Reasonable Hypothesis SOP [1] | 9 of 2023 |
Balance of Probabilities SOP [2] | 10 of 2023 |
SOP Bulletin 235 [3]
ICD-10-AM Code: F01
Vascular neurocognitive disorder is neurocognitive impairment caused by cerebrovascular disease or impaired cerberal blood flow. It includes vascular dementia, which is the second most common form of dementia, after Alzheimer disease.
This diagnosis is complex and other causes of dementia/neurocognitive disorder need to be evaluated. The diagnosis requires the presence of major or mild neurocognitive disorder, the presence of cerberovascular disease (by history of stroke or other clinical features, or by neuroimaging (CT or MRI)) and a judgement that the cerberovascular disease is the cause of the cognitive impairment. Neuropsychological testing may also be required.
The appropriate medical specialist is a neurologist.
* another SOP applies
# non-SOP condition
Clinical onset may become evident following a stroke, with a post stroke decline in cognitive function. There can also be progressive decline without a clinically apparent stroke. In either case clinical onset will be based on a clinical assessment of when congitive impairment first became significant.
Progressive or stepwise decline in function and hastened mortality are the normal course for this condition, with an average survival time of around 5 years after onset. Clinical worsening due to service is a very unlikely scenario for this condition given its typical age of onset (> 65 yrs) and the need for the condition to have manifest before the end of service for clinical worsening to be a consideration.
Place holder node for Rulebase for vascular dementia
For the purposes of this Statement of Principles, “cerebrovascular accident” means cerebral ischaemia (including vertebrobasilar ischaemia) or intracerebral haemorrhage.
15671 the veteran had a cerebrovascular accident at some time.
34783 the veteran has had cerebral ischaemia at some time.
or
34784 the veteran has had an intracerebral haemorrhage at some time.
36164 the veteran has established the causal connection between the cerebrovascular accident and VEA service for vascular dementia.
36171 the veteran had the identified illness or injury, a cerebrovascular accident, before the clinical onset of vascular dementia.
36165 the veteran has established the causal connection between the cerebrovascular accident and VEA service for the clinical onset of vascular dementia.
36167 the veteran has established the causal connection between the cerebrovascular accident and operational service for the clinical onset of vascular dementia.
or
36168 the veteran has established the causal connection between the cerebrovascular accident and eligible service for the clinical onset of vascular dementia.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
36172 the veteran had the identified illness or injury, a cerebrovascular accident, before the clinical worsening of vascular dementia.
36166 the veteran has established the causal connection between the cerebrovascular accident and VEA service for the clinical worsening of vascular dementia.
36169 the veteran has established the causal connection between the cerebrovascular accident and operational service for the clinical worsening of vascular dementia.
or
36170 the veteran has established the causal connection between the cerebrovascular accident and eligible service for the clinical worsening of vascular dementia.
15683 the identified illness or injury, a cerebrovascular accident, is causally related to operational service.
15684 the identified illness or injury, a cerebrovascular accident, is causally related to eligible service.
15683 the identified illness or injury, a cerebrovascular accident, is causally related to operational service.
35544 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, a cerebrovascular accident, is causally related.
15684 the identified illness or injury, a cerebrovascular accident, is causally related to eligible service.
35545 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, a cerebrovascular accident, is causally related.
‘Cerebrovascular disease’ means any abnormality of the brain resulting from a pathologic process of the cerebral blood vessels or decreased blood flow to the brain, including cerebral ischaemia, intracerebral haemorrhage or cerebral infarction’.
Note:
This definition includes cerebrovascular accident (CVA, stroke). However, for CCPS purposes, only non-CVA cerebrovascular disease should be dealt with under this contention.
General information
Cerebrovascular disease is common with aging and is frequently silent.
A diagnosis of cerebrovascular disease would be confirmed via radiological investigations such as computed tomography (CT) scans or magnetic resonance imagery (MRI). Cerebrovascular disease may be a consequence of a state of chronic hypoperfusion arising from outside the brain such as may occur with chronic cardiac failure or cardiac surgery where there is a clearly associated cognitive decline.
The most common form of cerebrovascular disease is chronic and progressive atherosclerotic change to the cerebral vessels. 437.0 (cerebral atherosclerosis) would be an appropriate ICD 9 code to use for this.
