moving Forward

Everyone who 

experiences a TBI 

wants to get back 

to “normal” life as 

soon possible. 

70
Becoming a Family Caregiver for a Service Member/Veteran with TBI

• Your family member may be concerned that he or she cannot easily 

make comfortable relationships with other people because of the 

cognitive and communication effects of TBI. You may be worried that 

he or she will behave inappropriately or unsafely because of reduced 

judgment or impulsivity. 

• Role play potential social situations with your family member with 

TBI before he or she ventures into community settings. This helps in 

understanding appropriate behavior. 

• You may also find it useful to help your family member with TBI 

prepare for and organize trips into the community. Recreational and 

occupational therapists are your best allies in this effort and they will 

work closely with you to practice community re-entry. 

• You can find more information about programs from the Department 

of Veterans Affairs to assist your service member/veteran with TBI reintegrate into the community in Module 4.

71

“My son volunteers at an elementary school. He loves 

children. He volunteers on Monday and Wednesday with his 

TBI team. He assists the physical education teachers twice a 

week for three hours.

He also volunteered at an animal shelter, and he would help 

walk the dogs, bathe them, and sometimes they’d let him give 

an injection. He has come a long way. I think they’re giving 

him different options for the future. You know, volunteer 

work, what he can do with his life every day, how he can keep 

himself busy and keep using his skills. We all know, if you 

don’t keep using it, you’re going to lose it. So it’s important to 

keep him busy.”

 - Cindy P.
How Can I Protect the Safety of My Service 

Member/Veteran with TBI?

• Use the Home Safety Checklist at the end of this chapter to assess 

the safety of your home. Your physical therapist and occupational 

therapist (PT/OT) will work with you to decide if you need to make 

safety modifications to your home. Talk to your PT/OT to learn about 

what other resources might be available through VA. 

• Be sure to remove or secure items from your home that could result in 

harm to your family member with TBI. For example, keep car keys put 

away if your family member is not cleared to drive. 

• Avoid keeping guns, knives, or other weapons in the house. 

• When your service member/veteran with TBI begins expanding his 

or her activities beyond the house, it is important that he or she carry 

identification at all times. 

• Some may choose to continue wearing dog tags but other forms 

of identification should be carried on his or her person, such as a 

MedicAlert bracelet or necklace. This will help insure that all medical 

information is readily accessible to emergency medical personnel if it 

is needed. 

• A cell phone, programmed for voice activation, can be a lifeline for 

those who have trouble reading numbers or text.

• Depending on level of cognitive and functional ability, 24-hour 

care may be needed to ensure safety. Your family member will be 

evaluated for his or her ability to live alone with or without help.

• Ask the OT/PT to help with fall prevention if your family member has 

trouble with dizziness and balance.

• Removing clutter and simplifying your home environment can 

help a person with TBI. Clutter—too many things in the visual 

environment—can contribute to a sense of overstimulation. 

• Clutter raises the likelihood that there are things that your family 

member may trip over or bump into, especially if he or she is 

experiencing balance or vision/perception problems.

Can My Family Member with TBI Drive?

Driving is a key mark of independence in our society. Your family member 

may be eager to get behind the wheel again. 

72 Chapter 8 - Moving Forward
Becoming a Family Caregiver for a Service Member/Veteran with TBI

A professional should evaluate your family member’s ability to drive. This 

evaluation is usually done by an occupational or physical therapist, a 

neuropsychologist, or a certified driving evaluator. 

Good vision and good perceptual skills, such as the ability to judge 

distances between cars, are required to drive safely. 

The evaluation will address the following skills as they relate to driving:

• Physical skills – 

- ability to physically steer and brake the car, and control speed 

- assessment of need for assistive devices for driving

- ability to get in and out of the car

• Visual/spatial skills –

- assess need for corrective lenses

- be able to concentrate attention in his or her central vision

- good peripheral vision

• Perceptual skills – 

- the ability to judge distances between cars on the road and space in 

parking lots

- ability to interpret complex visual information, such as following 

verbal directions to a store

- recognize shapes and colors of traffic signs

- left/right neglect, no drifting to one side of the road

• Speed of motor responses – 

- reaction time 

- ability to brake or change lanes safely within a reasonable amount 

of time

- ability to process a lot of information and react quickly

• Judgment – 

- adequate decision-making skills in an emergency

- possess a healthy self-awareness and an understanding of his or her 

strengths and weaknesses.

• As cognitive skills improve, driving skills may be re-evaluated. Many 

people with TBI do eventually return to driving and drive safely. 

Driving skills affected by TBI can be improved through training that 

focuses on visual scanning, attention skills, and spatial perception. 

Driving involves 

a large number 

of skills and 

the ability to 

integrate complex 

information very 

quickly. 

An evaluation 

of your family 

member’s ability 

to drive is crucial.

73
• Professionals certified through the Association for Driver Rehabilitation 

Specialists can provide evaluation and training. A list of experts is 

found at www.driver-ed.org.

• In some situations, the loss of skills needed to drive safely may prevent 

the person from driving again. When this occurs, it is important for 

the doctor or another appropriate professional to insure that the family 

member with TBI and other family members understand the reasons. 

• The family must be diligent about enforcing the “no driving” rule. For 

example, you may need to keep close control of the family’s car keys.

• If your family member cannot drive a motor vehicle safely, there 

are other transportation options. Public transportation (bus, train, 

subway) may be available. 

• Resources for transportation to medical facilities for appointments, to 

obtain medications, or other needs may be obtained from a variety 

of sources, such as the Department of Veterans Affairs, Medicaid, 

Community Transportation Association of America, or Disabled 

American Veterans.

• Consider driving assistance from family members, friends, church, or 

community groups.

Should I Be Concerned about Alcohol and/or 

Drug Use?

• Some people with TBI turn to alcohol and/or drugs to help them cope 

with the effects of their injury. This coping strategy for a person with 

TBI can be very harmful and is never a good idea. 

• After a TBI, the brain is more vulnerable to the effects of alcohol and 

drugs so the person will feel these effects much more quickly. 

Alcohol and other non-prescription drugs can slow down the recovery 

of your service member/veteran with TBI in the following ways:

- make it harder for the brain to heal

- interfere with thinking processes that are already slowed down

- interact negatively with prescription medications

- increase aggressive and socially inappropriate behaviors

- increase balance problems

- promote other risky behaviors

- create greater risk for seizures

Chapter 8 - Moving Forward

There is no safe 

amount of alcohol 

to consume after a 

brain injury. 

74
Becoming a Family Caregiver for a Service Member/Veteran with TBI

- increase problems with the law for public drinking

- cause addiction

- cause problems with friends and family

- worsen feelings of depression and anxiety

- put your family member and others at risk for falls, car crashes, and 

other accidents that can lead to another TBI or worse.

Cognitive difficulties and decreased awareness make it more difficult for 

your family member with TBI to recognize that alcohol and drugs have a 

negative effect on him or her. 

Take an active role in helping your service member/veteran with TBI avoid 

alcohol and drugs. You might:

• Talk with him or her about readiness to change drinking or drug 

use. Help your family member make a list of pros and cons of using 

substances.

• Spend time with those family and friends who are supportive of your 

service member/veteran not using substances. Minimize time with 

those who are not supportive.

• Avoid high risk situations, such as people or places that your service 

member/veteran associates with drinking or using drugs.

• Develop a plan to help your service member/veteran cope with 

tempting situations, such as leaving the situation or calling a 

supportive friend.

75

“There are situations where he wants to go out with the guys. 

What are 23-year-olds going to do? They’re going to go 

out and have a drink. With a brain injury, that’s not good 

because it can affect his recovery, and he knows that. But he’s 

one of the guys and he doesn’t want to be singled out. He 

wants to fit in. So it’s very difficult. 

What I do is tell his friends that they’re responsible for his 

well-being. I just keep reminding him, and I try to make sure 

that he’s in situations that are safe and that are going to be 

successful.”

 - Cindy P.
• Explore new social circles or environments that do not involve 

drinking.

• Encourage learning of new ways to deal with stress (see Chapter 4).

• Remove alcohol and other dangerous substances from the home.

• If depression or boredom or loneliness are reasons for use, seek 

counseling and other services.

• If your service member/veteran has recently quit using substances, 

talk openly with him or her about the possibility of using again in the 

future and stress that one “slip” does not need to mean a return to 

regular use. Encourage use of support systems to help avoid a full 

relapse. 

• Locate a local AA group or treatment program if advised by your 

health care team. 

Use of alcohol should be discussed with the health care team before 

leaving the rehabilitation facility. 

Chapter 8 - Moving Forward

“The one thing that’s been so good for my son is running 

marathons. When he was at the Wounded Warriors battalion, 

he was volunteering for Hope For The Warriors. They got 

him a trainer, and they set him up to run the Marine Corps 

marathon. They trained him and got him into running, which 

my son had always hated.

He’s constantly running and training. He’s training again 

for the Marine Corps marathon. He knows that when he’s 

training, he cannot drink and train. It just doesn’t go together. 

So that’s a wonderful way to keep the drinking away.”

 - Cyd D.

76
Becoming a Family Caregiver for a Service Member/Veteran with TBI

How Can My Family Member Avoid Another TBI?

• Repeated blows to the head result in further damage to the brain. The 

effects of repeated injuries to a brain that has sustained a previous 

injury tend to add up, causing greater damage than the initial injury. 

(Think of boxers, football players, and other professional athletes who 

have become disabled due to multiple TBIs.) 

• For this reason, it is best for people with TBI to exercise caution and 

avoid another TBI, if possible.

• You can help your service member/veteran with TBI avoid another 

injury by:

- safeguarding your home 

(see the Home Safety Checklist at the end of this chapter)

- insisting on the use of safe practices 

(e.g., wearing seatbelts in the car)

- following the recommendations of the health care team on activity 

restrictions (e.g., no contact sports). 

A good rule of thumb is: If they make a helmet for an activity (biking, 

downhill skiing, rollerblading, motorcycle riding, etc.), everyone in the 

family should wear one! 

Once a person has 

experienced a TBI, 

he or she is at risk 

for subsequent 

injury to the 

brain. 

77
 

Area of Focus Yes No

General Home Safety Checklist for Individuals with

Perceptual and Cognitive Problems

1. While cooking, is a timer available to help you keep track of items cooking 

on the flame? (attention and memory problems)

2. Do you use a “whistling” teakettle? 

(attention and memory problems)

3. Are commonly used items kept in the same location? 

(attention and memory problems)

4. Have commonly used telephone numbers been pre-programmed into the 

telephone and/or posted near the telephone? 

(memory problems, sequencing problems)

5. Do you use a calendar or scheduling book to help remind you of important 

events? (attention and memory problems)

6. If necessary, have you posted signs by the door to help remind you to:

Lock the front door when you leave

Turn off appliances when you finish using them

Take out the garbage

(attention, memory problems) 

7. Is your front door house key color coded for easy identification? 

(memory problems, distractibility)

8. When the doorbell rings, do you use the peep hole to identify who it is before 

opening the door to let the person in? (impulsivity, decreased judgment)

9. When necessary, do you utilize checklists with correct steps and sequences 

for household tasks, such as the laundry or making a bed? 

(poor attention, memory problems, sequencing problems)

Chapter 8 - Moving Forward

Home Safety Checklist

This checklist focuses on safety issues that commonly apply to individuals 

with perceptual and cognitive problems.

How To Use This Checklist:

Take this checklist with you and as you WALK through your home with 

your service member/veteran, carefully check “yes” or “no” for each item 

on this list.

Any item scored “no” is a safety concern and should be corrected.

78
Becoming a Family Caregiver for a Service Member/Veteran with TBI 79

If you have answered “YES” to all these items on this checklist, your home 

appears to be relatively safe. Any items scored “NO” should be corrected 

to promote a safe home environment. Remember to check with your 

health care professional to identify any potential safety issues that might 

be particular to your individual needs.

 

Area of Focus Yes No

General Home Safety Checklist for Individuals with

Perceptual and Cognitive Problems

10. Are directions and steps for multi-step tasks posted at appropriate locations 

(e.g., near washing machine)? (sequencing problems, difficulty initiating tasks, 

attention and memory problems) 

11. Are sharp utensils separated from other items and arranged in a kitchen 

drawer with handles pointing towards you? 

(perceptual impairments, impulsivity) 

12. Are toxic household cleaning fluids kept separate from other items to avoid 

potential confusion? (perceptual impairments, attention problems)

13. Have unnecessary items been removed from the living environment to 

decrease confusion and distraction? 

(perceptual impairments, attention problems)

14. Are commonly used items kept in a consistent, prominent place?

(memory and attentional problem)

15. Are cabinets labeled to assist in locating objects? 

(memory and attentional problems, safety)

16. If you are “neglectful” of one side of your body, are objects placed and 

positioned where you can see and reach them? (perceptual impairments)

17. Do you use a watch with an alarm and calendar display? 

(memory problems)

18. Are the most “taxing” household activities planned for the time of day 

when you feel most alert and attentive? (attentional problems, fatigue) 

19. Do you have a “Medi-Alert” system in place? (safety, language difficulties)

20. Does a family member or friend have a key to your home in case of 

emergencies? (safety)
80
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Chapter 9

Addressing Everyday Issues

This chapter provides information on your rights as an employee, job 

options for you and your family member if he or she is unable to return to 

duty, and how to balance work and caregiving. 

What is the Family and Medical Leave Act?

The Family and Medical Leave Act (FMLA) provides service members/

veterans and their spouses who are employed by companies with 50 or 

more employees with up to 26 weeks of unpaid leave per year to care 

for a seriously-injured service member without losing their jobs or health 

care insurance. 

This act may have small adjustments periodically. Please see the Web site 

for most current information: http://www.dol.gov/esa/whd/fmla. 

Check with your company’s human resources department about your 

eligibility for unpaid leave under the FMLA. Know your company’s 

caregiver leave policies. Explore alternative working arrangements, such 

as flexible hours, working from home, reduced hours, etc.

You may be 

eligible to take 

time off to care 

for your family 

member with TBI 

without losing 

your job. 

81

“Our employers did let us work remotely when my husband and 

I took turns being with our son in Texas. It did get a little dicey 

there for a little while, but they were very supportive. We were 

very fortunate. I’ve talked to many people who just quit their 

jobs, you know? Some people will just automatically quit their 

jobs and assume that their employer is not going to be there 

for them. We have to be here with our son or daughter.

Many employers are willing to work with you, too; maybe not 

indefinitely. But it’s certainly an avenue to pursue because it 

does keep you connected to something a little bit normal, or 

just to a network of people who just want to be there for you. 

Both of those things were very helpful to us.”

 - Pam E.
Some states and employers have more extensive policies regarding leave 

for caregiving. To see what your state policies are, check out:

• Family and Medical Leave Act site: http://www.dol.gov/esa/whd/fmla 

• National Partnership for Women & Families: 

http://www.nationalpartnership.org

• State specific Web sites or offices. 

Can I Receive Public Benefits if I Lose My Job?

• If you lose your job because caregiving is demanding too much of 

your time, check out unemployment benefits. They can provide some 

income while you look for other work. 

• You may also be eligible for other public benefits such as Temporary 

Assistance for Needy Families (TANF), Supplementtal Nutrition 

Assistance Program (SNAP, formerly Food Stamps), and Women Infants 

and Children (WIC) supplemental food benefits (if you have children 

up to age 5). 

• Look in the government pages of your local telephone directory 

for the appropriate agency that administers these programs in your 

community.

Can I Get Help in Finding a Job?

You and your injured family member can get help finding a job. There is 

support available if you are seeking employment. This support recognizes 

the important contribution that both you and your family member have 

made in service to the United States. 

Start by checking with your installation’s support services. Depending 

on your service member/veteran’s service branch, your Fleet and Family 

Support Center, Marine Corps Community Services, Airman and Family 

Readiness Center, or Army Community Service Center can provide you 

with information and support. 

A good starting place is the National Resource Directory (www.

nationalresourcedirectory.org). It is a collaborative effort between the 

Departments of Defense, Labor, and Veterans Affairs. 

The directory is a Web-based network of care coordinators, providers, 

and support partners with resources for wounded, ill, and injured service 

members, veterans, their families, families of the fallen, and those who 

support them. 

82 Chapter 9 - Addressing Everyday Issues
Becoming a Family Caregiver for a Service Member/Veteran with TBI

The Directory offers more than 10,000 medical and non-medical services 

and resources to help service members and veterans achieve personal 

and professional goals along their journey from recovery through 

rehabilitation to community reintegration. 

The National Resource Directory is organized into six major categories:

• Benefits and Compensation

• Education, Training, and Employment

• Family and Caregiver Support

• Health

• Housing and Transportation

• Services and Resources. 

It also provides helpful checklists, Frequently Asked Questions, and 

connections to peer support groups. All information on the Web site can 

be found through a general or state and local search tool. 

Other supportive services include:

Military Spouse

The Military Spouse Resource Center (www.MilSpouse.org) is a 

Web-based service provided by the Department of Defense and the 

Department of Labor. It provides information about education, training, 

and employment, as well as child care and transportation.

Also take a look at the Military Spouse JobSearch Web site (http://www.

militaryspousejobsearch.org/msjs/app). It can help you find companies 

that are committed to hiring military spouses. It also allows you to search 

for jobs by the name of a military base.

Military Spouse JobSearch also provides job search resources for people 

with disabilities, in the event that your service member is not able to 

return to duty due to disability. Other resources for veterans include 

federal government positions. The government’s Office of Personnel 

Management provides information on job opportunities for veterans at 

http://www.opm.gov/veterans.

Operation IMPACT

Operation IMPACT was launched by Northrop Grumman. The program 

provides transition support to service members severely injured in OEF/OIF 

and helps them identify career opportunities within the corporation. If an 

injured service member is no longer able to work, the program offers career 

83
support to a member of the individual’s immediate family who will act as 

the primary wage earner.

Program Eligibility

To be eligible for the program, candidates must meet the following criteria:

• severely injured during combat operations in the OEF/OIF on or after 

September 11, 2001 

• disability rating of 30 percent or greater from the Department of 

Veterans Affairs.

For more information, contact Operation IMPACT at 1-800-395-2361 or 

e-mail operationimpact@ngc.com for more details. 

Federal Civil Service

• If your family member with TBI is your spouse or child who is a totally 

disabled, retired, or separated member of the Armed Forces (has been 

retired with a disability rating at the time of retirement of 100 percent; 

or retired/separated from the Armed Forces with a disability rating of 

100 percent from the Department of Veterans Affairs), you are eligible 

for expedited recruitment and selection for Federal civil service positions.

• You will be given priority in Labor Department-funded employment 

and training programs, as well as preference in federal hiring. 

• You can search for a Federal civil service position by contacting a One 

Stop Career Center (find the nearest one at www.servicelocator.org). 

Introduce yourself as the spouse of a recently disabled veteran. Ask to 

speak with a work force specialist. This individual can tell you about 

job opportunities in your area. 

How Can I Balance Work and Caregiving?

• Talk to your supervisor about your caregiving responsibilities so that 

he or she understands your need for flexibility. Find out what your 

company’s policies on caregiving are.

• If your firm has an Employee Assistance Program (EAP), you may 

be able to obtain counseling, legal assistance, and/or referrals to 

community resources.

• At home, prioritize what needs to be done. Delegate tasks to others. 

And remember to make time for yourself. You can’t help anyone if 

you get run-down or sick from too much stress.

• If you are can’t work full-time because of caregiving tasks, look into 

part-time jobs, flex-time options, and/or job-sharing.

If your spouse 

is rated with 

a 100 percent 

service-connected 

disability, 

the Federal 

government 

considers you 

to be an “other 

eligible,” 

providing the 

same resources, 

rights, and 

services that 

are available 

to veterans and 

disabled veterans.

84 Chapter 9 - Addressing Everyday Issues

It can be 

difficult to 

balance the dual 

responsibilities 

of a job and 

caregiving. 
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Chapter 10

Planning for the Future

Legal issues to protect your family and your service member/veteran with 

TBI include:

• Guardianship

• Power of Attorney (POA)

• Medical POA, medical directives

• Trusts

• Life trusts, life insurance, and listing beneficiaries on life insurance policies

• Living wills.

You may need to consider these issues to make good decisions about 

your family’s future. It may also seem hard at first. 

Take your time to read this section carefully. It provides the basics of each 

legal concept. Discuss your personal situation with an attorney or social 

worker/case manager who has experience with legal matters. 

Each state has its own set of rules regarding these legal documents. You 

will need to find out what the rules in your state are from someone with 

legal expertise.

What is Guardianship?

If your service member/veteran is severely injured and unable to manage 

his or her own affairs and property, you may need to be appointed 

guardianship. 

There are three categories of guardians:

• A Guardian of the Person ensures the physical care and 

rehabilitation of the disabled individual.

• A Guardian of the Estate (also called a conservator) manages the 

financial affairs and property of the disabled person.

• A Plenary Guardian does both.

Guardianships are covered under state law. To obtain guardianship 

over your family member with TBI, you will most likely need an attorney 

to represent you in court. 

You will be required to submit periodic reports and a doctor will need to 

periodically re-certify that the guardianship is still needed.

Guardianship is a 

legal arrangement 

under which 

one person, the 

guardian, has the 

legal right and 

duty to care for 

another, the ward. 

85
In legal terms, a person is competent when he or she is 

able to reason and make decisions.

A Power of 

Attorney (POA) 

is a written 

document 

in which a 

competent person, 

the principal, 

appoints another 

person, the agent, 

to act for him or 

her in legal and 

financial matters. 

Chapter 10 - Planning for the Future

“I’m the one by his bedside, but I can’t make any decisions 

for my son. We finally went to court and fought, because his 

wife was the one making the decisions and she wasn’t by his 

bedside. The doctors don’t even know who she is. I said, ‘How 

can she make decisions when she’s not by his side and she 

doesn’t know what is going on?’ So I went to court and I had 

to fight.

Finally the court put in a guardian, a court-appointed 

guardian for José, and he’s the one who makes the medical 

decisions and the financial decisions for José.”

 - Nellie B.

What is Power of Attorney (POA)?

Because of decreased cognitive and functional abilities, your family 

member with TBI may need you or another person to be named Power 

of Attorney to act for him or her in legal and financial issues.

86

Check to see if your family member has already created a Power of 

Attorney (POA).

There are different types of POAs:

• A general power allows the agent to do any act or exercise any 

power on the principal’s behalf. Only use a general power when a 

special power is insufficient.

• A specific or special power limits the agent’s authority to only the 

act or acts listed in the POA document.

• A durable power of attorney permits the agent to continue to act on 

the principal’s behalf if he or she is incapacitated.

A Power of Attorney is created when the principal (your family member) 

signs a notarized document that legally authorizes another person to act 

on his or her behalf.
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Most POAs last from a definite start time to a specific end time, but they 

may be created to last for an indefinite period. A POA can be revoked at 

any time for any reason. There are two ways to revoke a POA:

• By destroying the original document; and/or

• By executing a “Revocation of Power of Attorney” form and sending 

a certified copy to any financial institution or company where your 

agent has conducted business on your behalf.

 A Guardian can override or revoke a POA.

What is a Medical Power of Attorney?

A durable Power of Attorney for Health Care is also known as a medical 

Power of Attorney or health care proxy. It appoints a primary and 

secondary agent to make decisions about medical care, including end-oflife issues, in the event that the principal is unable to make those decisions.

What is an Advanced Medical Directive/

Living Will?

A Living Will is often called an Advance Directive. A Living Will provides 

a person’s written instructions on providing or withholding life-sustaining 

care or procedures when he or she is in a terminal or permanently 

unconscious condition. It is not required to have a living will to receive 

medical care. 

Many people use a living will, along with a medical Power of Attorney 

(also called a health care proxy), to make their wishes known about 

medical treatment and health care. 

What Do I Need to Know about Wills?

If your family member with TBI is your spouse and is unable to make 

decisions regarding your estate or the care of your children, you may 

wish to consult your lawyer and make changes to your will. 

This may involve naming a guardian for your children and/or assets in the 

event of your death.

You may also wish to discuss creating a trust as an alternative estate 

planning tool. The next section describes different types of trusts.

A Living Will is 

often called an 

Advance Directive. 

87
What Do I Need to Know about Trusts?

A trust is a document used in estate planning. A trust is a written legal 

agreement between the individual who creates the trust (called the 

grantor, settlor, or creator) and a trustee, the person or institution who is 

named to manage the trust assets. 

The trustee holds legal title to the assets for the benefit of one or more 

trust beneficiaries. The ideal trustee has personal knowledge of the 

grantor and investment expertise. A trustee team—composed of an 

individual trustee who knows the grantor well and an institutional trustee 

with investment knowledge—is a workable solution for some people.

There are different types of trusts. The basic categories include:

• A revocable living trust is one that can be changed or cancelled

at any time. 

• An irrevocable living trust cannot be changed. 

• A testamentary trust is one that is irrevocable upon the 

person’s death.

Within these basic categories are a number of types of trusts. Two that 

may be of interest to families who have a service member/veteran with 

TBI are:

• A “special needs” trust is one that is created by a parent or other 

family member of a person with a disability who is the beneficiary of 

the trust. This can be either a living trust or a testamentary trust. The 

trust may hold cash, personal property, or real property, or can be the 

beneficiary of life insurance proceeds. The disabled person cannot 

have any control over these assets. 

• A Qualified Income Trust (“Miller Trust”) is used in states where 

there is a limit on the amount of income allowed for Medicaid nursing 

home eligibility. Some nursing home residents may have retirement 

incomes at or above the level that disqualifies them for Medicaid, 

yet do not have enough money to privately pay for a nursing home. 

Section 1396p of Title 42 of the United States Code permits the 

creation of an income diversion trust that allows pension, Social 

Security, and other income to be placed in an irrevocable trust. Upon 

the death of the beneficiary, the state receives all amounts remaining 

in the trust equal to the total medical assistance paid by Medicaid on 

behalf of the beneficiary.

A trust is a 

document used in 

estate planning. 

88 Chapter 10 - Planning for the Future
Becoming a Family Caregiver for a Service Member/Veteran with TBI

What Military Resources Can Help Me?

You can find more information about trusts, powers of attorney, and 

advance medical directives in the Estate Planning Tool Kit for Military Family 

& Members (https://www.jagcnet.army.mil/852573F600760E8C/0/09DC

434FFE528275852573ED004F3B8E?opendocument&noly=1). 

The Armed Forces Judge Advocate General’s Corps is comprised of 

the Army, Navy, Marines, Air Force, and Coast Guard Judge Advocate 

General’s Corps. The Corps provides legal assistance to all active duty 

service members, reservists on active duty for 30 days or more, and 

retirees from all branches of the service, and their lawful dependents, 

based upon available resources and personnel. 

To locate a legal assistance attorney, consult the Armed Forces Legal 

Assistance Web site at http://legalassistance.law.af.mil/content/locator.php.

The U. S. Army Judge Advocate General’s Corps maintains a Web site to 

inform military members on personal legal affairs and preventive law. 

The site (https://www.jagcnet.army.mil/legal) contains links to many 

legal resources.

The American Bar Association has a standing committee on Legal 

Assistance for Military Personnel (LAMP). Its Web site--http://www.

abanet.org/legalservices/lamp/home.html--contains useful legal 

information. It also includes a link to Operation Enduring LAMP which 

recruits volunteer lawyers across the country to assist military families 

with legal issues.

89
Document

Guardianship

Power of 

Attorney

Medical Power 

of Attorney

Living Will

Trust

New 

Beneficiary List 

on Insurance 

Policies

Need? Who Can Help? 

(Contact Info)

When?

My Legal Documents 

Check off whether or not you have each of the following legal documents for yourself and 

your service member/veteran with TBI. Do you need this document? If so, who will you 

contact for help? When?

90 Chapter 10 - Planning for the Future
Becoming a Family Caregiver for a Service Member/Veteran with TBI

The question below can help you reflect on your experience as a caregiver. 

You can write your thoughts here, copy this page and add it to your 

journal if you keep one, or reflect on these questions in your journal. 

What legal issues most concern you? Why? What do you plan to do to find 

answers to your questions and concerns?

91

Journal
92
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Chapter 11

Finding Meaning in Caregiving

May you find peace, compassion, and comfort along 

the way on your caregiving journey.

“It’s never going to be the same as it was... that’s one thing 

you have a hard time understanding. With a head injury, 

you grieve over and over and over again, because you realize 

through these times the things you’ve lost.

On the other hand, you appreciate the things you still have. 

You know, you really appreciate the little things—I appreciate 

how you throw a ball now, because it took us forever to teach 

him to throw a ball. So you really appreciate these things.”

 - Denise G.

Your journey as a caregiver may be challenging on many levels. Along 

the way, you may learn that you care about your service member/veteran 

with TBI beyond what you realized, and your reserves of strength may 

surprise you... even when you’re tired and lonely.

Take pride in your ability to be caring of another human being. Think 

about the ways you have changed and grown through your caregiving 

experience. Finding meaning in your caregiving journey will enlarge your 

sense of yourself and allow you to use your personal experience to give 

meaning to others.

Some caregivers find strength in religion or spirituality in the face of the 

challenges of taking care of a family member with TBI. You may find 

comfort in your religion or in the peace and beauty of nature. Nourish this 

part of your life if it is important to you because it may renew your spirit.

Your caregiving experience may change your life and your sense of self. 

Consider keeping a journal during your caregiving journey. Creating 

a journal will help you explore your own thoughts and feelings about 

what’s going on in your life. 

You may find that you will want to look back on this period in your life 

at some point in the future. Your journal will be an important guidepost 

93
Chapter 11 - Finding Meaning in Caregiving

“I’ve done certain things for myself, but it’s still hard having 

my own life at this point. I think my life has changed in some 

ways for the better. I don’t take things for granted, and I feel 

like my eyes are opened. I can find joy in little things, like 

possible recovery. 

Sense of self is hard right now. I told myself I would give it two 

years because it seemed most of his recovery would be in two 

years, so I’m doing all this. But I feel like I know my time will 

come—this is a commitment. It’s almost like an investment in 

my husband. With the progress he’s made, I feel like he can be 

independent and it will be worth it. But I just have to wait a 

little bit longer. So it gets frustrating, but I keep telling myself 

that my time will come where it will be more about me.”

 - Patty H.

to what you were thinking and feeling. It may also help you see the 

changes that happened so slowly that you didn’t notice them at the time 

they happened.

94
Becoming a Family Caregiver for a Service Member/Veteran with TBI

“Nobody chooses this. If I could have chosen for him not to 

be injured, definitely. But you just take what you’re given and 

make the best of it.

Other people don’t even get to come home. Their families 

don’t even get them back. So we still feel lucky. 

Initially, the injury is devastating. You don’t feel safe anymore. 

You kind of feel injured yourself. You just don’t really have any 

faith in a lot of things, and you just kind of navigate forward.

It is what it is. I would just say to make sure that you’re your 

own advocate and that you don’t wait for someone to come 

and fix you. Make sure that you’re getting what you need 

and that they’re doing everything possible for you. It’s a long 

process and nobody wants to be here forever. It takes a long 

time, especially since he’s been on all kinds of deployments. 

Just navigating the system is hard. You have to keep up with 

it and take it a day at a time because we don’t know what’s 

happening tomorrow, we don’t know what’s happening next 

week, but we get to live day to day. We don’t know where 

we’re going to be in five years. We don’t know where he’s 

going to be in his recovery.”

 - Emily S.

95
96
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Appendix A

Resources

These Web sites and phone numbers may be subject to change. Use any 

of the Internet search engines if you have trouble finding a site.

This appendix contains information about:

 The Brain Injury Association of America (BIAA) Chapters

 Information and Resources for Caregivers

 Military Information Sources

 Resources for Helping Children Cope

BIA of Arizona

777 E. Missouri Avenue, Suite 101

Phoenix, AZ 85014

Phone: 602-508-8024

Infoline: 602-323-9165

Fax: 602-508-8285

Toll Free: 888-500-9165

E-mail: info@biaaz.org

Web site: www.biaaz.org

BIA of Arkansas

PO Box 26236

Little Rock, AR 72221-6236

Phone: (501) 374-3585

In State: (800) 235-2443

E-mail: info@brainassociation.org

Web site: http://www.brainassociation.org

BIA of California

2658 Mt. Vernon Ave.

Bakersfield, CA 93306

Phone: 661-872-4903

Fax: 661-873-2508

E-mail: calbiainfo@yahoo.com

Web site: www.calbia.org 

BIA of Colorado

4200 West Conejos Place # 524

Denver, CO 80204

Phone: 303-355-9969 

In State: 800-955-2443 

Fax: 303-355-9968

E-mail: informationreferral@biacolorado.org

Web site: www.biacolorado.org

BIA of Connecticut

333 East River Drive, Suite 106

East Hartford, CT 06108

Phone: 860-721-8111 

In State: 800-278-8242 

Fax: 860-721-9008

E-mail: general@biact.org

Web site: www.biact.org

BIA of Delaware

Brain Injury Association of Delaware, Inc.

