Schedule of ratings—neurological conditions and convulsive disorders

Organic Diseases of the Central Nervous System

The table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than “total,” since any level of impaired consciousness would be totally disabling. Assign a 100-percent evaluation if “total” is the level of evaluation for one or more facets. If no facet is evaluated as “total,” assign the overall percentage evaluation based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet.

Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled “Evaluation Of Cognitive Impairment And Other Residuals Of TBI Not Otherwise Classified” with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition.

Note (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation.

Note (3): “Instrumental activities of daily living” refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one’s own medications, and using a telephone. These activities are distinguished from “Activities of daily living,” which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet.

Note (4): The terms “mild,” “moderate,” and “severe” TBI, which may appear in medical records, refer to a classification of TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under diagnostic code 8045.

Note (5): A veteran whose residuals of TBI are rated under a version of § 4.124a, diagnostic code 8045, in effect before October 23, 2008 may request review under diagnostic code 8045, irrespective of whether his or her disability has worsened since the last review. VA will review that veteran’s disability rating to determine whether the veteran may be entitled to a higher disability rating under diagnostic code 8045. A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating awarded as a result of such review, VA will apply 38 CFR 3.114, if applicable.

Miscellaneous Diseases

What Are Cranial Nerve Disorders?

Cranial nerve disorder alludes to an impedance of one of the twelve cranial nerves that rise up out of the underside of the brain, go through openings in the skull, and lead to parts of the head, neck, and trunk. These disorders can cause torment, shivering, deadness, shortcoming, or loss of motion of the face including the eyes. In the event that you have been determined to have a cranial nerve disorder, or trust you are encountering these manifestations.

The cranial nerves are 12 sets of nerves that rise up out of the brain and are liable for giving engine and tactile capacities. They are among the most sensitive nerves in the human sensory system and require specialists who have some expertise in their typical and strange introductions.

Cranial nerve issues can influence an engine nerve, called cranial nerve paralysis, or influence a tactile nerve, creating torment or decreased uproar. These disorders can likewise influence smell, taste, outward appearance, discourse, gulping, and muscles of the neck.

Trigeminal Neuralgia?

This disorder can be brought about by a tumor, or different sclerosis, or when veins push on the base of the trigeminal nerve. Trigeminal neuralgia is at first regarded equivalent to atypical facial torment (for example meds). On the off chance that drugs come up short, in any case, at that point it tends to be treated with neurosurgical intercession.

Hemifacial Spasm

A hemifacial fit is a neurological disorder wherein veins contract the seventh cranial nerve, making muscles on one side of the face jerk or 'spasm' automatically. Hemifacial fit can be brought about by a few elements: facial nerve injury, a vein hitting a facial sore spot, or a tumor

Glossopharyngeal Neuralgia

Glossopharyngeal neuralgia is a pressure of the 10th cranial nerve and causes brief yet horrifying torment at the base of the tongue which can transmit to the ear and neck. The torment can keep going for a couple of moments to a couple of moments and may restore on different occasions in a day or once at regular intervals.

Disability from lesions of peripheral portions of first, second, third, fourth, sixth, and eighth nerves will be rated under the Organs of Special Sense. The ratings for the cranial nerves are for unilateral involvement; when bilateral, combine but without the bilateral factor

Diseases of the Peripheral Nerves

The term “incomplete paralysis” with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The following ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor.

A thorough study of all material in §§4.121 and 4.122 of the preface and under the ratings for epilepsy is necessary prior to any rating action.

Mental Disorders in Epilepsies:  A nonpsychotic organic brain syndrome will be rated separately under the appropriate diagnostic code (e.g., 9304 or 9326). In the absence of a diagnosis of non-psychotic organic psychiatric disturbance (psychotic, psychoneurotic or personality disorder) if diagnosed and shown to be secondary to or directly associated with epilepsy will be rated separately. The psychotic or psychoneurotic disorder will be rated under the appropriate diagnostic code. The personality disorder will be rated as a dementia (e.g., diagnostic code 9304 or 9326).

Epilepsy and Unemployability:

(1) Rating specialists must bear in mind that the epileptic, although his or her seizures are controlled, may find employment and rehabilitation difficult of attainment due to employer reluctance to the hiring of the epileptic.

(2) Where a case is encountered with a definite history of unemployment, full and complete development should be undertaken to ascertain whether the epilepsy is the determining factor in his or her inability to obtain employment.

(3) The assent of the claimant should first be obtained for permission to conduct this economic and social survey. The purpose of this survey is to secure all the relevant facts and data necessary to permit of a true judgment as to the reason for his or her unemployment and should include information as to:

                        (a) Education;

                        (b) Occupations prior and subsequent to service;

                        (c) Places of employment and reasons for termination;

                        (d) Wages received;

                        (e) Number of seizures.

(4) Upon completion of this survey and current examination, the case should have rating board consideration. Where in the judgment of the rating board the veteran’s unemployability is due to epilepsy and jurisdiction is not vested in that body by reason of schedular evaluations, the case should be submitted to the Director, Compensation Service or the Director, Pension and Fiduciary Service.