a disease of hormone moderate or severe award SC if the condition deficiency that results from manifested within one year hypothalamo-pituitary after the TBI changes (any condition in the endocrine system section of the rating schedule, , or any condition evaluated analogous to one of conditions) g. When evaluating TBI-related secondary conditions, pyramiding when Considerations considering the initial TBI evaluation and symptoms that are now associated When with the five secondary conditions. Also, consider Notes 1 and 2 under , Establishing while ensuring that the claimant receives the highest overall evaluation under Secondary SC the provisions of (Combined Ratings Table). Depending on the most advantageous combined evaluation, it is permissible to reduce an existing TBI evaluation as long as the overall evaluation of both TBI and the separate secondary SC condition is not reduced. Use the combinator tool in VBMS-R to determine the combined evaluation of TBI and the secondary SC condition. Thoroughly explain the decision narrative in the rating decision. Consider symptoms which apply to both TBI and the secondary conditions as follows: If ... Then ... the symptoms associated consider removing evaluation of the with one of the five facet, and conditions were also used to use the next highest-evaluated facet as provide the highest level of the evaluation for the TBI residuals, as long evaluation for any facet the symptoms of that facet are not used as under to establish SC for one of the five diagnosable conditions. the same symptoms apply to evaluate the evidence and determine both disabilities whether the symptoms can be entirely associated with one disability versus the other disability, and do not request an additional medical examination for this determination. If it is unclear, assume that the manifestations are not separable. the same symptoms apply to select the most advantageous option from the both disabilities, and the following: symptoms are clearly associated with one disability versus the other disability
a disease of hormone deficiency that results from hypothalamo-pituitary changes (any condition in the endocrine system section of the rating schedule, , or any condition evaluated analogous to one of conditions) moderate or severe award SC if the condition manifested within one year after the TBI g. Considerations When Establishing Secondary SC When evaluating TBI-related secondary conditions, pyramiding when considering the initial TBI evaluation and symptoms that are now associated with the five secondary conditions. Also, consider Notes 1 and 2 under , while ensuring that the claimant receives the highest overall evaluation under the provisions of (Combined Ratings Table). Depending on the most advantageous combined evaluation, it is permissible to reduce an existing TBI evaluation as long as the overall evaluation of both TBI and the separate secondary SC condition is not reduced. Use the combinator tool in VBMS-R to determine the combined evaluation of TBI and the secondary SC condition. Thoroughly explain the decision narrative in the rating decision. Consider symptoms which apply to both TBI and the secondary conditions as follows: If ... Then ... the symptoms associated with one of the five conditions were also used to provide the highest level of evaluation for any facet under consider removing evaluation of the facet, and use the next highest-evaluated facet as the evaluation for the TBI residuals, as long as the symptoms of that facet are not used to establish SC for one of the five diagnosable conditions. the same symptoms apply to both disabilities evaluate the evidence and determine whether the symptoms can be entirely associated with one disability versus the other disability, and do not request an additional medical examination for this determination. If it is unclear, assume that the manifestations are not separable. the same symptoms apply to both disabilities, and the symptoms are clearly associated with one disability versus the other disability select the most advantageous option from the following: