10 Most Common Disabilities for Veterans
Veterans often experience certain medical conditions at higher rates than their civilian counterparts as a result of events that occurred during military service. Due to the physical intensity required by military service, many veterans face musculoskeletal conditions—in fact, conditions of the musculoskeletal system are the most common types of disabilities veterans face. Other common disabilities include those of the auditory system, likely caused by factors such as gunfire, and mental health disorders caused by the potential stressors military service can bring.
According to VA’s Annual Benefits Report for Fiscal Year 2019, there are approximately 5.2 million disabled veterans with over 25 million disabilities, averaging about 5 disabilities per veteran. Here are the most common disabilities among the veteran population:
1. Most Common VA Disability: Tinnitus
Generally speaking, tinnitus refers to the perception of noise or ringing in the ears. Most often, tinnitus is a symptom of an underlying condition, such as hearing loss, ear injury, or a circulatory system disorder. The most common symptoms of tinnitus may include phantom noises in the ears such as: ringing, buzzing, roaring, clicking, hissing, and humming. According to VA’s 2018 report, tinnitus is the most commonly claimed condition for all veterans with 157,152 compensation recipients.
As mentioned previously, service members are consistently exposed to loud noises from gunfire, machinery, armored vehicles, aircraft, as well as other combat-related noises. In addition, many veterans cope with traumatic brain injuries (TBIs) stemming from traumatic injuries or exposure to improvised explosive devices (IEDs). As a result, tinnitus is a common condition from which veterans suffer.
Importantly, veterans do not need a specific diagnosis of tinnitus to be granted service connection. Instead, veterans can provide a subjective report of their symptomatology and that is enough to show that you meet the rating criteria. From there, VA will decide if your tinnitus is related to your service.
After service connection for tinnitus is established, VA will award a disability rating based on the severity of the condition. VA rates tinnitus under 38 CFR § 4.87, Schedule of Ratings – Ear, Diagnostic Code 6260. The highest scheduler rating for tinnitus is 10 percent and it is very rare that veterans will receive higher than that on an extraschedular basis. According to VA, 93.6 percent of all veterans are rated at 10 percent for tinnitus. Importantly, this singular 10 percent disability rating takes both ears into account.
2. Bilateral Hearing Loss
Bilateral hearing loss involves muffling of speech and other sounds, difficulty understanding words, trouble hearing consonants, frequently asking others to speak more slowly, clearly, and loudly, withdrawal from conversations, and avoidance of some social settings.
Bilateral hearing loss essentially affects all veterans in all different eras of service. While hearing loss is most often thought of as being associated with combat, it can also be due to other causes. For example, if a veteran’s military occupational specialty (MOS) involved working around aircraft all day, they would likely be exposed to loud engine noises. As a result, they might be at a heightened risk of experiencing hearing loss later in life. The Duty Military Occupational Specialty (MOS) Noise Exposure Listing has been reviewed and endorsed by each branch of service. Based on the veteran’s records, VA adjudicators should review each duty MOS or duty assignment documented on the Duty MOS Noise Exposure Listing to determine the probability of exposure to hazardous noise. If the duty position is shown to have “Highly Probable” or “Moderate” hazardous noise exposure, such exposure should be conceded as an in-service event for service connection purposes.
After service connection is established, VA will assign a disability rating for bilateral hearing loss based on severity. The rating is primarily based on two auditory tests:
- Speech discrimination – assess how well an individual understands words / what someone else is saying
- Pure tone threshold – indicates the softest sound audible to an individual at least 50 percent of the time
Such tests are important because VA has specific criteria that a veteran’s hearing loss must meet in order to be considered a disability for compensation purposes. Simply having a doctor say that you suffer from hearing loss does not necessarily mean it is severe enough for VA criteria. Instead, it must rise to a certain level to be considered a disability that VA will grant service connection for. Most often, veterans are assigned a 10 percent disability rating for their service-connected hearing loss. Specifically, VA’s 2018 report shows that 93.6 percent of veterans who are service-connected for hearing loss are rated between 0 and 10 percent.
3. Post-traumatic Stress Disorder (PTSD)
Post-traumatic stress disorder (PTSD) is a mental health condition that results from experiencing a distressing, shocking, or otherwise traumatic event. Nearly 1.7 million veterans are service-connected for mental health conditions, of which 1 million are service-connected for PTSD specifically. To be granted service connection for PTSD, veterans must demonstrate the following:
- A current diagnosis of PTSD
- An in-service event (known as a stressor)
- A nexus opinion linking the current diagnosis of PTSD and the in-service event
In addition to the typical elements of service connection, veterans must verify a stressor, or the in-service event that they are claiming caused their PTSD. The stressor must be corroborated in order to show that it happened. To do so, veterans can provide lay statements detailing the in-service event.