32 West Loockerman Street, Suite 103

Dover, DE 19904

Toll Free: (800) 411-0505

Fax: (302) 302-346-2083 (call first)

E-mail: biadresourcecenter@cavtel.net

Web site: www.biausa.org/Delaware/bia.htm

BIAA Chapters

97
BIA of Florida

1621 Metropolitan Boulevard, Suite B

Tallahassee, FL 32308

Phone: 850-410-0103

In State: 800-992-3442 

Fax: 850-410-0105

E-mail: biaftalla@biaf.org

Web site: www.biaf.org

BIA of Georgia

Center for Rehab Medicine

1441 Clifton Rd. NE #114-A

Atlanta, GA 30322

Phone: 404-712-5504

Fax: 404-712-0463

Web site: http://www.braininjurygeorgia.org

BIA of Hawaii

2201 Waimano Home Road, Hale E

Pearl City, HI 96782-1474

Phone: 808-454-0699 

Fax: 808-454-1975

E-mail: biahi@verizon.net 

Web site: www.biausa.org/Hawaii

BIA of Idaho

P.O Box 414 

Boise, ID 83701-0414

Phone: 208-342-0999 

In State: 888-374-3447 

Fax: 208-333-0026

E-mail: info@biaid.org

Web site: www.biaid.org

BIA of Illinois

P.O. Box 64420

Chicago, IL 60664-0420

Phone: 312-726-5699

Toll Free: 800-699-6443

Fax: 312-630-4011

E-mail: info@biail.org

Web site: www.biail.org

BIA of Indiana

9531 Valparaiso Court, Suite A

Indianapolis, IN 46268 

Phone: 317-356-7722 

Fax: 317-808-7770

E-mail: info@biai.org

Web site: www.biausa.org/Indiana

BIA of Iowa

317 East Sixth Street

Des Moines, IA 50309-1903

Phone: 515-244-5606

Toll free: 800-444-6443

Fax: 800-381-0812 

E-mail: info@biaia.org

Web site: www.biaia.org

BIA of Kansas and Greater Kansas City

P.O. Box 413072

Kansas City, MO 64105 

Phone: 816-842-8607 

In State: 800-783-1356 

Fax: 816-842-1531

E-mail: Lliggett@biaks.org

Web site: www.biaks.org

BIA of Kentucky

7410 New LaGrange Rd. Suite 100

Louisville, KY 40222

Phone: 502-493-0609 

In State: 800-592-1117 x223

Fax: 502-426-2993

Web site: www.biak.us

BIA of Maine

13 Washington Street

Waterville, ME 04901 

Phone: 207-861-9900

In State: 800-275-1233 

Fax: 207-861-4617

E-mail: info@biame.org 

Web site: www.biame.org

98 Appendix B - Resources
Becoming a Family Caregiver for a Service Member/Veteran with TBI

BIA of Maryland

2200 Kernan Drive

Baltimore, MD 21207 

Phone: 410-448-2924 

In State: 800-221-6443 

Fax: 410-448-3541

E-mail: info@biamd.org 

Web site: www.biamd.org 

BIA of Massachusetts

30 Lyman St.

Westborough, MA 01581

Phone: 508-475-0032

In State: 800-242-0030 

Fax: 508-475-0400 

E-mail: biama@biama.org 

Web site: www.biama.org

BIA of Michigan

Director of Programs 

and Services: Cheryl A. Burda

7305 Grand River, Suite 100

Brighton, MI 48114-7379

Phone: 810-229-5880 

In State: 800-772-4323 

Fax: 810-229-8947

E-mail: info@biami.org

Web site: www.biami.org

BIA of Minnesota

34 13th Avenue NE, Suite B001

Minneapolis, MN 55413 

Phone: 612-378-2742 

In State: 800-669-6442 

Fax: 612-378-2789

E-mail: info@braininjurymn.org

Web site: www.braininjurymn.org

BIA of Mississippi

P.O Box 55912

Jackson, MS 39296-5912 

Phone: 601-981-1021 

In State: 800-641-6442 

Fax: 601-981-1039

E-mail: biaofms@aol.com 

Web site: www.msbia.org

BIA of Missouri

10270 Page Ave, Suite 100

St. Louis, MO 63132

Phone: 314-426-4024 

Fax: 314-426-3290 

In State: 800-377-6442 (MO, IL, KS only) 

E-mail: info@biamo.org 

Web site: www.biamo.org

BIA of Montana

1280 S. 3rd St. West, Suite 4

Missoula, MT 59802

Phone: 406-541-6442 

In State: 800-241-6442 

E-mail: biam@biamt.org

Web site: www.biamt.org

BIA of New Hampshire

109 North State Street, Ste 2

Concord, NH 03301

Phone: 603-225-8400 

In State: 800-773-8400 

Fax: 603-228-6749 

E-mail: mail@bianh.org 

Web site: www.bianh.org 

99
BIA of New Jersey

825 Georges Road, 2nd Floor

North Brunswick, NJ 08902

Phone: 732-745-0200 

In State: 800-669-4323 

Fax: 732-745-0211

E-mail: info@bianj.org

Web site: www.bianj.org

BIA of New Mexico

121 Cardenas NE

Albuquerque, NM 87108

Phone: 505-292-7414 

In State: 888-292-7415 

Fax: 505-271-8983

E-mail: braininjurynm@msn.com

Web site: www.braininjurynm.org 

BIA of New York

10 Colvin Avenue

Albany, NY 12206-1242

Phone: 518-459-7911 

In State: 800-228-8201

Fax: 518-482-5285 

E-mail: info@bianys.org 

Web site: www.bianys.org

BIA of North Carolina

PO Box 10912

Raleigh, NC 27605

Phone: 919-833-9634 

In State: 800-377-1464 

Fax: 919-833-5415

E-mail: Sandra.farmer@bianc.net

Web site: www.bianc.net

BIA of Ohio

855 Grand View Avenue, suite 225 

Columbus, OH 43215-1123

Phone: 614-481-7100 

Fax: 614-481-7103 

In State: 866-644-6242 (“Ohio BIA”) 

E-mail: Help@Biaoh.org 

Web site: www.biaoh.org 

BIA of Oklahoma

PO Box 88

Hillsdale, OK 73743-0088 

Phone: 405-513-2575

E-mail: brainhelp@braininjuryoklahoma.org

Web site: www.braininjuryoklahoma.org

BIA of Oregon

2145 NW Overton Street

Portland, OR 97210

Phone: 503-413-7707 

In State: 800-544-5243 

Fax: 503-413-6849

E-mail: biaor@biaoregon.org

Web site: www.biaoregon.org

BIA of Pennsylvania

2400 Park Drive

Harrisburg, PA 17110

Phone: 717-657-3601 

In State: 866-635-7097 

E-mail: info@biapa.org

Web site: www.biapa.org

BIA of Rhode Island

935 Park Avenue, Suite 8

Cranston, RI 02910-2743

Phone: 401-461-6599

Fax: 401-461-6561 

E-mail: braininjuryctr@biaofri.org

Web site: www.biapa.org

100 Appendix B - Resources
Becoming a Family Caregiver for a Service Member/Veteran with TBI

BIA of South Carolina

800 Dutch Square Blvd. Suite B-225

Columbia, SC 29210

Mailing Address: P. O. Box 21523

Columbia, SC 29221-1523

Phone: 803-731-9823 

Toll Free: 800-290-6461 (in-state) 

Fax: 803-731-4804

E-mail: scbraininjury@bellsouth.net

Web site: www.biausa.org/SC

BIA of Tennessee

151 Athens Way, Suite 100 

Nashville, TN 37228

Phone: 615-248-2541

Toll Free: 877-757-2428 

E-mail: sjohnson@BrainInjuryTN.org

Web site: www.BrainInjuryTN.org

BIA of Texas

316 W 12th Street, Suite 405

Austin, TX 78701 

Phone: 512-326-1212

In State: 800-392-0040 

Fax: 512-478-3370

E-mail: info@biatx.org

Web site: www.biatx.org

BIA of Utah

1800 S West Temple, Suite 203

Salt Lake City, UT 84115

Phone: 801-484-2240 

In State: 800-281-8442 

Fax: 801-484-5932

E-mail: biau@sisna.com 

Web site: www.biau.org

BIA of Vermont

P O Box 226

Shelburne, VT 05482

Phone: 802-985-8440 

Toll Free: 877-856-1772

E-mail: biavtinfo@adelphia.net 

Web site: www.biavt.org

BIA of Virginia

1506 Willow Lawn Drive, Suite 112

Richmond, VA 23230

Phone: 804-355-5748 

In State: 800-334-8443 

Fax: 804-355-6381

E-mail: info@biav.net 

Web site: www.biav.net

BIA of Washington State 

3516 S. 47th Street, Suite 100

Tacoma, WA 98409

Phone: 253-238-6085

In State: 800-523-5438

Fax: 253-238-1042

E-mail: info@biawa.org 

Web site: www.biawa.org

BIA of West Virginia

PO Box 574

Institute, WV 25112-0574

Phone: 304-766-4892 

In State: 800-356-6443 

Fax: 304-766-4940

E-mail: biawv@aol.com

Web site: www.biausa.org/WVirginia

101
102 Appendix B - Resources

BIA of Wisconsin

21100 Capitol Drive, Suite 5

Pewaukee, WI 53072

Phone: 262-790-9660 

In State: 800-882-9282 

Fax: 262-790-9670

E-mail: admin@biaw.org

Web site: www.biaw.org

BIA of Wyoming

111 West 2nd Street, Suite 106

Casper, WY 82601 

Phone: 307-473-1767 

Nationwide: 800-643-6457 

Fax: 307-237-5222

E-mail: biaw@tribcsp.com

Web site: www.biausa.org/Wyoming
Becoming a Family Caregiver for a Service Member/Veteran with TBI

State Contacts

The following are Brain Injury Community contacts in their respective 

states. The Brain Injury Association of America lists these contacts for 

informational purposes only and does not review, support, endorse, or 

guarantee the information, services or activities of these organizations.

Alabama

Alabama Head Injury Foundation, Inc.

3100 Lorna Road, Suite 226

Hoover, AL 35216

Phone: (205) 823-3818

Fax: (205) 823-4544

E-Mail: charlespriest@bellsouth.net

Web site: www.ahif.org

You may also contact the Brain Injury Association of America’s National Family 

HelpLine at (800) 444-6443 or FamilyHelpline@biausa.org 

Alaska 

Alaska Brain Injury Network, Inc.

3745 Community Park Loop, Suite 240

Anchorage, AK 99508

888-574-2824 or 907-274-2824

E-mail: contact@alaskabraininjury.net

Web site: www.alaskabraininjury.net

For any questions regarding service or assistance in Alaska, you may also contact 

The Brain Injury Association of America’s National Family HelpLine at 

(800) 444-6443 or FamilyHelpline@biausa.org 

The Traumatic Brain Injury Resource Directory (TBIRD)

You may also contact the Brain Injury Association of America’s National Family 

HelpLine at (800) 444-6443 or FamilyHelpline@biausa.org 

Louisiana 

Brain Injury Association of Louisiana (BIALA)

P.O. Box 57527

New Orleans, LA 70157

Phone: 504-619-9989

Toll Free: 1-800-500-2026

Web site: www.biala.org 

For any questions regarding service or assistance in Louisiana, please contact The 

Brain Injury Association of America’s National Family HelpLine at (800) 444-6443 

or FamilyHelpline@biausa.org 

103
Nebraska

For any questions regarding service or assistance in Nebraska, please contact The 

Brain Injury Association of America’s National Family HelpLine at (800) 444-6443 

or FamilyHelpline@biausa.org

Nevada

For any questions regarding service or assistance in Nevada, please contact The 

Brain Injury Association of America’s National Family HelpLine at (800) 444-6443 

or FamilyHelpline@biausa.org 

North Dakota

Open Door Center

209 2nd Avenue, S.E.

Valley City, ND 58072

Phone: (701) 845-1124

Fax: (701) 845-1175 

You may also contact the Brain Injury Association of America’s National Family 

HelpLine at (800) 444-6443 or FamilyHelpline@biausa.org 

South Dakota

South Dakota Brain Injury Alliance can be found online at: 

www.braininjurysd.org 

Please contact: Ron Hoops, President - (605) 395-6655 

E-mail: rmmfarm@nrctv.com

For information about brain injury resources in South Dakota, you may also 

contact the Brain Injury Association of America’s National Family HelpLine at 

(800) 444-6443 or FamilyHelpline@biausa.org

104 Appendix B - Resources
Becoming a Family Caregiver for a Service Member/Veteran with TBI

Information and Resources for Caregivers

Organization Services Eligibility

Assist Guide Information 

Services

www.agis.com

American Red Cross- Family 

Caregiver Training Program

www.redcross.org

ARCH National Respite 

Network

www.respitelocator.org

Brain Talk Communities

http://brain.hastypastry.

net/forums

Caregiver.com

www.caregiver.com

800-829-2734

Caregivers Marketplace

http://

caregiversmarketplace.com

800-888-0889

CAREgivinghelp.org

www.caregivinghelp.org

773-576-1602

Caring Connection

www.caringinfo.org

800-658-8898 (English)

800-658-8896 (Spanish)

Daily Strength

www.dailystrength.org

Provides information about longterm care and caregiving. Offers 

a caregiver kit

In-person educational sessions 

offered at local Red Cross chapters

Respite locator helps families 

locate respite services near them

Online forum for support and to 

learn about community resources

Online information and support 

for caregivers, including those in 

rural areas

Program that offers cash back on 

goods and products not typically 

covered by insurance, such as aids 

for daily living

Provides information about 

caregiving

Information about advance care 

planning, hospice care, and 

financial assistance from the 

National Hospice and Palliative 

Care Organization

Online support communities 

covering a variety of topics, 

including caregiving

Anyone

Anyone

Anyone

Caregivers for those 

with neurological 

disorders

Anyone

Anyone who 

purchases caregiver 

supplies

Anyone

Anyone

Anyone

105
Organization Services

Information and Resources for Caregivers

Eligibility

Easter Seals

www.easterseals.com

800-221-6827

Faith in Action

www.fianationalnetwork.org

866-839-8865

Family Caregiver Alliance 

(FCA) www.caregiver.org

800-445-8106

Share the Care

www.sharethecare.org

646-467-8097

Strength for Caring

www.strengthforcaring.com

Well Spouse Association

www.wellspouse.org

800-838-0879

Provides adult day services, 

including medical and social 

services, to people with disabilities

Network of interfaith volunteer 

caregiving programs that may 

provide help with shopping, 

cooking, and/or driving

A caregiver support organization 

that provides online information, 

an online caregiver group, and a 

state-by-state Help for Caregivers 

section.

Offers a handbook with guidelines 

for developing a support network 

and coordinating care

Online resource and community 

for family caregivers sponsored by 

the Caregiver Initiative, Johnson & 

Johnson

Provides support to wives, 

husbands, and partners of the 

chronically ill and disabled 

through established support 

groups across the country

People with 

disabilities

Varies by program

Friends and family 

caring for adults 

with cognitive 

disorders

Anyone

Anyone

Anyone caring for 

a chronically ill or 

disabled spouse

Military Information Sources

For more information on military resources and service-specific 

benefits, go to:

• Military OneSource: http//www.militaryonesource.com 

(800-342-9647)

• America Supports You: www.OurMilitary.mil

• Army Wounded Warrior Program (AW2): www.aw2.army.mil 

(800-237-1336)

106 Appendix B - Resources
Becoming a Family Caregiver for a Service Member/Veteran with TBI 107

• Air Force Wounded Warrior AFW2: 

http://www.wounded warrior.af.mil

• US Marine Corps Wounded Warrior Regiment: 

http:/www.woundedwarriorregiment.org

- Sergeant Merlin German Wounded Warrior Call Center 

(1-877-USMCWW) (1-877-487-6299)

- Wounded Warrior Battalion East (910-449-9855)

- Wounded Warrior Battalion West (1-888-738-7044)

- Wounded Warrior Injured Support in Landstuhl (1-866-645-8762)

• Safe Harbor (Navy): http://www.npc.navy.mil/CommandSupport/

SafeHarbor (866-746-8563)

• Disability Benefits for Wounded Warriors through the Social Security 

Administration: www.ssa.gov/woundedwarriors/index.htm

• Defense Centers of Excellence: www.dcoe.health.mil

• VA Polytrauma System of Care: www.polytrauma.va.gov 

• American Legion - Heroes to Hometowns: 

www.legion.org/veterans/h2h/about

• Defense and Veterans Brain Injury Center: 

www.dvbic.org

• Military JobSearch: 

http://www.militaryspousejobsearch.org/msjs/app

Resources for Helping Children Cope

MilitaryOneSource, www.militaryonesource.com, has information for 

families on a wide array of issues.

Sesame Street Workshop has produced videos to help children in military 

families understand issues related to military service and to help parents 

communicate effectively with their children about these issues. One 

video addresses “Changes” that occur when a parent has been injured. 

You can find these videos at http://archive.sesameworkshop.org/tlc. 

The National Resource Center at the Virginia Model TBI System has 

published a book entitled A Kid’s Guide to Brain Injury for children 6 to 14. 

You can find this and other resources at their Web site: 

www.neuro.pmr.vcu.edu.
Chapter 1 

Lee Woodruff quote used with permission, © 2008-2009, caregiver.com, 

800-829-2734

Chapter 4

Definition of Compassion Fatigue, Figley, CR. (1995). 

Compassion Fatigue. Brunner-Routledge.

The 13 Item Stress Test, page 27, reprinted with permission from Getting 

Better and Better After Brain Injury, National Resource Center for Traumatic 

Brain Injury www.nrc.pmr.vcu.edu, Virginia Commonwealth University. 

Caregiver Self-Assessment Questionnaire reprinted with permission of the 

American Medical Association.

Chapter 5

Communicating with Your Child about TBI: Reprinted with permission. 

Adapted from Orientation to Caregiving: A Handbook for Family Caregivers 

of Patients with Brain Tumors by Steffanie Goodman, Michael Rabow and 

Susan Folkman, Caregivers Project, University of California San Francisco.

Chapter 8

Home Safety Checklist: This checklist was developed by Patricia A. 

Gentile, MS, OTR/L and Yvette Kearns, OTR/L, Jamaica Hospital Medical 

Center & Brady Institute for Traumatic Brain Injury. Reprinted with 

permission.

108 References/Credits

References/Credits
Becoming a Family Caregiver for a Service Member/Veteran with TBI
www.DVBIC.org

Version: 1-2010 | www.traumaticbraininjuryatoz.org

This guide was produced in collaboration with

The Defense Health Board

The Defense and Veterans Brain Injury Center

and

The Department of Veterans Affairs
Module 4

Navigating Services and Benefits 

Traumatic Brain Injury: A Guide for Caregivers

of Service Members and Veterans

Navigating Services and Benefits 

Module 4 Summary

Chapter 1: Introduction

What is Point of Contact (POC) Case Management?

Who Coordinates Recovery Care and Services?

How Can I Speak Up When Needed?

What Services Do I Need?

Is My Family Member Eligible for Services? Am I?

Where Can I Learn More about Benefits and Services?

Chapter 2: The TBI Continuum of Care

What is the TBI Continuum of Care?

What is Community-Based Managed Care?

What Happens Next?

Chapter 3: Support for Wounded Service Members and Their Families

Where Can I Find Support if My Family Member is in the Air Force?

Where Can I Find Support if My Family Member is in the Army?

Where Can I Find Support if My Family Member is in the Navy?

Where Can I Find Support if My Family Member is in the Marine Corps?

What Family Support is Available at the VA Polytrauma Centers?

Chapter 4: Health Benefits

What is TRICARE and What Does it Cover?

What Does the VA Health Care System Cover?

What Benefits and Services are Available for Veterans’ Families?

Chapter 5: Counseling/Behavioral Health

What Counseling is Available for Active Duty, Activated National Guard, 

Reserve Components, and Families?

What is Post-Traumatic Stress (PTS)?

What Resources are Available to Prevent Suicide?

What Counseling is Available for Veterans?

What Other Services Are Available?

Table of Contents

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Chapter 6: Employment

But First ... Help Your Service Member/Veteran Get Organized

Is Unemployment Compensation Available for Ex-Service Members?

Is My Family Member’s Old Job Still Available?

What Employment-Related Services are Available for Veterans and 

Family Members?

What Employment-Related Resources are Available for Injured Veterans?

What Job Opportunities Exist for Spouses of Veterans with a 100% 

Disability Rating?

What Other Opportunities are Available for Active Duty Service Members 

and Veterans?

What Employment Resources are Available for Caregivers?

Is My Family Member Eligible for a Small Business Loan?

Chapter 7: Education

What Education Benefits are Available for Service Members and Veterans?

What Education Benefits are Available for Selected Reserve Members?

What Education Benefits are Available for Veterans?

What Education Benefits Are Available for Veterans with ServiceConnected Disabilities?

What Education Benefits are Available for Veterans and Their Family 

Members?

What Education Benefits are Available for Family Members?

What Education Benefits are Available for Caregivers?

What Other Education Benefits Should I Consider?

Chapter 8: Housing

What Temporary Housing is Available for Caregivers?

What Temporary Housing is Available for Those Leaving the Military?

What Housing Benefits are Available for Active Duty Service Members 

and Medically Retired Veterans?

What Housing Benefits are Available for Veterans?

ii Table of Contents

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Navigating Services and Benefits 

Chapter 9: Financial Issues

What Types of Pay are Available for Active Duty Service Members?

What is the Pay for the Medically Retired?

What Pay Issues are Specific to Combat Zone Injuries for Active Duty 

Service Members?

What about Disability Payments for Medically Retired Veterans?

What Insurance is Available for Veterans?

Is Emergency Help Available for Active Duty Service Members?

Chapter 10: Legal Services

When Will Your Family Member Need Legal Help? Who Will Help?

Chapter 11: Travel

What Travel Benefits Will My Family Member Receive?

What Travel Benefits are Available for Veterans?

What Travel Benefits are Available for Caregivers?

Chapter 12: Disability Evaluation System (DES)

How Does the Disability Evaluation System (DES) Process Work?

What Do I Need to Know to Understand Disability Ratings and Benefits?

Chapter 13: Transition

What Transition Services are Available for Service Members?

What Transition Services are Available for Disabled Service Members?

Chapter 14: State Benefits

Is There Special Job Search Help for Veterans?

Is My Family Member’s Previous Job Guaranteed?

Is My Service Member/Veteran Entitled to Unemployment Compensation?

Where Can I Find More Information about State Benefits?

Appendix A: Resources for Service Members, Veterans, and/or Family 

Members

iii

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iv Table of Contents

Appendix B: Resources for Veterans

Appendix C: Resources for Caregivers and Families

Appendix D: Resources Regarding MEB/PEB

Appendix E: Your Service Member’s Right to Appeal the PEB’s Decision

Appendix F: Rehabilitation Medical Support Resources

Appendix G: Resources Regarding Transition and Retraining for 

Employment

An electronic version of this Guide can be found at the following Web address: 

www.traumaticbraininjuryatoz.org

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Navigating Services and Benefits 

This module is about benefits and services from the Department of 

Defense (DoD) and the Department of Veterans Affairs (VA). Being a 

member of the military brings both honor and support. You want to be 

sure your family member gets the support—services and benefits--that he 

or she deserves.

It can be hard to find your way through the maze of programs at DoD 

and the VA. The good news is that you are not alone. There are many 

caring professionals at both agencies who can guide you. Your family 

member will also have a Point of Contact (POC). He or she is the first 

person to turn to for information. (What this person is called depends on 

your family member’s military branch.)

You also have an important role to play on your family member’s behalf. 

Part of being a caregiver is to be an advocate, for both your 

family member and for you. You need to speak up, clearly and firmly, to 

communicate your and your family member’s need for services and benefits. 

Understanding what services and benefits are available to you and your 

family member will help you feel more confident in advocating for them. 

That’s what this module is all about.

The information in this module is current as of its publication. 

Information on services and benefits changes from time to time. Please 

check with your Point of Contact (POC) (see Chapter 1) for updated 

information. He or she can also advise you about where to look for 

information you need. 

You can start your search with these main Web sites: 

• www.tricare.mil

• www.health.mil

• www.va.gov

If your service member/veteran has passed away due to his or her military 

injuries incurred during active military duty, you will surely have many 

questions to consider in the midst of your grief. As a survivor, you are 

eligible for special benefits. You can learn more about survivors’ benefits 

at http://www.vba.va.gov.

Module 4 Summary

v

Navigating Services and Benefits 

This module is about benefits and services from the Department of 

Defense (DoD) and the Department of Veterans Affairs (VA). Being a 

member of the military brings both honor and support. You want to be 

sure your family member gets the support—services and benefits--that he 

or she deserves.

It can be hard to find your way through the maze of programs at DoD 

and the VA. The good news is that you are not alone. There are many 

caring professionals at both agencies who can guide you. 

This module explains many services and benefits and who is eligible for 

them. It also describes how DoD and the VA rate a service member/

veteran’s disability. These disability ratings are used to decide some of 

the benefits and services your family member can receive. 

You will want to refer to this module time and again, as your family 

member’s situation and status changes. 

Your family member will also have a Point of Contact (POC). He or she 

is the first person to turn to for information. (What this person is called 

depends on your family member’s military branch. See page 3.)

Chapter 1

Introduction

“I would say be very close with your case worker going 

through this. I thought the case workers were invaluable in 

making sure that you have everything you should have and 

that you’re aware of everything you should be aware of as a 

caregiver.... From a medical standpoint, the doctors are going 

to keep you informed. But the case worker goes outside the 

whole medical thing. You know, ‘Let me make sure you have 

a place to stay. Let me make sure you have food, that you’re 

getting the per diem that you’re supposed to be getting, or 

that the paperwork for Jason is where it’s supposed to be at.’”

 - Pam E.

What is Point of Contact (POC) Case 

Management?

You will meet your Point of Contact (POC) early during your service 

member/veteran’s treatment. Over time, you may see more than one 

POC, depending on your family member’s situation and needs. 

Case management 

means 

coordinating all 

needed services. 

1
“The nurse case manager’s job is to take care of the nursing 

aspect of care. The TBI case manager takes care of the TBI 

and all those appointments. My husband has a sergeant 

that he reports to. So, he’s got a couple of different people he 

sees that make his appointments for him regarding different 

aspects of the Army and the hospital.

And there’s Linda with the Family Readiness Group. She just 

kind of knows everything. She can help with anything.”

 - Emily S.

Chapter 1 - Introduction

Some POCs will focus mostly on clinical (medical) issues. Others will 

focus on non-clinical services. You may find yourself talking more often 

to one of the POCs assigned to your service member/veteran, because 

you feel more comfortable with that person.

Table 1 shows the DoD and VA case management team members. The 

Primary Care Manager and the Medical Care Case Manager coordinate all 

clinical medical care.

Wounded Warrior Case Managers, VA Liaisons, and the Recovery Care 

Coordinators are non-medical care managers. They coordinate nonmedical services. 

These POCs can help you find and take advantage of the services and 

benefits available. 

Throughout 

this module, the 

case and care 

managers will be 

referred to as the 

POC.

“The most important thing I think, in the beginning, is having 

a case manager that you’re definitely seeing eye-to-eye with, 

because if you and your case manager aren’t on the same page 

and aren’t working together and there’s conflict, it’s just going 

to get worse. So you definitely need to make sure that the team 

that you have is the team that’s going to work for you. We’ve 

learned that the hard way.”

 - Sandy M.

2
Navigating Services and Benefits 

Table 1. Point of Contact (POC) Case Management Team Members

Recovering Service Member:

Veteran Status

Recovering Service Member: 

Active Duty Status

Role

3

Primary Care Manager – the medical 

professional who provides your family 

member’s clinical care and refers to 

other medical specialists

Medical Care Case Manager – 

Military Treatment Facility (MTF)/

VA Polytrauma Centers – the nurse 

manager who coordinates clinical care

Non-Medical Case Manager 

– system of case managers for 

wounded service members and 

families, helps with Disability 

Evaluation System, and helps with 

transition from DoD to VA

DoD Recovery Care Coordinator 

Program - Category (CAT) 1 & 2 

(mild-moderate/serious TBI) – works 

with medical personnel and Wounded 

Warrior program staff to create a 

recovery program 

DoD/VA Federal Recovery 

Coordinator Program - CAT 

3 (severe/catastrophic TBI) – 

coordinates federal health care teams 

and private community resources for 

recovery of severely wounded service 

members

DVBIC Regional Care Coordination 

Program – this network allows 

for coverage of the complete 

spectrum of care from acute injury 

to rehabilitation and transitional 

re-entry

TRICARE Regional Office 

Managed Care Program – provides 

coordination of managed care within 

the TRICARE system

Physician/Nurse Practitioner/Physician Assistant

Nurse/Nurse Practitioner

DoD Recovery Care Coordinator (RCC)

Federal Recovery Coordinator (FRC)

Regional Care Coordinator

Managed Care Support Case Managers

(Provided through Managed Care Support Contractors)

TRO North: Health Net

TRO West: TriWest

TRO South: Humana

*Army - Army Wounded 

Warrior Case Manager

*Navy - Navy Safe Harbor 

Program Case Manager

*Air Force - Wounded Warrior 

Program Case Manager

*Marine Corps - Wounded 

Warrior Regiment Case Manager 

*OEF/OIF Program 

Manager Liaison

*Transition Patient Advocate

*VA Liaison
Chapter 1 - Introduction

“When my husband was injured, I was notified by the battalion 

commander and a chaplain. Then a Marine was assigned 

the job of totally assisting us. He handled everything from 

terminating our lease on the house in Okinawa, to selling our 

vehicles, returning our library books, and making arrangements 

to meet my husband in the hospital. Once I was in Bethesda, 

he handled everything. The four VA hospitals with polytrauma 

units have Marine liaisons. They are there to provide 

information and support and assistance and handle all the pay 

issues and benefits, all those things. 

We also have a VA and Department of Defense polytrauma 

rehab nurse liaison. It is her function to help us transition into 

the VA system, but she was far more than that and helpful before 

we were at that point.”

 - Anna E.

“If I had to name the one person that I would pick up the phone 

and call about any question--it was our care coordinator in 

Buford. She works out of the Naval Hospital. She’s the one I 

called about everything,--when they were sending me bills and 

they shouldn’t have been sending me bills, when Mike needed 

equipment --I called her. When I was given the run around, 

I called her, and I was like, ‘Am I nuts? Am I going nuts? Is 

this how things ought to be?’ And she would say, ‘No, you’re 

not going nuts.’ She would intercede for me, and I felt really 

confident that she would take care of the stuff with TRICARE 

and that she would find a way to make things happen. She 

was the person I called to say, ‘I need help, and I’m lost.’”

 - Meredith H.

4
Navigating Services and Benefits 

Who Coordinates Recovery Care and Services?

The Recovery Coordinator will develop and oversee a Recovery Care Plan 

for your family member. The plan lists services and benefits that your 

family member and you need. 

The Recovery 

Coordinator can 

help you connect 

with federal, state, 

local, and /or 

non-government 

services.

Different Points of Contact are available, depending on where your family 

member is.

POC in the VA Polytrauma System

A Nurse Practitioner will manage your family member’s care at the VA 

Polytrauma Rehabilitation Centers and the Polytrauma Network Sites 

(see Module 2 to learn more). She or he:

• monitors treatment plans

• applies for needed benefits

• makes sure the transition from DoD into the VA health care system 

goes smoothly

• makes the best use of VA, DoD, and community resources. 

POC for WII, Category 3

A Federal Recovery Coordinator (FRC) is assigned to your family member 

if he or she is “severely WII” (wounded, ill, and injured). “Severely WII” is 

the same as Category 3 (CAT 3). 

The FRC will work with the health care team to make sure your family 

member has the clinical and non-clinical care he or she needs. This help 

begins when your family member is first admitted to a military treatment 

facility (MTF). The FRC also helps other family members of the service 

member/veteran.

“I finally got a Recovery Coordinator. She is an angel. That 

lady got all the different case managers and put them all 

together. That works. That works.”

 - Nellie B.

The Federal 

Recovery 

Coordinator will 

help with the 

Recovery Care 

Plan.

5
Chapter 1 - Introduction

POC for WII, Category 2

A Recovery Care Coordinator (RCC) is assigned to your family member if 

he or she is a Category 2 (CAT 2) WII.

A WII Category 2 service member has a serious injury or illness. He or she 

is unlikely to return to duty in less than 180 days and may be medically 

separated from the military. RCCs are assigned while the WII is located 

in a military treatment facility (MTF) and still on active duty. The RCC 

will oversee a personal Comprehensive Recovery Plan, and work with the 

health care team to make sure there is access to clinical and non-clinical 

care. These Recovery Plans also take into consideration the needs of the 

service member/veteran’s family members and caregiver.

POC for WII 

These service-specific case managers provide guidance and help to 

navigate government benefits available to military personnel and their 

families. They also help the service member and family during the 

recovery period and with the Medical Evaluation Board (MEB) and 

Physical Evaluation Board (PEB) process (see Chapter 12).

The Wounded Warrior/Safe Harbor Case Managers, for example, provide 

wounded service members and their families with a system of advocacy and 

follow-up with personal support to assist them as they return to duty or to 

civilian life. 

6

“The Wounded Warrior regiment has certainly been great. I’ve 

been able to go to the Wounded Warrior regiment office and 

ask them questions and take my MEB/PEB checklist and my 

applications and make sure that I have everything that I need 

and I’m not missing anything. They’ve been a great sounding 

board for me, walking me through that process, because I did a 

lot of the retirement stuff. I attended the D-TAP classes for Tim. 

We did the TAP class on DVD, and they helped me get those 

tapes. That was good.”

 - Shannon M.
Navigating Services and Benefits 

How Can I Speak Up When Needed?

While your POC can help you understand and obtain benefits and 

services, you also have an important role to play on your family member’s 

behalf. You may feel a need to speak up and advocate for yourself and 

your family member.

There is more information in Module 3 about becoming an advocate. 

Here are some important points for you to remember:

• It is important to speak up. No one knows your own needs and 

those of your service member/veteran better than you do. Don’t feel 

shy about telling your case manager, POC, or Recovery Coordinator 

about the unique circumstances that you are experiencing. Ask 

questions to make sure you understand what they are telling you. Let 

people know what you and your family member need to succeed. 

• Remember that this process is complex, not intuitive. Don’t 

feel as if there’s something wrong with you if you just don’t “get it” 

the first time. Take time to learn about each new benefit, the eligibility 

qualifications, and application procedures. Persevere. Over time, the 

DoD and VA systems will become increasingly clear to you.

• Always keep in mind that you are not alone. Help is available. 

The military family that has nurtured your family member in the past 

will continue to provide care and support in the future. Keep hope in 

your heart that your family member will recover from his or her injury, 

and know that excellent care and support will continue to be available.

Part of being a 

caregiver is to be 

an advocate, on 

behalf of both 

yourself and your 

service member/

veteran.

“I think one thing that I have learned is that you definitely 

have to speak up. If your needs aren’t being met, if your 

spouse’s needs aren’t being met, or your children’s needs aren’t 

being met, you ask somebody. If they don’t have an answer, 

more than likely they’ll find the answer for you. They’ll direct 

you in the right direction. And I’ve been pretty successful in 

that department. But you definitely have to speak up. You 

can’t sit back and let things happen to you.”

 - Sandy M.

7
What Services Do I Need?

Right now, you may be feeling overwhelmed and not sure which way you 

should channel your energy. It is always good to prioritize your concerns/

issues. Doing so will help you focus your self-advocacy efforts. Here is a 

self-assessment tool that can help you determine the services you most 

need. Use this tool to identify benefits and services that you want to 

explore in more detail with your POC.

On a scale of 0 (meaning none) to 5 (meaning a high level), rate your 

level of stress/concern with each issue listed in the table on page 9. Then, 

make a list of the areas where your concerns are highest. Each chapter 

in Module 4 provides information relating to each issue and available 

resources. Your areas of concern may change over time, so please use this 

chart to help you re-identify and prioritize your action plan.

“At his team meeting between the VA and the therapy agency-- 

there were about 20 people there. He has a case worker with 

the VA, from the VHA side, the hospital administration. He has 

a case worker with the Benefits Administration. He’s got a nurse 

case worker. Again, that’s with the VA. He’s got a case worker 

with the therapy agency, and he has the AW-2 person, and then 

the Wounded Warriors are assigning somebody to him too. 

Then he’s got an advocate; the VA has assigned an advocate to 

him as well, and he comes to the meetings. 

These are people we can go to. We ran out of medication and I 

was trying to get ahold of somebody and I couldn’t. I can call 

any one of these people and they’ll track down whoever needs 

to be involved.”

 - Pam E.

8 Chapter 1 - Introduction
Navigating Services and Benefits 

Issues

Health

Mental Health

Employment

Education

Housing

Financial

Legal

Travel

Level of Stress/Concern

None 1 2 3 4 5

Health

Mental Health

Employment

Education

Housing

Financial

Legal

Travel

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

9

Once you have identified your top concerns, turn to the following 

chapters in this module to find the information you need. You can also 

use this information as background to prepare questions for your Point 

of Contact (POC) so that he or she can help you identify and obtain the 

services you and your service member/veteran need.
Whether you 

and other family 

members are 

eligible depends 

on your injured 

family member’s 

status. Table 2. Definitions of Eligibility Status

For Invitational Travel Orders only, girl/boyfriends, siblings, parents, stepparents, 

or other individuals designated by the service member may be eligible.

Category Definition

Chapter 1 - Introduction

Is My Family Member Eligible for Services? Am I?

Is your family member eligible for certain benefits and services? 

It depends on his or her status within DoD and the VA. Here are some 

key definitions to keep in mind:

10

Active Duty Service 

Member

Reserve Member

National Guard

Veteran

Retired Military

Medically Retired

Family Member

Spouse

Full-time duty in the active military service of the 

United States - Army, Navy, Marine Corps, Air Force, 

Coast Guard, NOAA, and U.S. Public Health Service. 

This includes members of the Reserves and 

National Guard.

Members of the Air Force Reserve, Army Reserve, 

Coast Guard Reserve, Navy Reserve, and Marine 

Corps Reserve, who may be called to active duty. 

Members of the Air National Guard or the Army 

National Guard, who may be called to active duty. 

A person who served on Active Duty, but is now 

honorably discharged from the military. See www.

va.gov for eligibility for federal benefits.

A person who voluntarily separates from the military 

after 20 years or more of honorable service.

Separated from the military due to disability or 

inability to perform duty with a service-connected 

disability and with a service DES rating of 30 percent 

or more. 

Parents, spouses, children, siblings, or survivor and 

dependents 

http://www.nmfa.org/site/DocServer/Definiton_

of_a_Dependent_11-05.pdf?docID=3621

Husband or wife of a service member or veteran, 

sometimes includes former spouse 

http://www.nmfa.org/site/DocServer/Definiton_

of_a_Dependent_11-05.pdf?docID=3621

http://www.nmfa.org/site/DocServer/Former_

Spouse_Benefits_11-05.pdf?docID=3581
Navigating Services and Benefits 

Table 3. Category-specific Resources about Services and Benefits

Where Can I Learn More about Benefits and 

Services?

The table below lists some good sources of information about benefits. 

11

Active Duty

Army

Navy

Reserve Component

Retired Military

Veterans

Family Members

Compensation and Benefits Handbook for Seriously Ill 

and Injured Members of the Armed Forces

http://www.transitionassistanceprogram.com/

portal/transition/resources/PDF/Compensation_and_

Benefits_Handbook.pdf

2010 United States Military Handbook

http://www.militaryhandbooks.com

http://myarmybenefits.us.army.mil/EN

http://www.npc.navy.mil/CareerInfo/PayAndBenefits

2010 Reserve and Guard Benefit Guide

http://www.defenselink.mil/ra/documents/

Benefits%20Guide%202008%20FINAL.pdf

2010 U.S. Military Retired Handbook

2010 After the Military Handbook

http://www.militaryhandbooks.com

Wounded, Ill and Injured Compensation & Benefits 

Handbook

http://www.transitionassistanceprogram.com/

portal/transition/resources/PDF/Compensation_and_

Benefits_Handbook.pdf 

Federal Benefits for Veterans and Dependents, 2010 

edition, Department of Veterans Affairs 

http://www1.va.gov/opa/vadocs/fedben.pdf

2010 Veterans and Dependents Handbook

2010 Veterans Healthcare Handbook

2010 After the Military Handbook

http://www.militaryhandbooks.com

2010 Getting Uncle Sam to Pay for Your College 

Degree

2010 Children’s Scholarship Handbook

http://www.militaryhandbooks.com

(See references for veterans above.)

Service Resources
12
Navigating Services and Benefits 

Chapter 2

The TBI Continuum of Care

What is the TBI Continuum of Care?

Your service member (SM)/veteran will receive excellent medical care 

as he or she moves from treatment to recovery. The DoD and the VA 

worked together to create a Continuum of Care for service members/

veterans with TBI. The Continuum is shown in Figure 1 below. 

A continuum 

means a series of 

steps that keep 

moving forward. 

In this case, 

the steps show 

movement from 

initial injury to 

recovery.

Figure 1. The TBI Continuum of Care

Injury 

OCONUS

Occurred in theater

Evacuation to Landstuhl 

for medical stabilization

In-Patient

Medical Care

CONUS

Military Treatment Facility/ VA Polytrauma 

System of Care

Family Needs

1. Transportation

2. Lodging

3. Financial

4. Child care

5. Emotional

 Support

6. Coordination of 

 resources, both

 military and 

 community

SM Needs

1. Coordination 

 with Service

 Programs

2. Coordination

 with MTF sta

3. Emotional 

 Support

Out-Patient

Rehabilitation

Military Treatment Facility/

VA HealthCare System/

Civilian Facilities

1. Continued Coordination with

 MTF sta and Service Programs

2. Family Decisions, i.e., 

 does spouse stay or 

 return home

3. Adjustment issues for

 SM and family

4. Initiation of VA

 paperwork

5. Coordination with

 Dept. of Labor/Operation

 Warghter Program

Figure 1. The TBI Continuum of Care

“Fit for duty” & Return 

to Active Duty Support to SM and Family

1. Community Involvment “Heroes to Hometowns”

2. Employment/Vocational Rehab

3. Veterans Aairs Coordination

4. Medical Coordination with TRICARE

5. Adjustment/Emotional Support

6. Physical Accomodations for work/home

“Unt for Duty” and 

Reintegration into 

Community

1. Advocacy

2. Resources for

decision making

3. Support

Medical Evaluation Board

Physical Evaluation Board

Regular Follow-up

“As long as it takes”

Ongoing 

Assessment

13
Injured service members first receive inpatient treatment at a military 

treatment facility (MTF) or the VA Polytrauma System of Care (see 

Module 2). 

