- How do VA disability ratings work?
- What does VA look at to determine ratings?
- Who assigns VA ratings?
- The VA Rating Schedule (The VA Schedule for Rating Disabilities)
- Diagnostic Codes & maximizing benefits
- Combined Ratings: What if you have multiple service-connected disabilities?
- How does VA Math work? How does VA combine ratings?
- CCK’s Disability Calculator
- How to use VA’s Combined Ratings Table
- The Bilateral Factor
- Viewer Question: If you’re rated 100% Permanent and Total, is there any reason to apply for an increase?
Special Kinds of VA Disability Ratings
- Increased Rating Claims & Rating Reductions
- Permanent and Total VA Ratings & Total Disability based on Individual Unemployability (TDIU)
- Staged Ratings
- Extraschedular Ratings
- Analogous Ratings
- Rating Service Connection based on Aggravation
- What to do if you disagree with the disability rating VA assigned
- Applying for an increased rating when you’re already at 100 percent
Maura Clancy: Good afternoon, everyone! Welcome to today’s Facebook Live discussion. My name is Maura Clancy. I’m here at Chisholm Chisholm & Kilpatrick in Providence, Rhode Island and I’m joined today by Kerry Baker and Lindy Nash also of Chisholm Chisholm & Kilpatrick. Today, we are talking about VA Math. Before we get into the topics, we have prepared for you today. Just a few preliminary things. First, we will be taking any questions that anyone wants to ask that you are able to leave in the comments feed next to this video. So, we’ll do our best to get to some of the questions that you ask either by providing an answer from the live video today or at least by posting any materials that we think would be helpful to you and another thing that you can do to find additional materials on the topics that we discussed today, if for some reason they are not posted which we’ll try to do, is to visit our website at www.cck-law.com. We save a lot of our videos and blog posts there. So definitely check out those materials and so again, today we’re talking about VA Math. Lindy, why don’t you start us off, can you tell us how VA Disability Ratings work? So, what is it mean to have a rating? What’s the effect of it?
Lindy Nash: Sure, so basically a VA disability rating comes from, say you’re not in-service, active or anything, you’ve never filed a claim before. So, you file your first claim say for a knee condition that you think was due to service. Say that knee condition does get service-connected the VA will assign you a disability rating, ranging from 0 to 100 based on how severe your disability is. So, that is kind of the gist of it. So, every disability assuming it gets service-connected we’ll get a rating and that will dictate the amount of monthly compensation that you get. So, that is why it’s so important and usually the way it goes is as I said you’ll file the claim, it’ll get granted and what’s known as a rating decision and within that rating decision that is where the rating will be assigned from the VA.
Maura: So, ratings are decided by rating decisions as Lindy said. What factors into the assignment of the rating? What does VA look at in order to determine what rating to give a service-connected disability?
Lindy: Yes, so VA will look at or they’re supposed to look at on your whole C-File. So, everything ranging from exams to private treatment notes, in-service treatment records, lay statements, really anything that you’ve submitted within your time at the VA. That is what they should consider in assigning the disability rating. So, it’s a lot to look at but that is what they’re supposed to do.
Maura: And also, as Lindy mentioned, ratings are important because the rating percentage is associated with a certain monthly payment amount. So, that is typically why we usually work very hard in increased rating cases because there’s a compensatory value attached to it.
Lindy: Right, and so just to add on one more thing, typically, so, kind of on the low end a 10% rating this year is about $140 and then at the higher end a 100% rating or a total disability rating is a little bit over 3,000, I think it’s $3,057 right now. So, obviously that’s a huge gap and that is why your rating is really crucial to your monthly competition.
Maura: Great! And Kerry, tell us who it is at the VA that’s doing the ratings? Who’s assigning the rating percentages for service-connected conditions?
Kerry Baker: Well, typically, it’s going to be your regional office rating specialist who sits down to rate the case. That’s not in every scenario. If, for example, you receive a rating from the VA and you want to appeal it, you want a higher rating, the board of you know, you appeal that up to the Board of Veterans Appeals, they, too, can assign a different rating than the regional office but typically, it’s your rating specialist who’s a somewhat of a senior VA employee at the regional office.
