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Traumatic Brain Injury (TBI): C&P Exam Prep

Lasting effects of a traumatic brain injury (TBI), such as problems with memory, attention, judgment, mood or behavior, and symptoms like headaches, dizziness and sensitivity to light or sound.

This prep guide was generated with AI, so please also check the VA rating criteria (38 CFR Part 4) and the VA exam form (DBQ) for this condition.

← C&P Exam Prep Guide

Quick Must-Know

  • VA rates TBI on the effects you have now, not on how bad the injury was at the time. Your records may label your TBI as mild, moderate or severe. VA's rules say those labels describe the injury when it happened. They don't affect the rating.
  • Give real examples of memory and thinking problems. For example, you lose track of a conversation, forget the names of people you just met, can't find words, or often misplace things. The higher levels for memory need test results that show the problem.
  • Explain how your symptoms affect work, daily tasks and close relationships. Several TBI levels depend on how much your symptoms get in the way.
  • Tell the examiner about every problem, including headaches, mood, hearing and vision. Problems with their own diagnosis are rated under their own codes. The same symptom can't count twice.
  • Ask someone who knows you well to write a statement (VA Form 21-10210) about changes they've seen since the injury. VA's rules list not being fully aware of your own problems as one effect of TBI.
  • TBI can affect mood, too. If you have thoughts of suicide or of hurting someone, tell the examiner. If you're in crisis, call 988 and press 1.

Be accurate and complete

Describe your condition as it really is: on your worst days as well as on the day of the exam. Don't make it sound better than it is, and don't make it sound worse. The examiner writes down what you say, and VA compares it with your records.

The exam form

The examiner uses VA's "Initial Evaluation of Residuals of Traumatic Brain Injury" form. VA keeps this form for its own examiners and doesn't publish it, so this page describes the exam from VA's rules and its public information.

What the exam is for

The exam records the lasting effects (residuals) of your brain injury. VA looks at three areas: thinking and memory (cognitive), mood and behavior (emotional and behavioral), and physical problems. VA keeps its first TBI exam form for its own examiners, so it isn't published. What follows comes from VA's rating rules for TBI (38 CFR 4.124a). If VA doesn't already have a TBI diagnosis, VA's policy is that one of four kinds of specialist does the exam. They are a psychiatrist, a physiatrist (a rehab doctor), a neurosurgeon or a neurologist.

What the examiner will ask and measure

VA's rules list 10 facets (areas) of thinking, behavior and symptoms. Expect questions about each of them, and about physical and mental health problems.

  • Memory, attention, focus and planning skills (concentration and executive functions). These include getting organized, solving problems and making decisions. The higher levels need test results that show the problem.
  • Judgment: how well you make decisions, both hard or new ones and everyday ones.
  • Social interaction: how often the way you act with people fits the situation.
  • Orientation: whether you know who you are, the time, where you are and what's going on.
  • Movement (motor activity): whether you're slow at, or can't do, things you learned to do before, even though your muscles and feeling work (apraxia).
  • Finding your way (visual spatial orientation): whether you get lost, and how well you can read maps, follow directions, judge distance and use a GPS.
  • Symptoms you feel that others can't see (subjective symptoms). Examples are headaches, dizziness, ringing in the ears (tinnitus), trouble sleeping, sensitivity to light or sound, tiredness, and blurred or double vision. VA looks at how much they get in the way of work, daily tasks and close relationships.
  • Behavior changes (neurobehavioral effects). Examples are a short temper, acting without thinking, aggression, moodiness or lack of drive. VA looks at how often they get in the way at work or with people.
  • Communication: whether you can speak, write, and understand what people say or write.
  • Consciousness: the tenth facet covers a lasting altered state, such as a coma.
  • Physical problems, each rated under its own code: such as pain, weakness or numbness in the arms, legs or face; vision problems; hearing loss and tinnitus; loss of smell and taste; seizures; walking, coordination and balance problems; speech problems; and bladder or bowel problems.
  • Mood and behavior. If you have a mental health diagnosis, such as PTSD or depression, VA rates it under its mental health rules. It isn't rated on the TBI table.

