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Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans (2019)

Chapter: Appendix F: Case Definitions of Traumatic Brain Injury

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Suggested Citation:"Appendix F: Case Definitions of Traumatic Brain Injury." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
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F

Case Definitions of Traumatic Brain Injury

Organization Year Mild Moderate Severe
American Congress of Rehabilitation Medicine 1993 GCS 13–15 and a minimum of 1 of the following: (1) any LOC; (2) any amnesia; (3) alteration in mental status (e.g., dazed, disoriented, or confused); or (4) focal neurologic deficits (may or may not be transient) NA NA
American Academy of Neurology 1997 Grade 1: no LOC, transient confusion, symptoms (e.g., headaches and dizziness) and mental status changes (e.g., befuddlement, inability to focus attention, or posttraumatic amnesia) resolve in less than 15 minutes Grade 2: no LOC, transient confusion, symptoms or mental status changes last more than 15 minutes Grade 3: LOC (seconds or minutes) NA NA
American Medical Society for Sports Medicine 2013 Diagnosis guided by standardized symptoms checklist, cognitive tools, balance tests, and further neurologic physical examination and previous medical history NA NA
Centers for Disease Control and Prevention 2012 Normal imaging, LOC <30 minutes, PTA <24 hours, GCS (best score within 24 hours) 13–15, AIS: head 1–2 Normal or abnormal imaging, LOC 30 min to 24 hours, PTA >1 day, <7 days; GCS (best score within 24 hours) 9–12, AIS: head 3 Normal or abnormal, LOC >24 hours, PTA >7 days, GCS (best score
Suggested Citation:"Appendix F: Case Definitions of Traumatic Brain Injury." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
×
Organization Year Mild Moderate Severe
within 24 hours) 3–8, AIS: head 4–6
Department of Defense/Department of Veterans Affairs 2009 GCS (best available score in first 24 hours) 13–15 and one or more of the following: (1) LOC ≤30 minutes; (2) PTA ≤24 hours; or (3) alteration in mental status ≤24 hours GCS (best available score in first 24 hours) 9–12 and one or more of the following: (1) LOC 30 minutes–24 hours; (2) PTA 24 hours–7 days; or (3) alteration in mental status >24 hours GCS (best available score in first 24 hours) 3–8 and one or more of the following: (1) LOC ≥24 hours; (2) PTA ≥7 days; or (3) alteration in mental status >24 hours
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition 2013 Severity rating criteria include loss of consciousness, PTA, and disorientation and confusion at initial assessment (GCS score) In more severe TBI in which there is brain contusion, intracranial hemorrhage, or penetrating injury, there may be additional neurocognitive deficits, such as aphasia, neglect, and constructional dyspraxia [See previous column]
International Conference on Concussion in Sport 2017 Sport-related concussion is a traumatic brain injury induced by biomechanical forces. Clinical definition can include (1) caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head (2) typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over a number of minutes to hours (3) may result in neuropathological changes, but the acute clinical signs NA NA
Suggested Citation:"Appendix F: Case Definitions of Traumatic Brain Injury." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
×
Organization Year Mild Moderate Severe
and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies (4) results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged
Mayo Classification System 2007 Probable mTBI if one or more of the following criteria apply: loss of consciousness is momentary to 30 minutes and PTA does not extend beyond 24 hours. If the individual sustains a depressed, basilar, or linear skull fracture (dura intact), then the TBI is still a probable mTBI. Possible TBI if one or more of the following symptoms are present: blurred vision, confusion, dazed, dizziness, focal neurological symptoms, headache, or nausea Definite moderate–severe TBI if one of the following was present: death due to this TBI, loss of consciousness of 30 minutes or more, posttraumatic amnesia of 24 hours or more, worst Glasgow Coma Scale score in the first 24 hours <13 (unless invalidated by factors such as intoxication, sedation, systemic shock). Or, evidence of hematoma, contusion, penetrating TBI, hemorrhage, brain stem injury [See previous column]
National Institute of Neurological Disorders and Stroke 2018 A person with an mTBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mTBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased [See previous column]
Suggested Citation:"Appendix F: Case Definitions of Traumatic Brain Injury." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
×
Organization Year Mild Moderate Severe
memory, concentration, attention, or thinking confusion, restlessness, or agitation
World Health Organization 2004 GCS 13–15 after 30 minutes postinjury or later and one or more of the following: (1) confusion or disorientation; (2) LOC ≤30 minutes; (3) PTA <24 hours; (4) transient neurologic abnormalities (focal signs or seizure); or (5) intracranial lesion not requiring surgery NA NA

NOTE: AIS = Abbreviated Injury Scale/Score; GSC = Glasgow Coma Score; LOC = loss of consciousness; mTBI = mild traumatic brain injury; NA = not applicable/available; PTA = posttraumatic amnesia; TBI = traumatic brain injury.

Suggested Citation:"Appendix F: Case Definitions of Traumatic Brain Injury." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
×
Page 133
Suggested Citation:"Appendix F: Case Definitions of Traumatic Brain Injury." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
×
Page 134
Suggested Citation:"Appendix F: Case Definitions of Traumatic Brain Injury." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
×
Page 135
Suggested Citation:"Appendix F: Case Definitions of Traumatic Brain Injury." National Academies of Sciences, Engineering, and Medicine. 2019. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans. Washington, DC: The National Academies Press. doi: 10.17226/25317.
×
Page 136
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The Veterans Benefits Administration (VBA) provides disability compensation to veterans with a service-connected injury, and to receive disability compensation from the Department of Veterans Affairs (VA), a veteran must submit a claim or have a claim submitted on his or her behalf. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans reviews the process by which the VA assesses impairments resulting from traumatic brain injury for purposes of awarding disability compensation. This report also provides recommendations for legislative or administrative action for improving the adjudication of veterans’ claims seeking entitlement to compensation for all impairments arising from a traumatic brain injury.

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