VA/DoD Clinical Practice Guideline for Mild TBI
Adults with symptoms attributed to mild TBI after the acute phase. Written for VA and military health care, with 19 graded recommendations.
VA/DoD Clinical Practice Guideline for the Management and Rehabilitation of Post-Acute Mild Traumatic Brain Injury
Key recommendations
- Care is symptom-focused: each symptom — headache, sleep, dizziness, thinking, mood — is assessed and treated directly. Some people with persistent symptoms and co-occurring conditions may benefit from an individualized plan built by an interdisciplinary team.
- Diagnosis is clinical; imaging and other tests are ordered when specific findings call for them.
- If new symptoms appear more than 30 days after the injury, look for causes other than the mild TBI.
- Offer a trial of vestibular rehabilitation and balance (proprioceptive) exercise for persistent dizziness and imbalance.
- Refer memory, attention or executive-function problems for a short trial of clinician-directed cognitive rehabilitation once sleep, pain, mood, headache and balance are addressed.
- Evaluate and treat PTSD, depression, substance use and other mental health conditions the same way whether or not there was a mild TBI.
How it shows up in our care
We follow its symptom-focused approach: each symptom area is assessed and treated directly, with vestibular rehabilitation for dizziness and clinician-directed cognitive therapy with a speech-language pathologist. When symptoms persist, span several areas, or come with a neck or back injury, that plan is built by Go Clinic's coordinated team.
About this guideline
The guideline was developed by VA and Department of Defense clinicians using the GRADE approach. Each of its 19 recommendations is graded strong or weak, for or against, based on the quality of the evidence, the balance of benefits and harms, patient values and preferences, and other factors such as resource use.
Version 3.0 replaces the 2016 guideline. It covers the setting of care, diagnosis and assessment, symptom-based treatments (cognitive, behavioral, vestibular, visual, tinnitus and exertion-related symptoms) and interventions with insufficient evidence.
What it says about the conditions we treat
Each symptom — headache, sleep, dizziness, thinking, mood — is assessed and treated directly; persistent dizziness gets a trial of vestibular rehabilitation.
Some people with chronic, persistent symptoms and co-occurring conditions may benefit from an individualized plan built by an interdisciplinary team. New symptoms after 30 days should be checked for other causes.
People with persistent dizziness and imbalance should be offered a trial of vestibular rehabilitation and balance (proprioceptive) exercise.
Memory, attention or executive-function problems should be referred for a short trial of clinician-directed cognitive rehabilitation once sleep, pain, mood, headache and balance are addressed.
This summary is paraphrased for general information — see the source for its exact wording and full recommendations. Go Clinic is not affiliated with, and has not been reviewed or endorsed by, U.S. Department of Veterans Affairs and Department of Defense. Last updated October 2026. This page is not medical advice; Go Clinic's telehealth services are not for emergencies — call 911 or go to the nearest emergency room.
Care that follows the evidence.
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