Be ready to describe

  • How and when you were hurt in service, and what you remember about it.
  • Real examples of memory or thinking problems. For example, you forget what people told you or their names, lose your train of thought, can't find the right word, misplace things or get lost.
  • Daily tasks you now find hard or need help with: cooking, chores, shopping, getting around, laundry, keeping track of your medicines, or using the phone.
  • Headaches, dizziness, trouble sleeping, sensitivity to light or sound, ringing in the ears, tiredness or vision changes: how often they happen, and what you have to stop doing.
  • Changes in mood or behavior, such as a short temper, angry outbursts, acting without thinking, or losing interest in things. Say how they affect work and family.
  • Changes others have noticed. A statement from a family member or friend (on VA Form 21-10210) can help.
  • How your symptoms affect your job or your ability to work.

Common mistakes

  • Assuming a "mild TBI" label in your records means the effects can't count. VA rates the effects you have now.
  • Leaving out symptoms that seem small, like dizziness or sensitivity to light. VA looks at how several symptoms together affect you.
  • Not mentioning headaches, mood or hearing problems because you think they're separate. Tell the examiner about all of them.
  • Saying "I'm fine" or "I manage" out of habit, when that isn't the whole story.

How VA rates it

VA rates TBI in three areas: thinking and memory, mood and behavior, and physical problems. Thinking problems and symptoms without their own diagnosis are scored on a table of 10 facets, and the highest facet sets that rating. Physical problems and diagnosed mental health conditions are rated under their own codes and combined with it. VA proposed changes to its rules for neurological conditions, including TBI, in November 2024 (89 FR 88917). As of October 2026 they aren't final, so the current rules still apply.

In plain English

  • How the facets set the rating: VA gives each facet a level. The highest level of any facet sets the rating: level 0 = 0%; level 1 = 10%; level 2 = 40%; level 3 = 70%. If any facet is "total," the rating is 100%. Not every facet has every level.
  • Memory, attention, concentration and executive functions: 0 = no complaints of problems. 1 = you report mild problems (such as trouble following a conversation, recalling recent conversations, remembering names of new people or finding words, or often misplacing things), but testing doesn't show them. 2 = testing shows mild problems that cause mild trouble functioning. 3 = testing shows moderate problems that cause moderate trouble functioning. Total = testing shows severe problems that cause severe trouble functioning.
  • Judgment: 0 = normal. 1 = for complex or unfamiliar decisions, you're occasionally unable to weigh the choices and their results and make a reasonable decision. 2 = for complex or unfamiliar decisions, you're usually unable to, though you have little trouble with simple decisions. 3 = even for routine, familiar decisions, you're occasionally unable to. Total = even for routine, familiar decisions, you're usually unable to; for example, you can't choose the right clothes for the weather or tell when to avoid danger.
  • Social interaction: 0 = routinely appropriate. 1 = occasionally inappropriate. 2 = frequently inappropriate. 3 = inappropriate most or all of the time.
  • Orientation (knowing who you are, the time, the place and the situation): 0 = always oriented to all four. 1 = occasionally disoriented to one of the four. 2 = occasionally disoriented to two, or often disoriented to one. 3 = often disoriented to two or more. Total = consistently disoriented to two or more.
  • Motor activity (with normal muscles and feeling): 0 = normal. 1 = normal most of the time, but mildly slowed at times because you can't do movements you learned before (apraxia). 2 = mildly decreased, or moderately slowed, because of apraxia. 3 = moderately decreased because of apraxia. Total = severely decreased because of apraxia.
  • Visual spatial orientation: 0 = normal. 1 = mild: you occasionally get lost in unfamiliar places and have trouble reading maps or following directions, but you can use a GPS or similar aid. 2 = moderate: you usually get lost in unfamiliar places, have trouble reading maps, following directions and judging distance, and have trouble using a GPS. 3 = moderately severe: you get lost even in familiar places and can't use a GPS. Total = severe: for example, you may be unable to touch or name your own body parts when asked, tell where two objects are in relation to each other, or find your way from one room to another in a familiar place.
  • Subjective symptoms: 0 = symptoms that don't interfere with work, daily tasks, or family and other close relationships, such as mild or occasional headaches or mild anxiety. 1 = three or more symptoms that mildly interfere with work, daily tasks or close relationships, such as dizziness that comes and goes, daily mild to moderate headaches, tinnitus, frequent trouble sleeping (insomnia), or sensitivity to sound or light. 2 = three or more symptoms that moderately interfere, such as marked tiredness, blurred or double vision, or headaches that need rest periods during most days.
  • Neurobehavioral effects (such as irritability, impulsivity, unpredictability, lack of motivation, verbal or physical aggression, belligerence, apathy, lack of empathy, moodiness, lack of cooperation, inflexibility, and not being fully aware of your own problems): 0 = one or more effects that don't interfere with interacting with people at work or socially. 1 = they occasionally interfere, but don't prevent it. 2 = they frequently interfere, but don't prevent it. 3 = they interfere with or prevent interacting with people at work or socially on most days, or occasionally you need supervision for your safety or others' safety.
  • Communication: 0 = you can speak, write, and understand spoken and written language. 1 = understanding or expressing spoken or written language is only occasionally impaired, and you can share complex ideas. 2 = you can't communicate, or can't understand, spoken or written language more than occasionally but less than half the time, and you can generally share complex ideas. 3 = you can't communicate or understand at least half the time but not all the time; you may rely on gestures or other ways; you can communicate basic needs. Total = you can't communicate or understand spoken or written language at all, and can't communicate basic needs.
  • Consciousness: total only: a lasting altered state of consciousness, such as a vegetative state, a minimally responsive state or a coma.
  • "Daily tasks" (instrumental activities of daily living) means things beyond self-care that you need to live on your own, such as making meals, housework and chores, shopping, getting around, laundry, keeping track of your own medicines, and using a phone.
  • The symptoms listed are examples. They don't all have to be present for a level.
  • Physical problems and diagnosed mental health conditions are rated under their own codes and combined with the TBI table rating. VA won't use the same symptoms for more than one rating. If the symptoms of TBI and another condition can't be clearly separated, VA gives one rating under whichever rules better show your overall loss of function. If they can be separated, each gets its own rating.
  • The "mild," "moderate" or "severe" TBI labels in medical records describe the injury at or near the time it happened. They don't affect the rating.
  • VA also considers special monthly compensation for problems such as loss of use of an arm or leg, certain problems with the senses, erectile dysfunction, needing help from another person (aid and attendance), including help staying safe because of thinking problems, or being housebound.
  • If your TBI was rated under the rules in effect before October 23, 2008, you can ask VA to review it under the current rules, even if it hasn't gotten worse.

