VA Diagnostic Codes: What They Are and How They Work

CCK Law: Our Vital Role in Veterans Law

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 Some Examples of Diagnostic Codes?

One example of a diagnostic code is DC 8100, which covers migraines. Under DC 8100, a veteran’s migraine disorder can be assigned four potential disability ratings depending on severity: 0, 10, 30, or 50 percent. The criteria for these ratings are as follows:

• 50 percent – With very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability
• 30 percent – With characteristic prostrating attacks occurring on an average once a month over last several months
• 10 percent – With characteristic prostrating attacks averaging one in 2 months over last several months
• 0 percent – With less frequent attacks

Another example of a diagnostic code is DC 7304, which covers peptic ulcer disease. Under this code, veterans can receive ratings of 0, 20, 40, 60, or 100 percent disabled. The criteria for these ratings are:

• 100 percent – Post-operative for perforation or hemorrhage, for three months
• 60 percent – Continuous abdominal pain with intermittent vomiting, recurrent hematemesis (vomiting blood) or melena (tarry stools); and manifestations of anemia which require hospitalization at least once in the past 12 months
• 40 percent – Episodes of abdominal pain, nausea, or vomiting, that: last for at least three consecutive days in duration; occur four or more times in the past 12 months; and are managed by daily prescribed medication
• 20 percent – Episodes of abdominal pain, nausea, or vomiting, that: last for at least three consecutive days in duration; occur three times or less in the past 12 months; and are managed by daily prescribed medication
• 0 percent – History of peptic ulcer disease documented by endoscopy or diagnostic imaging studies

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.