9310 - Unspecified neurocognitive disorder

DBQ: Link to Index of DBQ/Exams by Disability for DC 9310 

Definition

Dementia is a gradual, pervasive decrease in mental functions. A formerly competent individual becomes personally and socially dependent.

Etiology

The etiology is unknown. It becomes necessary to rule out the many common causes of progressive dementia. Longevity in today's world may be a key factor regarding the increased incidence and frequency of dementia.

Signs & Symptoms

Signs and symptoms include cognitive deficits, manifested in impairment of memory, in at least one of the following areas: apraxia (inability to carry out motor activities); aphasia (language disturbance); agnosia (inability to recognize objects despite an intact sensory system); and disturbance in planning, organizing, sequencing, and abstracting.

Tests

Some, or all, of the following tests are useful in evaluating dementia:

  • Brain computed tomography (CT) scan

  • Magnetic resonance imaging (MRI)

  • Complete blood count (CBC)

  • Serologic test for syphilis

  • Erythrocyte sedimentation rate (ESR)

  • Evaluation of neuropsychological status

  • Metabolic screen (SMA12-16)

  • Serum Vitamin B12 level

  • Serum thyroid-stimulating hormone (TSH)

  • Chest x-ray

  • Analysis of cerebrospinalfluid

  • Electroencephalogram (EEG)

Treatment

Supportive measures that help to slow the inevitable decline are: frequent orientation; bright, cheerful environment; clocks and calendars for time orientation; familiar surroundings and people; occupational and music therapy; group therapy; and regular low stress activities and exercise. If medications are used to treat depression or sleep disorders, it is suggested that the dosage be kept at a minimum and given only for a short time to prevent developing toxicity.

Residuals

The long-term course of this disorder leaves the responsibility of care on the family. Possible nursing home placement may occur. Certain legal and financial arrangements will need to be made in the early disease stage.

Special Considerations

  • This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309 (a).  [chronic disease].

  • If a Veteran is a former prisoner of war, this disease shall be service connected if manifest to a degree of disability of 10% or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309 (c) Disease subject to presumptive service connection].

  • May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

  • Competency must be addressed in cases where a mental condition is initially evaluated as totally disabling or when the total evaluation is continued in a rating decision. This includes when individual unemployability is awarded or continued on the basis of a single mental health disability, and when assigning or continuing a temporary total evaluation for a mental disorder under 38 CFR 4.29 [38 CFR 3.353 [Determinations of incompetency and competency]].

  • Reference 38 CFR 3.384 for the applicability of the term psychosis.

  • Review 38 CFR 3.354 with regard to determinations of insanity

Notes

  • An incapacitating episode is a period during which bed rest and treatment by a physician are required.

  • Ratings under diagnostic codes 9201 to 9440 will be evaluated using the General Rating Formula for Mental Disorders. Ratings under diagnostic codes 9520 and 9521 will be evaluated using the General Rating Formula for Eating Disorders.

  • Review the special provisions outlined in 38 CFR 4.125 through 38 CFR 4.129 for decisions related to mental disorders

  • The nomenclature employed in this portion of the rating schedule is based upon the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) (see 38 CFR 4.125 for availability information). Rating agencies must be thoroughly familiar with this manual to properly implement the directives in 38 CFR 4.125 through 38 CFR 4.129 and to apply the general rating formula for mental disorders in 38 CFR 4.130.