Top 20 VA Disability Claims
Video Transcription
Alyse Phillips: Hello, everyone and thank you for joining us for another CCK Live. I’m joined here with my colleagues, Nick Briggs and Kevin Medeiros, and my name is Alyse Phillips.
So, veterans often experience certain medical conditions at a higher rate than their civilian counterparts due to the events that they experienced in service. So, today, we’re going to do a breakdown of the top 20 VA disability claims.
The first one we’re going to talk about is tinnitus, also known as tinnitus. This is a perception of noise ringing in your ears. It’s often a symptom of an underlying condition such as hearing loss, an ear injury, or some type of other circulatory system disorder.
One of the most common symptoms with tinnitus is that buzzing, ringing, roaring, clicking, hissing, or humming that you’re going to hear in your ear. Something that makes tinnitus claims unique is that you do not have to be diagnosed for tinnitus to be service-connected and you can actually get, show that you have tinnitus just based on your own subjective labor report of your symptoms since it is something that’s very difficult to test for. Tinnitus is going to be rated under 38 CFR 4.7A, and the highest rating that typically a veteran can get is at 10%. So, that goes for both if you have tinnitus in either ear.
Let’s go ahead and move on to number 2, that’s going to be hearing loss. Nick, do you want to cover that?
Nick Briggs: So, like you mentioned hearing loss and tinnitus are pretty interrelated and that’s why many veterans suffer from both hearing loss and tinnitus. Hearing loss itself involves muffling of speech and other sounds, difficulty understanding words, withdrawal from the conversation, and other symptoms. Common causes of hearing loss include damage to the inner ear, build-up of earwax, ear infections, and ruptured eardrums.
Ratings for hearing loss are rated based primarily off of two different auditory tests, which VA requires a veteran to, you know, undergo before they can confirm the hearing loss diagnosis and what the proper rating should be. Those tests are the speech discrimination test, specifically, the Maryland CNC Test, and then the pure tone thresholds, or the pure tone audiometric test.
Ratings for hearing loss can range anywhere from 0% up to 100%, but most veterans tend to receive a rating between 0 and 10%, depending on whether they have one or both ear service-connected and then, obviously, what their scores are on those two tests.
Kevin, do you want to take the next one?
Kevin Medeiros: Great. Yeah. The next one is the limitation of flexion of the knee and this is probably the most common lower body musculoskeletal condition that we see. Limitation of flexion of the knee refers to when the knee begins straight and the leg is curled inwards towards the body. It’s rated under the musculoskeletal, you know, rating criteria and 38 CFR 4.71a, and the specific diagnostic code is 5260.
The ratings are assigned based on, you know, the severity of the condition. The less amount of range of motion the veteran has in flexion, the higher their rating would be.
So, you know, starting at 10%, 20%, and then 30% are the ratings that VA assigns. And the most common we do see is the 10% rating, but, you know, the limitation of flexion accounts for the actual ability to flex the knee and, you know, VA is also supposed to account for the pain that comes along with that.
And the next, we’re going to move on to PTSD with Alyse.
Alyse: Yeah. So, PTSD stands for post-traumatic stress disorder. It’s a mental health condition and it’s going to result from experiencing a distressing, shocking, or otherwise traumatic event in service. PTSD, getting service-connected for PTSD is unique because, in addition to the normal element of service connection, veterans must also verify that that claim stressor in service occurred. So, it must be corroborated such as through lay statements or also just actual evidence from your record that shows that the stressor occurred.
One thing to note is that stressors don’t need to be combat-related. We have seen multiple different types of stressors, but you do not need to be a combat veteran to be service-connected for PTSD.
PTSD is rated under diagnostic code 4.13O, and we see ratings range from 0 to 100 percent. So it goes 0, 30, 50, 70, and 100 in the PTSD world. And those are going to be rated based on your level of social and occupational impairment. And then we’re also going to look at the frequency of the symptoms that you experience as well as the duration and the severity of those symptoms.
So, next, we’ll move on to number five, which is going to be lumber and cervical spine strains with Nick.
Nick: Sure. So veterans often suffer from back and neck pain that aren’t necessarily caused by underlying arthritic conditions. These veterans often suffer from chronic and recurrent strains. And ultimately, these conditions are rated under the same diagnostic codes.
Veterans will attend a VA exam to determine how far they can bend forwards, backwards, and side to side using a goniometer. And then VA will determine the severity of the back condition based off of the range of motion measurements taken during the VA exam.
Like Kevin mentioned earlier, when measuring these range of motion measurements, they need to account for functional loss, a.k.a. where pain begins during that pain of motion, range of motion, as well as flare-ups. Additional episodes of pain that cause it to become more severe and might limit the veteran’s range of motion more than that they would normally be limited otherwise.
VA rates back conditions and neck conditions under 38 CFR 4.71a, schedule of ratings for the musculoskeletal system. And like we mentioned earlier, this criteria is based almost exclusively on the veteran’s range of motion, and ratings under this diagnostic code range from 0 to 100%.
