9305 - Major or mild vascular neurocognitive disorder

DBQ: Link to Index of DBQ/Exams by Disability for DC 9305

Acronym: VAD

Definition

In vascular dementia, brain tissue is destroyed by infarction (tissue necrosis from occluded blood supply). There may be a single infarct to multiple infarct disease (MID). Vascular dementia typically results from the occurrence of multiple strokes (infarcts), usually occurring at different times.

Etiology

This condition is more prevalent in persons with hypertension, diabetes mellitus, and those who use tobacco heavily.

Signs & Symptoms

It may be somewhat difficult to distinguish vascular dementia from Alzheimer's. In early stages one's insight and personality seem to be better preserved than in Alzheimer's disease. Exaggerated, deep tendon reflexes, gait abnormalities, and weakness of an extremity are common neurological signs. In addition, there may be long-standing arterial hypertension, valvular heart disease, or extra-cranial vascular disease that may be sources of cerebral emboli that lead to infarcts.

Tests

Laboratory evidence from computed tomography (CT) or a magnetic resonance imaging (MRI) may support the diagnosis by showing vascular lesions of the cerebral cortex and areas below the cortex.

Treatment

Prevention of further infarction by early treatment of hypertension and vascular disease as well as avoidance of hypotension and hyperglycemia may prevent further progression of the disorder.

Residuals

The course of this disorder is highly variable. It can be insidious or abrupt. Usually, the pattern of deficits is scattered, depending on which regions of the brain have been destroyed. Eventually, patients become totally dependent and die from complications of immobility in the final stages.

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.