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Rating Central Nervous System Conditions
- Rating Tip of the Month
Traumatic brain injuries can be some
of the most complex cases; however,
the Guides provide a very specific
approach in rating these injuries. The
consequences of a traumatic brain injury
are assessed using Chapter 13, The Central
and Peripheral Nervous Systems, Section
13.2 Criteria for Rating Impairment
Due to Central Nervous System Disorders
(5th ed., 308) and Section 13.3 Criteria
for Rating Cerebral Impairments (5th
ed., 309-327). To rate this impairment
you must first determine which of the
following yield the highest rating:
- Assess disturbance in the level
of consciousness or awareness and
assign impairment according to Tables
13-2, 13-3, and 13-4.
- Evaluate mental status and highest
integrative function, as explained
in Section 13.3d, Mental Status,
Cognition and Highest Integrative
Function (5th ed., 319-322). Table
13-5, Clinical Dementia Rating (CDR),
is used to quantify deficits. It
should be noted this table is used
to score the examinee's mental status.
Table 13-6 is then used to assign
an impairment value.
- Identify any difficulty with
understanding and use of language
and rate impairment using Table
13-7 (5th ed., 323).
- Evaluate any emotional or behavioral
disturbances, such as depression,
that can modify cerebral function.
This process is explained in Section
13.3f Emotional or Behavioral Impairments
(5th ed., 325 - 327) and any impairment
assigned is based on Table 13-8
Criteria for Rating Impairment Due
to Emotional or Behavioral Disorders
(5th ed., 325).
The highest of all of the above impairments
assigned will then be combined with
any or multiple neurologic impairments
listed in Table 13-1 (5th ed., 308)
which references the following neurological
impairment.
- Cranial Nerve Impairments
(Tables 13-9 through 13-14).
- Station, gait and movement disorders
(Table 13- 15).
- Extremity disorders related
to central impairment
(Tables 13-16 through 13-17).
- Spinal cord impairments
(Tables 13-18 through 13-21).
- Chronic Pain (Table 13-22).
- Peripheral nerve, motor and
sensory impairments (Table 13-23).
As deemed appropriate impairment will
be assigned for the above impairments.
Those values will then be combined with
the highest impairment values assigned
for cerebral impairment to determine
the final central nervous system impairment
in the case.
A note of caution for determining impairment
in these cases is that the assignment
of impairment should be based on objective
findings whenever possible as these
ratings are primarily based on functional
impairment which is based on examinee
performance and reporting.
The most common problems we see in reviewing
central nervous system impairment ratings
are:
- Rating for CNS impairment when
there is no documentation of injury
or illness involving the central
nervous system.
- Rating prior to being at maximal
medical improvement.
- Ratings based on subjective
complaints or questionable studies.
- Combining multiple CNS impairments
(versus selecting that impairment
which is the greatest, as directed
by the Guides).
- Combining CNS impairment with
impairment from Chapter 14, Mental
and Behavioral Disorders.
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