Maura: And they base their ratings, from what I understand, on the VA rating schedule, is that right?
Kerry: Correct. They base the ratings on VA’s rating schedule which lists out thousands of disabilities that somebody could be service-connected for and each of those have different rates of severity. So, you could have a say a lumbar spine problem; it could be anywhere from 0% up to the highest it goes is 60%. There could be residuals from that that are separate from the low back problem such as radiculopathy down the extremities and that could have us another rating. So, they use the rating schedule to assign the ratings and the rating schedule itself is based on the average impairment of earning capacity and that’s been that way for decades. And that’s the best way the VA has come up with to figure out what disabilities are worth how much compensation and that’s the average earning capacity across the spectrum. So, that could be different for different people. A back disability might be a huge– as an example a back disability might be a huge impact on someone’s earning capacity. If they’re in a manual labor position. It may not be very much a reduction of earning capacity if someone’s in a very high-skilled low-impact job, so they use the average of that to try to come up with the ratings.
Maura: That makes sense, and it’s all based on how severe the condition is at the end of the day.
Kerry: That’s correct.
Maura: And the rating schedule also contains different diagnostic codes that are associated with different types of disabilities. So, tell us about those diagnostic codes and how those are used in rating conditions?
Kerry: So, the diagnostic codes, if anybody wants to look up VAs schedule for rating disabilities, it’s Title 38 in the Code of Federal Regulations Part 4 and that the whole section Part 4 is the VA schedule for rating disabilities. And so, you can look up, if your service-connected for something, you can look up and check that to see, “Well, this is what I’m rated, are my symptoms compatible with this?” And I think I probably got sidetracked from your actual question.
Maura: That’s okay. It’s all good. The original question was about diagnostic codes. So, usually and correct me if I’m wrong, but usually if you have a service-connected condition, they will choose a diagnostic code in the rating schedule that best contemplates the symptoms that you have due to your service-connected disability. So, tell us about, there’s a lot of different diagnostic codes and how those are used by the raters when they’re issuing rating decisions?
Kerry: So, the diagnostic codes, and I don’t know the total number of them, there is a lot. Think of every body system that you have, there’s a group of diagnostic codes for that. So, there’s a group of diagnostic codes for musculoskeletal disabilities, another group of diagnostic codes for neurological disabilities, for pulmonary disabilities, for mental health disabilities and so each group has multiple diagnostic codes of it. So, for example, there’s a diagnostic code for lung cancer. There’s only one diagnostic code for that and if it’s active lung cancer then you’re rated at 100% if it’s not active lung cancer then you’re going to go to the residuals and you could end up getting rated under a different diagnostic code than the original in that stage. So, it’s also important for people to know to look for those diagnostic codes because they may have you rated under something that really shouldn’t. You might be more accurately rated under a different diagnostic code. Now, one thing that most veterans will not see the diagnostic code that’s used because they put those on what’s called the code sheet which is a back page of the rating schedule and they typically don’t send the code sheet out to veteran claimants. They just don’t include that as part of the ratings. We think they should, but they don’t.
Maura: Right, yes, and that can be helpful to know what diagnostic code is being used because as you hinted up before VA has a duty to maximize benefits. So, if there are two potentially applicable diagnostic codes on the rating schedule that might apply to your condition, they’re supposed to use the one that not only best contemplates your symptoms but also yields the highest amount of compensation.
Kerry: That’s correct.
Maura: And in line with that, something you mentioned earlier was residuals. I think you were talking about lung cancer. Sometimes, we see that VA bases their rating decisions on residuals of a condition. So, for instance, residuals of a TVI, those are also relevant in assigning ratings. Is that right?
Maura: Okay, and Lindy, what happens if you have multiple VA disabilities that all have different ratings? So, say taking Kerry’s example, you have a lumbar spine disability that’s at a 40% rating. You may also have Tinnitus, that’s at a 10% rating. You might have a psychiatric condition that’s at a 30% rating. How does VA come up with your monthly compensation when there are so many different ratings in play?
