9304 - Major or mild neurocognitive disorder due to traumatic brain injury

9304 - Major or mild neurocognitive disorder due to traumatic brain injury (TBI)

DBQ: Link to Index of DBQ/Exams by Disability for DC 9304

Definition

Dementia is a progressive mental disorder characterized by cognitive and memory deficits. A single incident of head trauma is usually a non-progressive disorder, but a repeated head injury may lead to a progressive dementia.

Etiology

Head trauma is the cause of the dementia. The location and extent of the injury will determine the type and degree of impairment.

Signs & Symptoms

Amnesia frequently occurs after the trauma as well as memory impairment. Additionally, there may be motor or sensory deficits. Other problems may include: aphasia, attention-deficit problems, irritability, and anxiety or changes in personality or both. Head injuries may occur with patients who are alcohol or substance abusers and they should be watched for signs and symptoms of dementia.

Tests

Computed tomography (CT) scan and magnetic resonance imaging (MRI) may be done to determine the extent of the trauma. Brain scans, lumbar punctures, and a neurological assessment, using the Glasgow coma scale may also be done.

Treatment

The treatment depends on the nature and extent of the trauma. Treatment may require hospitalization.

Residuals

Repeated head trauma may lead to progressive dementia.

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 provision 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.