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Research Objectives To investigate the association between veteran socio-demographics and clinical factors with the likelihood of having a Traumatic Brain Injury (TBI), and the association of TBI with survival and Veterans Health Administration (VHA) costs. Design A retrospective study of veterans diagnosed with TBI and age-matched cohort without TBI were followed 2000-2015. Setting Veterans using VHA Medical Centers and Community Based Outpatient Clinics. Participants 181,521 veterans diagnosed with TBI and 291,015 veterans without TBI. Interventions Logit models were estimated to examine the association of veteran socio-demographics with the odds of a TBI diagnosis. A Cox proportional hazards model was estimated to examine the association of TBI with survival. Generalized linear and seemingly unrelated regression models were used to estimate the association of TBI with annual per veteran VHA costs. Costs were adjusted for inflation to 2019 values. Main Outcome Measures Risk of Traumatic Brain Injury, Veteran Survival and VHA total, inpatient, outpatient, pharmacy and community care costs. Results Non-Hispanic Blacks (OR 1.85; 95% CI 1.81:1.88), Hispanic (OR 1.94; 95% CI 1.88:2.00)), and veterans with 3+ mental (OR 5.83; 95% CI 5.68:5.98) and 3+ physical comorbidities (OR 2.47; 95% CI 2.42:2.52) had higher odds of TBI. Veterans with TBI were more likely to die (HR 1.16: 95% CI:1.14:1.17). Veterans with TBI had higher total annual VHA costs by $19,808 (95% CI $13,900: $25,715), The marginal impact of TBI on annual inpatient VHA costs per veteran was $10,295 (95% CI $7,431: $13,158) and outpatient costs was $9,255 (95% CI: $6,528: $11,981). The marginal impact of TBI on annual community care costs per veteran was $234 (95% CI $16: $451). Conclusions TBI imposes a significant burden on patient mortality as well as VHA costs. Minority veterans and those with multiple mental health and physical comorbidities are at higher risk for TBI. Author(s) Disclosures Disclaimer: This material is based upon work supported by the U.S. Army Medical Research and Materiel Command and from the U.S. Department of Veterans Affairs Long-Term Impact of Military-Relevant Brain Injury Consortium (LIMBIC) Award No. l01 HX003155.