When they are ready for outpatient treatment, they may receive that 

treatment at the MTF, VA, or a civilian hospital in the community. 

Many service members with TBI are treated and return to active duty. 

Others may be medically retired, continue through the Continuum, and 

receive lifetime community care. 

Your family member may need to be an inpatient for a long time in order 

to fully recover. He or she may be transferred to a treatment center that 

is closer to home.

Doctors consider many issues when deciding where to transfer your 

family member for inpatient care. These include: 

• Medical condition and type of specialty care required 

• The type of facility that can provide the best care for your family member 

• How close the best treatment center is to his or her home or parents’ 

home 

• His or her desires, spouse’s desires, and/or parents’ desires 

• How easy it is for the spouse or parents who will be helping to get to 

the treatment center.

Before your family member is transferred from one center to another, the 

Point of Contact and health care team members at the two locations talk 

to one another. The goal is to make sure that critical medical information 

is shared and non-medical support is in place. 

What is Community-Based Managed Care? 

TRICARE

WII service members who are recovering at home and/or don’t have access 

to the VA or a MTF can use the TRICARE Network for health care services. 

Each TRICARE Managed Care Contractor has created a program to 

assist WIIs. Contractors may change. Check www.tricare.mil/T3contracts.

Health Net Federal Services (North Region):

Health Net created the Warrior Care Support Program (WCS). Each 

warrior is provided his or her own Health Care Coordinator who works 

together with the MTF and VA serving as the Point of Contact for all 

Chapter 2 - The TBI Continuum of Care

Inpatient care 

is care in the 

hospital.

Outpatient care 

is when the 

patient lives in 

the community 

and comes to the 

hospital/clinic for 

care.

14
Navigating Services and Benefits 

civilian health care services. Phone numbers vary by region, go to: 

https://www.hnfs.net/common/caremanagement/WCS+Contact.htm.

For more information about this program, go to: https://www.hnfs.

net/common/caremanagement/About+the+WCS+Program.htm.

Humana Military Healthcare Services (South Region): 

Humana established the Warrior Navigation & Assistance Program 

(WNAP) to help guide warriors and their families through the 

military and VA’s health care systems, connect them with community 

resources, non-medical services, and civilian health care in order to 

return them to productive lives. These services are for WII active duty, 

Reserve Component, and those in the process of being medically 

retired. Call: 1-888-4GO-WNAP (888-446-9627) or go to: http://

www.humana-military.com/south/bene/TRICAREPrograms/wnap.asp.

TriWest Healthcare Alliance (West Region):

TriWest has a Wounded Warrior Project. Those WIIs who have been 

flagged by DoD in DEERS as a warrior in transition or self-identify as a 

wounded warrior and state during the call that they are experiencing 

difficulty accessing health care are escalated to the Priority Programs 

Unit. This elevation occurs internally so that all of their needs are 

addressed. The number to TriWest is: 1-888-TriWest. 

Community-Based Warrior Transition Unit (CBWTU) – 

Army National Guard or Army Reserve

If your family member is a member of the Army National Guard or Army 

Reserve and requires only outpatient care, he or she may request transfer 

to a Community-Based Warrior Transition Unit (CBWTU). This program 

allows your service member/veteran to live at home, receive outpatient 

care, and perform military duties at a local military organization, such as 

an armory or recruiting station. 

Your service member/veteran cannot work at a civilian job while he or she 

is attached to a CBWTU. 

Case managers at the CBWTU schedule outpatient appointments for your 

service member/veteran, and the commander and first sergeant provide 

command and control. CBWTU headquarters are located in Alabama, 

Arkansas, California, Florida, Massachusetts, Puerto Rico, Utah, Virginia, 

and Wisconsin. Each CBWTU is responsible for a specific area of the U.S. 

and for ensuring your service member/veteran receives the medical care 

15
he or she needs. Your Warrior Transition Unit squad leader can provide 

your family with information on the eligibility requirements and explain 

how to request a transfer. 

What Happens Next?

When your family member has been released from medical care, he or 

she may be returning to active duty, the National Guard or Reserve, or 

may be separated or retired from the military. 

Return to Active Duty

If your service member is returning to active duty, the POC will tell him 

or her when to return for follow-up care. The POC will assist your service 

member with scheduling these appointments. 

A Recovery Care Plan will be re-written with input from your service 

member and the POC. Normally, your service member will receive 

medical care at a MTF on the post or base where he or she is assigned. 

If there isn’t a MTF, other arrangements will be made by the POC for the 

service member to continue receiving appropriate care. 

Your service member may be scheduled to receive the follow-up medical 

care at a local military treatment facility, at the VA, or through the 

TRICARE Provider Network. 

Return to National Guard or Reserve Status

If your service member is a member of the National Guard or Reserve, the 

POC will tell him or her when to be seen for follow-up care. 

A Recovery Care Plan will be re-written with input from you, your 

family member, and the POC. Medical care for a service-connected 

wound, illness, or injury will be paid for by the Department of Defense; 

however, your service member/veteran will need to talk to the unit 

administrator or the Military Medical Support Office (MMSO) to be sure 

the paperwork is complete and he or she is authorized to receive the 

care. For more information, access the following Web site: 

http://www.tricare.mil/tma/MMSO.

Your unit commander may also ask some questions about the reasons 

and need for follow-up care. He or she will use this information to ensure 

the injury or illness was “in the line of duty” and that medical care is 

authorized. See the following Web site link for the MMSO Process Guide: 

http://www.tricare.mil/tma/MMSO/downloads/ProcessGuideMMSO1.pdf.

16 Chapter 2 - The TBI Continuum of Care
Navigating Services and Benefits 

Your service member may be scheduled to receive the follow-up medical 

care at a local MTF, at the VA, or through the TRICARE Provider Network. 

Your service member/veteran should also enroll at the VA. To do so, your 

service member/veteran needs to complete VA Form 10-10EZ to enroll, 

available from any VA health care facility, regional benefits office, online 

at www.va.gov/1010ez.htm, or call 1-877-222-VETS (8387). 

Medically Retired from the Military

If your service member has been medically retired from the military 

(Disability Evaluation System rating of 30 percent or more), the POC will 

tell your retiree/veteran when he or she needs to be seen for follow-up 

care. Your family member must enroll in TRICARE and may be scheduled 

for follow-up care at the local military treatment facility or through the 

TRICARE Provider Network. As a veteran, he or she may also be eligible 

for care through the VA. Your veteran should enroll at the VA. 

To do so, your service member/veteran needs to complete VA Form 

10-10EZ to enroll, available from any VA health care facility, regional 

benefits office, online at www.va.gov/1010ez.htm, or call 

1-877-222-VETS (8387). 

Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) 

veterans who were discharged or released from active service on or after 

January 28, 2003, are now eligible to enroll in the VA health care system 

for five years from the date of discharge or release. This means that 

combat veterans who were originally enrolled based on their combat 

service but later moved to a lower priority category (due to the law’s 

former two-year limitation) are to be placed back in the priority for 

combat veterans for five years beginning on the date of their discharge 

or release from active service. 

Retire from the Military

If your service member/veteran has been retired from the military 

(served 20+ years), the medical care providers at the hospital where 

your veteran received inpatient care will tell your veteran when he or 

she needs to be seen for follow-up care again. Your veteran must enroll 

in TRICARE and schedule follow-up care at the local military treatment 

facility or through the TRICARE Provider Network (See Chapter 4.) As a 

veteran, he or she should enroll in the VA in order to be eligible for care 

through the VA. Those who served in OIF/OEF will be eligible for all care 

through the VA for five years post-discharge from military service. 

17
Permanent/Temporary Disability Retired List (PTDL/TDRL)

If your service member has been told that he or she was placed on the 

“Permanent Disability Retired List” or the “Temporary Disability Retired 

List,” he or she is entitled to the same medical benefits as other retired 

service members. Learn more about PDRL and TDRL in Chapter 9.

Separate from the Military

If your service member/veteran has been separated or honorably 

discharged from the military, the POC will tell him or her when he or she 

needs to be seen for follow-up care. Your veteran will need to enroll with 

the VA Health Care System to schedule care. If your service member/

veteran: 

• has a service-connected disability rated at 50 percent or higher by 

the VA

• is unemployable due to the service-connected disability

• is seeking care for the service-connected disability,

your service member/veteran should also enroll in the VA Health 

Care System.

18 Chapter 2 - The TBI Continuum of Care
Navigating Services and Benefits 

During treatment and recovery, your family member will have one or 

more Points of Contact (POC). The POCs will support you and your 

family during this difficult time. 

This chapter is about other sources of support for your family member 

and you.

Many military treatment facilities have Family Assistance Centers. Families 

can seek help from the post or base chaplains, social workers, and the 

family center: 

• Airman and Family Readiness Centers 

• Army Community Services 

• Army’s MEDCOM Ombudsman Program and the Soldier Family 

Assistance Centers

• Marine Corps Community Services

• Navy Fleet and Family Support Center

• Coast Guard Work Life Offices.

Where Can I Find Support if My Family Member 

is in the Air Force?

Patient Squadron Program

The Patient Squadron Program is for any airman receiving medical care or 

hospitalization for moderate to severe injuries or illness lasting around 90 

days or more. 

The injured airman is assigned to the nearest MTF that can treat his or her 

injuries. The assignment can be temporary (TDY) or permanent (PCS). 

TDY involves:

• medical care not to exceed 90 days 

• a Medical Evaluation Board (MEB) review is not expected. 

PCS involves:

• medical care lasting more than 90 days

• a MEB is more likely. (See Chapter 12 to learn about the MEB.) 

The assigned MTF provides case management. 

Chapter 3 Support for Wounded

Service Members and Their Families

19
Reserve Component Airmen

Reserve Component (RC) members do not participate in the Patient 

Squadron program. RC airmen with approved Line of Duty injury or 

illness are hospitalized at the nearest MTF. 

They are placed on limited duty status while they receive outpatient care. 

They may also be placed on convalescent leave status and recuperate 

at home. 

The MTF is responsible for starting the MEB process for RC Airmen. 

Family Liaison Officers (FLO) help connect family members with the Air 

Force. They provide assistance, support, and non-medical services. FLOs 

stay involved as long as the family wishes.

Air Force Wounded Warrior (AFW2) Program

The Air Force Wounded Warrior (AFW2) program provides non-medical 

case management for airmen with: 

• a combat or hostile-related injury or illness that requires long-term care 

• a Medical Evaluation Board or Physical Evaluation Board to determine 

fitness for duty.

Assistance for Air Force Families

Airman and Family Readiness Centers offer resources for the airman and 

his/her family.

For immediate, 24-hour response, call 877-872-3435 or you can e-mail 

usafhelp@pentagon.af.mil. 

Where Can I Find Support if My Family Member 

is in the Army?

Army Wounded Warrior Program (AW2)

AW2 serves the most severely injured service members. It serves active 

duty, Reserve, or National Guard who were injured after September 

10, 2001 in support of Operation Enduring Freedom/Operation Iraqi 

Freedom (OEF/OIF). 

AW2 members have received or expect to receive a 30 percent rating for 

one or more injuries from the Disability Evaluation System (see Chapter 12).

20 Chapter 3 - Support for Wounded Service Members and Their Families
Navigating Services and Benefits 

This program offers support and advice to its members and their families. 

Service begins during treatment and continues until the service member/

veteran returns to active duty or a civilian community. 

AW2 helps you and your family member learn about federal, state, and 

private benefit systems. It links you and your family member to financial, 

educational, employment, legal, and medical resources. 

“The Army person from the AW2... oh my gosh, she’s great. 

She’s just wonderful. Now that she’s on board, I get e-mails 

from her. She does e-mails almost daily about job fairs. But 

she called me and said, ‘Hey, Congress just passed this thing 

and Jason should be able to get some kind of compensation 

from the Army, because they passed something about 

retirement or whatever.’ If it wasn’t for her, I wouldn’t even 

have realized what was on his DD-214. They put him down 

as honorable discharge instead of medical retirement. We are 

fixing that now.”

 - Pam E.

The AW2 toll free number is: 1-800-237-1336. To read more, go to the 

Army Web site: https://www.aw2.army.mil.

Warrior Transition Unit (WTU)

A Warrior Transition Unit (WTU) is an Army Brigade, Battalion, or 

Company that provides care to service members who are considered 

to not be severely injured (approximately 29 percent or less disability 

rating). 

WTU offers command and administrative support, primary care, and 

case management to its members. Soldiers are assigned a Primary 

Care Manager (Physician), Nurse Case Manager, and a Squad Leader to 

help the soldier and his or her family to heal and return to the Army or 

transition to civilian life. 

Warriors in Transition (WT) have enhanced access to care: 

• 24 hours for urgent care 

• three working days for routine primary care 

21
• seven working days for all initial specialty care 

• seven days for diagnostic tests

• 14 days for medically indicated non-emergency surgeries required to 

reach optimum medical benefit or fitness for duty status. 

Community-Based Warrior Transition Unit (CBWTU)

CBWTU provides support and care while the soldier is recovering at 

home. CBWTU’s goals are to evaluate, treat, and return the soldier to 

duty or to transition the soldier and his/her family out of the Army. If 

the latter, CBWTU refers the soldier to the Department of Veterans Affairs 

health care and/or TRICARE for follow-on care and benefits.

Assistance for Army Families

MEDCOM Ombudsman Program

The Ombudsmen function as soldier-family advocates for the U.S. Army 

Medical Command (MEDCOM) in support of the Army’s Warrior in 

Transition (WT) Program. They are located at Army MTFs and serve as a 

liaison between MEDCOM and the soldier, family members, and the MTF 

Commander. As liaisons, they communicate, facilitate, and problem solve. 

The Ombudsmen work closely with the MEDCOM Medical Assistance 

Group to help resolve issues that come through the Army Wounded 

Soldier and Family Hotline.

Soldier Family Assistance Center (SFAC)

SFACs provide a full spectrum of personnel, finance, and administrative 

support and non-medical assistance to wounded, ill, and injured soldiers 

and their family members. 

They coordinate with other government and non-government 

organizations for support services and receive and distribute donated 

items to deserving soldiers and family members.

For immediate, 24-hour response for WII soldiers, call 1-800-984-8523, 

e-mail: wsfsupport@conus.army.mil, or go to: http://www.aw2.army.mil.

Where Can I Find Support if My Family Member 

is in the Navy?

The Navy Safe Harbor Program is the Navy’s focal point for non-medical 

case management for all severely wounded, ill, and injured (SWII) sailors 

22 Chapter 3 - Support for Wounded Service Members and Their Families
Navigating Services and Benefits 

and their families. This service is also provided on an as-needed basis for 

any high-risk non-severely wounded, ill, or injured sailor. 

Safe Harbor provides support and assistance to sailors through recovery, 

rehabilitation, and reintegration. It also provides a lifetime of care. 

Safe Harbor tracks and provides oversight for all severely wounded sailors 

and coordinates with Federal Recovery Coordinators (FRC), various service 

WII programs, and other organizations. 

Case managers are assigned to all major Navy MTFs, Brooke Army 

Medical Center, and VA Polytrauma Centers. Medical issues are managed 

by the MTF and the Navy Bureau of Medicine and Surgery (BUMED). 

Safe Harbor is creating the “Anchor Program,” which will pair near-peer 

Reservists with volunteer retirees to mentor/sponsor WII sailors after they 

have been released from active duty to help connect them back into 

their communities. This program is open to anyone who was previously 

enrolled in Safe Harbor. Also, Safe Harbor will assist anyone who calls in 

(see the telephone number below) with help identifying support services 

in their community. 

Assistance for Navy Families

Safe Harbor will provide tailored support to the service member and his or 

her family through coordination with Fleet and Family Support Centers.

Safe Harbor offers 24/7 help via toll free number 1-877-746-8563, 

e-mailing safeharbor@navy.mil, or via Web site: 

http://www.npc.navy.mil/CommandSupport/SafeHarbor. 

Where Can I Find Support if My Family Member 

is in the Marine Corps?

Marine Corps Wounded Warrior Regiment (WWR), formerly the Marine 

For Life Injured Support program, provides assistance to wounded, ill, 

and injured Marines, sailors attached to or in support of Marine units, and 

their family members, throughout the phases of recovery. 

The WWR is a “single command with strategic reach.” WWR 

headquarters are located in Quantico, VA. The Battalions are located at:

• Camp Pendleton, CA (West) 

• Camp Lejeune, NC (East). 

WII Marines and sailors are assigned to the closest Battalion to their 

original duty station. 

23
Marine Corps’ programs also include the VA Polytrauma Rehabilitation 

Centers, Patient Affairs Teams, VA Liaisons, and District Injured Support Cells.

The WWR has implemented a Marine Corps Wounded Injured Ill Tracking 

System (MCWIITS) Case Management Module, established a Future 

Operations Cell, coordinated with Family Service Centers, and developed 

an Individual Comprehensive Recovery Transition Plan for WII Marines.

Assistance for Marine Families

Marines, sailors, and/or family members needing assistance can call tollfree: 877-487-6299.

For WWR Injured Support at Landstul Germany, e-mail:

injuredsupport@M4L.usmc.mil. For more information, go to: 

http://www.woundedwarriorregiment.org.

What Family Support is Available at the VA 

Polytrauma Centers?

You will find a description of the family support program at the VA 

Polytrauma Centers in Module 2.

24 Chapter 3 - Support for Wounded Service Members and Their Families
Navigating Services and Benefits 

You are proud of your family member for serving our country. Our 

country works hard to take care of its service members in return.

In Module 2, you learned about the DoD and VA medical treatment systems. 

This chapter is about other medical treatment resources. These other 

resources can provide recovery and rehabilitation services for your family 

member. They also provide health benefits for eligible family members. 

In Chapter 1 of this module, you learned about TBI case management 

and the Points of Contact (POCs) who can help you and your family 

member. 

The Recovery Care Plan will be adjusted as your family member recovers 

and moves through the TBI Continuum of Care. (See Chapter 2.) The 

POC will help your family member transfer from one facility to the next.

Use the information in this chapter to help you work with the POC to get 

the best care for your family member. 

What is TRICARE and What Does it Cover?

For Active Duty, Activated National Guard, Reserve 

Components, Retirees, Families, and Survivors 

TRICARE is a managed care program. TRICARE includes both direct care 

at military hospitals (MTFs) and purchased care (network care through 

Managed Care Contractors). 

Each service member/veteran has different needs and is eligible for 

different services and benefits. This chapter provides basic information 

about TRICARE. It also lists Web sites and other references where you can 

find more information. Talk to your POC about your family’s health care 

needs. He or she can help you understand TRICARE and help you enroll, 

if needed.

TRICARE Services and Benefits

TRICARE serves active duty service members, National Guard and Reserve 

members, retirees, their families, survivors, and some former spouses. 

TRICARE is a major component of the Military Health System. It 

brings together the health care resources of the Uniformed Services. 

It supplements military services with networks of civilian health care 

professionals, institutions, pharmacies, and suppliers. These may include 

community health and mental health centers.

Chapter 4

Health Benefits

The Points of 

Contact (POCs) 

will help you 

and your family 

member get the 

health benefits 

you need. 

The POCs also 

oversee your 

family member’s 

Recovery Care 

Plan. 

TRICARE is the 

military’s health 

insurance plan.

TRICARE operates 

around the world. 

25
TRICARE offers several health plan options to meet the needs of its 

members. TRICARE also offers two dental plans and several special 

programs. These programs include TRICARE for Life and TRICARE 

Pharmacy Options.

To find out what TRICARE services your service member/veteran and 

family members are eligible for, follow the steps below. Your POC can 

help you register in DEERS. Everyone must enroll in DEERS. 

Important steps to receive and use TRICARE benefits:

STEP 1

• Register in DEERS and/or update DEERS information as 

necessary. DEERS is the Defense Enrollment Eligibility Reporting 

System (DEERS). It is a worldwide, computerized database of 

Uniformed Services members (sponsors), their family members, and 

others who are eligible for military benefits.

 You must be registered correctly in DEERS to receive TRICARE benefits. 

 DEERS contact information:

- http://www.military.com/benefits/tricare/defense-enrollmenteligibility-reporting-system#1

- Toll-free: 1-800-538-9552. 

 If your service member/veteran has any change in status--such as 

separation, retirement, or change of address--make sure his or her 

information gets updated in DEERS as soon as possible. If these 

updates are not done, your service member/veteran and family might 

have a break in eligibility. This means a break in health care coverage.

 Mistakes in the DEERS database can cause problems with TRICARE 

claims. It is critical to keep your DEERS information correct and 

up-to-date.

 To update your DEERS information: 

- Visit your local Uniformed Services personnel office or contact the 

Defense Manpower Data Center Support Office (DSO) at 

1-800-538-9552. You can find the nearest Uniformed Services 

personnel office at: http://www.dmdc.osd.mil/rsl. 

- Fax address changes to DEERS at 1-831-655-8317. 

- Mail the address change to the Defense Manpower Data Center 

Support Office, ATTN: COA, 400 Gigling Road, Seaside, CA 

93955-6771. 

To be eligible 

for TRICARE 

benefits, you 

must be registered 

in the Defense 

Enrollment 

Eligibility 

Reporting System 

(DEERS). 

Registration 

in DEERS does 

not happen 

automatically. 

VERY IMPORTANT: 

After any change 

in service status, 

you must update 

registration in 

DEERS.

It is your 

responsibility to 

make sure the 

information in 

DEERS is correct. 

Check it every so 

often.

Family 

members whose 

applications are 

received through 

the 20th of 

the month are 

enrolled the first 

day of the next 

month.

26 Chapter 4 - Health Benefits
Navigating Services and Benefits 

- Go online to TRICARE to update your information: 

http://www.tricare.mil/deers. 

- Keep copies of the update forms until you see the change is made.

STEP 2

• Learn about TRICARE services and benefits.

 Take a look at the following Web sites to learn more about TRICARE: 

http://www.military.com/benefits/tricare/understanding-yourtricare-benefits and www.tricare.mil/tricareu.

 With so many health care plans and programs, TRICARE can seem 

complicated. The more you know about your coverage, the better 

equipped you’ll be to get the care you need.

 TRICARE has three main choices for health care coverage:

- TRICARE Prime - where military treatment facilities (MTFs) are the 

principal source of health care

- TRICARE Extra - a Preferred Provider option with cost sharing

- TRICARE Standard - a fee-for-service option 

(the original CHAMPUS program).

 TRICARE is available worldwide. It is managed in four separate 

regions. Three are in the United States. One is overseas.

- The three regions in the United States include:

 TRICARE North 

 TRICARE South 

 TRICARE West. 

STEP 3

• Find out what services and benefits your service member/

veteran and family members are eligible for:

- Visit the TRICARE Web site “Plan Wizard” at 

http://www.tricare.mil/mybenefit.

- The “Plan Wizard” lets you and your service member/veteran enter 

specific information about military status, etc. Then it explains the 

services that he or she is eligible for. 

- The Plan Wizard helps you understand which TRICARE options you 

and your family members may be eligible for. The military decides 

who is eligible for what. This information is reported to the Defense 

Enrollment Eligibility Reporting System (DEERS).

TRICARE is a large 

and complex 

health care 

system. Learn 

about it.

TRICARE “Plan 

Wizard” (http://

www.tricare.mil/

mybenefit) is a 

helpful tool.

27
TRICARE Services and Benefits for National Guard and 

Reserve Members

TRICARE Reserve Select (TRS) is a health insurance plan that qualified 

National Guard and Reserve members may purchase when not on active 

duty. TRS requires a monthly premium. It offers coverage similar to 

TRICARE Standard and Extra.

Key features of TRS include:

• Available worldwide to most Selected Reserve members (and families) 

when not on active duty orders or covered under the Transitional 

Assistance Management Program

• Must qualify for and purchase TRS to participate 

• Must pay monthly premiums. Failure to pay monthly premiums on 

time may result in disenrollment and an enrollment lockout 

• Freedom to manage your own health care; no assigned primary care 

manager:

- Visit any TRICARE-authorized provider or qualified host nation 

provider (if located overseas)

- Pay fewer out-of-pocket costs when choosing a provider in the 

TRICARE network

- Network providers not available overseas. 

• No referrals are required, but some care may require prior 

authorization

• May have to pay for services when they are received and then seek 

reimbursement 

TRICARE has an 

insurance plan 

for National 

Guard and 

Reserve members 

not on active 

duty. It is called 

TRS.

Chapter 4 - Health Benefits

“I have a phenomenal case manager with TRICARE. I go to 

her whenever there have been issues with one of the hospitals, 

or when there have been issues with some of the specialty 

doctors and paying, or the equipment. Tim has a biomedical 

device that goes around his leg that helps with the foot drop, 

and she was great at making sure that we were set up with 

funding so that he could get that equipment. So I go to her 

for a lot of issues.”

 - Shannon M.

28
Navigating Services and Benefits 

• May have to submit health care claims

• May receive care in a military treatment facility (MTF) on a spaceavailable basis only

• Offers comprehensive health care coverage, including TRICARE’s 

prescription drug coverage. 

Transitional Assistance Management Program (TAMP) 

The Transitional Assistance Management Program (TAMP) offers 

transitional TRICARE coverage to certain separating active duty members 

and their eligible family members. Care is available for 180 days.

The four categories for TAMP are:

• Members involuntarily separated from active duty and their eligible 

family members

• National Guard and Reserve members separated from active duty after 

being called up or ordered in support of a contingency operation for 

an active duty period of more than 30 days and their family members

• Members separated from active duty after being involuntarily retained 

in support of a contingency operation and their family members

• Members separated from active duty following a voluntary agreement 

to stay on active duty for less than one year in support of a 

contingency mission and their family members.

Active duty sponsors and family members enrolled in TRICARE Prime who 

desire to continue their enrollment upon the sponsor’s separation from 

active duty status are required to re-enroll. To re-enroll in TRICARE Prime, 

the sponsor or family member must complete and submit a TRICARE 

Prime enrollment application. 

Under TAMP, former active duty sponsors, former activated Reservists, and 

family members of both are not eligible to enroll or re-enroll in TRICARE 

Prime Remote or in TRICARE Prime Remote for Active Duty Family 

Members because both programs require the sponsor to be on active 

duty. Under TAMP, the sponsor is no longer on active duty but is treated 

as an active duty family member for benefits and cost sharing purposes. 

TRICARE Prime Enrollment and Re-enrollment

Initial enrollment in TRICARE Prime occurs during the TAMP period. 

Family members whose applications are received through the 20th of 

the month are enrolled the first day of the next month. For example, if 

the application is received June 20, TRICARE Prime coverage for the family 

TRICARE has 

coverage for 

some separating 

active duty 

members and 

their families. It 

is called TAMP.

29
member begins July 1. If the application is received June 21, coverage for 

the family member begins August 1.

Continued Health Care Benefit Program (CHCBP) 

The Continued Health Care Benefit Program (CHCBP) is a premium-based 

health care program administered by Humana Military Health Care Services, 

Inc. (Humana Military). CHCBP offers temporary transitional health 

coverage (18-36 months) after TRICARE eligibility ends. If you qualify, you 

can purchase CHCBP within 60 days of loss of eligibility for either regular 

TRICARE or Transitional Assistance Management Program (TAMP) coverage.

CHCBP benefits are comparable to TRICARE Standard with the same 

benefits, providers, and program rules. The main difference is that you 

pay premiums to participate.

Who is Eligible?

Under certain situations, the following recipients may be eligible:

• Former active duty service members released from active duty (under 

other than adverse conditions) and their eligible family members. 

Coverage is limited to 18 months. 

• Former spouses (not married again) who were eligible for TRICARE on 

the day before the date of the final decree of divorce, dissolution, or 

annulment. Coverage is usually limited to 36 months; however, some 

unremarried former spouses may continue coverage beyond 36 months if 

they meet certain criteria. Contact Humana Military for details. 

• Children who cease to meet the requirements to be an eligible family 

member and were eligible for TRICARE on the day before ceasing to 

meet those requirements. Coverage is limited to 36 months.

• Certain unmarried children by adoption or legal custody. Coverage is 

limited to 36 months. 

For more information about CHCBP, visit http://www.humana-military.

com/south/bene/TRICAREPrograms/chcbp.asp or call 1-800-444-5445. 

Contact your POC or a Beneficiary Counseling and Assistance Coordinator 

(BCAC) to discuss your eligibility for this program.

TRICARE Dental Program (TDP)

The TDP is a voluntary dental insurance program that is available to 

eligible active duty family members, Select Reserve and Individual Ready 

Reserve (IRR) members, and eligible family members. The TDP covers a 

wide range of diagnostic, preventive, and restorative services. You may 

Chapter 4 - Health Benefits

CHCBP acts as a 

bridge between 

military health 

benefits and 

your new civilian 

health plan. 

30
Navigating Services and Benefits 

seek care from a network of participating dentists, or you may use nonparticipating dentists at an additional cost to you.

TDP is separate from other TRICARE programs. Your service member/veteran 

is not required to be enrolled in any of them in order to enroll in the TDP. 

For more information about the TDP, visit 

www.TRICAREdentalprogram.com or 

call toll-free 1-800-866-8499 for general information. 

To enroll, call 1-888-622-2256. More information on 

the TRICARE Dental Program is available on your dental 

provider’s Web site or at www.tricare.mil/contactus.

Dental Care for Retirees and for Medical Retirees

Medically retired service members can obtain dental care coverage 

through the TRICARE Delta Dental Program. You are eligible to enroll in 

the TRDP (TRICARE Retiree Dental Program) if you are:

• A member of the Uniformed Services who is entitled to Uniformed 

Services retired pay, even if you are 65 or older

• A member of the retired National Guard/Reserve, including those 

in the “gray-area” who are entitled to retired pay but will not begin 

receiving it until age 60

• A current spouse of an enrolled member

• A child of an enrolled member, up to age 21 or to age 23 if a full-time 

student (proof of full-time student status required), or older if disabled 

before losing eligibility

• An unremarried surviving spouse or eligible child of a deceased 

member who died while in retired status or while on active duty 

• A Medal of Honor recipient and eligible family members, or an 

unremarried surviving spouse/eligible family members of a 

deceased recipient

• A current spouse and/or eligible child of a non-enrolled member with 

documented proof the non-enrolled member is: (a) eligible to receive 

ongoing comprehensive dental care from the Department of Veterans 

Affairs; (b) enrolled in a dental plan through employment and the plan 

31
is not available to family members; or (c) unable to obtain benefits 

through the TRDP due to a current and enduring medical or dental 

condition. Written documentation supporting any of these three 

situations must be submitted with your enrollment application. 

Former spouses and remarried surviving spouses are not eligible at this time.

For more information, go to www.tricare.mil/mybenefit/home/Dental/Retiree. 

TRICARE Military Medical Support Office (MMSO)

MMSO serves all three U.S. regions of TRICARE. It provides medical 

support and dental case management. It also coordinates civilian health 

care services outside the jurisdiction of a military treatment facility for 

TRICARE Prime Remote (TPR)-eligible active duty military and reserve 

component service members within the 50 United States and District of 

Columbia. For more information, access the following Web site: 

http://www.tricare.mil/tma/MMSO.

MMSO provides: 

• Pre-authorization for civilian medical and dental care 

• Authorizations for payment of civilian medical and dental bills 

• Coordination of civilian health care services for remotely located 

service members 

• Collaboration with unit representatives regarding Line-Of-Duty 

(LOD) cases. 

MMSO serves the following populations: 

• Active Duty Service Members (ADSMs) enrolled in TRICARE Prime 

Remote (TPR) 

• Non-enrolled ADSMs not managed by a military treatment facility (MTF) 

• Reservists with Line of Duty (LOD) injuries or diseases 

(Reservists, National Guard) 

• ADSMs receiving dental care outside the military dental treatment 

facilities (DTF), DTF-referred, or Remote Dental Program. 

TRICARE Fact Sheets

The TRICARE Fact Sheets are designed for anyone who needs detailed 

information on many TRICARE topics, such as: 

• Transitional Assistance Management Program 

• TRICARE Appeals

• TRICARE Mail Order Pharmacy. 

Chapter 4 - Health Benefits

MMSO is the 

central customer 

service office for 

TRICARE. 

Access TRICARE 

fact sheets at 

http://www.tricare.

mil/Factsheets/

browseatoz.cfm.

32
Navigating Services and Benefits 

What Does the VA Health Care System Cover?

For Veterans

The VA operates the nation’s largest integrated health care system with 

more than 1,400 sites of care, including hospitals, community clinics, 

nursing homes, readjustment counseling centers, and various other 

facilities. 

STEP 1 – Determine VA Eligibility 

The number of veterans who can be enrolled in the health care program 

is determined by the amount of money Congress gives the VA each year. 

Since funds are limited, the VA set up priority groups to make sure that 

certain groups of veterans are able to be enrolled before others. 

Once you apply for enrollment, your eligibility will be verified. Based on 

your specific eligibility status, you will be assigned a priority group. 

“One thing that’s pretty important: A National Guard or 

Reservist needs what’s called an LOD, a line of duty document, 

for each service-connected malady. In the case of my 

husband’s teeth, they did one on each tooth.

We needed that, and they really didn’t want to do it. It’s just 

that we made them do it –we’ve been around the block a few 

times. We have needed the LODs. He has had some dental 

problems and the VA has taken care of him, but he had to 

document that a particular tooth problem that he was having 

was service-connected.

He probably has 27 LODs, which is absurd, and most people 

wouldn’t have anywhere near that. I have probably five or 

six LODs on teeth. I have one for his broken nose. I have one 

for the cognitive deficit, one for TBI, one for his back, his neck, 

his this, his that. Anything that he was being treated for at 

Walter Reed that was a result of the blast injury, we have a 

line of duty investigation document on, and that’s what the VA 

goes on for treatment.”

 - Caroline M.

For information 

on VA health care, 

visit http://www.

va.gov/health.

33
The priority groups range from 1-8 with 1 being the highest priority for 

enrollment. Some veterans may have to agree to pay a co-pay to be 

placed in certain priority groups. 

• Basic Eligibility - If your service member served in the active military, 

naval, or air service and is separated under any condition other than 

dishonorable, he or she may qualify for VA health care benefits. If your 

service member is a member of the Reserves or National Guard who was 

called to active duty (other than for training only) by a federal order and 

completed the full period for which he or she was called or ordered to 

active duty, your service member may be eligible for VA health care. 

• Minimum Duty Requirements - If your service member/veteran 

enlisted after September 7, 1980, or entered active duty after October 

16, 1981, he or she must have served 24 continuous months or the 

full period for which he or she was called to active duty in order to 

be eligible. This minimum duty requirement may not apply to your 

service member/veteran if he or she was discharged for a disability 

incurred or aggravated in the line of duty. 

• Service Disabled Veterans - If your service member/veteran is 

50 percent or more disabled from service-connected conditions, 

unemployable due to service-connected conditions, or receiving care 

for a service-connected disability, he or she will receive priority in 

scheduling of hospital or outpatient medical appointments. 

STEP 2 – Enroll for VA health care

• To apply for VA health care, your service member/veteran must 

complete VA Form 10-10EZ, Application for Health Benefits. The form 

can be obtained from any VA health care facility or regional benefits 

office, online at http://www.va.gov/1010ez.htm, or by calling 

1-877-222-VETS (8387). 

• Many military treatment facilities have VA representatives on staff that 

can also help your service member/veteran with this request. 

STEP 3 – Learn about VA Services and Benefits

VA provides health care and other benefits to OEF/OIF veterans returning 

from the armed services.

Here are some of the benefits VA provides:

• Five Years of Enhanced Health Care. Your service member/veteran 

is eligible to receive enhanced VA health care benefits for five years 

following his or her military separation date. Whether or not your 

Chapter 4 - Health Benefits

Access this Web 

site for more 

information 

on specific VA 

benefits available: 

http://www.oefoif.

va.gov.

The VA priority 

groups are 

described on 

the following 

Web site: http://

www.va.gov/

HEALTHELIGIBILITY/

eligibility/

Determine 

Eligibility.asp.

34
Navigating Services and Benefits 

family member chooses to use VA health care after separation, he or 

she must enroll with VA within five years to get health care benefits 

later on.

• Dental Benefits. He or she may be eligible for one-time dental 

care but must apply for a dental exam within 180 days of his or her 

separation date.

• OEF/OIF Program. Every VA Medical Center has a team standing 

ready to welcome OIF/OEF service members and help coordinate their 

care. Check the home page of your local VA Medical Center.

• Primary Health Care for Veterans. VA provides general and 

specialized health care services to meet the unique needs of veterans 

returning from combat deployments.

• Non-Health Benefits. Other benefits available from the Veterans 

Benefits Administration may include: financial benefits, home loans, 

vocational rehabilitation, education, and more. Access 

http://www.vba.va.gov/VBA for information on these benefits.

• Benefits for Family Members. VA offers limited medical benefits 

for family members of eligible veterans. These include the following 

programs: Civilian Health and Medical Program of VA (CHAMPVA), 

caregiver support groups, counseling, and bereavement counseling.