Importantly, stressors do not have to be related to combat. Instead, veterans can get service-connected for PTSD as a result of non-combat related events (e.g. military sexual trauma).
Additionally, veterans should file a claim for PTSD even if they do not yet have a diagnosis. VA may find that they have another mental health condition that warrants a diagnosis and subsequently service connection. It is also possible that veterans may be diagnosed with multiple mental health conditions (e.g. anxiety, depression, and PTSD).
However, veterans will only receive one combined rating that takes into account the full level of impairment. All mental health conditions are rated under 38 CFR § 4.130, on a scale from 0 to 100 percent. Veterans are most commonly assigned a 70 percent rating for PTSD. As of 2018, 90.7 percent of veterans were rated at 30 percent or higher for mental health conditions, such as PTSD, while 41.1 percent of veterans were rated at 70 percent or higher.
Nonetheless, it is important to note that the way the rating schedule is set up, there is a lot of room for veterans to show they meet a higher rating. Lay testimony, medical evidence, and expert opinions are all valuable types of evidence that can be used to support an increased rating.
Vietnam-era veterans have the highest percentage of veterans service-connected for PTSD, with Persian Gulf War veterans being a close second. While these groups have higher percentages, they are not the only ones who can be afforded service connection. Rather, veterans serving in any period or era can also be afforded VA disability benefits for PTSD.
Veterans can receive service connection for scars that result from their time in military service, or from service-connected conditions that required surgery. When considering scars, it is common to think of gunshot and/or combat wounds as the cause. However, it is actually more common to see scars as secondary to surgeries, as mentioned above. Veterans with service-connected orthopedic conditions may undergo surgery that results in a scar.
VA disability ratings for scars are usually pretty low as the criteria to get above a 0 percent rating is very difficult. As of 2018, 76.2 percent of veterans are rated at 0 percent for skin conditions, while 18.6 percent of veterans have a 10 percent disability rating for skin conditions. To do so, veterans must have more than one or two scars that are painful or unstable (i.e. losing the skin covering the scar). This tends to be uncommon. VA does not rate scars based on where they are located, but the percentage of the body that is covered by the scars. Overall, scars affect nearly 10 percent of all veterans.
When providing evidence for service connection or increased rating claims for scars, it may be helpful to include clear, in-color photographs. Providing both the VA examiners and adjudicators detailed evidence of your scars may influence the final rating.
5. Limitation of Flexion of the Knee
Knee conditions are very common amongst veterans. Limitation of flexion of the knee is just one type of knee condition that can receive service-connected compensation. Specifically, limitation of flexion of the knee refers to the range of motion of the knee as the veteran moves it or curls it inward towards the body.
Generally speaking, VA rates this condition based on the range of motion that exists as the veteran moves their knee in that direction. The rating criteria is as follows:
- 50% – extension limited to 45 degrees
- 40% – extension limited to 30 degrees
- 30% – extension limited to 20 degrees
- 20% – extension limited to 15 degrees
- 10% – extension limited to 10 degrees
- 0% – extension limited to 5 degrees
The most common rating VA assigns for limitation of flexion of the knee is 10 percent. VA’s 2018 report determined that 92.2 percent of veterans are rated between 0 and 20 percent for this condition. This low evaluation speaks to how VA rates knee conditions. Namely, there are strict rating criteria and specifications veterans must meet to have their knee conditions rated at certain levels. It is not just about how painful it is or how much it hurts. Instead, VA will literally measure the range of motion and assign a rating based largely off that alone.
Within VA’s regulations, veterans should be afforded a 10 percent rating even if they do not necessarily meet the specific diagnostic code criteria for limited range of motion but can otherwise show they have painful motion. However, VA often makes mistakes when it comes to this.
VA should pay attention to other indicators of functional loss such as weakness, interference with sitting and standing, pain on motion, and fatigability. This does not always occur and as a result, veterans sometimes receive lower VA disability ratings than they deserve. While knee conditions affect all eras of veterans, Gulf War veterans were found to be most affected.