Lindy: Right. So that’s where VA Math comes in and I can’t tell you how many of my clients call and they say, “I don’t understand I have a 50% for PTSD and a 50% for sleep apnea, why don’t I have a 100%?” That’s such a frequent thing this is extremely confusing and complicated and so that is why we’re having this discussion for VA Math because it’s not your usual math 50+50 does not equal a 100. So, this is where combined ratings come in. So, basically, if you have numerous service-connected disabilities, all at different ratings, they do not combine the way that typical Math works. So, as I said 50+50 does not equal a 100. It’s also really hard to hit a 100 on the schedule ratings. So, I think that’s why some veterans opt for a TDIU if they’re unable to work with which is also 100% rating because it’s really difficult to hit a 100 even if you have multiple service-connected conditions, it’s really hard to get there and I think Kerry is going to get into how the Math actually works because it is complicated.
Maura: But before Kerry does that, the hardest part for sure of today’s discussion–
Lindy: We have diagrams.
Maura: But to Lindy’s point, if you have multiple different disability ratings, your monthly pay is based on your combined rating. So, there can be individual ratings for different conditions, as we were talking about before a rating for a lumbar condition, a rating for tinnitus, your monthly payment will be based on your combined rating in which Kerry is here to tell us about how VA Math works. If 50+50 doesn’t equal a 100, how is VA getting to the combined ratings? How are they figuring that out?
Kerry: Well, let me first say, it scares me a little bit when she says, “It’s complicated. So, Kerry is going to explain it”. I grew up, born and raised in Kentucky. So, you know how famous we are for our Math skills. When I’m asked to explain it to somebody without a diagram, without VAs actual combined rating table, I explain it like this. They look at a person as well as a whole person. All right, you’re 100% whole person and to Lindy’s example, why doesn’t 50 and 50 equal a 100. So, the easiest example I know to give is picture the veteran at a 100%. So, let’s say you gave that veteran a service-connected disability rated at 90%. They subtract 90% from 100% of the whole person. That leaves 10% of a whole person left. So, you’ve got a 90% disability rating and that’s what you’re compensated at. You’ve got 10% of a whole person left. So, what happens if you give that person another 10% disability for something else it’s not related to the 90%. They take that 10% from the 10% of the whole person left. So, you’ve got a 90% disability, 10% of the whole person left. Add another 10% disability to that, they take that 10% from the 10% that’s left of the whole person. 10% of 10 is only 1. They add that 1 to the 90%.
Okay, so now technically your combining rating becomes 91. But they only pay in 10% increments. They round up at 5 and down at 4. So, if you have a 91% disability, you’re getting compensated at the 90% right still. So, that extra 10% did not change your combined rating. Now, look at it with four different 10% in addition to the 90. All right and Lindy said, “The higher you go on the rating schedule, the harder it is to get higher.” Four additional 10% just going to equal, on that type of Math equal 94% combined rating and that’s going to again pay you at the 90% rate. So, even though you have a 90% disability rating for one disability and four 10%, you’re still going to get paid at the 90% rate. If you had five 10%, it bumps up to 95 that rounds up to a 100%. Or another way to look at it is you have that single 90% disability rating and you have a separate 50% disability rating. Just like those five 10’s, you’re going to take that 50% of the 10% of the whole person left that’s going to give you 5. You take that 5 and you add it to the 90 which is the 90% disability gives you a 95% disability rating which rounds up to 100. But that’s the easiest way I can explain it. If you want, I’ll go over to my rating’s table if you want to do that later.
Maura: Well, as you mentioned before, there is a table that’s in the Code of Federal Regulations 38 CFR Part 4 and the table is a way to figure out if you have a certain combined rating and then you have an additional rating added to that, you can utilize the table to figure out where your new combined rating will fall. Whether it’ll change and if it does go higher how much higher is it going. We also have, because this is clearly a very complicated stuff, none of us really do this in our head all the time. If we can, then that’s great but we use a disability calculator that we actually have on our website. Again, our website is www.cck-law.com. We will post a link to the calculator in the comments next to this video, but I use this all the time, I’m not sure about either of you but–
Kerry: All the time.
Maura: Good. The calculator is a way to select all the different. Kerry doesn’t need it.
Lindy: Kerry doesn’t need it. It’s just me.
Kerry: No, no. I use this.
Maura: Kerry’s fix at the table. But the calculator is great because you’ll see that there’s all different percentages and you can check off what percentages apply to you. So, if you have a list of disability ratings for individual conditions, you can click on them on the calculator and once they’re all accounted for, we have a function there that allows you to see what the combined rating is. So, use the table, do it in your head if you want the challenge or use the calculator. Either way, this is a complicated concept.
Kerry: I think it’s a good time, I’ll go ahead and explain the table if you like. So, like Maura said, the table is in Part 4 same section I cited earlier. To be more specific it’s Title 38 CFR section 4.25. So, if you go to that section in CFR, you’re going to find the VA’s combined rating table. It looks similar to this and I don’t know if you can see this or not.
Maura: Very small on this.
Kerry: Yeah, I wouldn’t set up.
Lindy: We might be able to put it on.
Kerry: Down one column it has the various disability ratings. Across the other column, it has disability ratings that you would combine with it. So, for example, if you had multiple disability ratings, this is important. We’re going to use the table and the only reason I don’t use a calculator is because I’ve been using this for so long, it’s just easier for me to do it and I don’t do it in my head, no way. So, if you had a 20% disability rating and let me say the different ways. Say, you had a 50% disability rating, a 30% disability rating and 10% disability rating. You want to take those in the highest order down to the lowest. So, you start with the 50% disability rating and you find that on the very left-hand side of the paper. So, once you find your 50% and now you’re going to want to combine 30% to that because you have a 50, a 30 and a 10, you go towards the top column here. The top row has the percentages that you’re going to combine to it. So, you find your 50 down on one side, you find your 30 down the other side, I’m looking at it from behind, and there’s your 30 and then you come to where those intersect. And a 50 and a 30 according to the table, I don’t have a whole table here, you go across to find it there and that’s 65. All right, so a 50 and a 30 is going to be a 65% disability. That’s going to pay you at a 70% combined rate, but we’ve got another one we got that 10% to combine with it, too. So, once you find the 50 and 30 which is 65, you go back to the column on the far left and you go down to 65. Once you find that 65, you want to combine that other 10% to it, you go over one row because that’s the row for 10% and that gives you 69, and 69 still obviously pays it to 70% rates as it rounds off. So that’s generally how you use that.
Maura: And one more, even more, complicated question for you Kerry about calculating the combined rating is about the bilateral factor, can you tell us what the bilateral factor is and how it works?
Kerry: Okay, so, the bilateral factor is the one, if you have a bilateral factor that you’re going to use that’s going to be the one time where you’re not going to follow the what I just said, take your highest rating first and the next highest and the next highest and combine them up. If you have something that’s going to be applicable to the bilateral factor, you have to compute that first. So, how would that work? A bilateral factor is anytime you have a compensable rating, for example, to bilateral extremities. So, if I had both my elbows were in bad shape and I had a 10% disability rating for each one of them. A 10 and 10 is a 19. Okay, so the first thing you have to do with those two bilateral factors. Let me back up. Say, I have a 10% for each elbow and an additional 50% for something unrelated post-traumatic stress disorder, heart condition or whatever the case may be. That 50% is not part of a bilateral factor. Bilateral factors only include bilateral extremities as an example and you have to have a compensable rating on each extremity, in other words, 10% or more on each extremity and in order for the bilateral factor to apply. So, if I had 10 and 10 on each elbow then that’s going to be combined into a 19. All right? You take 10% of that which is 1.9 in the case of two 10% and you add it back to that 19. So, once you add 19 and 1.9, you get 20.9, if I’m doing my Math right, and that rounds up to 21. So, that’s your bilateral factor.
So, instead of having a combined 20%, even though it’s technically 19 for say two elbows at 10% each, you really have 21. That’s where you start on the left column. You go down and find 21 and then you combine your other disability that doesn’t have anything to do with a bilateral factor which in that scenario was a 50%. So, you go down to 21, you go across the 50% that gives you your total rating. So, anytime there’s a bilateral factor, you always do that first. It’s meant and it’s 99.999% of the time is going to increase your disability rating. It may be the difference between that 54% and 55%, it’d be a 50% or 60%, or 90% and 100%. And if you have compensable ratings on, say all four extremities, then you’re going to use all four extremities in a bilateral factor. First, you’re going to do the normal routine and take the highest to lowest of the ones in the bilateral factor, combine them up, let’s say it comes to 44, just using that as a number. You’re going to take 10% of 44, that’s 4.4 and add it back to the 44, so your 44 combined rating now becomes 48.4. Because it’s a .4 instead of a .5, you round down, so your combined rating is 48 for your bilateral factor. And then you start applying the ones that don’t have the bilateral factor.
One important difference there is if you have two extremities that’s each compensable, and another to say, both elbows are compensable, and both knees are service-connected, but one knee is 10% and one knee is 0%. You cannot then use the lower extremities, because both extremities, when you’re dealing with impaired extremities have to be compensable. You got a 0%, that does not factor in there. But they don’t have to be identical disabilities. You can have a wrist and an elbow on one extremity, and just a wrist on the other. As long as they’re each 10% or more, all three of them are used for the combined for the bilateral factor. So, I hope that make some bit of sense.
Lindy: Importantly, the bilateral factor is also on our calculator, on our website. Just in case that didn’t, you know?
Maura: That’s exactly what I was going to say.
Maura: Thanks, Lindy.
Kerry: Do use the calculator for that.
Maura: We actually have a question from John. John, thank you for your question. John is asking, if you are rated a 100% rating permanent and total, is there a reason to make any further disability claims? And does it make any difference to do that? Any insight from the group here?
Kerry: I would say, it depends. That’s a huge it depends. So, if you’re a 100%, and you are thinking of filing a different claim, I always urge people, tread with caution there. One, what are you 100% for? And what else can you do functioning-wise, activities of daily living-wise? Do you need help with putting your clothes on and feeding yourself and bathing yourself? If you don’t, you can do all that stuff fine, a lot of times, you might not want to file another claim. So, you got to ask yourself, is there a benefit to be had, even a potential benefit for me to be had, by me filing another claim? And if the answer is no, just my personal opinion, not legal advice, I would not file another claim. But another thing to think about is, you’re 100% permanent and total, how long have you been 100% permanent and total? If you’ve been that way for 20 years, or more, then you’re protected. You’re legally protected from a reduction on benefits. So, that’s another thing to consider. But they can’t legally reduce you. Then you just have one question to answer, in my mind, that is, will that additional claim get you any additional benefits? If not, personally, I wouldn’t do it. If it will, I might do it. But if I was protected, it would make doing it a lot easier. Because then there’s no chance of a reduction. What you don’t want to run in to, is getting called in for a new exam because you think you’re going to get additional benefits when you’re already 100%, and it’s not going to help you. And you end up getting the one examiner that writes some things in your examination report that looks like you’ve improved and now you get a proposed reduction in benefits. So, that’s rare, and I don’t want to scare anybody. It doesn’t happen all the time, but it does happen. So, there’s a lot of things to consider when you’re answering that question.
Lindy: Yes. I definitely agree with what Kerry said, immediately what I thought of and I think what Kerry was referring to is SMC, Special Monthly Compensation, which we’ve talked about previously here at Facebook Live. And so exactly what Kerry said, depending on what you’re service-connected for, what disabilities gave you that 100% rating, and what you’re looking to file for, I think it depends. But it is you’re always hear a risk by filing for something new, going in for a new examination. You’re never totally sure unless you are protected with the 20-year permanent and total.
Maura: And that takes us to one of the other things we had on the list of things to talk about today, which is rating reductions. So, Lindy, can you tell us about increased ratings and rating reduction? So, say a person has a disability that’s rated at a certain rate, how does it happen that the rating could be increased? What needs to happen for that? And then the other side of it, what happens in a reduction process?
Lindy: Sure. So, you can file for increased rating at really anytime. It doesn’t matter if you’ve had one rating for a couple of years, or 30 years. Say, you’ve had PTSD at 30% for the last 20 years, and now you’re feeling like it’s really increased in severity and things are starting to change. So, you can file that claim for an increased rating and hopefully get a higher rating, which will lead to higher monthly compensation. So that’s always an option for you. And you should definitely do that. At the same time, you can have a reduction in your rating which would potentially lead to a reduction with your combined rating which would lead to a reduction in your monthly compensation. So that does happen, like Kerry said, not all the time, but it does happen and it’s something to be aware of especially if you’re filing claims, new claims and have a lot going on. So, it’s always something to be aware of and unfortunately a risk that you’re taking. And that would affect your monthly compensation in your combined rating if you were to be reduced.
Maura: And John who had asked us the question about permanent and total earlier, that brings up, can you tell the audience what permanent and total is? What does that phrase mean if we hadn’t already covered that?
Lindy: Yes. So, permanent and total is kind of what it sounds like. So, basically, you are 100% rating, you are deemed totally disabled. And if you’re found permanent and total, which is not an automatic finding, by the way. But if you are found P&T, or permanent and total, it means that the VA passed a pretty much leave you alone. So, they are not supposed to schedule you for any new examinations, you’re not supposed to be re-looked at, kind of they’re just supposed to let you be and go on your way with your 100% rating.
Kerry: Unless you invite them to.
Lindy: Right. Exactly.
Kerry: By filing another claim.
Lindy: Which is exactly what we were just saying. So yes. And then usually, a way to know if you’re permanent and total, a way that I can usually tell is when we get a rating decision, if you see that DEA, so Dependent’s Educational Assistance was awarded, that’s usually a sign of permanent and total as well. You can also look on the code sheet, if you did receive one. Sometimes it says on the code sheet if you’re permanent and total. Those are usually the ways that I can tell. But again, it isn’t automatic and sometimes you have to ask for it.
Kerry: So, I have a question on that. What if you’re unemployable?
Lindy: If you have TDIU?
Lindy: Then you have a 100% rating.
Maura: So, if you, as Kerry was getting at, if you have a TDIU or a total disability rating based on individual unemployability, you are paid at the 100% rate. That is different than a scheduler 100% rating that’s based on your combined rating, which is the product of all of your individual rating percentages adding up. But it is possible, I think, correct me if I’m wrong, to be permanent and total at the 100% rating when it’s based on TDIU or the unemployability benefits.
Kerry: Right. And on the only reason that I brought that up is because a lot of people had some confusion there. They think you have to be a scheduler 100% to be permanent and total. You can have a 70% rating and be getting 100% based on unemployability and it be permanent because you’re getting 100%, its total because your permanent is permanent, so you get permanent total status through TDIU as well.
Lindy: So, it’s basically VA kind of acknowledging that it’s unlikely that your condition’s going to improve. So, therefore, they’re going to assign you that P&T rating or give it to you.
Maura: And so, clearly, VA is sometimes in tuned to improvements on your condition. If you’re going to exams and the exams are showing a varying degree of severity of your condition, they might change their ratings based on that. And that kind of feeds in to the concept of stage ratings. Lindy, tell us about when stage ratings come up in some cases.
Lindy: Yes. So, stage ratings usually occur when the VAs looking through the C-file, looking over the evidence of record, and they see a really clear delineation of during this period of time from 2015 to 2018, your PTSD symptoms warranted a 30% rating. But then all of a sudden those next two years, your severity really increased, and so they’re going to award you a 50% rating. So therefore, it’s not really a reduction. It’s just a stage rating. So, you have 30% for this period of time, and 50% for this period of time. And again, that would change your combined rating and change your monthly compensation.
Maura: And another thing that can also change your compensation is if VA assigns you an extra scheduler rating. So, we’ve talked about the rating schedule, which is based on the average impairment and earning capacity. We’ve talked about the different percentages that you can get pursuant to the rating schedule, and the diagnostic codes in the rating schedule. But given VAs recognition that not all of the diagnostic codes, or not all of the things that are listed in the rating schedule are going to best fit your circumstances, they’d leave open the possibility for compensation based on an extra scheduler rating. Tell us about, just a little bit of basics on that idea.
