National Academies Press: OpenBook

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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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

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

F Case Definitions of Traumatic Brain Injury Organization Year Mild Moderate Severe American 1993 GCS 13–15 and a minimum NA NA Congress of of 1 of the following: (1) any Rehabilitation LOC; (2) any amnesia; (3) Medicine alteration in mental status (e.g., dazed, disoriented, or confused); or (4) focal neurologic deficits (may or may not be transient) American 1997 Grade 1: no LOC, transient NA NA Academy of confusion, symptoms (e.g., Neurology headaches and dizziness) and mental status changes (e.g., befuddlement, inability to focus attention, or post- traumatic 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) American 2013 Diagnosis guided by NA NA Medical standardized symptoms Society for checklist, cognitive tools, Sports balance tests, and further Medicine neurologic physical examination and previous medical history Centers for 2012 Normal imaging, LOC <30 Normal or abnormal imaging, Normal or Disease minutes, PTA <24 hours, LOC 30 min to 24 hours, abnormal, Control and GCS (best score within 24 PTA >1 day, <7 days; GCS LOC >24 Prevention hours) 13–15, AIS: head 1–2 (best score within 24 hours) hours, PTA >7 9–12, AIS: head 3 days, GCS (best score 133

134 TRAUMATIC BRAIN INJURY IN VETERANS Organization Year Mild Moderate Severe within 24 hours) 3–8, AIS: head 4–6 Department of 2009 GCS (best available score in GCS (best available score in GCS (best Defense/ first 24 hours) 13–15 and one first 24 hours) 9–12 and one available score Department of or more of the following: (1) or more of the following: (1) in first 24 Veterans LOC ≤30 minutes; (2) PTA LOC 30 minutes–24 hours; hours) 3–8 Affairs ≤24 hours; or (3) alteration in (2) PTA 24 hours–7 days; or and one or mental status ≤24 hours (3) alteration in mental status more of the >24 hours following: (1) LOC ≥24 hours; (2) PTA ≥7 days; or (3) alteration in mental status >24 hours Diagnostic 2013 Severity rating criteria In more severe TBI in which [See previous and Statistical include loss of there is brain contusion, column] Manual of consciousness, PTA, and intracranial hemorrhage, or Mental disorientation and confusion penetrating injury, there may Disorders, at initial assessment (GCS be additional neurocognitive Fifth Edition score) deficits, such as aphasia, neglect, and constructional dyspraxia International 2017 Sport-related concussion is a NA NA Conference on traumatic brain injury Concussion in induced by biomechanical Sport 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

APPENDIX F 135 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 2007 Probable mTBI if one or Definite moderate–severe [See previous Classification more of the following criteria TBI if one of the following column] System apply: loss of consciousness was present: death due to this is momentary to 30 minutes TBI, loss of consciousness of and PTA does not extend 30 minutes or more, post- beyond 24 hours. If the traumatic amnesia of 24 individual sustains a hours or more, worst depressed, basilar, or linear Glasgow Coma Scale score skull fracture (dura intact), in the first 24 hours <13 then the TBI is still a (unless invalidated by factors probable mTBI. Possible TBI such as intoxication, if one or more of the sedation, systemic shock). following symptoms are Or, evidence of hematoma, present: blurred vision, contusion, penetrating TBI, confusion, dazed, dizziness, hemorrhage, brain stem focal neurological symptoms, injury headache, or nausea National 2018 A person with an mTBI may A person with a moderate or [See previous Institute of remain conscious or may severe TBI may show these column] Neurological experience a loss of same symptoms, but may Disorders and consciousness for a few also have a headache that Stroke seconds or minutes. Other gets worse or does not go symptoms of mTBI include away, repeated vomiting or headache, confusion, nausea, convulsions or lightheadedness, dizziness, seizures, an inability to blurred vision or tired eyes, awaken from sleep, dilation ringing in the ears, bad taste of one or both pupils of the in the mouth, fatigue or eyes, slurred speech, lethargy, a change in sleep weakness or numbness in the patterns, behavioral or mood extremities, loss of changes, and trouble with coordination, and increased

136 TRAUMATIC BRAIN INJURY IN VETERANS Organization Year Mild Moderate Severe memory, concentration, confusion, restlessness, or attention, or thinking agitation World Health 2004 GCS 13–15 after 30 minutes NA NA Organization 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 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.

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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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