Potential Co-Payments

Some veterans must make small co-payments for medical supplies and 

VA health care. Combat veterans are exempt from co-payments for the 

care of any condition potentially related to their service in a theater of 

combat operations. However, they may be charged co-payments for 

treatment clearly unrelated to their military experience, as identified by 

their VA provider. 

Conditions not to be considered potentially related to the veteran’s 

combat service include, but are not limited to:

• care for common colds

• injuries from accidents that happened after discharge from active duty

• disorders that existed before joining the military. 

For more information regarding services available to returning active duty, 

National Guard, and Reserve service members of Operations Enduring 

Freedom and Iraqi Freedom, visit the Returning Service Members Web 

site at http://www.oefoif.va.gov.

35
VA Personal Health Record – My HealtheVet

My HealtheVet offers veterans 24/7 Internet access to their personal VA 

health care information.

My HealtheVet provides access to the following:

• health information 

• links to Federal and VA benefits, and other resources 

• the veteran’s Personal Health Journal.

Future plans are to include scheduled appointments, co-pay balances, 

and key parts of the VA medical records.

You can record and track your veteran’s health information online in one 

location. You can print your veteran’s information on a doctor’s sheet. 

The online VA prescription refills allow you to order medications online 

and have them sent to your home. 

Register for My HealtheVet at www.myhealth.va.gov.

What Benefits and Services are Available for 

Veterans’ Families?

CHAMPVA - VA Civilian Care for Eligible Family Members

The Civilian Health and Medical Program of the Department of Veterans 

Affairs (CHAMPVA) is a comprehensive health care program in which 

the VA shares the cost of covered health care services and supplies with 

eligible beneficiaries. 

Due to the similarity between CHAMPVA and the Department of Defense 

(DoD) TRICARE program (sometimes referred to by its old name, 

CHAMPUS), the two are often mistaken for each other. CHAMPVA is 

a Department of Veterans Affairs program. TRICARE is a regionallymanaged health care program for active duty and retired members of 

the Uniformed Services, their families, and survivors. If you are a military 

retiree, or the spouse of a veteran who was killed in action, you are and 

will always be a TRICARE beneficiary. Check with your POC.

To be eligible for CHAMPVA, you cannot be eligible for TRICARE and you 

must be in one of these categories:

1. The spouse or child of a veteran who has been rated permanently 

and totally disabled for a service-connected disability by a VA regional 

office, or 

CHAMPVA is 

civilian care 

through the VA.

My HealthVet 

is VA’s online 

Personal Halth 

Record.

36 Chapter 4 - Health Benefits
Navigating Services and Benefits 

2. The surviving spouse or child of a veteran who died from a VA-rated 

service-connected disability, or 

3. The surviving spouse or child of a veteran who was at the time of 

death rated permanently and totally disabled from a service-connected 

disability, or 

4. The surviving spouse or child of a military member who died in the line 

of duty, not due to misconduct (in most of these cases, these family 

members are eligible for TRICARE, not CHAMPVA). 

For information on CHAMPVA and to apply, access the following Web 

site: http://www.va.gov/hac/forbeneficiaries/champva/champva.asp.

Upon confirmation of eligibility, you will receive program material that 

specifically addresses covered and non-covered services and supplies in 

the form of a CHAMPVA handbook.

37
38
Navigating Services and Benefits 

Everyone needs a helping hand at one time or another. Coping with TBI 

can be challenging. Fortunately, there are resources to help you and your 

service member/veteran cope.

What Counseling is Available for Active 

Duty, Activated National Guard, Reserve 

Components, and Families?

The military offers non-medical counseling to the active force, National 

Guard and Reserve Components, and their families. Counseling is 

available for both children and adults. Couples or family counseling may 

also be available.

Active duty, National Guard and Reserve service members, and their 

families may receive counseling from:

• Military OneSource at http://www.militaryonesource.com

• Military and Family Life Consultants (MFLCs)

• chaplains

• post/base and National Guard/Reserve Family Support Centers. 

Some personnel may also be eligible for services at local Vet Centers.

Military OneSource

Military OneSource offers three different ways to receive counseling 

services:

• face-to-face with a counselor in your local area 

• by telephone with a Military OneSource consultant 

• online consultations in a secure, real-time “chat” format. 

All Military OneSource counseling services are free to service members 

and their eligible family members. 

Military OneSource professionals will help you develop personal solutions, 

goals, and plans. They will encourage you to build on your strengths, 

teach you to maximize your support systems, and help you find 

community resources to meet your needs. 

The Military OneSource counseling services are not designed to deal with 

long-term issues, such as child or spouse abuse, and mental illness. 

Those in need of long-term treatment are referred to a military 

treatment facility (MTF), TRICARE, or another health care provider in 

the community. 

Coping with 

TBI can be 

a challenge. 

Counseling is 

available.

Chapter 5

Counseling/Behavioral Health

For counseling, 

call Military 

OneSource at 

1-800-342-

9647 or through 

the Web site at 

http://www.

militaryonesource.

com.

39
TRICARE

TRICARE coverage includes mental health and behavioral counseling 

benefits, including:

• psychotherapy

• inpatient and outpatient care

• addictions counseling. 

For more information, see http://tricare.mil/mybenefit/home/

MentalHealthAndBehavior/TypesOfTreatments/Psychotherapy.

Family Service Centers

Counseling may also be available from a Family Service Center. Every 

military installation has a Family Service Center. Services vary across 

installations. 

If you do not live near an installation, many of the services can be 

provided via telephone and e-mail.

For Active Duty Service Members

Active military bases have family support centers:

• Navy Fleet and Family Support Center

• Marine Corps Community Service Center 

• Air Force Family Service Center 

• Army Community Service Center. 

Although the names vary, most of the services are the same. 

Centers are staffed by highly trained human services professionals and 

volunteers. All programs are free of charge.

For National Guard Members

The State Area Command (STARC) within the State National Guard 

Military Headquarters usually creates a Family Assistance Center 

(FAC) when a reserve unit is mobilized. The FAC will provide current 

information about family support available within the state. This includes 

military, federal, state, and local civilian support. 

The FAC will also provide government forms and assistance in filling them 

out. Check with your STARC to locate the FAC nearest you.

TRICARE 

also provides 

counseling 

benefits.

Check your 

military 

installation for 

a Family Service 

Center.

40 Chapter 5 - Counseling/Behavioral Health
Navigating Services and Benefits 

Chaplains

Chaplains help service members and their families deal with personal 

concerns such as:

• faith issues 

• stress

• anxiety 

• redeployment or reunion issues

• moral and ethical values

• social concerns.

Chaplains help to resolve problems by making appropriate referrals to 

command channels or social service agencies. 

They also assist military personnel in requesting emergency leave, 

compassionate reassignments, and hardship discharges.

Post-traumatic 

stress (PTS) is 

anxiety that 

can develop if 

you are exposed 

to or witness a 

traumatic event 

(like combat) 

that threatened 

or caused great 

physical harm to 

self or others.

“Chaplain Thames was sent with me to travel to Germany to 

meet my husband, and then to Bethesda, and then he returned 

to Okinawa. He traveled with me so that I wouldn’t be 

traveling alone.” 

 - Anna E.

What is Post-Traumatic Stress (PTS)?

Some people experience effects from the stress of combat that don’t go 

away without help. They may even get worse over time. This is called 

Post-Traumatic Stress, or PTS for short.

Your family member with PTS may have:

• nightmares 

• flashbacks 

• difficulty sleeping 

• emotionally numb feelings. 

These symptoms can make daily life difficult. 

For many service 

members, 

chaplains are 

the first person 

they can turn to 

for help outside 

their chain of 

command. 

41
Your family member may also:

• feel depressed

• begin to abuse alcohol or drugs 

• have problems with memory and understanding 

• have difficulty dealing with social or family situations 

• develop personality changes. 

If you think your family member may be suffering from PTS, there are 

many resources for help in dealing with it. 

Talk to your doctor. Also, check out Military OneSource. This Web site 

has links to information on dealing with PTS and how to seek help: 

www.militaryonesource.com/skins/MOS/home.aspx. 

Your family member may also call 1-800-342-9647 twenty-four hours a 

day. Military OneSource may authorize your service member to have six 

confidential counseling sessions at no cost. 

Mental and behavioral health care is also a TRICARE benefit. TRICARE 

will cover care that is medically or psychologically necessary in both 

outpatient and inpatient settings. The first eight behavioral health 

outpatient visits per fiscal year do not require prior authorization 

from TRICARE. 

You can visit the Web site: http://tricare.mil/mybenefit/ProfileFilter.do?

puri=%2Fhome%2FMentalHealthAndBehavior to find a list of behavioral 

health providers within your immediate area.

What Resources are Available to Prevent 

Suicide?

In the case of an emergency, call the National Suicide Prevention Lifeline 

right away at 1-800-273-TALK (8255). 

DoD Suicide Prevention and Risk Reduction Committee’s 

(SPARRC) Preventing Suicide Network

The DoD SPARRC Preventing Suicide Network is a resource center that 

provides information about suicide prevention. 

The SPARRC Web site (http://www.preventingsuicide.com/dodtest) 

provides information on what to look for and what to do to help 

someone who you think may be dealing with thoughts of suicide. 

SPARRC helps 

military personnel, 

family, and 

friends who are 

concerned about 

someone who 

may be at risk for 

suicide by offering 

tailored resources 

about suicide 

prevention. 

42 Chapter 5 - Counseling/Behavioral Health
Navigating Services and Benefits 

Up-to-date information is available so that your family member can learn 

more about suicide. The site provides service-specific resources: 

• Air Force – Air Force Suicide Prevention Program: http://afspp.afms.mil

• Army – U.S. Army Center for Health Promotion and Preventive 

Medicine Suicide Prevention Program: http://chppm-www.apgea.

army.mil/dhpw/Readiness/suicide.aspx 

• Coast Guard – Coast Guard Suicide Awareness Program: 

http://www.uscg.mil/worklife/suicide_prevention.asp 

• Marine Corps – Marine Corps Community Services Suicide 

Prevention Program: http://www.usmc-mccs.org/suicideprevent 

• Navy – Navy Suicide Prevention Program: http://www.npc.navy.mil/

CommandSupport/SuicidePrevention. 

For a more complete listing of Government Suicide Prevention Programs, 

see Appendix F.

What Counseling is Available for Veterans? 

The Department of Veterans Affairs Vet Center program is staffed by 

small multi-disciplinary teams of dedicated providers, many of whom are 

combat veterans themselves. 

Vet Centers provide individual, group, and family counseling to all 

veterans who served in any combat zone. This service may be provided 

free of charge to your veteran and/or family members. 

Vet Centers offer readjustment counseling — a wide range of services 

provided to combat veterans in the effort to help make the transition 

from military to civilian life go more smoothly. Services include: 

• individual and group counseling 

• marital and family counseling

• bereavement counseling 

• medical referrals 

• assistance in applying for VA benefits 

(see Chapter 2 for more information)

• employment counseling

• guidance and referral 

• alcohol and drug abuse assessments 

• information about and referral to community resources 

The Department 

of Veterans 

Affairs Vet Center 

program operates 

232 communitybased counseling 

centers across the 

country. 

43
• counseling and referral for sexual trauma that happened while serving 

in the military 

• outreach and community education. 

A service member or veteran who served in any combat zone (Vietnam, 

Southwest Asia, OEF, OIF, etc.) and received a military campaign ribbon, 

or their family members, is eligible for Vet Center services. 

Call toll free during normal business hours at 1-800-905-4675 (Eastern) 

and 1-866-496-8838 (Pacific). 

You can also locate a Vet Center near you by going to the Vet Center Web 

site at www.vetcenter.va.gov.

What Other Services Are Available?

There are behavioral health services being provided for free for service 

members/veterans and their caregivers. A list is at America Supports You 

(http://www.ourmilitary.mil/index.aspx). Ask your POC for a list.

Also check out the National Resource Directory at: 

http://www.nationalresourcedirectory.org.

44 Chapter 5 - Counseling/Behavioral Health
Navigating Services and Benefits 

If your service member/veteran is separating from the military or has 

already done so, he or she may be facing many challenges. 

Transitions can be stressful under the best of circumstances. A TBI can 

make transition all the more stressful. 

Your service member/veteran may feel discouraged about the prospect of 

finding employment. You may be concerned about how your family will 

survive economically. 

Finding a job 

or preparing 

for non-military 

employment can 

be a challenge. 

Chapter 6

Employment

“That’s probably been one of the hardest aspects of it, 

because things have changed, especially with the 100 percent 

rating he got from the Army. How is that going to affect his 

job prospects? He’s probably going to have a really hard time 

with a full-time job, period. 

That will probably change for me, too. I might have to get 

back out there in the workforce and help provide for the 

family. I’ve just got to figure out what I want to do.”

 - Aimee W.

Take heart: There are many avenues for injured service members/veterans 

to seek employment. Many public and private employers are committed 

to supporting those who have served their country. 

There may also be state benefits and/or preferences that your service 

member/veteran can receive. Chapter 14 provides more information 

about state-specific services.

The military provides your service member with a formal transition 

assistance program to learn about available employment resources. It’s 

important for you to understand these benefits as well, so you can discuss 

employment options with your family member.

But First ... Help Your Service Member/Veteran 

Get Organized

Before your service member/veteran applies for VA benefits or starts 

to look for a job, he or she needs to pull together some important 

documents and to make plans.

Knowing what 

services are 

available is a key 

to success.

45
Important Military Records

Certificate of Release or Discharge from Active Duty – DD Form 214

DD Form 214 is the key to participation in all VA programs, as well as 

several state and federal programs. 

Keep the original in a safe, fireproof place, and have certified photocopies 

available for reference.

In many states, the DD 214 can be registered/recorded like a land 

deed or other significant document. However, some jurisdictions will 

allow others to access the form. This can be problematic because the 

form contains the service member’s Social Security number. Check the 

privacy safeguards in place at your county recorder or town hall before 

registering the DD 214 there.

If your service member/veteran needs a replacement DD 214 or is in 

a medical emergency or other situation where the DD 214 is needed 

immediately, call the National Personnel Records Center at 314-801-0800.

Verification of Military Experience and Training (VMET) – 

DD Form 2586

DD Form 2586 (Verification of Military Experience and Training) lists your 

service member/veteran’s military job experience and training history, 

recommended college credit information, and civilian equivalent job titles. 

It is not a resume, but it can help service members/veterans apply for job.

The VMET can be downloaded from http://www.dmdc.osd.mil/vmet. 

If there are errors or omissions on the form, check the Frequently Asked 

Questions section on the Web site which explains most problems.

Errors on the VMET can be corrected, but the process can take months 

because the form is created from official automated records that must be 

searched and corrected. 

For more information or to request corrections, contact your service 

member/veteran’s service administration:

Army

Active, Reserve members, and National Guard personnel should 

contact their local personnel records manager. Additional questions 

may be submitted to the Army VMET On-Line Help Desk at vmet@

resourceconsultants.com.

Chapter 6 - Employment

DD Form 214 

is one of the 

most important 

documents that 

your service 

member/veteran 

will receive. 

46
Navigating Services and Benefits 

Navy

Sailors can get assistance via e-mail at p662c12a@persnet.navy.mil or by 

calling DSN: 882-4384; 901-874-4384.

Air Force

Air Force personnel should review their VMET prior to separation to 

ensure corrective action can be taken. Active members should send their 

requests for corrections to AFPC/DPSIA, Attn: VMET Correction, 550 C 

Street West, Ste 37, Randolph AFB TX 78150-4739 or by fax to DSN 

665-3385 or commercial: 210-565-3385. Include address, phone 

number, and an e-mail address. Air Force Reserve and National Guard 

personnel should contact their servicing military personnel flight.

Marine Corps

All active duty and Reserve Marines should contact Marine For Life (M4L): 

https//www.m4l.usmc.mil; (866-645-8762).

Is Unemployment Compensation Available for 

Ex-Service Members?

Under United States Code, Title 5, Section 8521, a former service 

member is eligible to receive unemployment compensation if the 

discharge or release is Under Honorable Conditions (at a minimum).

Receiving separation pay may also influence receipt of unemployment 

compensation. 

Retirees will almost certainly receive a lesser amount [or no amount] 

since the weekly amount of retirement pay is usually “offset” against the 

amount of unemployment compensation. 

Your state employment office handles unemployment compensation. 

Benefits vary from state to state. Because of this, only the office where 

your service member applies will be able to explain the amount and 

duration of his or her entitlement. The nearest state employment office is 

listed in your local telephone directory. 

To receive unemployment compensation, the service member/veteran 

must apply. The best time to do that is when he or she visits the Local 

Veterans Employment Representative (LVER) at the state employment 

services office for assistance in finding a new job (see pages 51 and 117 

for more information on the LVER). 

Service members 

separating from 

active duty 

may qualify for 

unemployment 

compensation if 

they are unable to 

find a new job. 

47
To apply for unemployment compensation, he or she must bring the DD 

214, his or her Social Security card, and civilian and military job history 

or resume. 

Is My Family Member’s Old Job Still Available? 

Under the Uniformed Services Employment and Reemployment Rights 

Act (USERRA), returning service members who meet basic eligibility 

criteria and left a civilian job to perform military service (voluntarily or 

involuntarily) may have the right to return to the job they held before 

they were deployed.

USERRA also requires that returning service members be reemployed 

in the job that they would have attained had they not been absent 

for military service with the same seniority, status, pay, etc., assuming 

eligibility requirements are met.

To be eligible for reemployment rights, the service member/veteran 

cannot have been absent from work for military duty for greater than a 

total of five years. There are important exceptions to the five-year limit, 

including initial enlistments lasting more than five years, periodic National 

Guard and Reserve training duty, and involuntary active duty extensions 

and recalls, especially during a time of national emergency.

Application for reemployment must be made within specific time frames:

• For military service of less than 31 days, return to work must occur at 

the beginning of the next regularly scheduled work period on the first 

full day after release from service, taking into account safe travel home 

plus an eight-hour rest period.

• For military service of more than 30 days but less than 181 days, 

application for reemployment must be made within 14 days of release 

from service.

• For service of more than 180 days, application for reemployment must 

be submitted within 90 days of release from service.

Service members/veterans who are recovering from injuries received 

during service or training have up to two years to return to the job.

USERRA also provides enhanced protection for disabled veterans. It requires 

employers to make reasonable efforts to accommodate the disability. 

It also requires employers to make reasonable efforts (such as training or 

retraining) to help returning service members refresh or upgrade their 

skills to qualify for reemployment.

Chapter 6 - Employment

Your family 

member may have 

the right to get 

his or her old job 

back.

48
Navigating Services and Benefits 

More information is available at the eLaws USERRA Advisor (www.dol.

gov/elaws/userra.htm). Complaints related to denial of reemployment 

may also be filed online through this site.

Information about USERRA and the Americans with Disabilities Act (ADA) 

is available at http://eeoc.gov/facts/Veterans-disabilities.html. 

Some states have state-specific reemployment rights laws that provide 

further protection for service members. See Chapter 14, State Benefits, 

for links and contacts to local VA offices.

What Employment-Related Services are 

Available for Veterans and Family Members?

Vocational and Education Counseling 

This program offers professional and qualified vocational and educational 

counseling to veterans and family members who are eligible for 

educational benefits under a program that the VA administers. 

Eligible applicants include:

• those who are discharged or released from active duty under honorable 

conditions not more than one year before date of application

• those who are still on active duty and who have six or fewer months 

remaining before their scheduled release or discharge from service. 

Use VA Form 22-5490 to apply.

Family and Medical Leave

The Family and Medical Leave Act (FMLA) of 1993 provides service members/ 

veterans and their spouses employed by companies with 50 or more 

employees up to 26 weeks of unpaid leave per year to care for a seriouslyinjured service member without losing their jobs or health care insurance. 

To qualify, an employee must have worked at least 1,250 hours during 

the preceding 12-month period. More details are available in this fact 

sheet from the U.S. Department of Labor: http://www.dol.gov/esa/whd/

regs/compliance/whdfs28.pdf.

Some states and employers have more extensive policies regarding leave 

for caregiving. To see what your state’s policies are, go to the state-bystate comparison from the National Partnership for Women & Families at 

http://www.nationalpartnership.org/site/DocServer/StateunpaidFMLLaws.

pdf?docID=969.

You may be 

eligible to take 

time off to care 

for your family 

member with TBI 

without losing 

your job. 

49
Check with your company’s human resources department about your 

eligibility for unpaid leave under the FMLA. Get to know your company’s 

caregiver leave policies. Explore alternative working arrangements, such 

as flexible hours, working from home, reduced hours, etc. 

Job-Seeking Help

There is support available to you and to your injured spouse if you are 

seeking employment. This support recognizes the important contribution 

that both you and your spouse have made in service to the United States. 

Start by checking with your post or base’s support services. Depending on 

your spouse’s service branch, your Fleet and Family Support Center, Marine 

Corps Community Services, Airman and Family Readiness Center, or Army 

Community Service Center can provide you with information and support.

What Employment-Related Resources are 

Available for Injured Veterans?

REALifelines

The REALifelines program from the Department of Labor (DOL) helps 

injured veterans return to fulfilling, productive civilian lives. 

Chapter 6 - Employment

Job search help is 

available to both 

you and your 

family member.

“If you have been wounded or injured serving this nation, 

real people are going to meet you face-to-face with the 

personalized help that you may need to recover and to succeed 

in a career that you love.”

 - Elaine L. Chao, Secretary of Labor 

 October 4, 2004 

The program unites federal, state, and local level efforts to create a 

network of resources that focus on veteran well-being and job placement 

assistance. It addresses the professional and educational goals of veterans 

while they deal with the realities of rehabilitation and recovery.

REALifelines connects injured military members with employment and 

rehabilitation advisors and facilitates development of a tailor-made 

plan to overcome obstacles related to employment, education, and 

workforce re-integration.

50
Navigating Services and Benefits 

For more information, go to http://www.dol.gov/vets/REALifelines/

index.html.

Job Accommodations for Disabled Veterans

Resources that may be helpful to disabled veterans and their managers 

include:

Job Accommodation Network (JAN)

JAN is a free service from DOL’s Office of Disability Employment Policy. 

It provides personalized worksite accommodations, information about the 

Americans with Disabilities Act (ADA) (see Module 3, page 12) and other 

disability-related information, and information about self-employment. 

Visit http://www.jan.wvu.edu or call 800-526-7234 (V/TTY).

America’s Heroes At Work

This DOL Web site (www.americasheroesatwork.gov) focuses on 

employment challenges of returning service members with TBI and PTSD. 

This site has extensive links to other Web sites.

America’s Job Bank (AJB) and DoD Job Search

America’s Job Bank is a service provided by DOL and the individual 

state employment services. Employers submit their hiring requirements 

directly into AJB and job seekers can search the online database and apply 

for jobs. Job seekers can also register and make their resumes available 

for employers.

The DoD Job Search Web site is part of the AJB that is designed 

exclusively for service members. It shows how to translate military 

occupational codes into a civilian occupation. Visit the Web site at 

http://dod.jobsearch.org.

State Employment Services and Local Veterans Employment 

Representatives

Every state employment service has specialists called Local Veterans 

Employment Representatives (LVER) and Disabled Veterans Outreach 

Program Specialists (DVOP). 

These specialists can help veterans find local job opportunities and 

prepare for a new job. 

Veterans should contact the state employment services office, identify 

themselves as veterans, and request an appointment with the LVER.

Disabled veterans 

may need and 

are entitled 

to workplace 

adjustments or 

accommodations 

for their disability. 

LVERs and DVOPs 

are trained to help 

veterans make 

the important 

adjustment to 

the civilian job 

market. 

51
DOL Disability Resources

Information on the ADA, along with links to agencies that enforce its 

provisions, may be found at www.dol.gov/dol/topic/disability/ada.htm.

ADA & IT Technical Assistance Centers

These ten regional centers provide ADA information, training, and 

technical assistance, including guidance on accommodation issues.

Visit www.adata.org or call 800-949-4232 (V/TTY) for more information.

Computer/Electronic Accommodations Program (CAP)

CAP is the federal government’s centrally-funded accommodation 

program. It provides assistive technology and services free of charge 

to federal agencies and injured service members through partnership 

agreements. 

In addition to customizing the most appropriate solution for each 

individual, CAP obtains and delivers the accommodation and covers 

the cost of installation, integration, and user training. Check out 

www.tricare.mil/cap or call 703-681-8813.

Office of Personnel Management, Federal Employment of People 

with Disabilities

www.opm.gov/disability is the federal government’s centralized Web 

site with information on federal disability hiring programs, resources for 

federal employees with disabilities, and discussion of laws and regulations 

on hiring and discrimination of disabled persons.

Some federal agencies have their own programs to provide expertise and 

support in providing reasonable accommodations. For agency-specific 

programs, visit www.dol.gov/odep/pubs/misc/advance.htm.

Veterans’ Preference Information

Disabled veterans who served on active duty during specified time 

periods or specific campaigns are entitled to preference over others in 

hiring for virtually all federal government jobs. 

To learn more about how the veterans’ preference works, visit the Office of 

Personnel Management site at www.opm.gov/Veterans/html/vetsinfo.asp. 

To learn more about the laws regarding the veterans’ preference and 

to see what your service member/veteran’s eligibility allows, visit the 

Veterans’ Preference Advisor at www.dol.gov/elaws/vetspref.htm.

52 Chapter 6 - Employment
Navigating Services and Benefits 

What Job Opportunities Exist for Spouses of 

Veterans with a 100% Disability Rating?

Federal Civil Service

If your service member/veteran with a TBI is your spouse who is a totally 

disabled, retired, or separated member of the Armed Forces (has been 

retired with a disability rating at the time of retirement of 100 percent or 

retired/separated from the Armed Forces with a disability rating of 100 

percent from the Department of Veterans Affairs), you are eligible for 

expedited recruitment and selection for Federal civil service positions.

If your spouse is rated with a 100 percent service-connected disability, the 

Federal government considers you to be an “other eligible,” providing 

the same resources, rights, and services that are available to veterans and 

disabled veterans. You will be given priority in Labor Department-funded 

employment and training programs, as well as preference in federal hiring. 

You can search for a Federal civil service position by contacting a One 

Stop Career Center (find the nearest one at www.servicelocator.org). 

Introduce yourself as the spouse of a recently disabled veteran. Ask to 

speak with a work force specialist. This individual can tell you about job 

opportunities in your area. 

Be sure to tell the work force specialist if your spouse received a 100 

percent disability rating so that he or she knows you are eligible for 

veterans’ and priority services.

What Other Opportunities are Available for 

Active Duty Service Members and Veterans?

Troops to Teachers (TTT) 

The Troops to Teachers (TTT) program is funded and overseen by the 

Department of Education and operated by the DoD. The TTT program 

helps recruit quality teachers for schools that serve students from lowincome families throughout America. 

A network of state TTT offices has been established to provide participants 

with counseling and assistance regarding certification requirements, route 

to state certification, and employment leads. 

Pending annual appropriation of funds, financial assistance is available 

to eligible individuals as stipends of up to $5,000 to help pay for teacher 

Spouses of 100 

percent disabled 

veterans have 

preference in 

federal hiring.

Troops to Teachers 

helps military 

members and 

spouses find 

second careers as 

teachers.

53
certification costs or as bonuses of $10,000 to teach in schools serving a 

high percentage of students from low-income families. 

Veterans separated due to a service-connected disability are eligible for 

immediate financial assistance. 

The TTT Web site (http://proudtoserveagain.com) provides information 

and resource links, including links to state Departments of Education, 

state certification offices, model resumes, programs leading to teacher 

certification, and job listing sites in public education. An Internet 

Referral System has been established to enable participants to search 

for job vacancies online and post resumes for view by school districts 

searching for teachers. A “Mentor Connection” site provides access to 

TTT participants who have made the transition to teaching and are also 

available to respond to questions from prospective teachers. 

Eligibility 

Military personnel within several years of retirement are encouraged to 

register with TTT. Counseling and guidance is available to help individuals 

assess academic background, identify programs that will lead to state 

teacher certification, and identify potential employment opportunities. 

Educational Requirements. Those interested in elementary or secondary 

teaching positions must have a bachelor’s degree from an accredited 

college. Individuals who do not have a baccalaureate degree, but have 

experience in a vocational/technical field may also submit an application. 

There is also a growing need for teachers with backgrounds in areas such 

as: electronics, construction trades, computer technology, health services, 

food services, and other vocational/technical fields. 

Hire in Advance Program 

This program guarantees teaching jobs for eligible service members up 

to three years before they retire or separate from active duty. Troops 

who qualify for the Hire in Advance program can send in applications 

and interview with school officials who can officially hire them up to 

three years before they leave active duty. The TTT and the Hire in 

Advance Program are both open to military spouses, as well. For more 

information, visit http://proudtoserveagain.com.

54 Chapter 6 - Employment
Navigating Services and Benefits 

What Employment Resources are Available for 

Caregivers?

The Military Spouse Resource Center (www.MilSpouse.org) is a 

Web-based service provided by the Department of Defense and the 

Department of Labor. It provides information about education, training, 

and employment, as well as child care and transportation.

If you need a job, investigate the Military Spouse JobSearch Web site 

(http://www.militaryspousejobsearch.org/msjs/app). It can help you find 

companies that are committed to hiring military spouses. It also allows 

you to search for jobs by the name of a military post or base.

Military Spouse JobSearch also provides job search resources for people 

with disabilities, in the event that your service member is not able to 

return to duty due to disability. 

Other resources for veterans and their spouses include federal 

government positions. The government’s Office of Personnel 

Management provides information on job opportunities for veterans at 

http://www.opm.gov/veterans.

Operation IMPACT

Operation IMPACT was launched within Northrop Grumman’s Mission 

Systems sector in May 2005. The program provides transition support to 

service members severely injured in the OEF/OIF. It helps them identify 

career opportunities within the corporation. If an injured service member is 

no longer able to work, the program offers career support to a member of 

the individual’s immediate family who will act as the primary wage earner.

Program Eligibility

To be eligible for the program, candidates must meet the following criteria:

• Severely injured during combat operations in OEF/OIF on or after 

September 11, 2001

• Disability rating of 30 percent or greater from the Department of 

Veterans Affairs

• One or more special category designation (SPECAT) casualty codes 

for the injury sustained — contact Operation IMPACT, Debbie 

Ortega, Program Administrator, at 1-800-395-2361 or e-mail 

operationimpact@ngc.com for more details.

55
• Special Note: The program will accept one primary family wage earner 

(spouse, parent, other) in cases where the service member has died or 

is too severely injured to serve as the primary wage earner for his or 

her immediate family.

Is My Family Member Eligible for a Small 

Business Loan?

Is your service member/veteran interested in starting a business? Business 

loans are available to veterans through the Small Business Administration 

(SBA). In addition, SBA offers loans specifically to disabled veterans. Go 

to http://www.sba.gov for more information about the SBA’s Patriot Loan 

Express program.

See Appendix G for additional employment resources.

56 Chapter 6 - Employment
Navigating Services and Benefits 

This chapter will help you identify the education benefits for which you 

and/or your service member/veteran are eligible. 

What Education Benefits are Available for 

Service Members and Veterans?

The Department of Veterans Affairs (VA) provides financial help to service 

members and veterans under the Post-9/11 GI Bill. 

You can find out more about VA’s education benefits at 

http://www.gibill.va.gov. The VA regional office in your area or the 

post/base Education Center can also give you more information.

Post-9/11 GI Bill

The Post-9/11 GI Bill is a new benefit that became effective on 

August 1, 2009. It provides educational help to those who have 

served on active duty on or after September 11, 2001.

This benefit provides up to 36 months of support for:

• graduate and undergraduate degrees

• vocational/technical training 

• foreign training. 

All training must be offered by a VA-approved institution of higher 

learning. The benefit also covers tutorial help and licensing and 

certification test reimbursement.

In addition, service members who are eligible for the Montgomery GI Bill 

(MGIB), Montgomery GI Bill – Selected Reserve (MGIB-SR), or the Reserve 

Educational Assistance Program (REAP) may also be eligible to pursue onthe-job training, apprenticeship, correspondence, flight, or preparatory 

courses under the Post-9/11 GI Bill.

Eligible service members/veterans will receive a percentage—as 

determined by length of creditable active duty service—of the following 

under the Post-9/11 GI Bill:

• Amount of tuition and fees not to exceed the most expensive in-state 

public institution of higher education

• Monthly housing allowance equal to the basic allowance for housing 

(BAH) amount payable to E-5 with dependents, in the same zip code 

as the school (except for those on active duty and those training at less 

than half time)

If re-training or 

higher education 

is a goal for you 

or your family 

member, help is at 

hand.

Active duty 

service members 

are eligible for 

the Post-9/11 

GI Bill or the 

Montgomery GI 

Bill.

Chapter 7

Education

57
• Yearly books and supplies stipend of up to $1000 (except for those on 

active duty)

• A one-time payment of $500 may be payable to the service member/

veteran if he or she relocates from a highly rural area.

Chapter 7 - Education

“We’re not going to go to vocational rehab until we absolutely 

have to, because he just sees that as a real negative. So we’re 

going with his GI Bill to take some college classes. In the State 

of Florida, Purple Heart pays your schooling 100 percent on top 

of your GI bill. We’re going with that for right now, just kind of 

testing the waters to see what’s going to happen.”

 - Cyd D.

Eligibility

Eligibility for the Post-9/11 GI Bill includes those that have a minimum of 

90 days active duty after September 10, 2001, and:

• Were honorably discharged from the Armed Forces; OR

• Were released from the Armed Forces with service characterized as 

honorable and placed on the retired list, temporary disability retired 

list, or transferred to the Fleet Reserve or the Fleet Marine Corps 

Reserve; OR

• Were released from the Armed Forces with service characterized as 

honorable for further service in a reserve component; OR

• Were discharged or released from the Armed Forces for Existed Prior to 

Service; Hardship; Condition Interfered with Duty; OR

• Continue to be on active duty.

Service members/veterans who are eligible for MGIB, MGIB-SR, REAP, or 

who were serving in the Armed Forces on August 1, 2009 are also eligible 

to receive benefits under the Post-9/11 GI Bill.

Vocation and Education Counseling 

This program offers professional and qualified vocational and educational 

counseling to:

• service members within six months of discharge

• veterans

58
Navigating Services and Benefits 

• family members who are eligible for educational benefits under a 

program that the VA administers. 

Eligible applicants include those who are discharged or released from 

active duty under honorable conditions not more than one year before 

date of application, as well as those who are still on active duty and have 

six or fewer months remaining before their scheduled release or discharge 

from service. Use VA Form 22-5490 to apply.

What Education Benefits are Available for 

Selected Reserve Members?

Montgomery GI Bill – Selected Reserve (MGIB-SR)

If your service member is a member of the Selected Reserve, he or she 

may be eligible for the MGIB-SR. The Selected Reserve includes:

• Army Reserve 

• Navy Reserve 

• Air Force Reserve 

• Marine Corps Reserve 

• Coast Guard Reserve 

• Army National Guard

• Air National Guard. 

This education assistance program may be used for:

• degree programs

• certificate or correspondence courses 

• cooperative training

• independent study programs 

• apprenticeship/on-the-job training 

• vocational flight training programs. 

Eligibility

Eligible candidates include those who meet the following requirements: 

• Have a six-year obligation to serve in the Selected Reserve signed after 

June 30, 1985. Officers must have agreed to serve six years in addition 

to their original obligation. For some types of training, it is necessary 

to have a six-year commitment that begins after September 30, 1990.

• Complete initial active duty for training (IADT).

The Select 

Reserve member 

may be eligible 

for financial 

assistance for 

education.

59
• Meet the requirement to receive a high school diploma or equivalency 

certificate before completing IADT. Not more than 12 hours may be 

used toward a college degree to meet this requirement.

• Remain in good standing while serving in an active Selected Reserve unit. 

How to Apply 

The Reservist’s unit will give him or her DD Form 2384-1, Notice of Basic 

Eligibility, when he or she becomes eligible for the program. The unit will 

also code his or her eligibility into the DoD personnel system so that VA 

may verify eligibility.

The Reservist must complete VA Form 22-1990, Application for Education 

Benefits, and send it to the VA regional office in the state where he or she 

will train. 

If he or she has already started training, he or she should take the 

application and Notice of Basic Eligibility to his or her school or employer. 

Ask them to complete VA Form 22-1999, Enrollment Certification, and 

then send all the forms to VA. 

What Education Benefits are Available for 

Veterans?

The VA provides financial assistance for education to veterans under the 

Montgomery GI Bill (MGIB) and the Veterans Educational Assistance 

Program (VEAP). 

To be eligible for the Montgomery GI Bill or VEAP, the veteran must have 

received an honorable discharge and elected enrollment in MGIB, making 

contributions through payroll deductions. 

If your service member with TBI is leaving the service involuntarily or 

through the SSB or VSI programs, he or she can enroll in MGIB by making 

a $1200 personal contribution prior to separation. 

Montgomery GI Bill – Active Duty (MGIB)

The MGIB provides up to 36 months of education benefits to eligible 

veterans for:

• college

• technical or vocational courses

• correspondence courses

• apprenticeship/job training

Veterans are 

also eligible 

for financial 

assistance for 

education.

60 Chapter 7 - Education
Navigating Services and Benefits 

• flight training

• high-tech training

• licensing and certification tests

• entrepreneurship training

• certain entrance examinations.

The monthly benefit is paid based on the type of training, length of 

service, veteran’s service category, and if DoD put extra money into the 

individual’s MGIB fund. 