6. Lumbar and Cervical Strains
Unfortunately, back conditions are quite common among Veterans. VA rates back conditions, such as lumbar and cervical strains, under 38 CFR § 4.71a, Schedule of Ratings, Musculoskeletal System and the criteria is based largely on a veteran’s range of motion. Generally speaking, veterans will attend a Compensation & Pension (C&P) exam and the examiner will measure how far they can bend forwards, backwards, and side to side, using a goniometer. VA will determine the severity of a veteran’s back condition based on the range of motion measurements provided by the examiner.
However, the C&P examiner should also take into account the functional loss caused by the veteran’s back condition, as evidenced by pain during motion. For example, a veteran might be able to bend forward 85 degrees but starts to experience pain at 55 degrees. In this case, the veteran should receive a disability rating that is consistent with both the range of motion measurements and the functional limitations caused by his or her back pain.
In addition to range of motion measurements and functional loss, VA examiners should also address the presence of flare-ups. If veterans experience flare-ups of back pain, they may be eligible for a higher disability rating. For example, a veteran is granted service connection for a back condition and receives a 10 percent disability rating. On most days, the veteran is unable to bend forward more than 60 degrees. However, when experiencing a flare-up, the veteran is unable to bend forward more than 30 degrees. Therefore, during the flare-up the veteran’s back condition becomes more than 10 percent disabling. As such, VA should assign a disability rating in accordance with this additional loss.
In a 2017 Court of Appeals for Veterans Claims case, Sharp v. Shulkin, the Court decided that examiners must offer an opinion on how the veteran could be functionally limited during a flare-up, even if the examination is not being performed during a flare-up. If an examiner fails to do so, then the examination is inadequate for VA rating purposes and a new examination may be warranted. If the examiner is unable to provide an opinion, they must prove they have considered all of the evidence available before arriving at that conclusion.
Overall, VA’s consideration of functional loss and flare-ups account for how a veteran’s back condition impacts their daily life, making up for the otherwise very mechanical application of the rating schedule. Based on the data from the 2018 report, 92.2 percent of veterans are rated between 0 and 20 percent for their lumbar or cervical strains.
Once again, Gulf War veterans are most affected by lumbar and cervical strains. Gulf War veterans are on the list a lot in terms of which era is affected the most by these commonly experienced conditions. This could be due to how long the Gulf war spans and consequently, the large number of veterans within this group. Other factors such as the physical training, heavy gear, and lack of proper shoes in service.
7. Paralysis of the Sciatic Nerve
Sciatica is a nerve condition in which pain radiates along the path of the sciatic nerve, traveling from the lower back down through the legs. It most often occurs when the sciatic nerve is compressed or pinched, usually by a herniated disk in the spine or an overgrowth of the bone on the vertebrae. Typically, sciatica affects only one side of the body. Common symptoms include numbness, tingling, burning sensation, and muscle weakness.
Paralysis of the sciatic nerve is very common amongst veterans primarily due to the fact that it is linked to back and neck issues. When rating back and neck conditions, VA is required to rate any neurological residuals. Therefore, paralysis of the sciatic nerve is often granted without veterans needing to file additional claims.
This condition involves a reduction in movement and feeling of certain limbs. Nerve issues, such as sciatica, are rated in three different categories based on the degree of severity of symptoms:
- Paralysis (the most severe category)
Technically, the term “sciatica” usually refers to neuralgia (i.e. sharp pain due to an irritated or damaged nerve) of the sciatic nerve. Therefore, neuralgia is generally the most common category that veterans fall into; however, it is possible that a veteran’s sciatica may present symptomatology consistent with a higher level of severity. Each of the three categories of nerve conditions mentioned above also have sub-categories for mild, moderate, or severe symptoms, creating many different possible ratings for a condition that affects a nerve.
VA rates sciatica under 38 CFR § 4.124a, Schedule of ratings – neurological conditions and convulsive disorders. For paralysis of the sciatic nerve, the rating criteria is as follows:
- 80% – complete paralysis in which all the muscles of the leg below the knee fail to work, causing serious difficulty in bending the knee
- 60% – incomplete but severe paralysis marked by muscular atrophy, poor blood circulation, and limited functionality of the affected body part
- 40% – incomplete but moderately severe paralysis
- 20% – incomplete but moderate paralysis
- 10% – incomplete but mild paralysis
The most common rating for paralysis of the sciatic nerve is also 10 percent. However, the criteria are very vague and open-ended seeing as there are no definitions for those terms. As a result, veterans do not know what is required for a higher rating.
Lay evidence may be helpful in demonstrating that a sciatic nerve condition is more severe than the disability evaluation reflects. Vietnam veterans are most affected by paralysis of the sciatic nerve, which may be related to their Agent Orange exposure. Many Vietnam veterans have diabetes and peripheral neuropathy, which also involves paralysis and nerve problems. As such, paralysis of the sciatic nerve tends to be a related residual.
