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Suggested Citation:"Front Matter." 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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Evaluation of the
Disability
Determination Process
for

TRAUMATIC
BRAIN
INJURY IN
VETERANS

Committee on the Review of the Department of Veterans Affairs Examinations for
Traumatic Brain Injury

Board on Health Care Services

Health and Medicine Division

A Consensus Study Report of

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." 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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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by a contract between the National Academy of Sciences and the Department of Veterans Affairs (Contract No. 36C10X18C0019). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-48686-6
International Standard Book Number-10: 0-309-48686-6
Digital Object Identifier: https://doi.org/10.17226/25317

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2019 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: 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: https://doi.org/10.17226/25317.

Suggested Citation:"Front Matter." 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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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private nongovernment institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public-policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." 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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Image

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on studies’ statements of task by committees of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committees and the committees’ deliberations. Each report has been subjected to a rigorous and independent peer-review process and represents the position of the National Academies on its statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at workshops, symposia, or other events convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." 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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COMMITTEE ON THE REVIEW OF THE DEPARTMENT OF VETERANS AFFAIRS EXAMINATIONS FOR TRAUMATIC BRAIN INJURY

DAN G. BLAZER (Chair), J.P. Gibbons Professor of Psychiatry Emeritus, Duke University Medical Center

JEFF BAZARIAN, Professor of Emergency Medicine, University of Rochester

JENNIFER BOGNER, Professor of Physical Medicine and Rehabilitation, The Ohio State University

JOHN D. CORRIGAN, Emeritus Professor of Physical Medicine and Rehabilitation, The Ohio State University

CHARLES C. ENGEL, Senior Scientist, RAND Corporation

MATTHEW E. FINK, Louis and Gertrude Feil Professor of Clinical Neurology, Chairman, Neurology, Associate Dean for Clinical Affairs, Weill Cornell Medical College

ANNETTE L. FITZPATRICK, Research Professor and Epidemiologist, University of Washington Schools of Medicine and Public Health

JESSICA M. GILL, Deputy Scientific Director, Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health

JUDITH GREEN-MCKENZIE, Professor and Division Chief, Division of Occupational Medicine, University of Pennsylvania Perelman School of Medicine

JEANNE M. HOFFMAN, Professor of Rehabilitation Medicine, University of Washington School of Medicine

HEATHER KRULL, Senior Economist, RAND Corporation

ROGER J. LEWIS, Professor and Chair of Emergency Medicine, Harbor–University of California, Los Angeles, Medical Center

GEOFFREY T. MANLEY, Professor and Vice Chairman of Neurological Surgery, University of California, San Francisco

GEORGE W. RUTHERFORD, Salvatore Pablo Lucia Professor, Chief of the Division of Infectious Disease Epidemiology, University of California, San Francisco

JENNIFER M. ZUMSTEG, Assistant Professor of Rehabilitation Medicine, University of Washington School of Medicine

Study Staff

CAROLYN FULCO, Scholar

BERNICE CHU, Program Officer

BLAKE REICHMUTH, Research Associate

JOSEPH GOODMAN, Senior Program Assistant

REBECCA MORGAN, Senior Research Librarian

SHARYL J. NASS, Director, Board on Health Care Services

Suggested Citation:"Front Matter." 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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Suggested Citation:"Front Matter." 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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Reviewers

This Consensus Study Report was reviewed in draft form by persons chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets institutional standards of quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain privileged to protect the integrity of the deliberative process.

We thank the following for their review of this report:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of the report was overseen by KENNETH W. KIZER, University of California, Davis, and NANCY ADLER, University of California, San Francisco. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Page viii Cite
Suggested Citation:"Front Matter." 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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Suggested Citation:"Front Matter." 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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Suggested Citation:"Front Matter." 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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Acronyms and Abbreviations

A&A aid and attendance
ACGME Accreditation Council for Graduate Medical Education
ADD attention deficit disorder
ADHD attention deficit hyperactivity disorder
APA American Psychiatric Association
ApoE apolipoprotein E
BBB blood–brain barrier
BBBD blood–brain barrier dysfunction
bTBI blast-induced traumatic brain injury
BTBIS Brief Traumatic Brain Injury Screen
BVA Board of Veterans Appeals
C&P compensation and pension
CARE Concussion Assessment, Research and Education (Consortium)
CDC Centers for Disease Control and Prevention
CENC Chronic Effects of Neurotrauma Consortium
CPG Clinical Practice Guide
CT computed tomography
DBQ Disability Benefits Questionnaire
DEMO Disability Examination Management Office
DMA [Office of] Disability and Medical Assessment
DoD Department of Defense
DRO decision review officer
DSM Diagnostic and Statistical Manual of Mental Disorders
DTI diffusion tensor imaging
DVBIC Defense and Veterans Brain Injury Center
ED emergency department
FDA Food and Drug Administration
FTE full-time equivalent
FY fiscal year
GAO Government Accountability Office
GCS Glasgow Coma Scale
GPS global positioning system
ICD International Statistical Classification of Diseases and Related Health Problems
IOM Institute of Medicine
Suggested Citation:"Front Matter." 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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IPR in-process review
IT information technology
MACE Military Acute Concussion Evaluation
MRI magnetic resonance imaging
mTBI mild traumatic brain injury
NCCT noncontrast computed tomography
NIRS near-infrared spectroscopy
PET positron emission tomography
PTSD posttraumatic stress disorder
QR quality review
QRT quality review team
RVSR rating veterans service representative
SNP single nucleotide polymorphism
SSA Social Security Administration
STAR Systematic Technical Accuracy Review
TBI traumatic brain injury
TRACK-TBI Transforming Research and Clinical Knowledge in Traumatic Brain Injury
VA Department of Veterans Affairs
VASRD Veteran Affairs schedule for rating disabilities
VBA Veterans Benefits Administration
VHA Veterans Health Administration
VSO veterans service organization
VSR veterans service representative
Suggested Citation:"Front Matter." 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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Suggested Citation:"Front Matter." 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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Suggested Citation:"Front Matter." 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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Suggested Citation:"Front Matter." 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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Suggested Citation:"Front Matter." 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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Suggested Citation:"Front Matter." 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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Suggested Citation:"Front Matter." 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 viii Cite
Suggested Citation:"Front Matter." 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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Suggested Citation:"Front Matter." 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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Suggested Citation:"Front Matter." 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 R10
Suggested Citation:"Front Matter." 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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Suggested Citation:"Front Matter." 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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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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