MGIB benefits must normally be used within ten years, but the time 

could be less or more. An extension of the time limit may be requested 

in the event of a later period of active duty, an illness or disability, or 

being detained by a foreign government or power after separation from 

the military. 

Requests for an extension should be sent to the nearest Regional 

Processing Office; locations may be found at http://www.gibill.va.gov/

contact/Office_locations.htm.

Eligibility

To be eligible for MGIB, the veteran must have received an honorable 

discharge, have a high school diploma or GED, or, in some cases, 

12 hours of college credit, and meet the requirements of one of the 

following categories:

Category I – Service after June 30, 1985

• Entered active duty for the first time after June 30, 1985

• Had military pay reduced by $100 per month for the first 12 months

• Continuously served for three years, OR two years if that was the 

period of initial enlistment, OR two years if the veteran entered the 

Selected Reserve within a year of leaving active duty and served four 

years (2” by 4” program).

Category II – Vietnam Era GI Bill

• Entered active duty before January 1, 1977

• Served at least one day between October 19, 1984, and June 30, 

1985, AND stayed on active duty through June 30, 1988 (or June 30, 

1987, if the veteran entered the Selected Reserve within one year of 

leaving active duty and served four years)

• On December 31, 1989, had entitlement left from Vietnam-Era GI Bill.

61
Category III – Involuntary Separation/Special Separation

• Not eligible for MGIB under Category 1 or II

• On active duty on September 30, 1990 AND separated involuntarily 

after February 2, 1991, OR involuntarily separated on or after 

November 30, 1993, OR voluntarily separated under either the 

Voluntary Separation Incentive (VSI) or Special Separation Benefit 

(SSB) program

• Before separation, had military pay reduced by $1,200.

Category IV – Veterans Educational Assistance Program

• On active duty October 9, 1996, AND had money remaining in a VEAP 

account on that date AND elected MGIB by October 9, 1997, OR 

entered full-time National Guard duty under U.S.C., Title 32, between 

July 1, 1985, and November 28, 1989, AND elected MGIB during the 

period October 9, 1996, through July 8, 1997

• Had military pay reduced by $100 a month for 12 months or made a 

$1200 lump-sum contribution.

How to Apply

A veteran can apply online at http://www.gibill.va.gov/GI_Bill_Info/How_

to_Apply.htm or by calling 1-888-GI BILL-1 (1-888-442-4551) to receive 

an application by mail.

Veterans Educational Assistance Program (VEAP)

VEAP is available to veterans who elected to make contributions from 

their military pay to participate in this education benefit program. The 

program provides up to 36 months of benefits for:

• degree programs

• certificate courses

• correspondence courses 

• apprenticeship/on-the-job training programs

• vocational flight training programs. 

In certain circumstances, remedial, deficiency, and refresher training may 

also be available. 

Benefit entitlement is one to 36 months, depending on the number of 

monthly contributions. 

Benefits must be used within 10 years after leaving active duty. If the 

benefit is not used after the 10-year period, the portion remaining in the 

fund will be automatically refunded to the veteran.

62 Chapter 7 - Education
Navigating Services and Benefits 

Eligibility

To qualify for VEAP, a veteran must meet the following requirements: 

• Entered service for the first time between January 1, 1977 and 

June 30, 1985

• Opened a contribution account before April 1, 1987

• Voluntarily contributed from $25 to $2700 

• Completed his or her first period of service 

• Was discharged or released from service under conditions other than 

dishonorable. 

Active duty service members who wish to receive VEAP benefits must 

have at least three months of contributions available. Contributions may 

be withdrawn if the service member does not meet the basic eligibility 

requirements or formally requests a refund of the contributions withheld. 

How to Apply

Complete VA Form 22-1990, Application for Education Benefits (available at 

https://www.va.gov/vaforms/form_detail.asp?FormNo=22-1990). Send it 

to the VA regional office within the state where the service member/veteran 

will train. 

If the service member/veteran is not on active duty, send copy 4 

(Member Copy) of DD Form 214. 

If the service member is on active duty, enrollment must be approved by 

the Education Services officer at his or her post or base, and service must 

be verified by his or her commanding officer. 

If a service member wishes to withdraw contributions from VEAP, he or 

she must obtain and complete VA Form 24-5281, Application for Refund 

of Educational Contributions, and send it to the nearest VA regional office. 

Veterans Upward Bound (VUB) program 

VUB is a free Department of Education program that helps eligible 

veterans refresh their academic skills so that they can successfully 

complete the post-secondary school of their choosing. 

The VUB program services include: 

• basic skills development to help veterans successfully complete a high 

school equivalency program and gain admission to college education 

programs 

63
• short-term remedial or refresher classes for high school graduates who 

have put off pursuing a college education 

• help with applications to the college or university of choice 

• help with applying for financial aid 

• personalized counseling 

• academic advice and assistance 

• career counseling 

• assistance in getting veterans’ services from other available resources 

• exposure to cultural events, academic programs, and other 

educational activities 

• tutorial and study skills assistance.

The VUB program can help veterans improve their skills in: 

• mathematics 

• foreign language 

• composition 

• laboratory science 

• reading 

• literature 

• computer basics 

• any other subjects needed for success in education beyond high school.

Eligibility

• Be a veteran with 181 or more days active duty service and discharged 

on/after January 31, 1955, under conditions other than dishonorable; 

and 

• Meet the criteria for low income according to guidelines published 

annually by the Department of Education, and/or be a first-generation 

potential college graduate; and

• Demonstrate academic need for VUB; and 

• Meet other local eligibility criteria as noted in the local VUB project’s 

Approved Grant Proposal, such as county of residence, etc. 

For more information, as well as a link to individual program locations, 

visit http://navub.org/programinformation.

64 Chapter 7 - Education
Navigating Services and Benefits 

What Education Benefits Are Available for 

Veterans with Service-Connected Disabilities?

The Vocational Rehabilitation and Employment Program 

(VR&E)

The VR&E program helps veterans with service-connected disabilities 

become suitably employed, maintain employment, or achieve 

independence in daily living. The law generally provides for a 12-year 

basic period of eligibility in which services may be used. 

To receive an evaluation for vocational rehabilitation services, 

a veteran must:

• Have received, or eventually receive, an honorable or other than 

dishonorable discharge 

• Have a VA service-connected disability rating of 10 percent or more 

• Apply for vocational rehabilitation services.

A Comprehensive Evaluation is completed with a Vocational Rehabilitation 

Counselor that includes:

• A full assessment of the veteran’s interests, aptitudes, and abilities to 

determine whether the veteran is entitled to VR&E services 

• An assessment of whether service-connected disabilities impair the 

veteran’s ability to find and/or hold a job using the occupational skills 

already attained 

• Vocational exploration and goal development. 

A VA counselor decides if a veteran has an employment handicap based 

upon the results of the comprehensive evaluation. Entitlement to services 

is established if the veteran has a 20 percent service-connected disability 

and an employment handicap. If the disability is 10 percent serviceconnected, then a serious employment handicap must be found to 

establish entitlement to vocational rehabilitation services.

After an entitlement decision is made, the veteran and the counselor will 

work together to develop a Rehabilitation Plan.

A Rehabilitation Plan is a written detailed outline of services provided 

under the Vocational Rehabilitation and Employment program. The 

following service delivery options may be provided under a 

Rehabilitation Plan:

1. Reemployment with previous employer 

2. Rapid employment services for new employment 

65
3. Self-employment 

4. Employment through long-term services 

5. Independent living services. 

For more information: http://www.vetsuccess.gov/about. 

What Education Benefits are Available for 

Veterans and Their Family Members?

Survivors’ and Dependents’ Educational Assistance

This VA program provides educational assistance for a spouse or child of 

a veteran who is permanently and totally disabled as a result of a serviceconnected disability or who dies due to a service-connected disability. 

(It also covers those who are missing in action or prisoners of war.)

The program provides up to 45 months of education benefits for:

• degree and certificate programs

• apprenticeship

• on-the-job training. 

Spouses may also be approved for correspondence courses. 

Remedial, deficiency, and refresher courses may be approved under 

certain circumstances.

VA Form 22-5490 is used to apply for this benefit. For more information, 

go to https://www.gibill.va.gov.

Vocation and Education Counseling 

This program offers professional and qualified vocational and educational 

counseling to veterans and family members who are eligible for 

educational benefits under a program that the VA administers. 

Eligible applicants include those who are discharged or released from 

active duty under honorable conditions not more than one year before 

date of application, as well as those who are still on active duty and have 

six or fewer months remaining before their scheduled release or discharge 

from service. Use VA Form 22-5490 to apply.

66 Chapter 7 - Education
Navigating Services and Benefits 

What Education Benefits are Available for 

Family Members?

Post-9/11 GI Bill entitlement (see above) may be transferred to a spouse 

or children with DoD approval. 

Scholarships

The Scholarships for Military Children Program was created in recognition 

of the contributions of military families to the readiness of the fighting 

force and to celebrate the role of the commissary in the military family 

community. 

It is the intent of the program that a scholarship funded through 

contributions be awarded annually for each commissary operated by the 

Defense Commissary Agency worldwide.

The Scholarships for Military Children Program is primarily funded 

through the generosity of manufacturers and suppliers whose products 

are sold at military commissaries, worldwide. 

Children of active duty, Reserve/Guard, or retired military personnel 

or survivors of a deceased member can apply. Applicants must have a 

military dependent I.D. card. 

Applicants must be planning to attend a college or university on a fulltime basis.

For more information, visit www.militaryscholar.org.

What Education Benefits are Available for 

Caregivers?

Scholarships

If you are the spouse of a service member/veteran, you can find 

scholarships to further your education by checking a list provided by 

MilitarySpouse.com at http://www.dantes.doded.mil/dantes_web/library/

docs/counselorsupport/fossm.pdf.

67
What Other Education Benefits Should I 

Consider?

Scholarships

Active duty, veterans, Reserve, National Guard, spouses, and dependents 

can search for scholarships at http://aid.military.com/scholarship/searchfor-scholarships.do. Be sure to explore scholarships for every eligibility 

requirement that you may meet.

Federal Student Aid

The U.S. Department of Education (ED) offers over $80 billion dollars in 

financial aid each year to help students manage the cost of education. 

There are three categories of federal student aid: 

• grants 

• work-study 

• loans. 

Find out more by visiting http://www.federalstudentaid.ed.gov.

Federal Student Aid is available to service members/veterans who are 

receiving benefits under the Montgomery GI Bill. These benefits should 

be listed on the Free Application for Federal Student Aid (FAFSA) (see 

How to Apply on page 69). 

The school will take into consideration the amount listed on the 

application, along with any other financial assistance the service 

member/veteran is eligible to receive, in preparing the student’s financial 

aid package. 

Federal Student Aid has a new tool called FAFSA4caster. It provides 

an early estimate of students’ eligibility for federal student financial 

assistance. 

Military dependents who are enrolled in college and are eligible to receive 

Pell Grants should check out the two newest programs: 

• Academic Competitiveness Grants 

• National Science and Mathematics Access to Retain Talent Grants 

(National SMART Grants). 

Visit the Web site at http://www.federalstudentaid.ed.gov/fafsa4caster.

html for more information. 

Chapter 7 - Education

Service members/

veterans who 

return to school 

may also apply 

for federal student 

aid.

68
Navigating Services and Benefits 

Eligibility

Eligibility for Federal Student Aid is based on financial need and on 

several other factors. The financial aid administrator at the college or 

career school the individual plans to attend can help determine his or her 

eligibility. 

To receive aid from the programs, the applicant must: 

• Demonstrate financial need (except for certain loans—the school can 

explain which loans are not need-based)

• Have a high school diploma or a GED certificate, pass a test approved 

by the Department of Education, meet other standards a state 

establishes that ED approves, or complete a high school education in a 

home school setting that is treated as such under state law

• Be working toward a degree or certificate in an eligible program

• Be a U.S. citizen or eligible non-citizen

• Have a valid Social Security number 

(unless from the Republic of the Marshall Islands, the Federated States 

of Micronesia, or the Republic of Palau)

• Maintain satisfactory academic progress once in school

• Certify that he or she is not in default on a federal student loan and 

does not owe money on a federal student grant

• Certify that he or she will use federal student aid only for 

educational purposes. 

How to Apply

Complete the Free Application for Federal Student Aid (FAFSA). You can 

apply online or on paper. Get further instructions on the application 

process at http://www.fafsa.ed.gov. 

Also apply for a Federal Student Aid PIN, which allows the applicant to 

sign the application electronically, speeding up the application process. 

Apply for a PIN at http://www.pin.ed.gov.

Eight questions on the application ask about the applicant’s dependency 

status. Veterans and active duty service members are considered 

independent students and would only include information for the 

individual (and spouse, if married). For more detailed information, go to 

http://www.fafsa.ed.gov.

69
70
Navigating Services and Benefits 

Where are you going to live while your service member is being treated? 

Will you need to modify your home so that your service member/veteran 

can move around in a wheelchair? 

You may be wondering about these questions. This chapter provides 

some answers to your housing questions. 

What Temporary Housing is Available for 

Caregivers?

During Treatment

If your service member/veteran is being treated at a military treatment 

facility (MTF) or a VA Polytrauma Center, you may be able to stay nearby 

for free or at a low cost. 

Housing for family members includes:

• Malone House at Walter Reed

• Navy Lodges

• Fisher Houses at the VA Polytrauma Centers. 

Each hospital or post/base commander decides who is eligible for free housing. 

Nonprofit organizations may also make some apartments near treatment 

centers available to families at little or no cost. 

Check with your POC to find out what temporary housing is available where 

your family member is being treated. The POC can also help you find 

housing when your family member moves to another DoD or VA facility.

The National Resource Directory provides information about temporary 

housing at https://www.nationalresourcedirectory.org/nrd/public/

DisplayPage.do?parentFolderId=6067. 

What Temporary Housing is Available for Those 

Leaving the Military?

Leaving Active Duty

Service members usually must leave family housing as soon as they leave 

active duty. 

In some cases, a service member may be eligible for an extension. An 

extension allows you to remain in family housing beyond your family 

member’s transition date. 

Chapter 8

Housing

Find out about 

Navy Lodges at 

https://www.

navy-lodge.com/

dodlodging/index.

html. You can 

find information 

on Fisher House 

at http://www.

fisherhouse.org.

71
Eligibility is limited to involuntary separations, including Selected Early 

Retirement Board (SERB) Retirement, Special Separation Benefit (SSB), 

Voluntary Separation Incentive (VSI), or separation due to medical 

condition. 

Housing extensions are made on a space-available basis. There may be 

restrictions in some locations.

Call the post/base housing office for details. 

The National Resource Directory lists organizations that provide 

temporary housing for wounded service members/veterans. For 

example, Operation Homefront Village (http://www.operationhomefront.

net/homefrontvillage) provides temporary housing as wounded service 

members transition out of the military and into civilian life.

What Housing Benefits are Available for Active 

Duty Service Members and Medically Retired 

Veterans?

Housing Adaptation

The goal of the Specially Adapted Housing (SAH) Grant Program is to 

provide a barrier-free living environment that helps the service member/

veteran live independently. There are two types of grants for severelydisabled veterans or service members: 

• Up to 50 percent of the cost of a specially adapted house. The 

maximum amount—currently $60,000--is set by law. 

• The actual cost to adapt a house or for the appraised market value 

of needed features already in the house when it was purchased. The 

maximum amount—currently $12,000—is set by law. 

For information, go to http://www.homeloans.va.gov/sah.htm.

Check with your POC about other sources of funds to adapt temporary 

housing and base housing to meet your service member/veteran’s 

needs. You may also find additional information in the National Resource 

Directory.

Service members/

veterans with 

specific serviceconnected 

disabilities may 

qualify for a grant 

from the VA to 

build an adapted 

home or modify 

an existing home 

to meet their 

needs. 

72 Chapter 8 - Housing
Navigating Services and Benefits 

Homes for Our Troops

Homes for Our Troops is committed to helping severely injured or 

disabled service members and veterans. Homes for Our Troops uses 

donated money, building materials, and professional labor. It coordinates 

the building of a new home or adapting an existing home to make it 

more accessible. For more information about this organization, please 

see www.homesforourtroops.org.

Other Organizations for Home Adaptation

There are many private organizations that are committed to helping with 

home adaptation. AMVETS, the American Legion, and Hope For The 

Warriors are just some of those who help. See the National Resource 

Directory (www.nationalresourcedirectory.org).

“We had to do some home modifications. Because of 

the brain injury, we weren’t sure what we needed to do 

permanently. We did hold off on a lot of stuff because we 

weren’t sure how far he was going to recover. Only as 

recently as last month did we even expand the opening in the 

bathroom door on the floor that he lives on. We still don’t 

have ramps.

We’ve just done minor modifications at this point. My 

thought process was that I didn’t want to use his money to 

do modifications until we were sure about his recovery. 

I didn’t know if eventually he may get to be somewhat 

independent and we build a place that he’s going to be able 

to live in or if he’s going to be able to go out on his own. We 

didn’t know because they said, ‘We can’t tell you what his 

prognosis is.’ We’re just hanging on to that whole allowance 

that they gave us because our home was already at least 

good enough for him for the level of recovery he’s at. He’s 

been doing all right.”

 - Pam E.

73
What Housing Benefits are Available for 

Veterans?

Home Loans

The main purpose of the VA home loan program is to make it easier for 

veterans to buy a home. Terms for VA loans include: 

• a lower interest rate

• no down payment

• limitations on closing costs 

• long repayment terms.

Certain members of the Selected Reserve, active duty service personnel, 

and certain groups of spouses may qualify for VA home loans. 

Your service member/veteran may be eligible if he or she served under 

the following time periods and conditions:

Wartime - Service during:

• WWII: 9/16/1940 to 7/25/1947

• Korean: 6/27/1950 to 1/31/1955

• Vietnam: 8/5/1964 to 5/7/1975

He or she must have at least 90 days on active duty and been discharged 

under other than dishonorable conditions. If he or she served less than 

90 days, he or she may be eligible if discharged for a service-connected 

disability.

Peacetime - Service during periods:

• 7/26/1947 to 6/26/1950

• 2/1/1955 to 8/4/1964

• 5/8/1975 to 9/7/1980 (Enlisted)

• 5/8/1975 to 10/16/1981 (Officer)

He or she must have served at least 181 days of continuous active duty 

and been discharged under other than dishonorable conditions. If he or 

she served less than 181 days, he or she may be eligible if discharged for 

a service-connected disability.

74 Chapter 8 - Housing
Navigating Services and Benefits 

Service after 9/7/1980 (Enlisted) or 10/16/1981 (Officer)

If he or she was separated from service which began after these dates, he 

or she must have:

• Completed 24 months of continuous active duty or the full period (at 

least 181 days) for which he or she was ordered or called to active duty 

and been discharged under conditions other than dishonorable, or

• Completed at least 181 days of active duty and been discharged under 

the specific authority of 10 USC 1173 (Hardship), or 10 USC 1171 

(Early Out), or have been determined to have a compensable serviceconnected disability, or

• Been discharged with less than 181 days of service for a serviceconnected disability. Individuals may also be eligible if they were 

released from active duty due to an involuntary reduction in force, 

certain medical conditions, or, in some instances, for the convenience 

of the Government.

Gulf War - Service during period 8/2/1990 to date yet to be 

determined

If he or she served on active duty during the Gulf War, he or she must have:

• Completed 24 months of continuous active duty or the full period (at 

least 90 days) for which he or she was called or ordered to active duty, 

and been discharged under conditions other than dishonorable, or

• Completed at least 90 days of active duty and been discharged under 

the specific authority of 10 USC 1173 (Hardship), or 10 USC 1173 

(Early Out), or have been determined to have a compensable serviceconnected disability, or

• Been discharged with less than 90 days of service for a serviceconnected disability. Individuals may also be eligible if they were 

released from active duty due to an involuntary reduction in force, 

certain medical conditions, or, in some instances, for the convenience 

of the Government.

Active Duty Service Personnel

If he or she is now on regular duty (not active duty for training), he or 

she is eligible after having served 181 days (90 days during the Gulf War) 

unless discharged or separated from a previous qualifying period of active 

duty service.

75
Selected Reserves or National Guard

If he or she is not otherwise eligible and has completed a total of six years 

in the Selected Reserves or National Guard (member of an active unit, 

attended required weekend drills and 2-week active duty for training) and

• Was discharged with an honorable discharge, or

• Was placed on the retired list, or

• Was transferred to the Standby Reserve or an element of the Ready 

Reserve other than the Selected Reserve after service characterized as 

honorable service, or

• Continues to serve in the Selected Reserves.

Individuals who completed less than six years may be eligible if 

discharged for a service-connected disability.

You may also be determined eligible if you:

• Are an unremarried spouse of a veteran who died while in service or 

from a service connected disability, or

• Are a spouse of a service person missing in action or a prisoner of war.

Note: Also, a surviving spouse who remarries on or after attaining 

age 57, and on or after December 16, 2003, may be eligible for the 

home loan benefit. However, a surviving spouse who remarried before 

December 16, 2003, and on or after attaining age 57, must have applied 

no later than December 15, 2004, to establish home loan eligibility. VA 

must deny applications from surviving spouses who remarried before 

December 6, 2003 that are received after December 15, 2004.

Eligibility may also be established for:

• Certain United States citizens who served in the Armed Forces of a 

government allied with the United States in WW II

• Individuals with service as members in certain organizations, such 

as Public Health Service officers, cadets at the United States Military, 

Air Force, or Coast Guard Academy, midshipmen at the United 

States Naval Academy, officers of National Oceanic & Atmospheric 

Administration, merchant seaman with WW II service, and others.

For more information about the VA’s home loan program, go to http://

www.homeloans.va.gov/index.htm.

76 Chapter 8 - Housing
Navigating Services and Benefits 

After a TBI, your family member may be unable to return to active duty, 

may retire, or may be separated from the service. 

You may be worried about where the money is going to come from to 

support your family, pay for your children’s education, or pay for your 

family member’s medical expenses. 

Your service member/veteran gave his or her all to defend our country. 

In return, your family member is eligible for important financial benefits. 

This chapter will help you understand the financial benefits that may be 

available to your family from DoD and the VA. 

Eligibility for each benefit varies, so be sure to read each section carefully. 

If you have questions, contact the Wounded Warrior Pay Management 

Team (WWPMT) and/or finance office at your service member’s location.

If your service member has been separated from the military, he or she 

may be eligible for VA benefits. To determine your service member/

veteran’s eligibility for benefits from the VA, he or she must file a claim 

with the VA. 

Forms may be downloaded from the forms page at www.insurance.va.gov. 

The VA representative at his or her location or an advisor from a Veterans 

Service Organization (VSO) can help. (See Appendix B for a link to a 

complete list of VSOs.) 

More information about VA benefits is available online at http://www.vba.

va.gov/VBA/benefits/factsheets/index.asp. You can review the latest VA 

Benefits Handbook at http://www1.va.gov/opa/vadocs/fedben.pdf.

What Types of Pay are Available for Active Duty 

Service Members?

Special/Partial/Casual Pays

If your family member is being treated at a location where it is difficult 

to get to his or her bank, he or she may qualify for a special payment to 

cover incidental costs during treatment. 

Each service has a different name for this payment: 

• Army: “casual pays” 

• Air Force: “partial pays”

• Navy/Marine Corps: “special pays.” 

Financial benefits 

include combat 

pay, retirement 

pay, disability 

payment, and 

insurance.

Chapter 9

Financial Issues

77
This payment is an advance on the end-of-month paycheck. It is 

automatically deducted from future pay periods until paid back. The 

closest military finance office can arrange this payment.

Basic Allowance for Subsistence (BAS)

If your service member is an inpatient in a hospital, he or she will 

continue to receive his or her BAS. 

When your family member becomes an outpatient, BAS will continue 

unless your service member is issued a meal card to eat in the military 

dining facility.

What is the Pay for the Medically Retired?

If your service member is judged able to return to active duty, he or she 

will continue to be paid according to his or her military schedule. 

If the PEB decides that your family member meets the criteria for one 

of these--

• Discharge with severance

• Temporary Disability Retirement List (TDRL) 

• Permanent Disability Retirement List (PDRL)

--he or she will receive compensation from the government. The 

compensation guidelines for these appear below. 

Details may be obtained at your service member’s local finance or 

personnel office or the Wounded Warrior Pay Management Team 

(WWPMT) member at his or her location.

Discharge with Severance

Pay is calculated by taking the service member’s base pay, multiplying it 

by two, and multiplying that number by the number of years of service 

completed. The minimum multiplier for years of service (no matter how 

long the actual service was) is:

• Three years

• Six years for those injured in a combat zone.

Because service members with 20 or more years of service receive 

retirement pay regardless of their combined disability rating, the 

maximum severance multiplier for years of service is 19.

78 Chapter 9 - Financial Issues

PEB stands 

for Physical 

Evaluation Board. 

See page 104.
Navigating Services and Benefits 

Temporary Disability Retirement List (TDRL)

If your service member is unfit for duty with a 30 percent or higher 

combined disability rating but his or her condition is not stable (it could 

get better or worse), he or she will be placed on TDRL. 

Pay under TDRL is determined by using one of two methods. The 

method which yields the highest percentage of base pay will be the one 

used. A service member will never be placed on the TDRL with less than 

50 percent of base pay.

Under the first method, your family member’s retirement is based on his 

or her combined disability rating. It can never be less than 50 percent 

of his or her current base pay or more than 75 percent of base pay. The 

following formula is used:

• 30-40 percent disability rating = 50 percent of base pay

• 50-70 percent disability rating = the percentage of base pay

• 80-100 percent disability rating = 75 percent of base pay

• Or 2.5 percent X years of service if sum is greater than percentage

of disability.

Under the second method, retirement pay is based on time in service 

using the formulas in U.S.C., Title 10, Chapter 71, Section 1401. Under 

this formula, retirement compensation is determined as follows:

• 2.5 percent X years of service = that percentage of base pay.

Every 18 months, your service member will receive a physical exam to 

determine if his or her condition has changed or stabilized. Based on 

these exams, your service member may remain on TDRL, return to duty, 

be discharged with or without severance, or moved to the Permanent 

Disability Retired List (PDRL):

• If your service member is fit for duty, he or she may choose to return 

to duty or to be discharged without severance. His or her TDRL 

payments will stop.

• If his or her condition has stabilized and he or she is unfit for duty with 

a disability between 0-20 percent, he or she will be discharged with 

severance (see above).

• If his or her condition has stabilized and his or her disability rated at 30 

percent or higher, he or she will be transferred to PDRL.

Your service member can only remain on TDRL for five years. At the end 

of five years, he or she will be declared fit or unfit, given a percentage of 

disability, and either returned to duty, discharged, or placed on PDRL.

79
Permanent Disability Retired List (PDRL)

If the Physical Evaluation Board found your service member to be unfit 

with a 30 percent or greater disability and his or her condition is stable, 

he or she will be placed on PDRL. 

If he or she has less than 30 percent disability but has completed 20 or 

more years of service, he or she will also be placed on PDRL.

Retirement payment under PDRL is determined using a formula much like 

the methods used to determine TDRL retirement pay, but without the 50 

percent minimum. 

A service member will receive retirement pay based on his or her years 

of service or combined disability rating. Whichever method yields the 

higher amount is the method used. However, retirement pay cannot be 

greater than 75 percent of base pay:

• 30-70 percent disability rating = that percentage of base pay

• 80-100 percent disability rating = 75 percent of base pay

• Or 2.5 percent X years of service if sum is greater than percentage of 

disability.

Combat-Related Special Compensation (CRSC)

In the past, veterans were not allowed to receive both military retirement 

pay and disability compensation from the VA. Beginning June 1, 2003, 

however, a law allowed retired members with two years of service and 

qualifying combat-related disabilities to receive special payments that 

lessened the offset of VA compensation for combat-related disabilities that 

reduced DoD retirement payments.

The 2008 National Defense Authorization Act expanded this law by 

including members who retired with less than 20 years for medical reasons. 

Eligible veterans with VA-rated disabilities that are combat-related and 

who have 20 or more years of service, are permanent medical retirees, or 

who are assigned to TDRL, are eligible for a monthly CRSC payment in 

addition to their reduced military retirement pay and their VA disability 

compensation. (See below for information on VA disability compensation.)

Each service uses a different process for determining eligibility. CRSC 

experts may be contacted at:

ARMY

Combat-Related Special Compensation (CRSC)

1-866-281-3254

http://www.crsc.army.mil

80 Chapter 9 - Financial Issues
Navigating Services and Benefits 

AIR FORCE

Disability Division (CRSC)

1-800-616-3775

http://www.afpc.randolph.af.mil/library/combat.asp

COAST GUARD

Personnel Command

http://www.uscg.mil/hr/psc

NAVY AND MARINE CORP

Secretary of the Navy Council of Review Boards

Combat-Related Special Compensation Branch

1-877-366-2772

www.hq.navy.mil/corb/CRSCB/combatrelated.htm

What Pay Issues are Specific to Combat Zone 

Injuries for Active Duty Service Members?

Table 4 lists other benefits available to those injured in a combat zone. 

For more information or to discuss your situation, contact the WWPMT 

point of contact.

Table 4. Pay Issues Specific to Combat Zone Injuries

Program Program

Pay and Allowance 

Continuation (PAC)

Travel Voucher for time 

in a combat zone

81

A service member who is hospitalized for treatment from an injury 

received in a combat zone will continue to receive all pay and 

allowances for up to one year after he or she was first hospitalized. 

Under “extraordinary circumstances,” the Principal Undersecretary 

of Defense for Personnel and Readiness can extend PAC beyond 

the one-year limit for six months. 

If a service member is evacuated from a combat zone for medical 

treatment, he or she will receive per diem for the travel day, as 

well as $3.50 for incidental expenses. The service member must 

complete a travel voucher (DD Form 1351-2) to receive the money.

When your service member is treated as an outpatient at a 

medical facility, he or she may also be eligible for travel pay, 

depending on where he or she is being treated. Each service 

handles travel payments differently. Contact the WWPMT point of 

contact; consult http://www.dfas.mil/travelpay.html and choose 

the particular service.
Table 4. Pay Issues Specific to Combat Zone Injuries (cont.)

Chapter 9 - Financial Issues

Program Benefits/Eligibility

82

Travel for Family 

Members

Army: 888-332-7366

Navy: 888-332-7366

USMC: 800-847-1597; 

703-784-9512

If calling over the DSN, 

the prefix is 278.

Air Force: 800-433-0048; 

210-565-3505

Family Separation 

Allowance (FSA)

Hardship Duty Pay 

Location (HDP-L)

Hostile Fire Pay/Imminent 

Danger Pay (HFP/IDP)

Combat Zone Tax 

Exclusion (CZTE)

To defray expenses for family members to be with the service 

member during treatment, family members may be issued 

Invitational Travel Authorizations (ITAs), Invitational Travel Orders 

(ITOs), or Emergency Family Member Travel (EFMT) orders, 

depending upon the service. Up to three members of a family 

(parents, spouses, children, or siblings) may be eligible to travel 

while the service member is an inpatient; one family member 

may receive orders to remain with the service member during 

recovery. The travel orders will cover the cost of travel, hotel bills, 

meals, and some incidentals.

If the service member has dependents and is away from his or 

her permanent duty station for more than 30 days for temporary 

duty or on a temporary change station, he or she will receive this 

pay. If the service member was receiving FSA while deployed 

and is then sent to a facility for treatment in a location that is not 

his or her permanent duty station, he or she will continue to be 

paid FSA unless all of his or her dependents come to stay at his 

location for more than 30 days.

HDP-L is paid while the service member is in a location identified 

by the military as a hardship duty location. The entitlement stops 

on the day the service member leaves the hardship location, unless 

he or she is covered by PAC (see above).

HFP/IDP is paid when a service member is in an area identified as 

placing the individual in imminent danger or under hostile fire. 

If the service member is injured while receiving HFP/IDP, he or 

she will continue to receive this pay while covered by PAC 

(see above).

If your service member was receiving CZTE benefits before he 

or she was medically evacuated, he or she will not be required 

to begin paying taxes for any month while an inpatient being 

treated for injuries received in the combat zone. This benefit 

continues for up to two years after discharge or after the 

official end of the hostilities. If treated as an outpatient, the tax 

exclusion ends at the end of the month in which he or she was 

either transferred out of theater or moved from inpatient to 

outpatient status. If re-admitted for the same injury to inpatient 

status, your service member will receive tax exclusion for the 

month in which he or she was re-admitted and for every month 

thereafter until discharge or the two-year period ends.
Navigating Services and Benefits 

Table 4. Pay Issues Specific to Combat Zone Injuries (cont.)

Program Benefits/Eligibility

83

Combat Related Injury 

and Rehabilitation Pay 

(CIP)

Savings Deposit 

Program (SDP)

SDP Help Line: 

888-332-7411, 

216-522-5096, 

DSN: 580-5096; E-mail 

CCL-SDP@dfas.mil

Traumatic 

Servicemembers’ Group 

Life Insurance (TSGLI)

The PAC program replaced CIP on May 15, 2008. CIP was an 

entitlement paid monthly. Wounded Warriors are still eligible 

to claim retroactive periods of CIP qualification. If the service 

member was medically evacuated out of a combat zone and 

admitted as an inpatient or was receiving extensive rehabilitation 

as an outpatient while living in quarters affiliated with the military 

health care system, he or she was considered hospitalized and 

therefore entitled to CIP.

When a service member is deployed to an area that makes him 

or her eligible for HFP/IDP and is there for at least 30 consecutive 

days (or at least one day in three consecutive months), he or she 

is allowed to deposit up to $10,000 in a DoD savings account 

that receives a 10 percent interest rate. If your service member 

has been evacuated, he or she may withdraw that money to 

cover immediate expenses, although doing so will reduce the 

overall interest earned. To do so, your service member should do 

one of the following:

• complete a withdrawal request form on the myPay Web site at 

https://mypay.dfas.mil/mypay.aspx

• send an e-mail request to CCL-SDP@dfas.mil

• send a fax to 216-522-5060

• send a letter to DFAS-Cleveland Center (DFAS-CL), 

ATTN: SDP, Special Claims, 1240 East 9th Street, 

Cleveland, OH 44199-2055.

Include the service member’s name, Social Security number, and 

date he or she left the combat zone.

If these funds are not withdrawn right away, DFAS will automatically 

transfer the balance into the service member’s regular military pay 

120 days after he or she leaves the combat zone.

See page 85.
What about Disability Payments for Medically 

Retired Veterans?

Pension and Compensation

Your veteran can file a VA claim (using VA Form 21-526) for disability 

compensation for a service-connected injury, continuing illness, mental or 

physical impairment, and/or permanent and combined disability.

Disability compensation is a monthly payment. The amount is determined 

by the veteran’s degree of disability and number of dependents. 

Receiving military retirement pay, disability severance pay, and separation 

incentive payments known as SSB (Special Separation Benefits) and VSI 

(Voluntary Separation Incentives) affect the amount of VA compensation. 

Veterans with certain severe disabilities may be eligible for additional 

special monthly compensation. 

No federal or state income tax is paid on disability compensation.

Only veterans who left the service under conditions other than 

dishonorable are eligible for disability payments.

CRSC (see previous section) provides a monthly CRSC payment to eligible 

retired veterans with combat-related duties, in addition to their reduced 

military retirement pay and VA disability compensation.

Increased Compensation Based on Unemployability

If your service member/veteran is unable to work due to total disability 

from service-related disabilities, he or be may be eligible for this benefit. 

Use VA Form 21-8940 to apply.

Concurrent Retirement and Disability Payments (CRDP)

CRDP, DoD compensation, is designed to remove the offset of VA and 

DoD payments. It provides a 10-year phase-out of the offset to military 

retired pay from receiving VA disability compensation for members who 

have a combined disability rating of 50 percent or greater. 

Those rated at 100 percent disability by the VA are entitled to full CRDP 

immediately. 

Members retired under disability provisions must have 20 years of service.

84 Chapter 9 - Financial Issues
Navigating Services and Benefits 

Traumatic Servicemembers’ Group Life Insurance (TSGLI)

The Servicemembers’ Group Life Insurance Traumatic Injury Protection 

(TSGLI) program is an automatic provision under Servicemembers’ Group 

Life Insurance (SGLI). TSGLI provides for payment to service members 

who are severely injured (on or off duty) as the result of a traumatic 

event and suffer a loss that qualifies for payment under TSGLI. TSGLI is 

designed to help traumatically injured service members and their families 

with financial burdens associated with recovering from a severe injury. 

All members of the Uniformed Services who have full-time or part-time 

Servicemembers’ Group Life Insurance (SGLI) are automatically covered 

by TSGLI while the member is in service. TSGLI coverage automatically 

ends upon the member’s separation or discharge from service or if the 

member declines SGLI coverage. Spouses and children covered under 

Family SGLI are not covered by TSGLI.

TSGLI payments range from $25,000 to $100,000 based on the 

qualifying loss suffered. The benefit is paid to the member, someone 

acting on the member’s behalf if the member is incompetent, or the 

member’s SGLI beneficiary if the member is deceased. 

TSGLI coverage was added to SGLI policies effective December 1, 2005. 

All members covered under SGLI who experience a traumatic event that 

directly results in a traumatic injury causing scheduled loss defined under 

the program are eligible for TSGLI payment.