Less common forms of cerebrovascular disease also include more obscure vascular pathologies associated with deep white-matter lesions (as seen in Binswanger’s disease), small-vessel disease, arteriovenous malformations, lacunar and cortical infarcts or lesions. Cerebrovascular disease may be inflammatory (vasculitis) or non-inflammatory (arteriopathy) and includes the following rare conditions:
36173 there is some evidence that a cerebrovascular disease may be a factor in the development or worsening of the condition under consideration.
23994 the veteran has suffered from a cerebrovascular disease affecting the cerebral vessels at some time.
36174 a cerebrovascular disease means any abnormality of the brain resulting from a pathologic process of the cerebral blood vessels or decreased blood flow to the brain, including cerebral ischaemia, intracerebral haemorrhage or cerebral infarction.
36175 the veteran has established the causal connection between the cerebrovascular disease and VEA service for vascular dementia.
36182 the veteran had the identified illness or injury, a cerebrovascular disease, before the clinical onset of vascular dementia.
36176 the veteran has established the causal connection between the cerebrovascular disease and VEA service for the clinical onset of vascular dementia.
36178 the veteran has established the causal connection between the cerebrovascular disease and operational service for the clinical onset of vascular dementia.
or
36179 the veteran has established the causal connection between the cerebrovascular disease and eligible service for the clinical onset of vascular dementia.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
36183 the veteran had the identified illness or injury, a cerebrovascular disease, before the clinical worsening of vascular dementia.
36177 the veteran has established the causal connection between the cerebrovascular disease and VEA service for the clinical worsening of vascular dementia.
36180 the veteran has established the causal connection between the cerebrovascular disease and operational service for the clinical worsening of vascular dementia.
or
36181 the veteran has established the causal connection between the cerebrovascular disease and eligible service for the clinical worsening of vascular dementia.
36184 the identified illness or injury, a cerebrovascular disease, is causally related to operational service.
36185 the identified illness or injury, a cerebrovascular disease, is causally related to eligible service.
36184 the identified illness or injury, a cerebrovascular disease, is causally related to operational service.
36186 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, a cerebrovascular disease, is causally related.
36185 the identified illness or injury, a cerebrovascular disease, is causally related to eligible service.
36187 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, a cerebrovascular disease, is causally related.
Appropriate clinical management for vascular dementia involves confirmation of the diagnosis, treatment of the underlying cause, if possible, as well as supportive care and treatment of symptoms.
Type | Title | PDF Format | Word Format |
---|---|---|---|
Medical Report | Inability to Obtain Appropriate Clinical Management | GQACM.pdf [5] | GQACM.docx [6] |
11109 the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.
7066 there is some evidence that an inability to obtain appropriate clinical management for the condition under consideration may be a factor in the worsening of the condition under consideration.
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
7378 the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.
7379 the inability to obtain appropriate clinical management for the condition under consideration contributed to the clinical worsening of the condition under consideration.
11234 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and VEA service for the clinical worsening of the condition under consideration.
11235 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and operational service for the clinical worsening of the condition under consideration.
or
11236 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and eligible service for the clinical worsening of the condition under consideration.
7384 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service.
21084 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service, as a causal result of operational service.
7387 the veteran's inability to obtain appropriate clinical management for the condition under consideration during operational service was due to the veteran's serious default, wilful act or serious breach of discipline.
or
7389 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.
7390 the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to operational service.
7392 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.
7385 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service.
7386 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service, as a causal result of eligible service.
7388 the veteran's inability to obtain appropriate clinical management for the condition under consideration during eligible service was due to the veteran's serious default, wilful act or serious breach of discipline.
or
7389 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.
7391 the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to eligible service.
7393 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.
Links
[1] http://www.rma.gov.au/assets/SOP/2023/b12c415e36/009.pdf
[2] http://www.rma.gov.au/assets/SOP/2023/362ca0c423/010.pdf
[3] https://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20235.pdf
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/64214%23comment-form
[5] https://clik.dva.gov.au/system/files/media/GQACM_17.pdf
[6] https://clik.dva.gov.au/system/files/media/GQACM_17.docx