Examining the prognostic utility of symptom etiology groupings on the VA's comprehensive traumatic brain injury evaluation.

Traumatic brain injury (TBI) is a prevalent condition among military service members and Veterans. As such, the Veterans Health Administration established the TBI Screening and Evaluation Program to identify and assess suspected deployment-related TBI's among post-9/11 Veterans. Veterans who screen positive on an initial four-item TBI Screen are referred for a Comprehensive Traumatic Brain Injury Evaluation (CTBIE), a structured clinical interview used to confirm TBI diagnosis and evaluate the likely etiology of current symptoms. This study examined whether clinician-rated symptom etiology classifications on the CTBIE (i.e., Symptom Resolution, TBI, Behavioral Health, Comorbid [TBI + Behavioral Health], or Other) predict clinical and functional outcomes assessed ∼3 years later among Veterans with a history of suspected deployment-related TBI. Clinical and functional outcomes included posttraumatic stress disorder symptoms, depression/anxiety symptoms, subjective cognitive functioning, sleep, and employment. Participants (N=1,213) had a suspected TBI per the CTBIE, enrolled in the VA Million Veteran Program (MVP), and completed MVP surveys. Adjusted regression analyses demonstrated that symptom etiology group classification was significantly associated with most clinical and functional outcomes. Follow-up analyses elucidated how symptom etiology groups differed from one another across outcomes, with the Comorbid and Behavioral Health groups consistently experiencing the poorest outcomes. Findings demonstrate that clinician-rated symptom etiology groupings from the CTBIE provide meaningful insight into chronic symptoms and functional status of Veterans with suspected deployment-related TBI. These results support the clinical utility of the CTBIE's symptom etiology classification as a prognostic indicator to inform individualized care and targeted interventions for Veterans navigating long-term recovery.