Qualifying traumatic injuries under the program are injuries that cause 

physical damage to the body and result from external force or violence 

or a condition that can be linked to a traumatic event. Several possible 

injuries (called a “loss”) stemming from a TBI qualify for payment 

under TSGLI. Examples of “losses” are loss of sight, loss of hearing, 

hospitalization due to TBI, loss of ability to perform at least two activities 

of daily living. For a complete list of “losses” and general TSGLI 

information, see the following Web site: http://www.insurance.va.gov/

SGLIsite/TSGLI/TSGLIGuide/TSGLIProceduresGuide.pdf.

85
To file a claim, go to www.insurance.va.gov/sglisite/TSGLI/TSGLI.htm or contact the 

TSGLI point of contact for the appropriate service:

Chapter 9 - Financial Issues

Branch of Service General Information Claims Information

Army

Army National 

Guard 

Navy

Air Force

(Active Duty) 

86

Phone: (800) 237-1336

E-mail: tsgli@conus.army.mil 

Web site:

www.tsgli.army.mil

Phone: (703) 607-5851

E-mail:

raymond.holdeman@ng.army.mil 

Web site:

www.tsgli.army.mil

Phone: (800) 368-3202 / 

901-874-2501 

E-mail: MILL_TSGLI@navy.mil 

Web site:

www.npc.navy.mil/

CommandSupport/

CasualtyAssistance/TSGLI

Phone: (800) 433-0048 

E-mail:

afpc.casualty@randolph.af.mil

Web site:

ask.afpc.randolph.af.mil

Submit Claims via fax:

(866) 275-0684

Submit Claims via e-mail:

tsgli@conus.army.mil 

Submit Claims via postal mail:

Army Human Resources Command 

Attn: TSGLI 

200 Stovall Street

Alexandra, VA 22332-0470

Submit Claims via fax:

(866) 275-0684

Submit Claims via e-mail:

tsgli@conus.army.mil 

Submit Claims via postal mail:

Army Human Resources Command 

Attn: TSGLI 

200 Stovall Street

Alexandra, VA 22332-0470

Submit Claims via fax:

(901) 874-2265

Submit Claims via e-mail:

MILL_TSGLI@navy.mil (MILL_

TSGLI@navy.mil)

Submit Claims via postal mail:

Navy Personnel Command

Attn: PERS-62 

5720 Integrity Drive 

Millington, TN 38055-6200 

Submit Claims via fax:

(210) 565-2348

Submit Claims via e-mail:

afpc.casualty@randolph.af.mil

Submit Claims via postal mail:

AFPC/DPWCS

550 C Street West, Suite 14 

Randolph AFB, TX 78150-4716 
Navigating Services and Benefits 

Branch of Service General Information Claims Information

Air Reserves 

Air National 

Guard 

USMC

Coast Guard

87

Phone: (800) 525-0102, Ext. 227 

Phone: (703) 607-1239

Phone: (877) 216-0825 or 

(703) 432-9277 or (877) 487-6299

E-mail: t-sgli@usmc.mil

Web site:

www.woundedwarriorregiment.org

Phone: (202) 475-5391 

E-mail:

compensation@comdt.uscg.mil

Submit Claims via fax: 

(303) 676-6255 

Submit Claims via e-mail:

ramon.roldan@arpc.denver.af.mil

Submit Claims via postal mail: 

HQ, ARPC/DPPE 

6760 E Irvington Place, #4000 

Denver, CO 80280-4000 

Submit Claims via fax: 

(703) 607-0033 

Submit Claims via e-mail: 

tsgliclaims@ngb.ang.af.mil

Submit Claims via postal mail:

NCOIC, Customer Operations 

Air National Guard Bureau 

1411 Jefferson Davis Hwy 

Suite 10718 

Arlington, VA 22202 

Submit Claims via fax:

(888) 858-2315

Submit Claims via e-mail:

t-sgli@usmc.mil

Submit Claims via postal mail:

HQ, Marine Corps 

Attn: WWR-TSGLI 

3280 Russell Road 

Quantico, VA 22134 

Submit Claims via fax:

(202) 475-5927

Submit Claims via e-mail:

compensation@comdt.uscg.mil

Submit Claims via postal mail: 

Commandant, US Coast Guard 

Attn: CG-1222

2100 2ND St, NW 

Washington, DC 20593-0001
When the branch of service denies a member’s TSGLI claim, the member 

can appeal the decision. The issue the member is appealing determines 

the appropriate organization and process to use in making the appeal. 

For the appeals process see: http://www.insurance.va.gov/SGLIsite/TSGLI/

TSGLIGuide/TSGLIProceduresGuide.pdf.

Appendix A contains resource information about DoD compensation.

Social Security Benefits

The Social Security Administration (SSA) provides disability benefits to 

Americans who are unable to work because of medical conditions. 

SSA benefits are different from VA benefits. They require a separate 

application.

If your service member/veteran became disabled after October 1, 2001, 

he or she is eligible for quicker processing of disability benefits from the 

SSA. (See www.socialsecurity.gov/woundedwarriors)

SSA defines a disability as follows:

• The person must be unable to do substantial work because of his or 

her medical condition(s).

• The person’s medical conditions must have lasted, or be expected to 

last, at least one year or be expected to result in death.

SSA pays disability benefits through two programs:

• Social Security Disability Insurance Program (SSDI) for those who are 

considered “insured” by the SSA. This means that he or she had to 

have worked long enough and paid enough Social Security taxes to be 

eligible for benefits.

• Supplemental Security Income (SSI) for those who can demonstrate a 

financial need.

These benefits cover the eligible disabled service member/veteran, as 

well as:

• His or her spouse, if 62 or older

• His or her spouse of any age, if he or she is caring for a child who is 

younger than 16 or disabled

88 Chapter 9 - Financial Issues
Navigating Services and Benefits 

• His or her unmarried child, including an adopted child and—in some 

cases—stepchild or grandchild, if the child is younger than 18 or 

younger than 19 if still in secondary school

• His or her unmarried child, age 18 or older, if he or she has a qualified 

disability that started before age 22.

Being on active duty or getting military pay does not make someone 

ineligible for Social Security benefits. Service members/veterans may 

apply while in the military or after separating from the military. 

Service members who are hospitalized, in a rehabilitation program, or 

undergoing outpatient treatment in a military treatment facility (MTF) or 

civilian medical center can also apply.

Being eligible for SSI also means you are eligible for Medicare. 

You can learn more about Medicare benefits: http://www.medicare.gov/

Publications/Pubs/pdf/10050.pdf.

Ask your POC about SSI and Medicare benefits you may be eligible for. 

Ask for assistance in applying for these benefits. 

There is a starter kit to help complete the application at 

www.socialsecurity.gov/woundedwarriors. Applications may also be 

made in person at the nearest Social Security office. Call 800-772-1213 

between 7 a.m. and 7 p.m. to schedule an appointment.

TRICARE for Life

Once a person is disabled or age 65 and Medicare Part B-eligible, 

TRICARE for Life (TFL) becomes the secondary payer to Medicare. 

Anyone who is Medicare Part A- and B-eligible must elect Part B of the 

Medicare plan to be entitled to TRICARE for Life. TFL is available to all 

Medicare-eligible TRICARE beneficiaries, regardless of age, including 

retired members of the National Guard and Reserve who are in receipt of 

retired pay, family members, widows and widowers, and certain former 

spouses. Dependent parents and parents-in-law are not eligible for TFL. 

See Chapter 4 to learn more about TRICARE benefits.

89
VA Insurance for Disabled Veterans

Here are some VA insurance programs for disabled veterans.

What Insurance is Available for Veterans?

The VA offers multiple insurance programs for veterans. To learn more, 

visit www.insurance.va.gov or call the VA Insurance Service toll-free at 

800-669-8477.

Forms may be downloaded from the forms page at 

www.insurance.va.gov.

Table 5 summarizes key insurance programs available through the VA.

90 Chapter 9 - Financial Issues

SGLI Disability Extension to VGLI

800-419-1473

www.insurance.va.gov

Service Disabled Veterans Insurance 

(S-DVI)

(VA Form 29-4364)

For online application, go to www.

insurance.va.gov/autoform/index.asp

Veterans who are totally disabled at 

the time of separation are eligible 

for SGLI Disability Extension which 

provides SGLI at no cost for up to 

two years. At the end of that time, 

the policy is automatically converted 

to VGLI.

S-DVI is a life insurance program 

designed to meet the needs of 

certain veterans with serviceconnected disabilities. It is available 

as both permanent and term 

insurance. Policies are issued for a 

maximum face value of $10,000. 

Eligible applicants:

• Received other than a 

dishonorable discharge

• Were released from active duty 

after April 25, 1951

• Received a rating for a new 

service-connected disability 

(even 0 percent) within the past 

two years.

Application must be made 

within two years of the date of 

VA notification of a new serviceconnected disability.
Navigating Services and Benefits 

Table 5. VA Insurance Programs

Program Description

91

Veterans’ Group Life 

Insurance (VGLI)

(Form SGLV-8714)

800-419-1473

www.insurance.va.gov

Waiver of S-DVI Premiums

(VA Form 29-357)

Supplemental S-DVI

(VA Form 29-0188)

Veterans Mortgage Life 

Insurance (VMLI)

(VA Form 29-8636)

A Specially Adapted 

Housing Agent can assist; 

call the VA Insurance 

Service toll-free at 

800-669-8477.

SGLI may be converted to VGLI, renewable term life insurance, up 

to the amount of coverage when the veteran left the service. This 

benefit is available to:

• Veterans who had full-time SGLI coverage upon release from 

active duty or the Reserves

• Ready Reservists with part-time SGLI coverage who incur a 

disability or aggravate a pre-existing disability during a reserve 

period that leaves them uninsurable at standard premium rates

• Members of the Individual Ready Reserve and Inactive 

National Guard.

If the veteran submits an application and initial premium within 

120 days of leaving the service, he or she will be covered 

regardless of his or her health. After 120 days, he or she has an 

additional year to convert to VGLI by submitting an application, 

paying the premium, and showing evidence of insurability. 

VGLI is convertible at any time to a permanent plan policy with 

any participating commercial insurance company.

S-DVI policyholders who have a mental or physical disability 

that prevents them from working may be eligible for a waiver of 

premiums. The disability must have begun before the age of 65 

and must continue for at least six consecutive months.

Supplemental S-DVI provides $20,000 of supplemental coverage 

to S-DVI policyholders under 65 who are approved for waiver of 

premiums. Premiums may not be waived on this supplemental 

coverage. A veteran must apply for Supplemental S-DVI within 

one year from notice of the grant of waiver of premiums. In 

addition to VA Form 29-0188, a signed letter requesting this 

insurance must be submitted.

VMLI provides mortgage life insurance to severely disabled 

veterans. It is designed to pay off home mortgages of disabled 

veterans in the event of their death. A veteran who receives a 

Specially Adapted Housing grant from VA to build or modify 

a home to accommodate the disabilities is eligible for this 

insurance. It provides up to $90,000 of mortgage life insurance 

payable to the mortgage holder.
Is Emergency Help Available for Active Duty 

Service Members?

The Air Force Aid Society (AFAS), Navy Marine Corps Relief Society 

(MCRS), and Army Emergency Relief (AER) can offer financial assistance in 

a number of cases.

For more information regarding what is available to help your service 

member/veteran and family, contact the appropriate organization below: 

• Air Force Aid Society: http://www.afas.org or call 800-769-8951. 

• Navy Marine Corp Relief Society: http://www.nmcrs.org or call 

703-696-4904. For a more local number, select the location nearest 

your service member/veteran from the map located on this Web page: 

http://www.nmcrs.org/locations.html.

• Army Emergency Relief: http://www.aerhq.org/index.asp, or call 

866-878-6378. 

• http://www.ourmilitary.mil lists many organizations who can 

offer assistance.

• Military OneSource lists organizations that can offer help: call 

1-800-342-9647 or visit the Web site at www.MilitaryOneSource.com.

92 Chapter 9 - Financial Issues
Navigating Services and Benefits 

When your family member needs legal help, he or she can turn to the 

Judge Advocate General’s (JAG) Corps. Each military service has its own 

JAG offices.

Some JAG services are available to you, the caregiver. You may need legal 

help to protect the best interests of your family member with TBI. See 

Module 3 to learn more.

When Will Your Family Member Need Legal 

Help? Who Will Help?

Your family is most likely to consider legal help when he or she prepares 

for a formal Physical Evaluation Board (PEB). The PEB decides if she or he 

is fit for duty. (See Chapter 12 for more information on the PEB.) 

An attorney from JAG can represent your family member at the PEB. This 

service is free to your family member. 

Your family member can also choose a civilian attorney or a representative 

from a Veterans Service Organization (VSO). (See Appendix B for a link to 

a complete list of VSOs.) If your family member chooses to use his or her 

own counsel and not a representative from the JAG Corps, your family 

member will have to pay this lawyer’s legal fees. 

A third source of legal help may come from your state’s legal aid society 

or other local resources. For a consumer’s guide to state resources, 

including sources of free legal aid, visit the American Bar Association’s 

guide to state legal referral services at www.abanet.org/legalservices/

findlegalhelp/home.cfm.

The National Resource Directory contains information on additional 

sources of legal assistance for wounded service members/

veterans and their families. Explore these resources at https://

www.nationalresourcedirectory.org/nrd/public/DisplayPage.

do?parentFolderId=6076.

Chapter 10

Legal Services

A judge advocate 

is a legal advisor 

on the staff 

of a military 

command.

93
94
Navigating Services and Benefits 

You may live far away from where your family member with TBI is being 

treated. You may worry that travel costs are too high for you to be with 

your family member and care for him or her.

Your POC can help you locate and apply for the travel benefits described 

in this chapter. 

What Travel Benefits Will My Family Member 

Receive?

When your family member returns to active duty or National Guard or 

Reserve status, he or she may need to travel outside the local area for 

medical care. If so, his or her unit may provide travel orders that cover 

the cost of transportation.

These travel orders may cover mileage, parking, and tolls for a private 

auto. The travel orders may also authorize funds to cover lodging, meals, 

and incidental expenses. 

An attendant or escort may also receive authorization funding for 

transportation expenses and per diem to offset lodging, meals, 

and incidental expenses. Additionally, your family member may be 

authorized to have an attendant appointed by a medical authority or 

an escort appointed by his or her command, if he or she is incapable of 

traveling alone.

Access to Follow-up Care Standards 

Your service member/veteran can expect the following standards to apply 

to the care he or she receives: 

• Travel time may not exceed 30 minutes from home to a primary care 

delivery site unless a longer time is necessary because of the absence 

of providers (including providers not part of the TRICARE network) in 

the area. 

• The wait time for a routine appointment will not exceed one week. 

The wait time for a well-patient visit or a specialty care referral will not 

exceed four weeks. 

• Office waiting times in non-emergency circumstances will not exceed 

30 minutes, except when emergency care is being provided to 

patients, and the normal schedule is disrupted. 

• The network must also include a sufficient number and mix of 

board-certified specialists to reasonably meet the anticipated needs 

of enrollees. 

Chapter 11

Travel

There are 

many resources 

available to help 

you defray travel 

costs. 

95
• Travel time for specialty care will not exceed one hour under normal 

circumstances, unless a longer time is necessary because of the 

absence of providers (including providers not part of the TRICARE 

network) in the area.

Your service member/veteran is permitted to waive these standards for 

personal reasons if he or she prefers. However, they can only be waived 

at your family member’s request and benefit. 

What Travel Benefits are Available for Veterans?

VA reimburses eligible veterans for mileage for ALL veteran travel. This 

includes Compensation and Pension (C&P) exams and when the VA has 

determined that a deficiency lab, EKG, x-ray, etc., exists in relation to a 

C&P exam (“Convenience of the Government”).

There is a deductible that a veteran must meet each month before these 

travel benefits kick in. 

Your service member/veteran qualifies for travel benefits if:

1. he or she has a service-connected (SC) rating of 30 percent or more, 

or 

2. he or she is traveling for treatment of a SC condition, or 

3. he or she receives a VA pension, or 

4. his or her income does not exceed the maximum annual VA pension 

rate, or 

5. he or she is traveling for a scheduled C&P examination. 

Your service member/veteran qualifies for Special Mode Transportation 

(ambulance, wheelchair van, etc.) if:

1. his or her medical condition requires an ambulance or a specially 

equipped van, and 

2. he or she meets one of the eligibility criteria in 1 through 4 above, 

and 

3. the travel is pre-authorized (authorization is not required for 

emergencies if a delay would be hazardous to life or health). 

For more information see: http://www.va.gov/healtheligibility/

coveredservices/SpecialBenefits.asp#Travel.

96 Chapter 11 - Travel
Navigating Services and Benefits 

What Travel Benefits are Available for 

Caregivers?

Travel and Transportation Orders (T&TOs)

You may be invited to travel to the bedside of your family member if the 

attending medical officer decides that it is in the patient’s best interest to 

have family members present. 

Once the physician files the request, the process of obtaining official 

government travel orders (a T&TO) is set in motion. The cost of your 

travel is paid for by the military.

Government regulations determine which family members are offered 

government-paid travel. T&TOs are prepared for the family members 

and most often flight reservations are made by emergency DoD 

personnel of the particular branch of service of your service member. 

T&TOs are also known as Invitational Orders, because as a civilian you are 

traveling at the invitation of the government. These are temporary orders 

and last 15 to 30 days. They provide reimbursement of some expenses. 

Travel arrangements for family members who are not at the invitation of 

the military may be requested through the Fisher HouseTM Foundation’s 

Hero Miles Program. Airline tickets, provided by many airlines, have been 

donated to the Fisher House Foundation for distribution. These tickets 

are provided free to wounded service members and their families. 

Requests are handled on a need basis and approval varies depending on 

availability. See www.fisherhouse.org.

Non-Medical Attendant Orders

If you need to stay beyond 15-30 days, you may be issued a new set of 

travel orders called non-medical attendant orders (NMAO). Your service 

member’s physician will need to file another request, stating that it is 

necessary for you to be with your service member. 

Non-medical attendant orders entitle you to benefits similar to T&TOs 

and may remain in effect until your service member returns to his or her 

active duty unit or becomes retired or is discharged. These orders also 

include per diem.

Check with your POC about travel benefits for your service member/

veteran and you and your family.

97
98
Navigating Services and Benefits 

You may have heard your POC or other families talk about disability 

ratings and wondered what they meant. 

A disability rating is the outcome of a process called the Disability 

Evaluation System (DES). This chapter explains the DES and how the 

parts of the system work, including the Medical Evaluation Board (MEB) 

and the Physical Evaluation Board (PEB). 

This chapter includes a brief discussion of how disability ratings are 

determined and what they mean.

When a service member or veteran is wounded, injured, or ill, a formal 

set of rules is in place to evaluate the person’s ability to remain in the 

military. If the person is judged to be unfit for duty, he or she will receive 

a disability rating. 

The DES operates under Public Law (Title 10 and Title 38) to ensure fair 

treatment. 

How Does the Disability Evaluation System 

(DES) Process Work?

Each military service has its own procedures for DES. While there are 

some differences between the services, all have the same general steps: 

• Evaluate service member’s fitness for duty 

• Authorize a return to duty for those members who are found fit for duty

• Approve disability separations or retirements, to include making a 

benefits determination, for those service members who are found unfit 

for duty.

Your family member with TBI is being treated by doctors and staff of an 

appropriate medical facility. For many service members, this is the end of 

the process if they fully recover from their injury. 

For a small number of service members, a TBI can result in a permanent 

condition that may make them unfit for continued duty in their current 

jobs. If your service member/veteran suffers a permanent or long-lasting 

effect from a TBI, the doctor will refer your service member/veteran to 

the DES process by writing a narrative summary of his or her condition. 

The doctor sends your service member’s case summary and medical 

record to the nearest designated military treatment facility commander, 

who assigns a Physical Evaluation Board Case Manager to help with the 

DES process. 

The disability 

rating determines 

what kind of 

benefits your 

family member 

can receive in the 

future. So the DES 

is an important 

step. 

Chapter 12

Disability Evaluation System (DES)

99

The DES Pilot 

Study

The President’s 

Commission on 

Care for America’s 

Returning 

Wounded 

Warriors, 

sometimes 

called the DoleShalala Report, 

recommended 

removing the 

dual-evaluation 

process (by the 

VA and DoD) 

and applying one 

medical exam 

and one rating 

determination by 

the VA that the 

DoD could use 

for determining 

fitness at the PEB.

In November 

2007, the DoD 

and VA began 

a joint DES 

Pilot program 

in the National 

Capital Region 
Each service uses a slightly different method to enter a member into the 

DES. Additionally, because of unique missions and the service member’s 

job classification, retention standards can vary:

• The Army uses a physical profile system that measures soldiers’ physical 

limitations in six areas with a level between 1 (fully healthy) to 4 (severely 

limited) in each. If a soldier receives a permanent level 3 or 4 in any area, 

the doctor is required to recommend that a Medical Evaluation Board 

(MEB) review the soldier’s case. 

• The Air Force evaluates a member for retention. If his or her 

condition(s) is limiting (not unfitting), it will assign an assignment 

limitation code and re-evaluate the member at a later date. If the 

condition is not expected to improve within 12 months and the condition 

is permanently unfitting, he or she will be referred to a MEB. 

• In the Navy and Marine Corps, the process begins with the doctor 

writing the narrative summary. No prior profiling requirement exists. 

Chapter 12 - Disability Evaluation System (DES)

“To get through all the paperwork from his PEB and 

retirement, I have a folder and an envelope that I taped 

checklists to. I have one folder with the checklist and then the 

envelope with another checklist. The folder has the general 

checklist that the military provided me on the number of steps 

that had to be done toward retirement. The manila envelope 

has all of the applications filled out that I store in there until 

they’re ready to turn in. Then the checklist on the manila 

folder has the application names and the dates that have to 

be checked. That’s how I keep on top of what needs to be 

turned in and when.”

 - Shannon M.

Your service member/veteran should talk with the chain of command 

and his or her doctors to find out how the DES process begins for his or 

her service. 

It is important for your service member to maintain thorough 

documentation of military and medical records. These documents will 

play an important role in determining his or her disability rating, and the 

rights of your service member to certain benefits. 

100

(NCR) and 13 

sites outside the 

NCR, to improve 

the timelines, 

effectiveness, and 

transparency of 

the DES review 

process. The 

DoD and VA are 

evaluating the 

results of the pilot 

program and 

hope to expand 

the pilot’s benefits 

to all recovering 

service members.

For more information on the DES 

Pilot Program, 

ask your POC.
Navigating Services and Benefits 

Complete documentation is critical to a successful PEB outcome. This 

is especially important if your service member used medical facilities 

that were not at his or her military post or base. See Module 3 for a 

suggested system for keeping track of records. 

Make sure you keep:

• medical examinations

• prescription medication dosages and refills

• military personnel records

• VA compensation and examination records 

• laboratory findings 

• radiological studies

• any other relevant documentation.

“The spouse or caregiver has to be an informed advocate. 

Ask questions, demand answers, because the person with TBI 

doesn’t understand.

The caregiver needs to take the lead in accessing resources 

to protect the interest of the soldier as you move through the 

MEB/PEB process and the VA disability rating application. 

Keep copies of the medical records. It is extremely important 

to obtain medical records as you move through treatment. 

Don’t wait until you need the records to request them...it 

can take forever to get them. Keep a list of medical issues 

and disabilities. The Disabled American Veterans (DAV) has 

counselors who help prepare for the MEB and any appeal. 

Contact the DAV before the PEB/MEB process.”

 - Caroline M.

The Medical Evaluation Board (MEB)

Once your service member has been assigned a Physical Evaluation Board 

Case Manager, a Medical Evaluation Board (MEB) will review the record 

to decide if he or she meets the service’s medical retention standards. 

While each service has individual rules, the MEB is generally made up of 

medical care professionals. In the case of mental health conditions, it 

includes a mental health care provider as well. 

101
The Physical Evaluation Board Case Manager will build a packet of 

information containing the following:

• your service member’s medical records 

• results from tests and medical exams performed for the MEB 

• letters from the chain of command related to how the injury or illness 

impacts your service member’s duty 

• copies of your service member’s performance evaluation reports 

• other personnel records that the MEB may require.

Every individual’s situation is different. The doctor may wait to write the 

narrative summary until he or she sees how your family member responds 

to treatment and rehabilitation therapy before making a referral to the 

MEB. The doctor will refer your family member’s case to the MEB only 

after he or she is satisfied that all has been done medically to improve 

your service member’s TBI. 

In general, the military services require doctors to initiate a MEB after a 

year of treatment for the same injury or illness. 

When the MEB members review your family member’s case, they are 

responsible for answering the question: 

“Does this service member meet the retention standards for his 

or her branch of service?” 

In answering this question, there are several decisions the board members 

can make: 

• They may decide that your service member meets medical retention 

standards and return your service member to full duty in his or her 

current job. 

Chapter 12 - Disability Evaluation System (DES)

Keep in touch with your Physical Evaluation Board Case 

Manager to closely follow the MEB process. 

The MEB process takes time because there is much 

information that needs to be gathered and many 

people are involved in the evaluation. 

Stay informed of the progress as much as possible. Ask 

questions, if you don’t understand. Offer to help find 

information, if necessary.

102
Navigating Services and Benefits 

“Oh, going through the MEB. What a joy.

I definitely would say read every single piece of paper you’re 

given. Don’t leave anything out, even if you think it’s the most 

minute thing to write down on the paperwork. Be thorough 

when you’re filling out your initial stuff. When they give you 

the paperwork back, read through it. Take every minute that 

they allow you to read through it. 

Voice your discrepancies. If you don’t agree with it, tell them 

you don’t agree with it. If they send it back to you and they 

say we can’t change it, still say no, I still don’t agree with it, 

and take your time.

Seek the advice of JAG and the DAV when you can. Don’t ever 

feel like ‘It’s me against the MEB’; there are so many people 

out there to help. There are so many organizations that will sit 

down with you and they’ll read through your paperwork. It’s 

all medical jargon, and that is the most frustrating thing of it 

all, that it’s all medical terms. It’s hard for the general person 

to be able to understand all of that.

So definitely go to the DAV, go to JAG, go to the VA. Go to a 

doctor who is not involved in the process, because there’s help 

out there. You have to be proactive. You can’t let it happen to 

you. You can’t let them dictate what’s going to happen. You 

need to be the dictator.”

 - Sandy M.

• They may determine that your service member meets medical 

retention standards in another job and recommend your service 

member re-train for that position. 

• They can refer your service member to limited duty board, usually 

six months in duration with an option to extend another six months, 

allowing for recovery and rehabilitation before making a determination 

against retention standards.

• If they determine that your service member does not meet the medical 

retention standards, they will forward a recommendation to the PEB. 

103
Notice that the MEB does not determine your service member’s fitness for 

duty or level of disability. 

The only question the MEB answers is whether your service 

member meets the retention standards for the job in his or her 

branch of service. 

The Physical Evaluation Board (PEB)

The Physical Evaluation Board (PEB) process can be confusing. But 

it’s important--understanding PEB can mean the difference between 

your service member staying in the military or being retired. And 

just as important, if your service member is being discharged, a good 

understanding of this process may help you help your service member to 

obtain needed benefits. 

The PEB determines your service member’s fitness for duty and level 

of disability. 

Fit for Duty means your service member can reasonably perform the duties 

of his or her grade and military job. If your service member is medically 

unfit to perform the duties of his/her current job, the PEB can recommend 

re-training into a job he or she will be medically qualified to perform.

Fitness for duty and level of disability are very important decisions for the 

future of your service member.

The Department of Defense (DoD) regulations list minimum requirements 

for the membership of a PEB, but leaves the exact determination of who 

will sit on the boards up to the military department to decide. 

Generally, the services have opted for a three-person PEB, with a mix of 

military and civilian members. The president of the PEB is generally a 

colonel or a Navy captain and the other board members include a fieldgrade personnel officer and a senior medical officer. 

This ensures that each board has the expertise of a line officer in the 

president of the board, the medical knowledge of a senior medical officer, 

and the personnel policy knowledge of a senior personnel officer. 

The PEB usually meets informally to review your service member’s case 

and will not require him or her to attend the informal meeting. Using 

the packet developed by the Physical Evaluation Board Case Manager 

during the MEB process, the board reviews the medical record, the 

doctor’s narrative summary, your service member’s personnel evaluations, 

and letters from his or her commander. The board then makes an initial 

decision on your service member’s case. 

104 Chapter 12 - Disability Evaluation System (DES)
Navigating Services and Benefits 

The PEB determines if your service member is fit or unfit for continued service. 

The members also determine the severity of any disability your service 

member/veteran may have, with a rating between 0-100 percent using 

the VA Schedule for Rating Disabilities (VASRD). The members will then 

determine your service member’s disposition:

• return to duty 

• separation

• permanent or temporary retirement.

The Physical Evaluation Case Manager will notify your service member 

of the findings of the informal PEB. At this point, your service member 

will have to choose between requesting a formal PEB or accepting the 

informal PEB findings. 

If a formal PEB hearing is chosen, your service member will be allowed to 

appear before the PEB and discuss his or her case with the board members to 

ask them to reconsider their decision. Your service member can also provide 

them additional information important to that reconsideration. 

Your service member has a right to be represented by legal counsel at the 

formal PEB. More information on the disability rating percentages and 

the benefits of those percentages provide appear below.

Again, keep in touch with your Physical Evaluation 

Board Case Manager to closely follow the PEB process. 

The PEB process also takes time because there is more 

information that needs to be gathered and more people 

are involved in this evaluation. 

Stay informed of the progress as much as possible. Ask 

questions, if you don’t understand. Offer to help find 

information, if necessary. 

Be an advocate for your service member. The PEB 

is very important to your service member’s future 

employment, disability benefits, and/or retirement.

105
What Do I Need to Know to Understand 

Disability Ratings and Benefits?

If the PEB finds your service member unfit based on one or more 

conditions, it will provide a combined disability ratings percentage. 

This is an important number because it determines what type 

of separation your service member receives and, subsequently, 

the types of benefits your service member and you, as a 

caregiver, are eligible to receive from the DoD and the 

Department of Veterans Affairs (VA). VA benefits are discussed at 

length in various chapters within this module. 

Although both the military disability and the VA disability system use 

the VA Schedule for Rating Disabilities (VASRD), they have some major 

differences. These differences are listed here:

The military disability system:

• The military services only evaluate unfitting disabilities, thereby 

compensating for the loss of a career.

• The military services’ disability ratings are contingent on rank and 

length of service.

• With the exception of TDRL ratings, the military services’ ratings are 

permanent and do not provide for flexibility or deterioration of a 

medical condition.

The VA disability system:

• The VA compensates for all service-connected disabilities, with the 

intent of compensating for lost civilian earning capacity.

• The VA ratings are based on fixed disability percentages.

• The VA’s disability ratings can fluctuate and increase or decrease with 

the change in a medical condition.

Some veterans are confused when they receive a higher, combined 

disability rating from VA than from the DoD. It is important to remember 

that the PEB calculates your service member’s combined rating based 

only on conditions that make your service member unfit for continued 

service. So, if the VA finds that your service member has disabilities that 

are connected to military service but that did not make him or her unfit 

for service, your service member will receive a higher disability rating 

from the VA than from the DoD. This difference is required by law. 

106 Chapter 12 - Disability Evaluation System (DES)
Navigating Services and Benefits 

The combined disability rating is not calculated by adding the percentage 

of disability for each condition rated “unfitting.” Rather, the highest 

disability rating is considered first, then the next highest, and so on in 

order of severity. 

If your service member has a 60 percent disability, the VA Schedule 

for Rating Disabilities (VASRD) considers him or her to be 40 percent 

“efficient.” Efficiency is the measure of total health minus disability, so 

someone with a 60 percent disability has only 40 percent of his or her 

total health that is not impacted by the disability. 

The next highest disability percentage will be applied to the 40 percent 

efficiency left after the initial 60 percent rating is applied to the total 

healthy score of 100 percent efficient. 

Example: service member with three unfitting conditions rated 60, 30, 

and 20 percent: 

• First rating is 60 percent of the whole person, leaving the member 

with 40 percent efficiency. 

• Second rating is 30 percent of the 40 percent efficiency, which is a loss 

of 12 percent efficiency (.30 X .40=.12). This is added to the original 

disability percentage of 60, for a cumulative score of 72 percent 

combined disability from the first two conditions. This leaves the 

member with 28 percent efficiency. 

• Third rating is 20 percent of the 28 percent efficiency, which is a loss 

of 6 percent efficiency (.20 X .28=5.6 which is rounded up to 6). Add 

this to the combined disability in the second rating of 72 and the 

rating becomes 78 percent. 

• The combined rating of 78 percent must be rounded to the nearest 

10, giving the member a combined rating of 80 percent. 

The math can be complicated. 

The VASRD uses a table in Section 4.25 (Table 1) of Title 38 of the Code 

of Federal Regulations (CFR) to allow your service member/veteran to 

determine his or her combined rating, but the rating will be combined for 

your service member by the PEB and VA for use in determining benefits 

they will provide to your service member. 

A copy of the sections of Title 38 related to combined ratings is 

available online by going to http://www.access.gpo.gov/nara/cfr/

waisidx_04/38cfr4_04.html and scrolling down to Section 4.25. 

107
PEB Disposition Finding 

When the PEB provides its final disposition of your service member’s 

case, there are five possible outcomes. These outcomes are based on the 

combined rating, based on the “unfitting” conditions. The dispositions 

available from the PEB are: 

• Return to Duty: If your service member’s TBI and other possible 

injuries are not considered severe enough to make him or her unfit 

for duty, he or she will be returned to his or her previous job. No 

disability benefits are required, since he or she is allowed to continue 

in the branch of service. When your service member separates from 

Chapter 12 - Disability Evaluation System (DES)

“I think the most challenging and stressful phase for me and 

for many other families that I have heard of, is that phase 

when you’re trying to decide whether medical discharge is 

right at this time or whether you think you want to push 

for continued active duty, a permanent limited duty phase, 

or what-have-you. It still seems to me that it’s unclear, and 

there’s nobody who really sits down with a family at that point 

and goes through the calculations of the pay and benefits.

Tim and I have gone through the pilot program, he received 

his findings, and we know his disability rate with the military. 

We know his disability rate with the VA. The DoD rate is 

pretty obvious. We know how that’s going to be calculated. 

But because of his special monthly compensation codes, we’re 

having huge trouble finding somebody who can really explain 

how that’s calculated out. Then we can plan for this change 

in salary and what we need to do to insure that we can pay 

our mortgage or know that we’re going to be fine.

I think that’s probably the greatest stress out of all of this. 

After you’ve gone through all the traumatic medical stuff, after 

you’ve gone through the recovery and the heartache and all 

the other physical and emotional challenges--the financial 

stress on a family still needs to be resolved.”

 - Shannon M.

108
Navigating Services and Benefits 

the military, he or she may be eligible for benefits from the VA for 

a service-connected disability that could impact his or her earning 

potential after military separation. He or she may be eligible for Social 

Security benefits.

• Separate with Severance Pay: If one or more of your service 

member’s conditions is considered “unfitting” for continued service 

in the military, but the combined disability of all his or her unfitting 

conditions is between 0 and 20 percent, he or she may receive 

severance pay based on time in service and current pay grade. The 

local finance office, or the Defense Finance and Accounting Service 

(DFAS) Wounded Warrior Pay Management Team (WWPMT), will help 

calculate the amount of severance pay your service member/veteran 

is authorized to receive. However, if your service member has served 

at least 20 years and is eligible for retirement, he or she will instead be 

retired from service as explained below. 

• Separate without Benefits: If your service member’s illness or injury 

resulted from a medical problem that your service member had before 

he or she entered service, and the injury or illness was not aggravated 

by military service, he or she may be separated without benefits. 

There are some special rules for this situation. If your service member has 

served more than six months in the military, he or she could be eligible 

for benefits unless there is compelling medical evidence showing that the 

condition existed at the same level of severity before he or she joined. 

Some injuries are determined to be “not in the line of duty.” These are 

injuries which are a result of intentional misconduct or willful negligence 

on your service member’s part or that took place when he or she was 

not on orders (if your service member is a National Guard or Reserve 

member). If the injury is found to be “not in the line of duty” but is 

“unfitting,” your service member could be separated without benefits for 

those injuries. 

Your service member’s Physical Evaluation Board Case Manager can 

help your service member understand the rules for separation without 

disability benefits. 

• Permanent Disability Retirement List (PDRL): If all your service 

member’s unfitting conditions result in a combined disability rating 

of 30 percent or higher, and his or her condition is considered stable 

(meaning it is unlikely, in the doctor’s opinion, that the disability 

rating will change within five years), your service member will be 

109
permanently retired for disability and placed on the PDRL. This 

provides your service member with:

- disability retirement pay 

- access to TRICARE for him or her and dependent family members 

enrolled in the Defense Enrollment Eligibility Reporting System 

(DEERS) 

- access to commissary and exchange shopping 

- all other benefits of regular military retirement. 

If your service member has more than 20 years in service, and the 

combined disability rating is 0-20 percent, your service member/

veteran will be allowed to retire with all the regular retirement 

benefits. The local finance office or the DFAS Wounded Warrior Pay 

Management Team will help your service member/veteran calculate 

the amount of retirement pay he or she will receive. 

• Temporary Disability Retirement List (TDRL): The TDRL allows 

the service to ensure a medical condition stabilizes before making 

a final disability determination. If your service member is eligible 

for permanent disability retirement, but his or her condition is not 

considered stable, he or she will be temporarily retired and placed 

on the TDRL for a maximum of five years. Every 12-18 months, your 

service member will be re-evaluated to see if his or her condition has 

stabilized and if he or she can re-enter the service. 

