A roofer hits his head; they get a clean brain scan; months later, they can’t even retain a short grocery list in their mind. In Texas, doctors are now legally mandated to determine if such issues are the results of a brain injury, depression or something else.

In October 2026, the Texas Division of Workers’ Compensation tackled the issue in a six-part online case study related to non-musculoskeletal traumatic brain injury. Designated doctors were taught to rate impairment, using the AMA Guides to the Evaluation of Permanent Impairment (Fourth Edition, 1993), by performing a physical exam that covers all areas and functions of the brain. Doctors were told to use neuropsychological testing, structured memory, attention and effort test to objectively determine whether TBI residuals exist or if there is an alternate explanation. (Questionnaires like the oft-used PHQ-9, a nine-question depression screen, can result in exaggerated symptoms, and lack built-in checks which can have legal ramifications.)

Other states, including California, train their independent medical examiners in impairment rating, so Texas’s dedicated TBI module is unique. Its stress on objective evidence echoes federal concussion guidance from agencies like the CDC and VA.