Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans (2019)
Chapter: Front Matter
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
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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
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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.
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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
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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.
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Contents
Overview of the Organization of the Department of Veterans Affairs
Brief History of the Department of Veterans Affairs Compensation System
Disability Compensation and the Disability Claims Process
Compensation and Pension Examination
VA’s Schedule for Rating Disabilities: The VASRD
2 DIAGNOSIS AND ASSESSMENT OF TRAUMATIC BRAIN INJURY
Emerging Evidence on Natural History of Mild TBI
Co-occurring TBI, PTSD, Depression, Pain, and Sleep Disturbance
3 DISABILITY DETERMINATION PROCESS FOR VETERANS WITH TRAUMATIC BRAIN INJURY
Disability and Disability Compensation
The Disability Benefits Questionnaire and a Schedule for Rating Disabilities for Residuals of TBI
Credentials and Training Required in Evaluating Residuals of TBI for VA Disability Compensation
Quality Assurance in the Adjudication of Disability Compensation Claims for Residuals of TBI
Definitions of Quality Domains
Approaches for Ensuring Quality
Adequacy of the Adjudication Process
A LEGISLATION DIRECTING THE STUDY
B DEFINITIONS OF TRAUMATIC BRAIN INJURY
C TIMELINE OF DISABILITY AND VETERANS COMPENSATION POLICY
E § 4.124A SCHEDULE OF RATINGS—NEUROLOGICAL CONDITIONS AND CONVULSIVE DISORDERS.
F CASE DEFINITIONS OF TRAUMATIC BRAIN INJURY
G MACE 2: MILITARY ACUTE CONCUSSION EVALUATION
H FACT SHEET: CODING GUIDANCE FOR TRAUMATIC BRAIN INJURY
I M21-1 COMPENSATION AND PENSION MANUAL
J REVIEW POSTTRAUMATIC STRESS DISORDER (PTSD) DISABILITY BENEFITS QUESTIONNAIRE
K INFORMATION AND INSTRUCTIONS FOR COMPLETING NOTICE OF DISAGREEMENT (NOD)
L APPEAL TO BOARD OF VETERANS’ APPEALS
M NECK (CERVICAL SPINE) CONDITIONS DISABILITY BENEFITS QUESTIONNAIRE
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 |
| 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 |