The benefits of the TDRL are the same as those your service member 

would have received had he or she been retired under the PDRL. If, 

during those five years, the service determines that your service member’s 

condition is stable, and he or she is fit for duty, your branch of service 

will offer your service member the chance to return to duty. If his or 

her condition stabilizes but he or she is not able to return to duty, your 

service member will be permanently retired. 

An overview of the Disability Evaluation System appears in Figure 2. See 

Appendix D for Resources regarding MEB/PEB. Information about your 

service member’s right to appeal the PEB decision and the appeal process 

may be found in Appendix E.

In lieu of the appeal process outlined in Appendix E, service members 

who have been medically separated since September 11, 2001 may have 

their disability ratings reviewed to ensure fairness and accuracy. Check 

with your POC and attorney.

110 Chapter 12 - Disability Evaluation System (DES)
Navigating Services and Benefits 

A new Physical Disability Board of Review (PDBR) will examine each 

applicant’s medical separation, compare DoD and VA ratings, and make 

a recommendation to the respective Service Secretary (or designee). 

A disability rating cannot be lowered and any change to the rating is 

effective on the date of final decision by the Service Secretary. 

To be eligible for PDBR review, a service member must have been medically 

separated between September 11, 2001 and December 31, 2009 with a 

combined disability rating of 20 percent or less, and not found eligible for 

retirement. The DoD Instruction on the PDBR process is available here: 

http://www.dtic.mil/whs/directives/corres/pdf/604044p.pdf. To access 

Frequently Asked Questions about the PDBR, look at the following Web 

site: http://www.health.mil/Content//docs/PDBR%20FAQsDec10.pdf.

3 Member Board

*Identify Impairment/Illness

*Meet Retention Standards

Meets Medical 

Return to Retention Std

Duty

3 Member Board

*Review Case

*Personal 

 Appearance

*Legal 

 Representation

3 Member Board

*Paper Review

*Fit/Unt

*Rate in 

 Accordance 

 with VASRD

Agency HQ

1. Nonconcur

2. Physicians Cases

3. General Ocers

*Quality Review

Servicemember

Nonconcur

Request

Reconsideration

Unt

Servicemember 

Concur

All Decisions 

Reviewed by PDB

Final 

Disposition

Servicemember

Appeal

Servicemember 

File PFR/rebutta

Fit Fit

Medical Retention Board Commander Physicians

Medical Evaluation Board

(Medical Based Evaluation

Physical Evaluation

Board (Formal)

Physical Evaluation

Board (Informal)

PDA

PDB

ABCMR

The Disability Evaluation System

111

Figure 2. The Disability Evaluation System.
112
Navigating Services and Benefits 

Is your family member leaving the military?

Transitions can be stressful, even in the best of times. You may be feeling 

unsure about what the future will bring. 

Comfort yourself with the thought that you and your service member/

veteran are part of a large family (the military). This family will support 

your transition to the future in every way possible.

What Transition Services are Available for 

Service Members?

Transition Assistance Program

DoD has a Transition Assistance Program to help service members move 

from military service to civilian life. The Transition Assistance Office offers 

this program. It is usually located:

• On Air Force installations, in the Airman and Family Readiness Center

• On Navy and Marine Corps installations, with the Family Support/

Service Center

• On Army installations, through the Army Career and Alumni 

Program (ACAP).

To find the Transition Assistance Office closest to you, go to 

http://www.militaryinstallations.dod.mil.

All service members who are leaving the military are required to receive 

pre-separation counseling. By law, this must happen within 90 days 

before active duty ends. 

It takes time, however, to develop a good transition action plan. For 

that reason, service members should set up a pre-separation counseling 

appointment at least 180 days before their active duty is complete. 

Arranging a pre-separation counseling appointment 90 days prior to 

leaving active duty may be impractical for Reserve Component service 

members because of their demobilization timeline. Make sure to make 

your appointment as soon as possible within the demobilization process. 

During pre-separation counseling, service members learn about benefits 

and rights. They also learn about services that are available. 

During the counseling, service members complete a “Pre-separation 

Counseling Checklist” with help from the counselor. For active duty 

Chapter 13

Transition

113
service members, this is DD Form 2648. For Reserve Component service 

members, it is DD Form 2648-1. 

These checklists help the service member to identify his or her needs and 

develop a personal plan for getting help to meet those needs. He or she 

will be given a copy of the checklist at the end of the counseling - don’t 

lose it. 

Throughout your service member’s transition, he or she will have free 

access to trained transition assistance counselors. They can help modify 

the individual transition plan, secure necessary services, and resolve 

problems. 

Another key to successful transition is planning. Transitioning is serious 

business and requires a carefully thought out Individual Transition Plan (ITP). 

The ITP is your service member’s game plan for a successful transition to 

civilian life. It is a framework he or she can use to fulfill realistic career 

goals based upon his or her unique skills, knowledge, experience, and 

abilities. 

The ITP is not an official form. It is something the service member 

creates. The ITP identifies actions and activities associated with the 

individual’s transition. 

Fortunately, the Transition Assistance Office can give your service member 

a head start on the development of his or her ITP. His or her copy of 

the Pre-separation Counseling Checklist (DD Forms 2648 or 2648-1) will 

serve as an outline for the ITP. 

On this checklist, your service member will indicate the benefits and 

services for which he or she desires to receive additional counseling. He 

or she will then be referred to subject experts who will gladly answer 

questions. 

Your service member’s Transition Assistance Office can furnish additional 

information and emphasize certain points to consider. 

Spouses are encouraged to attend all transition assistance briefings, 

such as the Transition Assistance Workshops described below. You will 

learn many helpful ideas that you can apply to your own transition from 

military to civilian life, including employment.

Transition Assistance Workshops

The Transition Assistance Program (TAP) includes employment assistance 

services. These begin with TAP workshops conducted by instructors from 

114 Chapter 13 - Transition
Navigating Services and Benefits 

the Department of Labor. They provide the basic knowledge and skills 

needed to plan and execute a successful job search: 

• Assessing the individual’s preferences, skills, experience, and 

education/training 

• Making career decisions regarding career objectives and financial 

needs 

• Obtaining an interview by identifying job opportunities, writing 

effective resumes and applications, and researching potential 

employers 

• Winning the job by preparing for and participating in successful 

interviews.

The Transition Assistance Office can provide additional employment 

assistance and resources. Services vary by location, but often include: 

• Individual counseling and assistance 

• Job fairs 

• Job search libraries 

• Access to job listings 

• Automated tools for preparing resumes, cover letters, and federal job 

applications 

• Assistance in preparing resumes and cover letters. 

If your family member is hospitalized or not close to a major 

installation with a Transition Assistance Office, he or she can use 

the DoD official Transition Assistance Program Web site, TurboTAP 

(http://www.transitionassistanceprogram.com/register.tpp), which 

provides information and links to other helpful Web sites.

What Transition Services are Available for 

Disabled Service Members?

Disabled Transition Assistance Program (DTAP)

DTAP is the part of the Transition Assistance Program that works with 

disabled service members.

The goal of DTAP is to help service members who might be eligible for 

the VA’s Vocational Rehabilitation and Employment Program (VR&E) to 

make an informed decision about this program. (See Chapter 7 for more 

information about VR&E.)

115
It also helps eligible service members in filing an application for vocational 

rehabilitation benefits so they can receive these benefits more quickly.

DTAP presentations are usually group sessions that cover:

• VR&E

• educational/vocational counseling available to separating service 

members and veterans. 

If your service member/veteran is unable to attend a group session 

because of treatment, the VA Regional Office VR&E Officer will coordinate 

services for him or her.

116 Chapter 13 - Transition
Navigating Services and Benefits 

You and your family member may be eligible for benefits from your state. 

Don’t overlook these programs!

State benefits include:

• state employment services

• unemployment compensation

• financial and medical programs for veterans, spouses, and 

dependents. 

These programs can help you build a new life after TBI.

Many states offer benefits for veterans and Reserve Component

members. These may include:

• educational grants and scholarships

• special exemptions or discounts on fees and taxes

• home loans

• veterans’ homes

• free hunting and fishing privileges, and more.

Each state manages its own benefit programs. 

Table 6 lists contact information for each state/territory’s VA office. You 

can find more information about your state benefits from this office.

Don’t forget the National Resource Directory 

(www.NationalResourceDirectory.org).

It lists state and local resources for you and your family member. 

Is There Special Job Search Help for Veterans? 

Every state employment service has specialists called Local Veterans 

Employment Representatives (LVER) and Disabled Veterans Outreach 

Program Specialists (DVOP). They are trained to help veterans adjust to 

the civilian job market. 

They can help veterans find local job opportunities and prepare for a new 

job. Veterans should ask for an appointment with the LVER when they 

call the state employment office.

Is My Family Member’s Previous Job 

Guaranteed? 

Some states have reemployment rights laws that offer protection for 

service members. 

Chapter 14

State Benefits 

117
Is My Service Member/Veteran Entitled to 

Unemployment Compensation?

Your state employment office handles unemployment compensation. 

Each state is different. Only the office where your family member applies 

can explain how much money he or she will receive and for how long. 

The nearest state employment office is listed in your local telephone 

directory. 

To receive unemployment compensation, your family member must 

apply. The best time to do that is when he or she visits the Local 

Veterans Employment Representative (LVER) at the state employment 

services office for help in finding a new job (see above). To apply for 

unemployment compensation, he or she must bring the DD 214, his or 

her Social Security card, and civilian and military job history or resume.

Where Can I Find More Information about 

State Benefits?

Table 6 lists the Web site and contact information for the head VA office 

in each state/territory.

Unemployment 

compensation 

gives you money 

to live on while 

you look for a job.

118 Chapter 14 - State Benefits
Navigating Services and Benefits 

Table 6. VA State Offices

State/

Territory

Link to Web site for 

State Specific Benefits

Office Address Office Phone

Alaska

Alabama

American 

Samoa

Arizona

California

Colorado

Connecticut

Delaware

District of 

Columbia

Florida

Georgia

P.O. Box 5800

Camp Denali

Fort Richardson, AK 99505

RSA Plaza Building

Suite 530

770 Washington Avenue

Montgomery, AL 36130

P.O. Box 8586

Pago, Pago, AS 96799

3839 North Third Street

Suite 209

Phoenix, AZ 85012

1227 “O” Street

Sacramento, CA 95814

7465 East 1st Avenue

Unit C

Denver, CO 80230

287 West Street

Rocky Hill, CT 06067

Robbins Building

802 Silver Lake Boulevard

Suite 100

Dover, DE 19904

441 4th Street, NW

Suite 570 South

Washington, DC 20001

4040 Esplanade Way

Suite 152

Tallahassee, FL 32399-0950

Floyd Veterans Memorial 

Building

Suite E-970

Atlanta, GA 30334

907-428-6016

334-242-5077

684-633-4206

602-255-3373

800-952-5626

303-343-1268

860-529-2571

302-739-2792

202-724-5454

727-518-3202

404-656-2300

119

http://ftp.ak-prepared.com/

vetaffairs

http://www.va.state.al.us/laws.htm 

http://americansamoa.gov/

departments/offices/vets_affairs.htm

http://www.azdvs.gov/vsd.htm

http://www.cdva.ca.gov/

Default.aspx

http://www.dmva.state.co.us/

page/va

http://www.ct.gov/ctva/site/

default.asp

http://Veteransaffairs.delaware.gov

http://ova.dc.gov/ova/site/

default.asp

http://www.floridavets.org/benefits/

benefits.asp

http://sdvs.georgia.gov
Table 6. VA State Offices (cont.)

Chapter 14 - State Benefits

State/

Territory

Link to Web site for 

State Specific Benefits

Office Address Office Phone

Guam

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Guam Veterans Affairs Office

Office of the Governor

P.O. Box 2950

Hagatna, GU 96932

Tripler Army Medical Center

459 Patterson Road

E-Wing, Room 1-A103

Honolulu, HI 96819

320 Collins Road

Boise, ID 83702

833 South Spring Street

P.O. Box 19432

Springfield, IL 62794

302 W. Washington Street

Room E120

Indianapolis, IN 46204

7105 NW 70th Avenue

Camp Dodge, Bldg. A6A

Johnston, IA 50131

Jayhawk Tower

700 SW Jaskson, Suite 701

Topeka, KS 66603

1111B Louisville Road

Frankfort, KY 40601

1885 Wooddale Boulevard

P.O. Box 94095

Baton Rouge, LA 70804

117 State House Station

Augusta, ME 04333

16 Francis Street, 4th Floor

Annapolis, MD 21401

600 Washington Street

Suite 1100

Boston, MA 02111

671-475-8388

808-433-0420

208-334-3513

217-782-6641

317-232-3910

515-242-5331

785-296-3976

502-564-9203

225-922-0500

207-626-4464

410-260-3838

617-210-5480

120

http://www.nasdva.net/group/

guam

http://hawaii.gov/dod/ovs

http://www.Veterans.idaho.gov

http://www.veterans.illinois.gov/

benefits/ 

http://www.in.gov/dva/2364.htm

https://www.iowava.org/benefits/

index.html

http://www.kcva.org/vb

http://Veterans.ky.gov/benefits 

http://www.vetaffairs.com/

benefits.html

http://www.maine.gov/dvem/bvs/

benefits.htm

http://www.mdva.state.md.us/

state/index.html

http://www.mass.gov/?pageID=

veteranstopic&L=2&L0=Home&L1=

Benefits&sid=Eveterans
Navigating Services and Benefits 

Table 6. VA State Offices (cont.)

State/

Territory

Link to Web site for 

State Specific Benefits

Office Address Office Phone

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New 

Hampshire

New Jersey

New Mexico

New York

North 

Carolina

3423 N. Martin Luther 

King, Jr. Boulevard

Lansing, MI 48906

20 West 12th Street

Room 206

St. Paul, MN 55155

P.O. Box 5947

Pearl, MS 39288

205 Jefferson Street

12th Floor, Jefferson Bldg.

P.O. Drawer 147

Jefferson City, MO 65102

1900 Williams Street

P.O. Box 5715

Helena, MT 59604

P.O. Box 95083

301 Centennial Mall South, 

6th Floor

Lincoln, NE 68509

5460 Reno Corporation Dr.

Reno, NV 89511

275 Chestnut Street

Room 517

Manchester, NH 03103

P.O. Box 340

Trenton, NJ 08625

Bataan Memorial Building

407 Galisteo Street

Room 142

Santa Fe, NM 87504

5 Empire State Plaza, Suite 2836

Albany, NY 12223

1315 Mail Service Center

Raleigh, NC 27699

517-335-6523

651-296-2562

601-576-4850

573-751-3779

406-324-3741

402-471-2458

775-688-1653

603-624-9230

888-865-8387

866-433-8387

888-838-7697

919-733-3851

121

http://www.michigan.gov/dmva/ 

0,1607,7-126-2362---,00.html

http://www.mdva.state.mn.us/

stateprgms.htm

http://www.vab.state.ms.us/

booklet.htm

http://mvc.dps.mo.gov

http://dma.mt.gov/mvad/

vasitemap.asp

http://www.vets.state.ne.us/index_

html?page=content/benefits.html

http://www.Veterans.nv.gov

http://www.nh.gov/nhveterans/

benefits/index.html

http://www.state.nj.us/military/

Veterans

http://www.dvs.state.nm.us/

benefits.html

http://veterans.ny.gov

http://www.doa.state.nc.us/vets/

benefits.htm
Table 6. VA State Offices (cont.)

State/

Territory

Link to Web site for 

State Specific Benefits

Office Address Office Phone

North Dakota

North Mariana 

Islands

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

P.O. Box 9003

Fargo, ND 58106

P.O. Box 503416

Saipan, MP 96950

77 South High Street

30th Floor

Columbus, OH 43215

2311 N. Central

Oklahoma City, OK 73105

Federal Building

1220 SW 3rd Avenue

Portland, OR 97204

Building S-0-47

FTIG Annville, PA 17003

PO Box 11737

San Juan, PR

00910-1737

480 Metacom Avenue

Bristol, RI 02809

1205 Pendleton Street

Suite 461

Columbia, SC 29201

Soldiers & Sailors Memorial 

Building

425 East Capitol Avenue

Pierre, SD 57501

215 Rosa L. Parks Avenue

Nashville, TN 37243

Stephen F. Austin Building

Suite 800

Austin, TX 78701

701-239-7165

670-664-2650

614-644-0898

405-521-3684

503-373-2000

800-547-2838

787-758-5760

401-253-8000 

Ext. 495

803-734-0200

605-773-3269

615-741-2931

800-252-8387

122 Chapter 14 - State Benefits

http://www.nd.gov/veterans/

benefits

Veterans@vzpacifica.net

http://dvs.ohio.gov

http://www.ok.gov/ODVA

http://www.oregon.gov/ ODVA/

BENEFITS

http://www.milvet.state.pa.us/

DMVA/169.htm

http://www.gobierno.pr/OPV/inicio

http://www.dhs.state.ri.us/dhs/

dvaoffic.htm

http://www.govoepp.state.sc.us/va/

benefits.html

http://state.sd.us/applications/

MV91MVAInternetRewrite/ default.

asp?navid-12

http://www.state.tn.us/veteran/

benefitsstate.html

http://www.tvc.state.tx.us/

StateBenefits.html
Navigating Services and Benefits 

State Benefits

123

Table 6. VA State Offices (cont.)

State/

Territory

Link to Web site for 

State Specific Benefits

Office Address Office Phone

Utah

Vermont 

Virginia

Virgin Islands

Washington

West Virginia

Wisconsin

Wyoming

http://veterans.utah.gov/

homepage/stateBenefits/index.html

http://www.va.state.vt.us

http://www.dvs.virginia.gov

http://www.nasdva.net/group/

usvirginislands

http://www.dva.wa.gov

http://www.wvs.state.wv.us/va

http://dva.state.wi.us/benefits.asp

http://wdh.state.wy.us/mhsa/

treatment/veteransindex.html

550 Foothill Blvd., #202

Salt Lake City, UT 84108

118 State Street

Montpelier, VT 05620

900 E. Main St. 

Richmond VA 23219

1013 Estate Richmond

Christiansted

St. Croix, VI 00820

1102 Quince St. SE - 1st floor

P.O. Box 41155

Olympia WA 98504-1155

1321 Plaza East – Suite 109

Charleston, WV 25301-1400

30 W. Mifflin Street 

P.O. Box 7843 

Madison, WI 53707-7843

5500 Bishop Blvd.

Cheyenne, WY 82009

800-894-9497

802-828-3379

804-786-0286

340-773-6663

800-562-2308

866-984-8387

800-947-8387

307-772-5145

“We have to thank those organizations out there that help 

us continue being where we are. If it wasn’t for a couple of 

those organizations, those nonprofit organizations out there, 

I don’t know what the families would do, I really don’t.”

 - Nellie B.
124
Navigating Services and Benefits 

Support Programs

www.military.com

This Web site provides information about all branches of the military, 

employment, benefits, and keeping in contact with buddies.

Air Force Wounded Warrior (AFW2) Program

Go to www.woundedwarrior.af.mil, call 1-800-581-9437 between 7 a.m. 

to 4 p.m. (Central time), or e-mail afwounded.warrior@randolph.af.mil. 

Closed on holidays.

Air Force Survivor Assistance Program

Call 1-877-USAF-HELP (1-877-872-3435) any time for support and/or 

referral to agencies that serve wounded airmen.

America Supports You

America Supports You (ASY) was a DoD-sponsored site with links to 

organizations that want to help severely injured service members and 

their families. The site has been incorporated into 

http://www.ourmilitary.mil/index.aspx. 

All ASY information now may be found in the ‘Support for our Troops’ 

and ‘Community Relations News & Headlines’ sections of that Web site.

Army Knowledge Online (AKO)

Army Knowledge Online (AKO) is the U.S. Army’s main intranet. It serves 

registered users to include active duty and retired service personnel and 

their family members, and provides single sign-on access to over 300 

applications and services. The Web site is www.us.army.mil.

Army Wounded Warrior Program

Go to https://www.aw2.army.mil. You can also call 1-800-237-1336 

between 8 a.m. and 7 p.m. or e-mail aw2@conus.army.mil.

Bar Association

The Bar Association in your community may have a panel that refers 

callers to lawyers in various specializations. Initial consultations generally 

include a nominal fee. Visit the Web site at 

http://www.abanet.org/legalservices/findlegalhelp/home.cfm.

Appendix A Resources for Service Members, 

Veterans, and/or Family Members

125
GovBenefits.gov

GovBenefits.gov is the official benefits Web site of the U.S. government, 

with information on over 1,000 benefit and assistance programs. 

Provides information, fact sheets, and other resources for military 

personnel, family members, and veterans. The Web site can be found at 

http://www.govbenefits.gov.

Heroes to Hometown

Learn more about this American Legion program by calling 202-631-9924, 

or e-mail legion.h2h@itc.dod.mil.

Marine Corps Wounded Warrior Regiment

Go to http://www.m4l.usmc.mil and click on the “Visit the Wounded 

Warrior Regiment Homepage” icon to get to the site. You can e-mail 

questions to smbwwropscenter@usmc.mil.

Go to http://www.woundedwarriorregiment.org or call 877-487-6299.

Military Homefront

http://www.m4l.usmc.mil and click on the “Visit the Wounded Warrior 

Regiment Homepage” icon to get to the site. You can e-mail questions to 

smbwwropscenter@usmc.mil. 

Military One Source/Wounded Warrior Resource Center

Go to http://www.militaryonesource.com. Select your branch of service, 

click on “Find Information,” and search for “Wounded Warrior.”

Military One Source (including the former Military Severely Injured 

Center) - 1-800-342-9647 or for the Wounded Warrior Resource Center 

(http://www.woundedwarriorresourcecenter.com) - 1-800-342-9647. 

(Both available 24 hours a day, seven days a week) – Umbrella service 

to connect family members to appropriate service-specific and DoD 

programs and resources that will assist them with their severely injured 

service member.

My Army Benefits

This site produces personalized survivor and retirement benefit reports for 

active duty soldiers and their family members. It also provides fact sheets 

on various programs/agencies, including those offered by the various 

states. The Web site can be found at http://myarmybenefits.us.army.mil. 

126 Appendix A - Resources for Service Members, Veterans, and/or Family Members
Navigating Services and Benefits 

Navy Safe Harbor – Severely Injured Support

The Navy’s Safe Harbor program provides personalized assistance to 

severely injured sailors and their families. Go to the Web site 

http://www.npc.navy.mil/SafeHarbor. You can e-mail the Safe Harbor 

program at safeharbor@navy.mil, or call 1-877-746-8563.

TRICARE

TRICARE Online is the entry point that offers beneficiaries access to 

available healthcare services, benefits, and information. The Web 

site can be found at: www.tricare.mil. Visit this site and take the 

self-assessment, located at http://www.tricare.mil/mybenefit/home/

MentalHealthAndBehavior/GettingHelp, to determine if you could benefit 

from mental health treatment or evaluation.

Military Aid Societies

Air Force Aid Society: http://www.afas.org or call 1-800-769-8951.

Navy Marine Corp Relief Society: http://www.nmcrs.org or call 

703-696-4904. For a more local number, select the location nearest 

you from the map located on the Web page 

http://www.nmcrs.org/locations.html.

Army Emergency Relief: http://www.aerhq.org/index.asp or call 

866-878-6378.

Handbooks

Intrepid Fallen Heroes Fund

This handbook provides a number of benefits and rights for service 

members and their families. It includes information on financial, medical, 

educational, employment, and other needs. You can view this handbook 

online at www.fallenheroesfund.org.

Our Hero Handbook

This handbook guides recovering service members and their families 

from day one through recovery, transition, and beyond. It includes DoD 

procedures regarding notification, travel, and medical care. It also lists 

government agencies and private organizations that support recovering 

service members and their families. This handbook can be obtained 

127
at http://www.wramc.army.mil/WarriorsInTransition/handbooks/

WalterReedHeroHandbook.pdf.

VA Federal Benefits for Veterans and Dependents

This handbook provides a list of programs, benefits, and services 

provided by the Department of Veterans Affairs legislated in Title 38 of 

the United States Code. This handbook can be found online at 

http://www1.va.gov/opa/vadocs/fedben.pdf.

Wounded Warrior Entitlements Handbook by DFAS

This handbook provides information on programs and entitlements for 

recovering service members. This handbook can be located at http://www.

dfas.mil/army2/woundedinaction/WWEHandbook_Web_062607.pdf.

Other Helpful Web Sites

https://mypay.dfas.mil/mypay.aspx - military pay and W-2 information 

http://www.defenselink.mil/comptroller/fmr/07a/index.html - Office 

of the Under Secretary of Defense (Comptroller) – contains extensive 

information about all pay regulations.

http://www.militaryhomefront.dod.mil/portal/page/mhf/MHF/

MHF_HOME_2?section_id=20.40.500.450.0.0.0.0.0&tab_

id=20.40.500.0.0.0.0.0.0 - Operation Warfighter - The Department 

of Defense (DoD) is sponsoring Operation Warfighter, a temporary 

assignment/internship program for service members who are 

convalescing at military treatment facilities in the National Capital Region.

Operation Warfighter is designed to provide recuperating service 

members with meaningful activity outside of the hospital environment 

that assists in their wellness and offers a formal means of transition back 

to the civilian workforce.

Open to active duty, National Guard and Reserve components, 

Operation Warfighter represents a great opportunity for service 

members in a medical hold status to build their resumes, explore 

employment interests, develop job skills, and gain valuable federal 

government work experience that will prepare them for the future. 

The program simultaneously enables participating federal agencies 

to avail themselves of the considerable talent and dedication of these 

recuperating service members.

128 Appendix A - Resources for Service Members, Veterans, and/or Family Members
Navigating Services and Benefits 

Vet Centers

Network of 232 community-based Vet Centers located in all fifty states, 

DC, Guam, Puerto Rico, U.S. Virgin Islands. Centers provide readjustment 

counseling to combat veterans or family members. Services include: 

individual counseling, group counseling, marital and family counseling, 

bereavement counseling, medical referrals, assistance in applying for VA 

benefits, employment counseling, substance abuse assessments, referral 

to community resources, military sexual trauma counseling and referral. 

Call toll free during normal business hours at 1-800-905-4675 (Eastern) 

and 1-866-496-8838 (Pacific). You can locate a Vet Center near you by 

going to www.vetcenter.va.gov, which contains eligibility requirements 

and a map where a service member can locate the center closest to him 

or her.

Veterans Service Organization

Veterans Service Organizations (VSOs)

A complete listing of all chartered and non-chartered VSOs is available on 

line at http://www1.va.gov/vso/index.cfm. 

http://www.avbi.org - American Veterans with Brain Injuries (AVBI)

- American Veterans with Brain Injuries (AVBI) was organized in 2004 as 

a grassroots effort whose mission is to offer support to the families of 

American service members and veterans who have suffered traumatic 

brain injuries. In 2006, AVBI.org was established to provide a Web-based 

peer support network for these veterans and their family members. 

American service members/veterans and their family members/caregivers 

are invited to meet in the peer chat room and forum. Both the forum 

and chat room are interactive and designed for you to ask questions, get 

information, and share your personal experiences with others. The blog 

offers public awareness information, commentaries, and announcements. 

Links to other Web sites are also provided. 

http://www.vfw.org – Veterans of Foreign Wars of the United States: 

Several programs:

• National Veteran Service: Veteran Service Officers are professional, 

full-time advocates who are expert at helping veterans (members and 

non-members alike) with their VA claims.

• National Legislative Services: The VFW works for veterans on Capitol Hill.

Appendix B

Resources for Veterans

129
• National Military Services: Programs include VFW Unmet Needs 

that helps service members and their families who face unexpected 

financial difficulties; Operation Uplink, to connect active-duty 

troops and hospitalized veterans with their loved ones; and various 

community service volunteer activities.

http://www.bva.org – The Blinded Veterans Association (BVA) is an 

organization of blinded veterans helping blinded veterans. There is no 

charge for any BVA service and membership is not a prerequisite to obtain 

help. All legally blinded veterans are also eligible for BVA’s assistance 

whether they become blind during or after active duty military service. 

http://www.dav.org – Disabled American Veterans (DAV). With more 

than 1.4 million members, Disabled American Veterans is an organization 

of disabled veterans who are focused on building better lives for disabled 

veterans and their families. The organization accomplishes this goal by 

providing free assistance to veterans in obtaining benefits and services 

earned through their military service. It is fully funded through its 

membership dues and public contributions. It is not a government 

agency and receives no government funds.

DAV’s largest endeavor is the National Service Program. In 88 offices, a 

corps of 260 National Service Officers (NSOs) and 26 Transition Service 

Officers (TSOs) directly represent veterans with claims for benefits from 

the Department of Veterans Affairs and the Department of Defense. This 

free service is available to all veterans.

The National Voluntary Service Program operates an extensive network 

of programs through which veterans and concerned citizens provide 

services for their disabled veterans. This includes the Transportation 

Network, which provides veterans with rides to and from VA medical 

facilities for treatment, and the Voluntary Service Program, which 

facilitates volunteers at VA hospitals, clinics, and nursing homes through 

the VA Voluntary Service Program. 

http://www.iava.org/index.php – Iraq and Afghanistan Veterans of 

America is the nation’s first and largest group dedicated to the troops 

and veterans of the wars in Iraq and Afghanistan, and the civilian 

supporters of those troops and veterans. IAVA is an independent 

organization and is not affiliated with any groups other than its sister 

organization, IAVA Action Fund. 

http://www.pva.org – The Paralyzed Veterans of America works to 

maximize the quality of life for its members and all people with SCI/D as 

a leading advocate for health care, SCI/D research education, veterans’ 

130 Appendix B - Resources for Veterans
Navigating Services and Benefits 

benefits and rights, accessibility, and the removal of architectural barriers, 

sports programs, disability rights.

http://www.amc.army.mil/AlwaysASoldier – The Always a Soldier

program provides service-connected disabled veterans opportunities to 

seek employment, career advancement, job mobility, family economic 

well-being, and greater financial security.

Specific employment tracks include:

• Wage Grade positions involving trades and labor 

• Internship programs providing monitored or supervised work/training 

experience with learning goals 

• Various federal full performance positions.

To accomplish this goal, the Always A Soldier program partners with 

existing Army programs (Disabled Soldier Services, Army Community 

Service), the Department of Veterans Affairs, and Disabled American 

Veterans. 

Links for Veterans

Below are Web sites that provide information on veterans’ benefits. These 

sites explain everything you need to know about benefits: how to ask for 

them, where to obtain the information you need to apply, and how to 

appeal a decision if your application is denied.

Board of Veterans’ Appeals: http://www.va.gov/vbs/bva

CARES Draft National Plan: http://www1.va.gov/caresdecision/

page.cfm?pg=105

Center for Minority Veterans: http://www1.va.gov/

centerforminorityveterans

Center for Veterans Enterprise: http://www.vetbiz.gov

Center for Women Veterans: http://www1.va.gov/WOMENVET

Veterans Compensation Benefits Rate Tables, 12-1- 08:

http://www.vba.va.gov/bln/21/Rates/comp01.htm 

Department of Veterans Affairs Home Page: http://www.va.gov

Directory of Veterans Service Organizations: http://www1.va.gov/VSO

Disability Examination Worksheets Index, Comp: 

http://www.vba.va.gov/bln/21/Benefits/exams/index.htm

Electronic Code of Federal Regulations: http://www.gpoaccess.gov/ecfr

131
132 Appendix B - Resources for Veterans

Evaluation Protocol for Gulf War and Iraqi Freedom Veterans with 

Potential Exposure to Depleted Uranium (Du):

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1158

See also, Depleted Uranium Fact Sheet: http://www1.va.gov/gulfwar/

docs/DepletedUraniumFAQSheet.doc 

Federal Benefits for Veteran Dependents and Survivors: 

http://www1.va.gov/opa/vadocs/fedben.pdf or, http://www.va.gov/OPA/

vadocs/current_benefits.asp

Forms and Records Request: http://www.va.gov/vaforms 

Geriatrics and Extended Care: http://www1.va.gov/geriatricsshg 

Homeless Veterans: http://www1.va.gov/homeless 

M21-1 Table of Contents: http://www.warms.vba.va.gov/M21_1.html

Mental Disorders, Schedule of Ratings: 

http://www.warms.vba.va.gov/regs/38CFR/BOOKC/PART4/S4_130.DOC

Mental Health Program Guidelines: 

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1094 

Neurological Conditions and Convulsive Disorders, Schedule of Ratings: 

http://www.warms.vba.va.gov/regs/38cfr/bookc/part4/s4_124a.doc

OMI (Office of Medical Inspector): http://www.omi.cio.med.va.gov

Peacetime Disability Compensation: 

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=browse_

usc&docid=Cite:+38USC1131& docid=Cite:+38USC1131 

Prosthetics Eligibility: 

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=337

Public Health and Environmental Hazards Home Page: 

http://www.vethealth.cio.med.va.gov 

Publications and Manuals: http://www1.va.gov/vhapublications/

publications.cfm?Pub=4 Title 38 

Title 38

Index 

Parts 0-17 

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?sid=1b0c269b510d31

57fbf8f8801bc9b3dc&c=ecfr&tpl=/ecfrbrowse/Title38/38cfrv1_02.

tpl&c=ecfr&tpl=/ecfrbrowse/Title38/38cfrv1_02.tpl 
Navigating Services and Benefits 133

Part 18

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?sid=1b0c269b510d31

57fbf8f8801bc9b3dc&c=ecfr&tpl=/ecfrbrowse/Title38/38cfrv2_02.

tpl&c=ecfr&tpl=/ecfrbrowse/Title38/38cfrv2_02.tpl 

Title 38 

Part 3 Adjudication 

Subpart A, Pension, Compensation, and Dependency and Indemnity 

Compensation:

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=1b0c269b510d

3157fbf8f8801bc9b3dc&tpl=/ecfrbrowse/Title38/38cfr3_main_02.tpl&si

d=1b0c269b510d3157fbf8f8801bc9b3dc

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=1b0c269b51

0d3157fbf8f8801bc9b3dc&tpl=/ecfrbrowse/Title38/38cfr3_main_02.

tpl&tpl=/ecfrbrowse/Title38/38cfr3_main_02.tpl 

Title 38

Part 4 - Schedule for Rating Disabilities

Subpart B - Disability Ratings

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=ab7641afd195c

84a49a2067dbbcf95c0&rgn=div6&view=text&node=38:1.0.1.1.5.2&idn

o=38ab7641afd195c84a49a2067dbbcf95c0

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=ab7641afd195c

84a49a2067dbbcf95c0&rgn=div6&view=text&node=38:1.0.1.1.5.2&idn

o=38&rgn=div6&view=text&node=38:1.0.1.1.5.2&idno=38

U.S. Court of Appeals for Veterans Claims: 

http://www.uscourts.cavc.gov

VA Best Practice Manual for Posttraumatic Stress Disorder (PTSD): 

http://www.avapl.org/pub/PTSD%20Manual%20final%206.pdf 

VA Loan Lending Limits and Jumbo Loans: 

http://valoans.com/va_facts_limits.cfm

VA Emergency Management: http://www1.va.gov/emshg

VA Schedule for Rating Disabilities: 

http://www.warms.vba.va.gov/bookc.html 

VA War-Related Illness and Injury Study Center: 

http://www.va.gov/WRIISC-DC

Veterans Benefits Administration Main Web Page: 

http://www.vba.va.gov
134 Appendix B - Resources for Veterans

Veterans Legal and Benefits Information: http://valaw.org

Veterans Online Application: 

http://vabenefits.vba.va.gov/vonapp/main.asp

VHA Public Health Strategic Health Care Group Home Page: 

http://www.publichealth.va.gov

Vocational Rehabilitation: http://www.vba.va.gov/bln/vre

Wartime Disability Compensation: http://frwebgate.access.gpo.gov/

cgi-bin/getdoc.cgi?dbname=browse_usc&docid=Cite:+38USC1110> 

War-Related Illness and Injury Study Center - New Jersey: 

http://www.wri.med.va.gov

Welcome to the GI Bill Web Site: http://www.gibill.va.gov
Navigating Services and Benefits 

Caregiver Support

http://www.visn8.med.va.gov/v8/Clinical/cccs/clinical/CaregiverFAQ.pdf

http://www.naccrra.org/MilitaryPrograms/injured.php - Child Care 

Assistance for Families of Severely Injured Military Families. The 

National Association of Child Care Resource and Referral Agencies 

(NACCRRA) and the Department of Defense (DoD) have partnered to 

provide families of severely injured military members with assistance 

to find and pay for safe, licensed child care services for a period of six 

months during their period of recuperation. (Extensions beyond the sixmonth period will be considered based upon physician reassessment.) 

The program is available nationwide wherever the injured member is 

receiving either inpatient or outpatient medical care.

NACCRRA will coordinate with state and local Child Care Resource and 

Referral agencies to help military families locate child care in the civilian 

community when a military program is unavailable. This will allow the 

spouse to be at bedside or to help with outpatient medical appointments. 

NACCRRA and the DoD will provide an offset to the civilian child care fees 

during the recovery period. 

http://www.militaryfamily.org - National Military Family Association 

(NMFA). This organization educates military families concerning 

their rights, benefits and services available to them, and influences the 

development and implementation of legislation and policies that 

benefit them.

www.strongbonds.org - Strong Bonds has specialized programs for 

single soldiers, couples, and families. Those soldiers being deployed 

or redeployed can also learn special coping tactics. Strong Bonds 

empowers soldiers and their loved ones with relationship-building 

skills, and connects them to community health and support resources. 

It is a holistic, preventative program committed to the restoration and 

preservation of Army families, even those near crisis. The program is 

initiated and led by the Army Chaplains. More than 90 percent of those 

who have attended the program rate it positively.

http://www.emilitary.org - The mission of the Military Family Network 

is to support military families and increase their readiness and well-being 

by connecting them with their communities and the organizations that 

provide the best service and value.

Appendix C

Resources for Caregivers and Families

135
http://www.militarychild.org/education/living-in-the-new-normal

- Program from the Military Child Education Coalition. Sparked by 

concerns about military children dealing with illness, injury, or death of 

a parent, the Living in the New Normal or LINN initiative was developed 

through collaboration with experts in the fields of trauma and grief, 

resiliency, health care, and child development.

LINN encourages families to ensure their children have the tools to 

weather life’s storms, fosters homefront efforts to support military children, 

and provides educators and other concerned adults with information to 

help them support children during times of uncertainty, trauma, and grief. 

LINN’s efforts are predicated on the belief that children are courageous 

and resilient and that these skills can be strengthened through deliberate 

encouragement by the adults in their lives. 

Adult Day Care and Adult Social Day

The National Adult Day Services Association can help you find adult day 

care services that are suitable for your loved one’s needs. Visit 

http://www.nadsa.org or call them at 877-745-1440.

DisabilityInfo.gov

DisabilityInfo.gov is the federal government’s one-stop Web site for 

people with disabilities, their families, employers, veterans and service 

members, workforce professionals, and many others.

The Web site can be found at http://www.disabilityinfo.gov.

Deployment Health Clinical Center

www.pdhealth.mil/hss/smfss.asp offers a list of programs that can assist 

family members who are caregivers to injured service members.

Family Caregiver Alliance

Family Caregiver Alliance offers a caregiver support group at 

www.caregiver.org. The Alliance can also be reached at 415-434-3388 or 

800-445-8106, or e-mail info@caregiver.org.

National Association of Child Care Resource and 

Referral Agencies

This site will help you cut the cost of child care if you are the spouse of a 

service member who is severely injured. 

Go to www.naccrra.org/MilitaryPrograms/progdesc.php.

136 Appendix C - Resources for Caregivers and Families
Navigating Services and Benefits 

National Family Caregivers Association

Call 800-896-3650 or visit http://www.nfcacares.org.

Transportation Services

To learn about paratransit near you, call Project Action which maintains 

a national paratransit database, at 800-659-6428 or 202-347-3066. 

You can view the database at http://projectaction.easterseals.com/site/

PageServer?pagename=ESPA_travelers_database.

National Family Caregivers Support Program

The number is 800-896-3650 and the Web site is http://www.aoa.gov.

National Respite Locator Service

http://www.respitelocator.org/index.htm.

National Women’s Health Information Center

Call for more information at 1-800-994-9662.

U.S. National Library of Medicine and the National 

Institutes of Health

U.S. National Library of Medicine and the National Institutes of Health’s 

Web site is: www.nlm.nih.gov/medlineplus/caregivers.html. You can e-mail 

your questions to custserv@nlm.nih.gov. For those who speak Spanish, visit 

http://www.nlm.nih.gov/medlineplus/spanish/caregivers.html.

137
138
Navigating Services and Benefits 

MEB/PEB Support by Service:

Army

My MEB/PEB site inside the Army intranet provides links to Army and 

DoD regulations, and the ability to track your MEB’s progress (requires 

Army Knowledge Online login).

https://www.us.army.mil/suite/page/417118 

Additional information on the MEB/PEB process can be found at the Army 

Wounded Warrior (AW2) program site: www.aw2.army.mil. You can call 

1-800-237-1336, or e-mail aw2@conus.army.mil.

The Army provides a handbook specifically tailored to understanding the 

DES process for soldiers: http://www.cs.amedd.army.mil/apdes/docs/

General%20and%20Reference%20Information/Army_PDES_booklet.doc.

Air Force

The information on this Web site will provide you the particular details of 

the Air Force DES process.

http://airforcemedicine.afms.mil/idc/groups/public/documents/

webcontent/knowledgejunction.hcst?functionalarea=LeadersGuideDistres

s&doctype=subpage&docname=CTB_030792&incbanner=0

PEB appeals process rights for airmen can be found in these two 

locations:

• Headquarters Air Force Personnel Center’s Disabilities Division’s Web 

site at http://ask.afpc.randolph.af.mil. Click on “Retiree,”’ then 

“Disability Program” or “Military,” then “Disability Program.”

• Headquarters Air Force Personnel Center’s Judge Advocate Web site 

at http://ask.afpc.randolph.af.mil. Click on “Military,” then “Support 

Programs,” then “Judge Advocate.” On the next page, select the link 

to the information you need from the “Physical Evaluation Board” 

menu under the “Judge Advocate Support” heading.

Navy

For Navy-specific information about the DES process and your case, visit 

the Safe Harbor Web page or call/e-mail the Point of Contact to receive 

individual assistance.

Web page: http://www.npc.navy.mil/safeharbor

E-Mail: safeharbor@navy.mil

Appendix D

Resources Regarding MEB/PEB

139
Phone: 1-877-746-8563

Information and support for sailors during MEB: 

http://www-nmcphc.med.navy.mil/LGuide/Medical/Medical_Boards.htm

USMC

For Marine-specific information about the DES process and your case, go 

to the Wounded Warrior Regiment Web page and click on the Disability 

Evaluation System Pocket Guide or call/e-mail the point of contact to 

receive individual assistance.

Web page: http://www.woundedwarriorregiment.org

E-mail: smbwwropscenter@usmc.mil

Phone contacts: 877-487-6299

DoD/Regulations

The DoD sets the broad guidance for the DES process. Information on 

that process can be found in the following DoD instructions (DoDI) and 

directives (DoDD):

DoDI 1332.38, Physical Disability Evaluation

http://www.dtic.mil/whs/directives/corres/pdf/133238p.pdf

DoDD1332.18, Separation for Physical Disability

http://www.dtic.mil/whs/directives/corres/html/133218.htm

DoDI 6040.44, Physical Disability Board of Review (PDBR)

http://www.dtic.mil/whs/directives/corres/pdf/604044p.pdf

Service Regulations

Each service manages its own DES process. To find out more about your 

particular service, you can review the regulations and manuals governing 

your service’s system at the links below:

Navy and Marine Corps

Council of Review Boards

http://www.donhq.navy.mil/corb

USMC DES pocket guide

http://www.woundedwarriorregiment.org. Click on Disability Evaluation 

System Pocket Guide

140 Appendix D - Resources Regarding MEB/PEB
Navigating Services and Benefits 

Secretary of the Navy Instruction 1770.3C - Management and Disposition 

of Incapacitation and Incapacitation Benefits for Members of Navy and 

Marine Corps Reserve Components

http://www.combatindex.com/mil_docs/pdf/secnav/1700/1770-3C.pdf

Army

Army Regulation 635-40 – Physical Evaluation for Retention

http://www.army.mil/usapa/epubs/pdf/r635_40.pdf

Army Regulation 40-501 – Standards of Medical Fitness

http://www.army.mil/usapa/epubs/pdf/r40_501.pdf

Army Regulation 600-60 – Physical Performance Evaluation System

http://www.army.mil/usapa/epubs/pdf/r600_60.pdf

Army Regulation 40-400 – Patient Administration

http://www.army.mil/usapa/epubs/pdf/r40_400.pdf

Air Force

Air Force Instruction 36-3212 – Physical Evaluation for Retention

http://www.e-publishing.af.mil/shared/media/epubs/AFI36-3212.pdf

Air Force Instruction 36-2910 – Line of Duty

http://www.e-publishing.af.mil/shared/media/epubs/AFI36-2910.pdf

Air Force Instruction 36-3209 – National Guard/Reserve separations

http://www.e-publishing.af.mil/shared/media/epubs/AFI36-3209.pdf

VA Schedule for Rating Disabilities (VASRD)

For an explanation on how combined ratings are determined for 

numerous compensable conditions for one person, see 32 CFR, Section 

4.25 (Table 1).

http://www.access.gpo.gov/nara/cfr/waisidx_04/38cfr4_04.html

141
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Navigating Services and Benefits 

Appendix E Your Service Member’s 

Right to Appeal the PEB’s Decision

The Disability Evaluation System (DES) is guided by Public Law. Each 

branch of service, however, has its own policies for how the system runs. 

Every service system offers a right to appeal the decisions of the Physical 

Evaluation Board (PEB) on your service member’s condition. Below, you 

will find the information for each branch of service about how to appeal 

the PEB decisions. 

Army: 

The case will go before the informal PEB without your service member 

being present. The PEB members only see your service member’s record 

from the MEB. The PEB makes a decision based on the record. (See 

Chapter 12 for more information.)

If your service member is found fit:

• He or she can agree (concur) or disagree (non-concur) with the 

Board’s decision. 

- If your service member disagrees, he or she may present a written 

explanation about why he or she disagrees. This is the chance to 

provide more information on your service member’s condition and 

how it affects his or her duty performance. Because your service 

member was found fit, he or she does not have a right to a formal 

PEB where he or she can discuss the case in person. However, your 

service member can ask for a formal PEB as an exception to policy. 

If your service member is found unfit:

• He or she can agree or disagree with the findings. 

• If your service member disagrees, he or she may send a written 

rebuttal to the PEB. This should include new information on his or her 

condition and its effects on duty performance. Because your service 

member was found unfit, he or she also has the right to a formal 

hearing. If your service member would like, he or she may appear at 

the hearing in person. 

- Your service member may seek legal help to prepare for a formal 

PEB. He or she may be represented at the hearing by an attorney 

from the Judge Advocate General’s (JAG) Corps. He or she can also 

choose a civilian attorney or a representative from a Veterans Service 

Organization (VSO), such as Disabled American Veterans (DAV). 

(See Appendix B for a link to DAV and a link to a complete list of 

VSOs.) If your service member chooses to use his or her own lawyer 

and not a representative from the JAG Corps, your service member 

143
must pay any fees for outside counsel. Legal help from the JAG 

Corps is free to your service member. 

• When your service member appears before a formal PEB, he or she 

may present evidence, testimony, and documents to support his or her 

case. Your service member’s lawyer will help him or her prepare 

for this. 

The formal PEB will:

• listen to your service member’s new information

• ask him or her questions about his or her medical limitations

• give your service member a chance to make a final statement before it 

makes a decision.

Your service member will be excused from the hearing after his or her 

statement. The PEB members will discuss and vote on your service 

member’s case. 

The formal PEB makes decisions by majority vote. If some members of 

the board disagree with the majority, they must write a minority opinion. 

It will become part of the report that documents the board’s actions. 

The board will bring your service member and his or her counsel back 

into the room and disclose its decision. It will also provide your service 

member with a written copy of the Board’s report. Your service member 

will have 10 calendar days after the board ends to decide if he or she 

agrees or disagrees with its findings. 

If your service member disagrees, he or she will again be able to provide 

a written rebuttal to the formal PEB. 

If the PEB does not accept your service member’s rebuttal and upholds 

its decision, the case will go to the U.S. Army Physical Disability Agency 

(USAPDA) for review. All cases decided by informal or formal PEBs are sent 

to the USAPDA. USAPDA automatically reviews all cases where the service 

member disagrees with the findings or where there is a minority report. 

The USAPDA can uphold the PEB findings, issue revised findings, or send 

the case back to the PEB for another review. If the USAPDA revises the 

findings or sends the case back to the PEB for another review, your service 

member will again have the chance to agree or disagree with the findings 

and to provide a written rebuttal to the PEB. 

If your service member didn’t request a formal review before, he or she 

may request one based on revised findings by the USAPDA. The formal 

review will take place at that level. 

144 Appendix E - Your Service Member’s Right to Appeal the PEB’s Decision
Navigating Services and Benefits 

Once the USAPDA makes a final decision on your service member’s case, 

he or she will have to follow that decision. If that requires separation or 

retirement, then he or she will be separated or retired. 

Your service member may still dispute the findings after he or she has 

separated or retired by filing a petition for relief with the Army Board for 

the Correction of Military Records (ABCMR). 

Your service member can find out more about appeal rights by reviewing 

the Army Physical Disabilities Evaluation System Handbook, dated March 

16, 2007. Your service member can find a copy of that handbook 

by visiting the Web site http://www.cs.amedd.army.mil/apdes/docs/

General%20and%20Reference%20Information/Army_PDES_booklet.doc.

Navy/Marine Corps: 

The Navy and Marine Corps use the same PEB process. It begins with 

an informal PEB. It only moves to a formal PEB if the sailor or Marine 

requests it. 

The informal PEB will take place without your service member being 

present. The board will decide if your service member is fit or unfit for 

duty, based on his or her records and the MEB results. 

If the board finds your service member fit for duty, he or she will have a 

chance to agree or disagree with that decision. Your service member can 

ask the board to reconsider the case based on new information on his 

or her medical condition and other information the board did not have 

before. 

If the PEB still believes your service member is fit for duty, your service 

member can request a formal PEB. A formal PEB is not a right if your 

service member is found fit for continued service. The board may choose 

not to grant a formal PEB. 

If your service member is found unfit, he or she has three choices:

• accept the findings of the PEB 

• disagree with the findings and request a formal PEB 

• conditionally accept the findings and request a formal PEB.

If your service member requests a formal PEB, the Navy will assign 

a judge advocate to help your service member prepare evidence, 

documents, and statements to support his or her case. 

Your service member may attend the formal PEB in person or just send 

information to the board. Your service member may also choose to be 

145
represented by a civilian attorney or a representative from a Veterans 

Service Organization (VSO). (See Appendix B for a link to a complete 

list of VSOs.) Your service member must pay any costs for using a nonmilitary lawyer. 

Here’s what will happen at the formal PEB:

• If your service member chooses not to testify under oath, he or she 

may make a statement. The board members will not ask questions of 

your service member.

• If your service member testifies under oath, the board will ask about 

his or her condition and the effect it has on duty performance. After 

your service member has answered the questions, he or she will have a 

chance to make a final statement. 

• Your service member will be excused while the board makes a decision. 

After discussing the case, the board will tell your service member what it 

decided. At this point, your service member can:

• accept the findings

or 

• file a “petition for relief” (PFR) with the Director, Secretary of the Navy 

Council of Review Boards (DIRSECNAVCORB). 

The DIRSECNAVCORB can revise the findings of the board or uphold them. 

If your service member is separated or retired and still disagrees with 

the findings of the PEB or the DIRSECNAVCORB, he or she can petition 

the Board for Correction of Naval Records (BCNR) for relief from any 

perceived injustice or inequity. 

Air Force 

The Air Force PEB starts with an informal board that your service member 

does not attend. 

Your service member’s record will be forwarded from the MEB to the PEB. 

The informal PEB members will review it and make a decision. 

Within a few days of the board meeting, your Physical Evaluation Board 

Case Manager will report the results of the informal PEB. Your service 

member will be asked to sign an Air Force Form 1180 to tell the PEB if he 

or she agrees with the findings or not. 

If your service member disagrees with a finding of fit, he or she will need 

to submit the Air Force Form 1180, along with a written explanation of 

146 Appendix E - Your Service Member’s Right to Appeal the PEB’s Decision
Navigating Services and Benefits 

why he or she would like a formal PEB. A formal PEB is not a right when 

your service member receives a fit for continued duty finding. 

If your service member is found unfit, he or she does not have to 

provide a justification for requesting a formal PEB. Your service member 

will need to contact the legal office at Lackland Air Force Base, where the 

formal PEBs are held. Your service member can contact this office at 

DSN 473-4295 or commercial: 210-671-4295 to have a lawyer 

assigned to the case. 

Your service member can also choose a civilian attorney or a 

representative from a Veterans Service Organization (VSO) like the 

Disabled American Veterans (DAV). (See Appendix B for a link to DAV 

and a link to a complete list of VSOs.) If your service member chooses 

to use his or her own lawyer, he or she must pay any fees for that lawyer. 

Legal representation from the military is free to your service member. 

When your service member appears before a formal PEB, your service 

member may present evidence, testimony, and documents to support the 

case. The lawyer will help your service member prepare for this. 

If your service member has witnesses who could testify in person, he or 

she must pay the expense of bringing them to the formal PEB location. 

If your service member decides that he or she does not want to do a 

formal PEB after meeting with a lawyer, he or she can waive rights to a 

board. However, the president of the board will decide whether or not to 

hold a formal PEB once your service member has requested one.

Audio of the formal PEB is always recorded. If your service member asks, 

video of the meeting can also be recorded. 

After your service member has presented information to the formal PEB, 

board members will meet privately to make a decision. The formal PEB 

will either uphold the informal PEB findings or recommend different 

findings. 

The board will notify your service member of its decision. Your service 

member will have a day to respond if he or she agrees or disagrees with 

its findings. 

If your service member agrees with the formal PEB findings, the case 

will be sent to the Physical Disability Division at Headquarters, Air Force 

Personnel Command, for finalization. The Physical Disability Division will 

review the case, the findings of the informal and formal PEB, and decide 

if the case should be finalized or forwarded for further review by the 

147
Secretary of the Air Force Personnel Council (SAFPC). This only happens 

when the Physical Disability Division thinks a review by the SAFPC is in 

the best interest of the service member or the Air Force. 

If your service member disagrees with the formal PEB findings, there 

will be 10 days to submit a rebuttal to the formal PEB for forwarding to 

the SAFPC. If the formal PEB does not receive your service member’s 

rebuttal in that time, the case will go to the Physical Disability Division 

for processing. 

Even if the SAFPC upholds the formal PEB and your service member is 

separated or retired, he or she may still appeal that decision by applying 

to the Air Force Board for Correction of Military Records (AFBCMR). 

This is the highest administrative appeal available for the Air Force. The 

burden of proof is on your service member to show that an error or 

injustice happened in his or her case during the DES process. 

Your service member can get additional information on the Air Force 

appeals process at these locations: 

• Headquarters Air Force Personnel Center’s Disabilities Division’s 

Web site at http://ask.afpc.randolph.af.mil. Click on “Retiree,” then 

“Disability Program” or “Military,” then “Disability Program.” 

• Headquarters Air Force Personnel Center’s Judge Advocate Web site 

at http://ask.afpc.randolph.af.mil. Click on “Military,” then “Support 

Programs,” then “Judge Advocate.” On the next page, select the 

link to the information your service member/veteran needs from 

the “Physical Evaluation Board” menu under the “Judge Advocate 

Support” heading. 

148 Appendix E - Your Service Member’s Right to Appeal the PEB’s Decision
Navigating Services and Benefits 

Access to Medical Care

Military Health System

For general information on the Military Health System, go to 

http://mhs.osd.mil. This site includes links to all of the military 

departments’ health care systems, DEERS, Wounded Warrior Programs, 

and much more. For information on the mission of the military medical 

departments, their leadership, and links to their policies and regulations: 

Army: http://www.armymedicine.army.mil/index.cfm; 

Navy: http://navymedicine.med.navy.mil;

Air Force: http://www.sg.af.mil.

Military Medical Support Office (MMSO)

In order to schedule appointments for medical care for your family 

member’s service-connected injury or illness, the unit administrator 

contacts MMSO. You may also call 1-888-MHS-MMSO (1-888-647-6676) 

and follow menu prompts, for information regarding pre-authorization, 

appointments, claims, and reimbursements for civilian medical bills. 

Hours of operation are Monday through Friday, 7 a.m. to 6 p.m., Central 

time. Or visit the MMSO Web site at http://www.tricare.mil/MMSO.

TRICARE

TRICARE information can be accessed in several ways. The main page, 

http://www.tricare.mil, includes general information about TRICARE 

and links to benefits and plans. This TRICARE site, https://www.

tricareonline.com/welcome.do, allows you to see information on all of 

the military treatment facilities, make some appointments, and refill some 

prescriptions. You will need to register for access.

TRICARE Dental

For more order information about the TDP, visit 

www.TRICAREdentalprogram.com or call toll-free 1-800-866-8499 for 

general information. To enroll, call 1-888-622-2256. More information 

on the TRICARE Dental Program is available on your dental provider’s 

Web site or at www.tricare.mil/contactus and at 

http://www.tricaredentalprogram.com/tdptws/home.jsp.

If you are a retiree (including National Guard and Reserve retired 

members), you can enroll in the TRICARE Dental Plan. See the 

instructions at www.tricare.mil/mybenefit/home/Dental/Retiree.

Appendix F Rehabilitation

Medical Support Resources

149
Continued Health Care Benefit Program (CHCBP)

For more information, visit http://www.humana-military.com/chcbp/

main.htm or call the toll-free line at 1-800-444-5445.

DoD Mental Health Self Assessment Program

Anonymous self-assessments are available for depression, bipolar disorder, 

alcohol use, post-traumatic stress disorder (PTSD), and generalized 

anxiety disorder. Individualized results and military health resources, 

including TRICARE, Vet Centers, and Military OneSource are provided at 

the end of every assessment. More information can be found at 

http://www.pdhealth.mil/mhsa.asp.

National Center for Post Traumatic Stress Disorder (PTSD)

This is a special center within the Department of Veterans Affairs created 

to advance the clinical care and social welfare of America’s veterans 

through research, education, and training in the science, diagnosis, 

and treatment of PTSD and stress-related disorders. To learn more, visit 

http://www.ncptsd.va.gov/index.html.

Courage to Care

The site, located at http://www.usuhs.mil/psy/courage.html, was created 

by Uniformed Services University for the Health Sciences, which belongs 

to the Center for Traumatic Studies and includes a wealth of additional 

information. “Courage to Care” is an electronic health campaign for 

military and civilian professionals serving the military community, and for 

military men, women, and families.

The American Red Cross

The American Red Cross offers confidential services to all military 

personnel and their families. Counseling, guidance, information, referrals, 

and other social services are available through the Red Cross worldwide 

network of chapters and offices on military installations. Red Cross 

chapters are listed in local telephone books and at 

http://www.redcross.org/where/where.html.

150 Appendix F - Rehabilitation Medical Support Resources
Navigating Services and Benefits 

Department of Health and Human Services (DHHS)

DHHS

The DHHS Web site provides up-to-date information on a variety of health 

topics and includes resources on veterans’ health at http://www.hhs.gov.

Center for Disease Control and Prevention (CDC)

For information about ongoing studies of veterans’ health, visit 

http://www.cdc.gov/nceh/veterans/default.htm or call the CDC at 

1-800-232-4636.

HRSA Health Center Locator

Use this tool at http://findahealthcenter.hrsa.gov to locate your nearest 

Health Center which can provide check-ups, vaccinations, and more.

MedlinePlus for Veterans

Visit MedlinePlus for veterans at http://www.nlm.nih.gov/medlineplus/

Veteransandmilitaryhealth.html to learn about veteran-specific health 

issues and news.

National Institute of Diabetes and Digestive and Kidney 

Diseases (NIDDK)

The NIDDK conducts and supports basic and clinical research on 

diabetes, liver and kidney diseases, nutrition, and much more. Visit 

http://www2.niddk.nih.gov or call 301-496-3583.

National Institute on Dental and Craniofacial Research (NIDCR)

The NIDCR conducts research related to oral, dental, and craniofacial 

health. To learn more, visit http://www.nidcr.nih.gov, e-mail 

nidcrinfo@mail.nih.gov, or call 301-496-4261.

National Institute on Deafness and other Communicative 

Disorders (NIDCD)

To learn about the NIDCD and its research and support for people 

with communication disorders, visit http://www.nidcd.nih.gov, e-mail 

nidcdinfo@nidcd.nih.gov, or call the NIDCD at 1-800-241-1044 or TTY at 

1-800-241-1055.

151
National Institute of Mental Health

The NIMH is the largest scientific organization in the world dedicated 

to research focused on the understanding, treatment, and prevention 

of mental disorders and the promotion of mental health. For more 

information, you can go to http://www.nimh.nih.gov, e-mail 

nimhinfo@nih.gov, or call 1-866-615-6464.

Substance Abuse and Mental Health Services 

Administration (SAMHSA)

Visit the SAMHSA Web site at www.samhsa.gov to get access to mental 

health and substance abuse services, as well as resources for families 

coping with trauma. SAMHSA can also be reached at 

SHIN@samhsa.hhs.gov or by phone at 1-877-726-4727.

Mental Health Services Locator

The SAMHSA Mental Health Services Locator, available at 

http://mentalhealth.samhsa.gov/databases, provides state-specific 

information about local mental health services and resources.

Substance Abuse Treatment Facility Locator

This SAMHSA locator allows you to find your closest Substance Abuse 

Treatment Facility. To use the locator, go to http://dasis3.samhsa.gov.

HealthierUS Vets Program

The HealthierUS Vets Program educates veterans and their families about 

eating healthy, being active, and the risks of obesity and diabetes. Visit 

the program’s Web site at http://www.healthierusveterans.va.gov, or call 

for more information at 1-800-827-1000.

Traumatic Brain Injury (TBI)

Defense and Veterans Brain Injury Center (DVBIC) provides TBI 

patients with state-of-the-art medical care, innovative clinical research 

initiatives, and educational programs. To learn more about DVBIC, you 

can visit http://www.dvbic.org, e-mail info@dvbic.org, or call 

1-800-870-9244.

152 Appendix F - Rehabilitation Medical Support Resources
Navigating Services and Benefits 

Find a VA Polytrauma Care Facility

Polytrauma centers assist patients with injuries to more than one 

region or organ system, and those which result in physical, cognitive, 

psychological, or psychosocial impairments and functional disability. 

To locate a Polytrauma center near you and to learn more about the 

Polytrauma centers, visit http://www.polytrauma.va.gov/

facility_locations.asp?isFlash=1 or call 1-877-222-8387.

National Institute of Neurological Disorders and Stroke 

(NINDS) – TBI

The NINDS provides publications, organizations, clinical trials, and other 

information, all related to TBI. To learn more about NINDS and TBI, you 

can go to http://www.ninds.nih.gov/disorders/tbi/tbi.htm or call NINDS 

at 1-800-352-9424.

Suicide Prevention

Air Force – Air Force Suicide Prevention Program

Visit the program’s Web site at http://afspp.afms.mil to learn about 

initiatives to help prevent and to deal with suicides within the Air Force 

community.

Army – U.S. Army Center for Health Promotion and 

Preventive Medicine Suicide Prevention Program

The Army’s Suicide Prevention Program provides resources and research 

related to suicide prevention. Visit http://chppm-www.apgea.army.mil/

dhpw/Readiness/suicide.aspx.

Coast Guard – Coast Guard Suicide Awareness Program

The Coast Guard’s Suicide Awareness Program, located on the Web at 

http://www.uscg.mil/worklife/suicide_prevention.asp, provides tips and 

resources for dealing with suicides. The crisis phone number is 

1-800-222-0364.

Marine Corps – Marine Corps Community Services Suicide 

Prevention Program

Visit the program Web site at http://www.usmc-mccs.org/suicideprevent

or call 1-800-342-9647 for risk factors, warning signs, and prevention tips 

for suicide.

153
Navy – Navy Suicide Prevention Program

The Navy Suicide Prevention Program has resources, tips, and a 

Web-based training tool to help prevent and handle suicides. For 

more information, visit http://www.npc.navy.mil/CommandSupport/

SuicidePrevention or e-mail suicideprevention@navy.mil.

National Suicide Prevention Lifeline

The Preventing Suicide Network has a crisis phone line at 1-800-273-8255. 

You can also visit http://www.preventingsuicide.com/dodtest for 

problem-specific information about suicide prevention in the military.

National Strategy for Suicide Prevention

This Web site http://mentalhealth.samhsa.gov/suicideprevention lets you 

find state-specific suicide prevention programs as well as recent news and 

information on suicide prevention. For more information, 

call 1-800-789-2647.

National Institute of Mental Health – Suicide Prevention

This portion of the NIMH Web site, http://www.nimh.nih.gov/health/

topics/suicide-prevention/index.shtml, contains prevention information 

and ongoing clinical trials related to suicides. You can contact NIMH at 

1-866-615-6464.

Center for Disease Control and Prevention

The CDC’s Suicide Prevention site, on the Web at http://www.cdc.gov/

ncipc/dvp/Suicide/default.htm, contains resources and information about 

suicide. It can also be reached by calling 1-800-311-3435.

American Foundation for Suicide Prevention (AFSP)

The AFSP focuses on research and new educational campaigns to help 

people deal with the difficulties of suicide. To learn more about how 

AFSP can help, visit http://www.afsp.org, e-mail inquiry@afsp.org, or call 

1-888-333-2377.

MedlinePlus - Suicide

This page of the MedlinePlus site, at http://www.nlm.nih.gov/

medlineplus/suicide.html, contains new information, prevention and 

coping strategies, and resource links.

154 Appendix F - Rehabilitation Medical Support Resources
Navigating Services and Benefits 

National Association for People of Color Against Suicide 

(NOPCAS)

NOPCAS provides a counseling certification program, Survivor’s Circle 

support groups, and other resources. Visit NOPCAS on the Web at 

http://www.nopcas.org/resources or, for more information, you can 

e-mail info@nopcas.org.

Depression Screening

If you go to http://www.depression-screening.org, you can access a 

free, confidential depression screening test. NOTE: This tool does not 

provide a clinical diagnosis, but may be able to help identify underlying 

symptoms that could need further attention.

Suicide Awareness Voices of Education (SAVE)

Visit SAVE’s Web site at http://www.save.org or call SAVE at 952-946-7998 

to learn more about suicide, how to deal with it, as well as current news 

and information related to suicides.

Mental Health Self-Assessment Program

This program allows you to take anonymous mental health and alcohol 

use self-assessments online, via the phone, and through special events 

held at military installations. For more information or to take one of the 

assessments, visit http://www.mentalhealthscreening.org/military/index.

aspx or e-mail smhinfo@mentalhealthscreening.org.

Suicide Prevention Advocacy Network (SPAN)

SPAN is an organization dedicated to preventing suicide through public 

education and awareness, community action, and federal, state, and 

local grassroots advocacy. To learn how to get involved, visit 

http://www.spanusa.org, e-mail info@spanusa.org, or call 202-449-3600.

Post-Traumatic Stress Disorder (PTSD)

Sidran Institute

The Sidran Institute provides resources for treatment, support, and 

self-help for individuals dealing with PTSD. To learn more about the 

resources Sidran offers, visit http://www.sidran.org, e-mail 

info@sidran.org, or call 1-888-825-8249.

155
National Center for Post-Traumatic Stress Disorder 

(NCPTSD)

The NCPTSD provides veterans and their families with fact sheets and 

videos to answer your questions on trauma, PTSD, and related issues. 

For more information, go to http://www.ncptsd.va.gov, e-mail ncptsd@

va.gov, or call 1-802-296-6300.

DoD’s After Deployment Behavioral Health Web site for 

Veterans

The DoD’s Military Health System has launched a behavioral health Web 

site that allows service members to anonymously seek mental health 

treatments for illnesses such as combat stress and PTSD. Check out 

www.afterdeployment.org.

156 Appendix F - Rehabilitation Medical Support Resources
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Transition Assistance Program (TAP)

TurboTAP.org

The TAP Web site at http://www.transitionassistanceprogram.com

provides a wealth of information regarding the TAP program and many 

other aspects involved in the transition of military personnel and family 

members leaving active duty. For more information, visit the Web site 

and select the link for the TAP Counselor.

TAP Office Locator

To locate your closest TAP office, go to www.militaryinstallations.dod.mil, 

select “Transition Assistance Program” under “Program or Service,” and 

enter your information.

Small Business Administration (SBA)

The SBA Office of Veterans Business Development provides veterans 

with resources for starting their own businesses. To learn more, visit 

http://www.sba.gov/aboutsba/sbaprograms/ovbd/index.html or e-mail 

answerdesk@sba.gov.

Education Benefits

VA GI Bill Site

VA’s GI Bill Web site, located at http://www.gibill.va.gov, discusses all of 

the aspects of the GI Bill including its benefits, eligibility, and application 

procedures. You can also call 1-888-442-4551 for more information 

about VA and the GI Bill.

Department of Education Student Aid Programs

The Department of Education’s source for free information, guidance, 

and tools for federal student assistance can be found on the Web at 

http://www.federalstudentaid.ed.gov or you can call 1-800-433-3243.

Department of Veterans Affairs Vocational Rehabilitation 

and Employment (VR&E) Program

The VR&E Web site at http://www.vba.va.gov/bln/vre/index.htm, along 

with the VetSuccess Web site, http://vetsuccess.gov, can provide you with 

all of the information and services that the VR&E program can offer. You 

can also call 1-800-827-1000 for more information about the program.

Appendix G Resources Regarding Transition

and Retraining for Employment

157
Free Application for Federal Student Aid (FAFSA)

Visit FAFSA Web site http://www.fafsa.ed.gov to fill out your FAFSA and 

become eligible for Federal Student Aid. For more information on the 

FAFSA, you can call 1-800-433-3243.

FAFSA PIN Register

In order to electronically sign your FAFSA, you must register for your 

FAFSA Pin at http://www.pin.ed.gov.

Veterans Upward Bound Program (VUB)

The VUB program is designed to help you refresh your academic skills 

so that you can successfully complete the postsecondary school of your 

choosing. To learn about VUB and to locate a VUB office near you, go to 

http://navub.org/programinformation/index.php.

Federal Student Aid Forecaster

The FAFSA4-caster, on the Web at http://www.federalstudentaid.ed.gov/

fafsa4caster.html, can provide you and your family with an early estimate 

of the financial aid you will be able to receive.

Troops to Teachers (TTT)

TTT provides referral assistance and placement services to military 

personnel interested in beginning a second career in public education 

as a teacher. To learn more and determine your eligibility for TTT, go to 

http://www.proudtoserveagain.com, e-mail ttt@navy.mil , or call 

1-800-231-6242.

Reemployment Assistance

Department of Veterans Affairs Vocational Rehabilitation 

and Employment (VR&E) Program

The VR&E Web site at http://www.vba.va.gov/bln/vre/index.htm, along 

with the VetSuccess Web site, http://vetsuccess.gov, can provide you with 

all of the information and services that the VR&E program can offer. You 

can also call 1-800-827-1000 for more information about the program.

U.S. Department of Labor eLaws REALifelines Advisor

The eLaws REALifelines Advisor provides a step-by-step walkthrough 

of the resources and information available through the REALifelines 

158 Appendix G - Resources Regarding Transition and Retraining for Employment
Navigating Services and Benefits 

program. To use the Advisor, visit http://www.dol.gov/elaws/vets/

realifelines/menu.htm, or call 1-866-487-2365 for more information 

about REALifelines.

Job Accommodation Network (JAN)

JAN is a free consulting service designed to increase the employability of 

people with disabilities. Visit www.jan.wvu.edu or call 1-800-526-7234 to 

learn more about JAN’s services for veterans.

America’s Job Bank & DoD Job Search

This service allows you to search for your state’s job bank information. 

To use the search tool, go to http://dod.jobsearch.org, or for more 

information, e-mail info@careeronestop.org or call 1-877-348-0502.

Department of Labor Disability Resources

The Department of Labor provides a Web site, http://www.dol.gov/

dol/topic/disability/ada.htm, that provides resources for people with 

disabilities and offers explanations of important regulations such as 

the Americans with Disabilities Act (ADA). You can also call for more 

information at 1-866-487-2365.

ADA & IT Technical Assistance Centers

There are 10 regional ADA Centers across the country that provide 

information and services to people with disabilities. To locate an ADA 

Center in your region, visit www.adata.org or call 1-800-949-4232.

Computer/Electronic Accommodations Program (CAP)

The CAP program provides assistive technology and services to injured 

service members.

To learn about services available to you, go to www.tricare.mil/cap, 

e-mail cap@tma.osd.mil, or call 703-681-8813.

Office of Personnel Management (OPM), Federal 

Employment of People with Disabilities

This portion of the OPM Web site, www.opm.gov/disability, contains 

information about federal disability hiring programs and about gaining 

access to accommodation in the federal workplace. You can also call 

202-606-1800 to learn more about the OPM.

159
Veterans’ Preference Information

This portion of the OPM Web site, www.opm.gov/veterans/html/vetsinfo.

asp, details the Federal Veterans’ Preference program and opportunities in 

the federal government for veterans. To learn more, call 202-606-1800.

Other Employment Resources

These Web sites provide assistance, resources, and information for all 

points along your service member/veteran’s career pathway:

Career One Stop - www.careeronestop.org 

EarnWorks – www.earnworks.com – connects employers with job seekers 

Hire Vets First - www.hirevetsfirst.gov

Jobs for Vets - www.jobsforvetsalpha.org 

Job Central - www.jobcentral.com

Recruit Military - www.RecruitMilitary.com 

Monster.com - www.monster.com

USA Jobs - www.usajobs.gov

Simply Hired - www.simplyhired.com

Indeed.com - www.indeed.com

Hot Jobs - www.hotjobs.com

Military Stars - www.militarystars.com

Job A Lot - www.jobalot.com

RetirementJobs.com – www.retirementjobs.com

State Benefits Programs 

VA Facility Locator

Use this service on the VA Web site at http://www1.va.gov/directory/

guide/home.asp?isFlash=1 in order to locate the VA facility closest to you.

160 Appendix G - Resources Regarding Transition and Retraining for Employment
Navigating Services and Benefits 161

Notes
162
Navigating Services and Benefits 
www.DVBIC.org

Version: 1-2010 | www.traumaticbraininjuryatoz.org

This guide was produced in collaboration with

The Defense Health Board

The Defense and Veterans Brain Injury Center

and

The Department of Veterans Affairs