Lindy: Yes, yes. We can definitely talk about extra scheduler ratings for a while. But you, totally hit the nail on the head. The basis is that, an extra scheduler rating can be awarded if your symptoms fall outside these scheduler ratings. So, if you think your symptoms are not adequately contemplated by the rating criteria, then you can apply for an extra scheduler rating. So, kind of an example that I think of all the time, is say that you have a 40% rating for a back disability, lumbar spine. So typically, or it is, the diagnostic code for the lumbar spine is based on limitation of motion, range of motion, it’s a pretty rigid schedule. However, say your back disability also causes depression and sleep impairment. So, obviously, your 40% rating for your back isn’t adequately compensating those extra symptoms that you’re getting. Therefore, you could apply for an extra scheduler rating. They are kind of rare, honestly. I don’t see them granted too often. Which is why they aren’t super popular. But it is a special, unique circumstance that you can seek.
Maura: Great. Thank you.
Maura: And analogous ratings, Kerry. What does it mean when VA starts rating conditions by analogy?
Kerry: So analogous ratings are when you are service-connected for a disability where there is no diagnostic code for that specific disability. So, you heard us talk about diagnostic codes earlier, if one does not exist for your disability, they will choose something by analogy. So, in other words, a code of a disability that best fits your disability. And they’ll code it in a special way that if you’re looking on the codes, you happened to have copy of it, it’ll be a hyphenated code, a certain way. And that’s kind of your indication that it’s been rated by analogy. They’re not supposed to do that if there’s a kind of specific diagnostic code that mandates that they follow that diagnostic code for a disability. But there can be some circumstances where there could be more than one analogous rating. So maybe this diagnostic code, and these other two basically are similar to your disability, so which one do you use? Which code do you use to rate a disability that’s not listed in the rating schedule to the one your service-connected for? They’re supposed to pick the ones that compensate you the most, that still account for your level of functioning. So that’s always something that we just have to look out for, are they using the analogous ratings correctly to maximize your benefits or they’re doing it to minimize your benefits.
Maura: And I think Kerry makes a great point. A lot of the concepts that we’ve talked about today, extra scheduler ratings, increased ratings, stage ratings, especially all of that derives, I think from VAs mission, or their mandate to make sure that they are capturing the maximum impairment and paying you for it. If there’s a time period, even a short time period within an appellate period where your rating should be higher, then they are required to give you that higher rating whenever it’s warranted. The same thing goes for extra scheduler ratings, just to make sure that all of your impairments are being captured by compensation. So, one of the things that we get asked sometimes that I thought we could just touch on briefly today, although I know that we do have other videos and blog post on it is, how VA goes about rating conditions that are service-connected based on aggravation? So, I know that there’s some math involved in terms of having to figure out what the baseline was of the condition before it was aggravated. Kerry, can you talk about how they calculate those ratings?
Kerry: Yes. So, there’s a little bit of difference if you’re referring to a disability that pre-existed service that was aggravated by the military service, or a disability that’s at a non-service-connected disability that you acquired after service that’s aggravated by another service-connected disability. They’re both aggravations. They both generally work the same way. I don’t want to get into the nuances between the two litigation on some of it, but generally, let’s pick out what you see the most is aggravation of a non-service-connected condition by a service-connected condition. We use two knees for example. So, you had one knee, so you got shot through the knee and it’s progressed to the point where you had a total knee replacement, and that knee is service-connected. But you had, say a non-service-connected arthritic condition in the other knee. And you applied for service-connection based on aggravation of your opposite knee. If they can determine the base line prior to the service-connected disability aggravating it, then they’ll deduct that level from the rating, the total rating. So, let’s say, they’ll look at your arthritic knee and it’s a judgement call in a lots of situations here. They think, all right, before the service-connected knee replacement aggravated the other leg, it was worth 10%. But now it’s progressed to a point where it’s worth 30%. You will get a 20% rating for that other knee. If they cannot discern the degree of aggravation, they are not supposed to deduct anything. Now, there’s a little difference there when you’re talking about the two types of aggravation which we can get into later.
Maura: Okay. Good to know though that there is additional Math involved in those.
Kerry: There’s more Math, yes.
Maura: And so, finally, I wanted to get some advice from both of you about what you should do if you disagree with the rating that’s assigned. Maybe you disagree with the initial rating that’s assigned after you’re granted service connection, maybe you disagree with a decision that you haven’t shown that you deserved an increase rating, or maybe you are disagreeing with a rating reduction. What should you do if you want to change the rating that you have for a disability? Either of you.
Kerry: I’ll go first because I’m closer. First, I mean you got to ask yourself a good question, “Do you have a representative? Are you on your own? Do you know what you’re rated for? Why you’re rated that?” So, it’s best, in my opinion to educate yourself. Find out what diagnostic code you’re rated under. Get a copy of your claim file. If you asked for that, it’ll include the code sheets that you might not otherwise have. Look at your rating, look at the schedule for rating disabilities to see what diagnostic code they have. You know what your symptoms are. Are they accurately compensating you? If you feel they’re not, I would file an appeal against that. And I know Lindy will probably talk appeals so, that’s my two cents.
Lindy: Yes. Appeal that thing. It is not uncommon for the VA to assign an improper rating. So, if you, like Kerry said, you’re the one who knows your symptoms the best. So, if you feel like your rating does not adequately compensate your symptoms, then appeal. Be really cognizant of the deadlines. There are deadlines for filing appeals, so make sure you’re within the deadline. Gather whatever evidence you can. Whether that’s treatment notes or lay statements, or opinions, whatever you have and in file that appeal. And definitely this can be really complicated, so if you’d like to seek representation from your local– from your VSO or colleagues at the DAV. Anything along those lines, I definitely encourage you to do that.
Maura: Great. Any other questions?
Lindy: Use the online calculator.
Maura: Yes. Use the online calculator.
Kerry: I’d like to add one more thing to the answer we gave to John. And I apologize, I think there’s something I may not have covered and I want to add this because I’ve seen this in lots and lots of cases. Let me take John’s scenario which is 100% permanent and total. And add some more examples to that. So, let’s say for example that was based on, I’ll just use a Vietnam vet exposed to Agent Orange who developed lung cancer. That’s all a presumptive disability. And so, let’s say a veteran developed lung cancer, he was rated 100% while the cancer was active, all right? Which what they’re supposed to do. And they got it under remission. They reduced it down to 10%, whatever the case may be, and say it comes back. Or it comes back a year later, two years later, and VAs supposed to rate it at 100% again because it’s active. So, say this time they– it doesn’t look like it’s going to brought under control. And they make that 100% permanent and total, right?
They usually won’t do that on the first time out unless you’re already terminally ill because of the cancer. And I’m just using cancer as an example, because it’s easy. So, let’s assume that it comes back you get that 100% reinstated and other than that, you’re okay. Okay? Not that lung cancer’s okay, but you’re up and around, you can feed yourself, you can take care of yourself, but a little while later say, that cancer moves to your spine. From the lung cancer, from the original service-connected cancer. Now, you can’t walk. All right? And you know you’re not getting better. All right? At that point even though you might not be protected, there is a very, very, very, very slim chance you’re going to get reduced. And if you do, you should appeal that decision. There I would file for an inquiry, I’d file for the increase based on the cancer of the spine, if that’s where it spread to, if you can’t walk because of it, there’s additional. So, there are times in various severe scenarios that I’ve seen people at 100% that could have gotten high into the special monthly compensation levels, which we have a video on, so we don’t need to get in to that, they could have gotten a lot more compensation. But those are very, very severe cases, so, just take that with a grain of salt. There are scenarios where you want to do that.
Maura: Great. Thank you both so much for all of this information. And thank you everyone for joining us today. We hope this was helpful to you. Again, check back through the comments next to the video for any additional information that might be helpful to you. And please visit our website for other blog posts and videos at www.cck-law.com. And thanks again for joining us today.