The Skull

Topics:

Ratings for Skull Conditions
Other Skull Conditions
Principles that Apply

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

 


Ratings for Skull Conditions

Code 5296: This rating for the skull is strictly for the bone itself and CAN be used in addition to ratings for brain injuries, etc. If part of the skull is missing but the brain is remaining in its proper place, then the rating is based on the size of the hole. If it is the size of a quarter (2.4 cm across) or smaller, the rating is 10%. If it is bigger than a quarter but smaller than 3.6 cm across, then the rating is 30%. Anything bigger than 3.6 cm across is 50%.

If the brain is coming out of the hole in the skull, however, the rating is 80% regardless of the size of the hole.

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Other Skull Conditions

Diseases that affect the skull can be found on the Diseases of the Musculoskeletal System page and cancer in the skull can be found on the Cancer and Tumors of the Musculoskeletal System page. All other skull bone injuries or conditions will be rated analogously (see the Analogous and Equivalent Codes page) with the above rating. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

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Principles that Apply

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

Pyramiding: A single condition can only be rated once! However, if a mental disorder or brain condition exists that is additional to the skull condition (not simply caused by it), then it can also be rated.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the Musculoskeletal Principles and the VASRD Principles pages for further guidance.

For psychiatric conditions, please see the Mental Disorders page. For conditions caused by trauma to the head, see the Traumatic Brain Injury (TBI) page.

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