VA Diagnostic Codes: What They Are and How They Work
What is the VA Schedule for Rating Disabilities (VASRD)?
The Department of Veterans Affairs uses the VA Schedule for Rating Disabilities (VASRD) to assign diagnostic codes and disability ratings for service-connected conditions. The VASRD is located in Part 4 of Title 38 in the U.S. Code of Federal Regulations. Specifically, the VASRD contains the disabilities for which veterans can be rated, divided into 15 categories depending on the bodily system to which the disability pertains. For instance, there are separate categories for the digestive system, respiratory system, and musculoskeletal system, among others. Each bodily system’s list contains diagnoses that can occur within that system with its corresponding diagnostic code. The VASRD explains how disabilities will be evaluated for purposes of receiving a VA disability rating.
VA Diagnostic Codes Defined
According to VA, a diagnostic code is defined as “arbitrary numbers for the purpose of showing the basis of the evaluation assigned and for statistical analysis in the Department of Veterans Affairs, and as will be observed, extend from 5000 to a possible 9999” (38 CFR § 4.27). In other words, the four-digit number is listed as a way to explain exactly how VA Rating Authorities choose to rate a veteran’s service-connected condition. If a veteran’s disability is based on residual conditions, they will see an eight-digit VA diagnostic code instead, with the first four digits representing the initial condition and the last four digits representing the residual condition. While the VA diagnostic codes listed in the regulations cover a wide range of conditions, there are times in which certain conditions do not have a corresponding code.
Knowing the VA diagnostic codes that apply to your conditions can help you have a more prepared and thorough claim. VA diagnostic codes allow you to breakdown the specific rating criteria used to evaluate your claimed conditions and tell you what aspects of your disability VA will take into account when assigning a rating.
What Are Analogous Ratings?
Analogous ratings are ratings given to conditions that are not explicitly included in the VASRD. Generally speaking, they are assigned based on what condition most closely matches the overall symptoms or treatment of the disability that VA is trying to rate. Under 38 CFR § 4.20, VA can look at “not only the functions affected” when assigning an analogous rating, but also “the anatomical localization and symptomatology” to ensure they “are closely analogous.” Furthermore, when assigning an analogous rating, VA must apply the rating criteria that is most favorable to the veteran, meaning that which results in the higher disability rating for that condition. Typically, VA will state in its decision that the veteran’s disability is being rated analogous to another diagnostic code and explain how that diagnostic code was chosen.
Where Are Diagnostic Codes Located in VA Decisions?
Rating Decisions from the Regional Office are almost always issued in conjunction with a VA award letter, which indicates a veteran’s disability ratings along with the corresponding amount of monthly compensation. At the end of a VA Rating Decision, there is a final document called a rating code sheet. The rating code sheet will display all of the veteran’s conditions that are subject to compensation. In doing so, it will provide the diagnostic code of each condition used to assign the disability rating.
What Happens When Multiple Diagnostic Codes Apply?
It is not always easy to find the appropriate diagnostic code for certain conditions. It is important to note that if there is more than one diagnostic code that applies to a veteran’s service-connected condition, then VA is required to assign the diagnostic code that will grant the veteran the highest evaluation.
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- Board relied on insufficient exam in heart condition denial
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- Bilateral knee condition denial ignored possible connection to service
- Board Erred in Denying Service Connection for Veteran’s Psychiatric Condition and Seizure Disorder
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