For more information on References: the importance on examiner qualifications for TBI cases, see M21-1, Part III, Subpart iv, 3.D.2.h, and pyramiding see , and , 6 Vet.App. 259 (1994). i. Opinion Ensure that sufficiently and unequivocal exists medical opinion evidence Evidence and in the claims folder whenever there is a question of whether TBI and a mental Separate disorder are distinct and can be separately evaluated. Veterans Benefits Evaluations of Administration (VBA) decision makers are not qualified to make such TBI and determinations. Mental Disorder The opinion may be provided by either an examiner assessing the TBI or an examiner assessing the mental disorder as long as the individual offering the opinion is properly qualified. If a medical provider cannot make the required determination without resorting to mere speculation, then careful consideration must be given to whether that statement can be accepted under , 23 Vet.App. 382 (2010). j. Additional When considering a claim for reevaluation of TBI, do not automatically TBI or concede that a new sign, symptom or diagnosis is a residual of TBI simply Symptoms because it is listed in M21-1, Part III, Subpart iv, 4.G.2.d or in the evaluation Upon criteria. Reevaluation If there is not competent evidence that the sign, symptom or diagnosis is associated with the SC TBI, obtain medical clarification. k. TBI and Brain injuries may be associated with loss of use of an extremity, sensory SMC impairments, erectile dysfunction, need for regular aid and attendance (including need for protection from hazards of the daily living environment due to cognitive impairment), and being factually housebound or statutorily housebound. Carefully consider eligibility for special monthly compensation (SMC) when evaluating TBI residuals. l. Temporary In cases of recently discharged Veterans, consider the applicability of a temporary 50-percent or 100-percent prestabilization evaluation under the Evaluations provisions of . and TBI Lengthy VA hospitalizations or surgeries with convalescence may also implicate consideration of eligibility for temporary total evaluation under and .
References: For more information on the importance on examiner qualifications for TBI cases, see M21-1, Part III, Subpart iv, 3.D.2.h, and pyramiding see , and , 6 Vet.App. 259 (1994). i. Opinion Evidence and Separate Evaluations of TBI and Mental Disorder Ensure that sufficiently and unequivocal medical opinion evidence exists in the claims folder whenever there is a question of whether TBI and a mental disorder are distinct and can be separately evaluated. Veterans Benefits Administration (VBA) decision makers are not qualified to make such determinations. The opinion may be provided by either an examiner assessing the TBI or an examiner assessing the mental disorder as long as the individual offering the opinion is properly qualified. If a medical provider cannot make the required determination without resorting to mere speculation, then careful consideration must be given to whether that statement can be accepted under , 23 Vet.App. 382 (2010). j. Additional TBI or Symptoms Upon Reevaluation When considering a claim for reevaluation of TBI, do not automatically concede that a new sign, symptom or diagnosis is a residual of TBI simply because it is listed in M21-1, Part III, Subpart iv, 4.G.2.d or in the evaluation criteria. If there is not competent evidence that the sign, symptom or diagnosis is associated with the SC TBI, obtain medical clarification. k. TBI and SMC Brain injuries may be associated with loss of use of an extremity, sensory impairments, erectile dysfunction, need for regular aid and attendance (including need for protection from hazards of the daily living environment due to cognitive impairment), and being factually housebound or statutorily housebound. Carefully consider eligibility for special monthly compensation (SMC) when evaluating TBI residuals. l. Temporary Evaluations and TBI In cases of recently discharged Veterans, consider the applicability of a temporary 50-percent or 100-percent prestabilization evaluation under the provisions of . Lengthy VA hospitalizations or surgeries with convalescence may also implicate consideration of eligibility for temporary total evaluation under and .