Kevin: Next, we’re going to talk about the scars veterans can receive service-connected compensation for scars and, you know, a variety of ways whether from an incident or an injury during service or, you know, after service once a veteran’s been service-connected for a condition that requires surgery. They can also receive service connections for the scars resulting from that surgery.
Scars are rated under 38 CFR 4.11a, diagnostic code 7800 to 7805. And the ratings are based on the number of scars or disfigurement, the area of the body, their permanence, and the presence of pain or instability of the scar if there’s anything like that.
Scars on the head, face, or neck are rated based on skin loss and how many facial features have been disfigured, and ratings for scars on, you know, other areas of the body outside the head, face, or neck are generally based on the size of the scar, and again, whether their painful or unstable.
The ratings for scars range anywhere from 0, also referred to as non-compensable, all the way up to 80% depending on what type of scar it is and what diagnostic code it falls under. So, we’ll move on to the sciatic nerve with Alyse.
Alyse: So, sciatica is a nerve condition involving pain rating along the path of your sciatic nerve. So, typically, that’s going to travel down your lower back and through your legs. It most commonly occurs when there is pinching or compression of the sciatic nerve. Paralysis of the sciatic nerve is another condition and it’s very common amongst veterans. We see that most commonly linked with back and neck issues, typically, secondary to those issues, and that will typically involve a reduction of movement and feeling in certain limbs.
So, it’s going to be both sensory, whereas you’re feeling numbness, and also can be more than sensory so that you’re actually feeling physical limitations based on that paralysis. Both conditions are going to be rated under section 4.124a and we are going to be looking at how limiting basically that paralysis is. It’s going to be ranging from a 10 to an 80 depending again on how limiting it is, whether it’s totally sensory, whether you’re just feeling numbness, or whether you’re actually feeling weakness, something more than just, you know, a loss of sensation.
So, next, we’ll move on to number 8, which is going to be limitation of motion of the ankle.
Nick: Sure. So, like I mentioned earlier with the back in the neck, limitation of motion in the ankle could come from either an underlying arthritic condition or a recurrent or chronic sprain that didn’t adequately heal during a veteran’s service. And many veterans suffer from these sorts of limitations due to the physical demands of their military training and their service duties generally.
Limitation of motion in the ankle is usually rated under 38 CFR 4.71a, schedule of ratings for musculoskeletal disabilities, with the specific diagnostic code being DC-5271. Again, the code is based off of limitation of motion of the ankle, and the ratings are limited to either a 10% rating or a 20% rating, depending on how severe the range of motion measurements are.
Moving on next, we have Kevin with migraines.
Kevin: Yeah. Number nine is migraine headaches. Migraines are recurring, intense, and frequent headaches that can be, you know, so debilitating that the individual is not able to function. Symptoms can include pain, nausea, vomiting, sensitivity to light and sound, and another variety of symptoms. Some factors that contribute to the higher rate of migraines in veterans are the noise exposure, intense and stressful situations, and also brain injuries including traumatic brain injuries.
VA rates migraine headaches under 38 CFR 4.124a, which contemplates neurological conditions. The diagnostic code is 8100 and it provides ratings starting at non-compensable and moving up to 50%. So, non-compensable, 10%, 30%, and 50%. And like most other conditions, they’re based on the severity of the condition. But the migraine headaches also takes in, diagnostic code takes into account the frequency and, you know, ultimately the amount that it interferes with a veteran’s ability to function.
So, VA uses the word prostrating in the diagnostic code for the migraine headaches, which commonly is referred to as debilitating. Each case will be a little bit different depending on the effects of the migraines on the individual veteran, but the condition must be prostrating to warrant compensable and higher ratings.
Alyse: Okay, and next, we’ll move on to number 10, which is going to be limitation of motion of the arm. Typically, we’re going to see this when there is an injury to the arm or the shoulder, maybe the elbow, that has not fully healed or was not rehabbed correctly. Also, repeated injuries to your arm, your shoulder, your elbow can also result in some type of instability or maybe popping of the socket.
So, common causes of arm conditions in service include lifting heavy objects, forms of physical training, scar tissue in the muscles, and, you know, a more traumatic injury like a fall and impact or an accident.
Arm conditions are going to be rated under a 4.71a and they are going to be rated based on the limitation of motion in the arm, but we’re also going to take into consideration whether the arm affected is either the non-dominant or the dominant arm, and also how severely it’s otherwise limited including, for example, instability. Ratings are going to range from about 20, 30, 40% for the arm condition.
And then, number 11 is sleep apnea with Nick.
Nick: Sleep apnea is a potentially serious sleep disorder in which a person’s breathing is repeatedly interrupted during the course of the night. To confirm a sleep apnea diagnosis for VA disability purposes, VA requires that a veteran undergo a sleep study, and then depending on the results of that sleep study and whether or not a CPAP is prescribed, they’ll assign a rating under diagnostic code 6847, which can be found at 38 CFR 4.97, which covers sleep apnea syndromes generally as there are a few different types, though I think obstructive sleep apnea is probably the most common that veterans are rated for.
And under that diagnostic code, you can be assigned either a 0% rating, a 30% rating, a 50% rating, or 100, depending on how severe the condition happens to be.
