9312 - Major or mild neurocognitive disorder due to Alzheimer's disease

DBQ: Link to Index of DBQ/Exams by Disability for DC 9312 

Acronym: AD

Definition

A progressive loss of cognitive function that is associated with large numbers of senile plaques in the cerebral cortex and in the gray matter below.

Etiology

The cause of the condition is unknown. In 25% of cases, the history reveals that a relative has the disease.

Signs & Symptoms

The onset of Alzheimer's disease is usually slow and gradual. The three stages are designated as early, intermediate and severe.

  • The early stage usually begins with loss of recent memory, failure to learn new and recent events, and inability to recognize previously known familiar places. There may be progressive inability to perform activities of daily living (ADL), such as balancing a checkbook, walking to a store without getting lost, and labile (rapidly shifting) emotions.

  • The intermediate stage is often characterized by being unable to recall new information, fading remote memory, and the need for help to complete daily living activities. Accidents and falls may be more common due to confusion.

  • In the severe stage, patients are bedridden, incontinent, and present and remote memory are lost. As swallowing ability becomes impaired, then choking, malnutrition or hypostatic pneumonia are possibilities.

Tests

Diagnosis of the condition is based on demonstration of multiple cognitive deficits manifested by both memory impairment and cognitive disturbances which are not better accounted for by another condition. The following tests are done to rule out other etiologies:

  • Physical examination and history

  • Laboratory and x-ray studies to rule out any causes for the condition

  • Blood count (CBC)

  • Sedimentation rate (ESR)

  • Blood test for syphilis (VDRL)

  • Metabolic screen (SMA 12-16)

  • Thyroid-stimulating hormone (TSH)

  • Vitamin B12 level

  • Chest x-ray

  • Brain-computed tomography (CT)

  • Magnetic resonance imaging (MRI)

  • Analysis of cerebrospinal fluid (CSF)

  • Electroencephalogram (EEG)

  • Mental status test.

Treatment

The treatment principles are the same as for dementia of unknown etiology (see Diagnostic Code: 9310 Dementia of unknown etiology). Some drugs, which are under investigation, temporarily improve memory in the early stages, but they do not stop the disease progression.

Residuals

The rate of progression varies, but survival ranges from 2 to 20 years with 7 years being the average.

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.

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