8003 - Brain, new growth of: benign
DBQ: Link to Index of DBQ/Exams by Disability for DC 8003
Definition
A new and abnormal formation of tissue as a tumor or growth is termed a neoplasm. A benign tumor does not metastasize or exhibit anaplasia. Benign tumors grow slowly, with few mitoses (cell divisions), no necrosis, and no vascular excess.
Etiology
The cause of benign brain tumors is unknown.
Signs & Symptoms
The signs and symptoms of benign intracranial neoplasms will vary, and depend on the type, size, and location of the tumor. Benign tumors may achieve considerable size before producing symptoms. General manifestations are created by increased intracranial pressure which may include: headaches; vomiting; convulsive seizures; drowsiness; and lethargy. There also may be listlessness; impaired mental faculties; aphasia; anosmia; visual field defects; exophthalmos and loss of the ability to write (agraphia). Other signs and symptoms may include: an inability to remember names (anomia); skin sensitivity; weakness, imbalance or double vision.
Tests
Diagnostic measures may include: a complete neurologic consultation; biopsy; tests of visual fields and acuity; audiometry; computed tomography (CT) scan; magnetic resonance imaging (MRI); and cerebral angiography.
Treatment
Treatment depends on the type, size, and location of the tumor. Treatment includes surgical removal and radiation therapy.
Residuals
Brain tumors may cause residual neurologic deficits that handicap the patient physically and mentally. The patient may require self-care aids such as bathroom rails and wheelchairs. Patients who are aphasic, may require speech therapy. Benign tumors that cannot be entirely excised because of size or location usually cause death due to local growth.
Special Considerations
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It is required for the minimum rating for residuals (signs and symptoms) of benign brain growth that there be a confirmed diagnosis. Subjective residuals (symptoms), e.g., headache, lethargy, drowsiness, must be consistent with benign brain growth, and should be accepted when they are consistent and not more likely attributable to other disease or no disease. "It is of exceptional importance that when ratings in excess of the prescribed minimum ratings are assigned, the Diagnostic Code used as a basis of evaluation be cited, in addition to the code identifying the diagnoses." 38 CFR 4.124a [Neurological conditions and convulsive disorders]
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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].
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Benign neoplasms of the brain shall be service connected when meeting the criteria as set forth in 38 CFR 3.311 [Claims based on exposure to ionizing radiation], and 38 CFR 3.311(b) [Initial review of claims] provided the provisions of 38 CFR 3.311(b)(5)(iv) have been met. A claim under 38 CFR 3.311 that involves radiation exposure requires an opinion by the C&P Service before any decision may be made by a Regional Office to grant or deny benefits.
Notes
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Minimum rating of 10%.
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It is required for the minimum ratings for residuals under diagnostic codes 8000-8025, that there be ascertainable residuals. Determinations as to the presence of residuals not capable of objective verification, i.e., headaches, dizziness, fatigability, must be approached on the basis of the diagnosis recorded; subjective residuals will be accepted when consistent with the disease and not more likely attributable to other disease or no disease. It is of exceptional importance that when ratings in excess of the prescribed minimum ratings are assigned, the diagnostic codes utilized as bases of evaluation be cited, in addition to the codes identifying the diagnoses.
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Disability in this field is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, injury to the skull, etc. In rating disability from the conditions in the preceding sentence refer to the appropriate schedule. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances. 38 CFR 4.120
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With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves” 38 CFR 4.124a