8. Limitation of Motion of the Ankle
Limitation of motion of the ankle is common amongst veterans. This condition usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. An unhealed ankle sprain increases the likelihood of another ankle sprain occurring in the future. Repeated ankle sprains often cause and perpetuate ankle instability and limited motion. Additional sprains lead to further weakening, or stretching, of the ligaments thereby producing greater limitations.
Many veterans suffer from limitation of motion of the ankle due to the physical demands of military training and service. Specifically, veterans have engaged in fitness-related activities and jobs that required physical exertion while serving. Such activities and jobs may have resulted in ankle sprains and injuries throughout service, thereby leading to issues later on. In addition, a veteran may have been involved in an accident resulting in a traumatic injury to their ankle. For example, veterans involved in parachuting accidents often report ankle injuries later in life.
When rating limitation of motion of the ankle, VA primarily looks to diagnostic code 5271. Similar to the other orthopedic conditions mentioned above, the rating criteria deals with the range of motion of the ankle. VA then rates the condition based on the limitations to the range of motion.
Veterans usually receive either a 10 or 20 percent disability rating. A 10 percent rating consists of moderate symptomology while a 20 percent rating consists of marked conditions. There are no definitions as to what these criteria mean either, which results in an absence of analysis or rationale in deciding which evaluation is appropriate. This ambiguity gives veterans an opportunity to appeal and argue for an increased rating.
Migraines, the 9th most common VA disability, are recurring, intense, and frequent headaches that can be completely debilitating. Oftentimes it causes people to lock themselves in their room with complete darkness and no sound. Furthermore, it prevents people from working and going about their day to day activities. Service-connected migraines are rated under diagnostic code 8100 based on the frequency, severity, duration, and impact on daily life. All of these factors are outlined in the rating criteria and incorporated into how VA evaluates the veteran’s migraine condition.
In addition to direct service connection, veterans may also receive service connection for their migraines on a secondary basis. Namely, if the veteran has a separate service-connected condition that then causes or aggravates their migraine condition, secondary service connection may be warranted. For example, a veteran’s orthopedic condition (e.g. neck strain) is so painful that over time it leads to intense migraine headaches. Here, the veteran may be able to link their migraine headaches to their service-connected orthopedic condition in order to receive VA disability benefits. Another common example involves migraine headaches resulting from service-connected traumatic brain injury (TBI).
Service-connected migraines are rated under diagnostic code 8100 based on the frequency, severity, duration, and impact on daily life. The rating criteria are as follows:
- 50% – with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability
- 30% – with characteristic prostrating attacks occurring on average once a month over last several months
- 10% – with characteristic prostrating attacks averaging one in two months over last several months
- 0%- with less frequent attacks
Generally speaking, the word “prostrating” means that the veteran’s migraine headaches are so severe and debilitating that they are required to lay down for an extended period of time due to complete exhaustion and physical weakness. Typically, prostrating migraines also require veterans to stop all activity and possibly take medication or seek medical attention. According to VA’s 2018 report, migraines are usually rated 30 percent or higher.
10. Degenerative Arthritis of the Spine
The final most common VA disability is degenerative arthritis of the spine. There are two main types of arthritis of the back: degenerative arthritis and rheumatoid arthritis. Degenerative arthritis occurs when cartilage between joints erodes over time resulting in joint stiffness, limited mobility, and pain. This type of arthritis usually takes place in weight-bearing joints (e.g., back, hips, knees). Arthritis of the spine is a breakdown of the cartilage of the joints and discs in the neck and back.
Degenerative arthritis of the spine is the final common condition for which veterans receive VA disability benefits. The American Academy of Orthopedic Surgeons states that degenerative arthritis of the spine is the primary reason for disability discharge among service members.
Over 395,000 veterans are currently receiving disability benefits for degenerative arthritis of the spine. The rating criteria is based on the joint involved and whether it is major or minor. However, veterans are often not rated under the arthritis diagnostic code as it usually results in such a low rating. If veterans also have limited range of motion or incapacitating episodes, it could result in a higher rating.
VA should acknowledge both diagnostic codes involved (i.e. arthritis and limitation of motion). Veterans are sometimes confused as to why VA is not rating them under the arthritis diagnostic code. Ultimately, it is because has to defer to the rating code that gives veterans the most compensation.
Call Chisholm Chisholm & Kilpatrick LTD for a Free Case Evaluation
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