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Tbi Dc 8045 - New Criteria Oct 2008 - TBI Traumatic Brain Injury - Veterans Affairs Disability Compensation Benefits Forums - HadIt.com Veterans
Tbi Dc 8045 - New Criteria Oct 2008
For the reasons set out in the preamble, 38 CFR part 4, subpart B, is
2. In Sec. 4.124a, in the table titled ``Organic Diseases of the
Central Nervous System,'' the entry for 8045 is revised in its entirety
and a new table titled ``Evaluation of Cognitive Impairment And Other
Residuals of TBI Not Otherwise Classified'' is added after the
``Organic Diseases of the Central Nervous System'' table, to read as
Sec. 4.124a Schedule of ratings--neurological conditions and
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.''
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.
[[Page 54706]]
``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 (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.
Evaluation of Cognitive Impairment and Other Residuals of TBI Not
Facets of cognitive impairment
and other residuals of TBI not Level of Criteria
otherwise classified impairment
Memory, attention, 0 No complaints of
concentration, executive impairment of memory,
functions. attention,
1 A complaint of mild
loss of memory (such
as having difficulty
recalling recent
remembering names of
new acquaintances, or
finding words, or
often misplacing
items), attention,
but without objective
evidence on testing.
2 Objective evidence on
testing of mild
impairment of memory,
3 Objective evidence on
testing of moderate
resulting in moderate
Total Objective evidence on
testing of severe
resulting in severe
Judgment....................... 0 Normal.
1 Mildly impaired
judgment. For complex
occasionally unable to
identify, understand,
and weigh the
choices, and make a
2 Moderately impaired
decisions, usually
unable to identify,
understand, and weigh
although has little
difficulty with simple
3 Moderately severely
impaired judgment. For
even routine and
familiar decisions,
Total Severely impaired
judgment. For even
routine and familiar
For example, unable to
clothing for current
weather conditions or
judge when to avoid
[[Page 54707]]
Social interaction............. 0 Social interaction is
routinely appropriate.
1 Social interaction is
2 Social interaction is
3 Social interaction is
inappropriate most or
Orientation.................... 0 Always oriented to
person, time, place,
disoriented to one of
(person, time, place,
situation) of
disoriented to two of
orientation or often
disoriented to one
aspect of orientation.
3 Often disoriented to
four aspects (person,
Total Consistently
disoriented to two or
aspects (person, time,
place, situation) of
1 Motor activity normal
mildly slowed at times
due to apraxia
(inability to perform
despite normal motor
2 Motor activity mildly
decreased or with
moderate slowing due
to apraxia.
due to apraxia.
Total Motor activity severely
Visual spatial orientation..... 0 Normal.
1 Mildly impaired.
Occasionally gets lost
surroundings, has
maps or following
directions. Is able to
2 Moderately impaired.
Usually gets lost in
maps, following
judging distance. Has
as GPS (global
impaired. Gets lost
even in familiar
surroundings, unable
to use assistive
devices such as GPS
Total Severely impaired. May
be unable to touch or
name own body parts
examiner, identify the
space of two different
objects, or find the
way from one room to
another in a familiar
Subjective symptoms............ 0 Subjective symptoms
that do not interfere
living; or work,
family, or other close
Examples are: mild or
1 Three or more
that mildly interfere
that might be seen at
dizziness, daily mild
to moderate headaches,
tinnitus, frequent
interfere with work;
impairment are: marked
fatigability, blurred
or double vision,
headaches requiring
rest periods during
Neurobehavioral effects........ 0 One or more
effects that do not
or social interaction.
unpredictability, lack
of motivation, verbal
aggression, physical
belligerence, apathy,
moodiness, lack of
inflexibility, and
impaired awareness of
disability. Any of
range from slight to
severe, although
aggression are likely
to have a more serious
interaction than some
1 One or more
occasionally interfere
interaction, or both
but do not preclude
frequently interfere
3 One or more
effects that interfere
with or preclude
workplace interaction,
social interaction, or
both on most days or
for safety of self or
Communication.................. 0 Able to communicate by
language (expressive
communication), and to
comprehend spoken and
1 Comprehension or
expression, or both,
of either spoken
language or written
language is only
occasionally impaired.
2 Inability to
communicate either by
written language, or
both, more than
occasionally but less
than half of the time,
or to comprehend
3 Inability to
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
time. May rely on
gestures or other
communication. Able to
communicate basic
Total Complete inability to
both, or to comprehend
both. Unable to
Consciousness.................. Total Persistently altered
consciousness, such as
state, coma.
3. In Appendix A to Part 4, Sec. 4.124a, add diagnostic code 8045 in
numerical order to the table to read as follows:
Appendix A to Part 4--Table of Amendments and Effective Dates Since
Sec. code No.
4.124a...................... 8045 Criterion and evaluation
4. In Appendix B to Part 4, diagnostic code 8045 is revised to read as
Appendix B to Part 4--Numerical Index of Disabilities
8045...................................... Residuals of traumatic brain
5. In Appendix C to Part 4 under the heading for ``Brain'' remove
``Disease due to trauma'' and its diagnostic code ``8045''; and add in
alphabetical order a new heading ``Traumatic brain injury residuals''
and its diagnostic code ``8045''.