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Tbi Criteria - Schedule Of Rating Disability
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carlie
http://edocket.access.gpo.gov/cfr_2009/jul...38cfr4.124a.htm
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 Sec. 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 Sec. 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.........................
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 Sec. 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.....................
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