9327 - Organic mental disorder, other (including personality change due to a general medical condition)

DBQ: Link to Index of DBQ/Exams by Disability for DC 9327 

Acronym: OMD

Definition

Organic brain syndrome (OBS) is a term used to denote any of a large group of acute or chronic mental disorders or altered brain function which may result in delirium, dementia, or behavioral abnormalities. According to current practicing physicians, the term organic mental disorder is no longer used iin the Diagnostic and Statistical Manual of Mental Disorders, 1st Edition (DSM-5) because it incorrectly implies that non-organic mental disorders do not have a biological basis.

Etiology

In the acute stage of OBS, there is delirium; in the chronic state, dementia. Some causes of altered brain function by a metabolic process outside the brain are a Vitamin B12 deficiency, hypothyroidism, or uremia. Structural damage to the cortex will alter brain function as seen in Alzheimer's disease, multi-infarct disease, and brain tumor. Some infectious causes of dementia are human immune deficiency virus (HIV), neurosyphilis, and viral encephalitis. (See Diagnostic Code: 9300 Delirium and Diagnostic Code: 9310 Dementia of unknown etiology)

Signs & Symptoms

The signs and symptoms will vary with the underlying organic disorder, and with the individual. Usually, there is impairment in orientation, level of consciousness, memory, judgment, language skill, insight, and the possible occurrence of hallucinations or illusions.

Tests

Laboratory studies are used to determine the reason for the delirium or dementia. The studies may include, some, or all, of the following listings:

  • Mental status examination.

  • Brain-computed tomography (CT)

  • Magnetic resonance imaging (MRI)

  • Complete blood count (CBC)

  • Erythrocyte sedimentation rate (ESR)

  • Test for syphilis (VDRL)

  • Metabolic screen (SMA 12-16)

  • Serum thyroid-stimulating hormone level (TSH)

  • Vitamin B12 level

  • Human immunodeficiency virus (HIV) testing

  • Tests for substance abuse, alcohol or poison

  • Electroencephalogram (EEG)

  • Chest x-ray (CXR)

  • Cerebrospinal fluid analysis (CSF)

  • Blood urea nitrogen test (BUN)

  • Blood sugar level.

Treatment

The basic organic disease may require investigation and specific treatment with the possibility of psychiatric care.

Residuals

Acute OBS (delirium) may be fully reversible with appropriate recognition and treatment. Chronic OBS (dementia) is frequently progressive; however, there are some cases that are partially or completely reversible.

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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