Chronic Solvent-induced neurocognitive disorder F083

Current RMA Instruments

Changes from previous Instruments

ICD Coding

• ICD-9-CM Codes: 349.82
• ICD-10-AM Codes: G92

Brief description

This is an injury to the brain caused by recurrent or chronic exposure to volatile solvents, which manifests as a significant decline in cognitive function.  Exposure is usually via inhalation.  Exposure is typically intentional but can also occur in an occupational setting. The brain damage is irreversible and does not progress once exposure has ceased.

Confirming the diagnosis

This diagnosis is complex, is a diagnosis of exclusion, and is based on a specialist neurologist report. Normally brain imaging is required.  A battery of blood tests, and neuropsychological testing may also be utilised. A diagnosis of chronic solvent-induced neurocognitive disorder should be made by a neurologist and not by a psychiatrist, neurosurgeon or psychologist.

Note that:

• all features of the detailed diagnostic criteria must be met;
• the condition must be demonstrably symptomatic and interfering with the veteran’s everyday activities;
• the connection with the solvent exposure must be temporally close; and
• the condition should be non-progressive once the exposure has ceased.

A toxic based neurological disorder is normally considered as one which produces brain damage at the time or within a reasonable time period of chemical exposure.

Additional diagnoses which may be covered by SOP

• Chemical brain injury
• Chronic solvent encephalopathy 
• Substance-induced dementia

Conditions excluded from SOP

• Alcoholic encephalopathy^#
• Disorder from anaesthetic gas use or short acting vasodilators^#

^# non-SOP condition

Clinical onset

Onset will be based on the clinical presentation and will be when the decline in cognitive function is first significant enough to meet the thresholds established by the diagnstic criteria.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  The only treatment that will alter the course of the disease is ceasation of exposure to the causative agent/s.  The damage caused is permanent/irreversible but also non-progressive, so the condition will not worsen if exposure has stopped.