The regulation, word for word

Quoted from 38 CFR Part 4 (current as of October 16, 2026). This is what VA applies. The plain-English version above is our summary of it.

38 CFR 4.124a, diagnostic code 8045: Residuals of traumatic brain injury (TBI) Open in the Rating Criteria Lookup

CriteriaRating
8045 Residuals of traumatic brain injury (TBI):
There are three main areas of dysfunction that may result from TBI and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation.
Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Evaluate cognitive impairment under the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.”
Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Evaluate subjective symptoms that are residuals of TBI, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” However, separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere's disease, even if that diagnosis is based on subjective symptoms, rather than under the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table
Evaluate emotional/behavioral dysfunction under § 4.130 (Schedule of ratings—mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.”
Evaluate physical (including neurological) dysfunction based on the following list, under an appropriate diagnostic code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions.
The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, evaluate under the most appropriate diagnostic code. Evaluate each condition separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine under § 4.25 the evaluations for each separately rated condition. The evaluation assigned based on the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations
Consider the need for special monthly compensation for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc
CriteriaRating
Evaluation of Cognitive Impairment and Subjective Symptoms
The table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than “total,” since any level of impaired consciousness would be totally disabling. Assign a 100-percent evaluation if “total” is the level of evaluation for one or more facets. If no facet is evaluated as “total,” assign the overall percentage evaluation based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet.
Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled “Evaluation Of Cognitive Impairment And Other Residuals Of TBI Not Otherwise Classified” with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition.
Note (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation.
Note (3): “Instrumental activities of daily living” refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one's own medications, and using a telephone. These activities are distinguished from “Activities of daily living,” which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet.
Note (4): The terms “mild,” “moderate,” and “severe” TBI, which may appear in medical records, refer to a classification of TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under diagnostic code 8045.
Note (5): A veteran whose residuals of TBI are rated under a version of § 4.124a, diagnostic code 8045, in effect before October 23, 2008 may request review under diagnostic code 8045, irrespective of whether his or her disability has worsened since the last review. VA will review that veteran's disability rating to determine whether the veteran may be entitled to a higher disability rating under diagnostic code 8045. A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating awarded as a result of such review, VA will apply 38 CFR 3.114, if applicable.

Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified

Facets of cognitive impairment and other residuals of TBI not otherwise classifiedLevel of impairmentCriteria
Memory, attention, concentration, executive functions0No complaints of impairment of memory, attention, concentration, or executive functions.
1A complaint of mild loss of memory (such as having difficulty following a conversation, recalling recent conversations, remembering names of new acquaintances, or finding words, or often misplacing items), attention, concentration, or executive functions, but without objective evidence on testing.
2Objective evidence on testing of mild impairment of memory, attention, concentration, or executive functions resulting in mild functional impairment.
3Objective evidence on testing of moderate impairment of memory, attention, concentration, or executive functions resulting in moderate functional impairment.
TotalObjective evidence on testing of severe impairment of memory, attention, concentration, or executive functions resulting in severe functional impairment.
Judgment0Normal.
1Mildly impaired judgment. For complex or unfamiliar decisions, occasionally unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision.
2Moderately impaired judgment. For complex or unfamiliar decisions, usually unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision, although has little difficulty with simple decisions.
3Moderately severely impaired judgment. For even routine and familiar decisions, occasionally unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision.
TotalSeverely impaired judgment. For even routine and familiar decisions, usually unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision. For example, unable to determine appropriate clothing for current weather conditions or judge when to avoid dangerous situations or activities.
Social interaction0Social interaction is routinely appropriate.
1Social interaction is occasionally inappropriate.
2Social interaction is frequently inappropriate.
3Social interaction is inappropriate most or all of the time.
Orientation0Always oriented to person, time, place, and situation.
1Occasionally disoriented to one of the four aspects (person, time, place, situation) of orientation.
2Occasionally disoriented to two of the four aspects (person, time, place, situation) of orientation or often disoriented to one aspect of orientation.
3Often disoriented to two or more of the four aspects (person, time, place, situation) of orientation.
TotalConsistently disoriented to two or more of the four aspects (person, time, place, situation) of orientation.
Motor activity (with intact motor and sensory system)0Motor activity normal.
1Motor activity normal most of the time, but mildly slowed at times due to apraxia (inability to perform previously learned motor activities, despite normal motor function).
2Motor activity mildly decreased or with moderate slowing due to apraxia.
3Motor activity moderately decreased due to apraxia.
TotalMotor activity severely decreased due to apraxia.
Visual spatial orientation0Normal.
1Mildly impaired. Occasionally gets lost in unfamiliar surroundings, has difficulty reading maps or following directions. Is able to use assistive devices such as GPS (global positioning system).
2Moderately impaired. Usually gets lost in unfamiliar surroundings, has difficulty reading maps, following directions, and judging distance. Has difficulty using assistive devices such as GPS (global positioning system).
3Moderately severely impaired. Gets lost even in familiar surroundings, unable to use assistive devices such as GPS (global positioning system).
TotalSeverely impaired. May be unable to touch or name own body parts when asked by the examiner, identify the relative position in space of two different objects, or find the way from one room to another in a familiar environment.
Subjective symptoms0Subjective symptoms that do not interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples are: mild or occasional headaches, mild anxiety.
1Three or more subjective symptoms that mildly interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment are: intermittent dizziness, daily mild to moderate headaches, tinnitus, frequent insomnia, hypersensitivity to sound, hypersensitivity to light.
2Three or more subjective symptoms that moderately interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment are: marked fatigability, blurred or double vision, headaches requiring rest periods during most days.
Neurobehavioral effects0One or more neurobehavioral effects that do not interfere with workplace interaction or social interaction. Examples of neurobehavioral effects are: Irritability, impulsivity, unpredictability, lack of motivation, verbal aggression, physical aggression, belligerence, apathy, lack of empathy, moodiness, lack of cooperation, inflexibility, and impaired awareness of disability. Any of these effects may range from slight to severe, although verbal and physical aggression are likely to have a more serious impact on workplace interaction and social interaction than some of the other effects.
1One or more neurobehavioral effects that occasionally interfere with workplace interaction, social interaction, or both but do not preclude them.
2One or more neurobehavioral effects that frequently interfere with workplace interaction, social interaction, or both but do not preclude them.
3One or more neurobehavioral effects that interfere with or preclude workplace interaction, social interaction, or both on most days or that occasionally require supervision for safety of self or others.
Communication0Able to communicate by spoken and written language (expressive communication), and to comprehend spoken and written language.
1Comprehension or expression, or both, of either spoken language or written language is only occasionally impaired. Can communicate complex ideas.
2Inability to communicate either by spoken language, written language, or both, more than occasionally but less than half of the time, or to comprehend spoken language, written language, or both, more than occasionally but less than half of the time. Can generally communicate complex ideas.
3Inability to communicate either by spoken language, written language, or both, at least half of the time but not all of the time, or to comprehend spoken language, written language, or both, at least half of the time but not all of the time. May rely on gestures or other alternative modes of communication. Able to communicate basic needs.
TotalComplete inability to communicate either by spoken language, written language, or both, or to comprehend spoken language, written language, or both. Unable to communicate basic needs.
ConsciousnessTotalPersistently altered state of consciousness, such as vegetative state, minimally responsive state, coma.

