Rating Central Nervous System Conditions

Saturday, August 11, 2007 | 0

By Leslie Dilbeck

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:

1. Assess disturbance in the level of consciousness or awareness and assign impairment according to Tables 13-2, 13-3, and 13-4.

2. 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.

3. Identify any difficulty with understanding and use of language and rate impairment using Table 13-7 (5th ed., 323).

4. 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.

Leslie Dilbeck, W.C.C.P., CIR, is a senior consultant for Brigham & Associates. To view more of these tips visit:

www.impairment.com/tips

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