Related

About every C&P exam

What is it?

After you file a claim, VA may ask you to have a claim exam, also called a compensation and pension (C&P) exam. It helps VA decide whether your condition is connected to your service, and how severe it is. It isn't treatment: the examiner won't treat you, prescribe medicine or refer you to anyone.

Who does it?

A VA provider or a provider from one of VA's exam contractors (Loyal Source, OptumServe, QTC or VES). VA picks; you can't choose. Hearing, mental health, eye and dental exams are done by specialists. For a reproductive, breast, rectal or mental health exam, or a claim related to military sexual trauma, you can ask for a male or female examiner.

How long does it take?

VA says anywhere from 15 minutes to an hour or more, depending on what you claimed. Some exams are by phone or video. If you claimed more than one condition, VA tries to schedule them on the same day.

Does the examiner decide my claim?

No. The examiner writes a report on a standard form (a Disability Benefits Questionnaire, or DBQ) and sends it to VA. VA decides your claim using all the evidence: the report, your medical and service records, and statements from you and others. The examiner can't tell you the results or answer questions about your claim.

Does everyone get one?

No. If your records already have what VA needs, VA can decide from the records alone (VA calls this Acceptable Clinical Evidence, or ACE).

What if I can't make it?

Call the number on your appointment letter at least 48 hours ahead to reschedule. Missing an exam delays your claim. VA may decide your claim on the evidence it already has, and some claims, such as a claim for an increase, are denied (38 CFR 3.655). If you had a good reason, such as being in the hospital or a death in your family, tell VA and ask for a new exam.

What should I bring?

VA says you don't need to bring anything. Send any new medical records to VA before the exam, because the examiner can't send them in for you. Arrive 15 minutes early and wear clothes you can move in. Many veterans find it helps to bring a short list of their symptoms, medicines and side effects, and key dates, so nothing is forgotten.

Can someone come with me?

You can ask the examiner. They may ask family members or caregivers to wait outside. For a sensitive physical exam, you can ask for a chaperone in the room.

Can I get a copy of the report?

Yes. Ask VA with a Freedom of Information Act or Privacy Act request (VA Form 20-10206). VetEZ Claim can help you fill it out and send it.

Can my own doctor fill out the form instead?

For many conditions, yes. VA publishes the exam forms (DBQs) your own doctor can fill out and you can send in. VA doesn't pay for this. A few exam forms are for VA's own examiners.

Checked against VA's forms and rules on October 20, 2026. General information only, not medical or legal advice about your claim. VA decides every claim.

File with VetEZ Claim

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