Moving on to arthritis of the spine with Kevin.
Kevin: Yeah. So, arthritis is when the cartilage between the joints erodes over time, resulting in joint stiffness, limited mobility, and pain. This usually takes place in weight-bearing joints so not only the spine but also the hips and the knees.
And degenerative arthritis is rated by VA based on limitation of motion, so referring back to some of the conditions that we spoke about earlier. It’ll be rated under 38 CFR 4.71a based on the veteran’s ability to move the joint.
So, that’s number 12, degenerative arthritis and number 13 is traumatic brain injury.
Alyse: So, traumatic brain injury is also known as TBIs. They’re caused by many different factors, including trauma, a blow to the head, or an object penetrating the brain, which could result in some type of brain dysfunction. Typically, we’re going to see these very commonly with motor vehicle accidents or other combat exposures.
TBI is also, of note, are considered a signature wound of post 9/11 wars. And VA is going to rate TBIs based on the residual symptoms that you have as a result of the TBI. Typically, that we’re going to look at, you know, changes in cognitive ability, as well as maybe other issues with a mood disorder, that type of stuff.
These are going to be rated under 38 CFR, section 4.124a. And there are actually 10 subcategories that they look to when they evaluate TBIs, but again, it’s just generally based on the level of severity and impairment that you have in each of these subcategories, including cognition that type of stuff.
Ratings, also, are going to range between 0 and 100% based on how severe they are. And that covers TBIs. Next, we’re going to go to number 14, which is depression.
Nick: So, depression, like Alyse mentioned, is up next. Major depressive disorder, persistent depressive disorder – many different specific diagnoses can fall under the larger umbrella of depression. All these conditions are serious mental health conditions characterized by feelings of sadness, lack of motivation or interest, sleep issues, and other psychological symptoms.
Just like PTSD, discussed earlier, depression is rated under 38 CFR 4.130, the general rating formula for mental health conditions, and depending on the frequency, severity, and duration of the specific symptoms the veteran suffers from. They could be assigned either a 0, 10, 30, 50, 70, or 100% rating, again, ultimately based off of their level of social and occupational impairment.
Up next we have respiratory conditions.
Kevin: Respiratory conditions such as asthma, COPD, and respiratory cancers are common among veterans because of, you know, recent exposure to burn pits, previous exposure to Agent Orange, and other airborne hazards. And the ratings will differ, you know, because there are a variety of different respiratory conditions, but, for example, asthma is rated anywhere from 0 to 100%, depending on its severity. Whereas allergic rhinitis is rated anywhere from 10 to 30%.
And there are, VA does presume service connection. There are presumptions for certain respiratory conditions depending on, you know, what the condition is and the actual exposure that took place. So, it could be Agent Orange exposure, it could be new particulate matter exposure like burn pits. But we do have some information about this in blogs and videos on our website about which conditions specifically are contemplated by VA’s presumptions.
Moving on to number 16 is diabetes with Alyse.
Alyse: So, we’re going to cover Type 2 diabetes, is going to be one of the most common types of VA conditions that we see. Type 2 diabetes is a chronic condition that causes a person to experience increased levels of blood glucose and due to insulin and resistance or deficiency thereof.
Diabetes Type 2, it’s included, actually, in that list of presumptive conditions that Kevin just mentioned associated with exposure to Agent Orange. So, if you have been exposed and you have diabetes, you can get service connected.
Diabetes is going to be rated under section 4.119, and the ratings will range between 10, 20, 40, 60, and 100, depending on certain factors like whether you require insulin, how often you require insulin, whether you’re on a restricted diet, if you are having your exercise be prescribed to you, those type of things, which all relate to, basically, how disabling your diabetes is.
That pretty much covers diabetes. We’ll move on next to number 17, which is cancer.
Nick: Cancer, obviously being a pretty large umbrella. There are many different types of cancers that veterans may experience as a result of their service. Among those, some of the more common ones include lung cancer and prostate cancer, which both fall under the presumption for herbicide exposure mentioned earlier for diabetes. But brain cancers, leukemias, all different sorts of cancers can be service connected, oftentimes based off of a veteran’s exposure to some of the environmental hazards mentioned above.
If a veteran has an active cancer, they should be assigned a 100% rating throughout the time that the cancer is active and that rating continues for as long as it’s active, and for another six months after completion of a successful treatment program, be it chemotherapy, radiation, or surgery to remove the cancer.
After that six-month period, VA will schedule a new VA exam to evaluate the current status of cancer. If they determine that the condition is in remission, they will then evaluate the residuals and grant a disability rating accordingly.
So, when you’re talking about cancers, you can’t necessarily know which diagnostic code you’re going to be rated for until they determine what the residuals are so that’s why it’s important to make sure that you’re attending those VA examinations so that they rate your condition properly. Up next, we have pes planus with Kevin.
Kevin: Yes. So, pes planus or pes planus, however you say it, is flat feet. So, it’s a common deformity in which the arch of the foot is flattened to the point where it touches or nearly touches the ground. There are some common causes including torn or stretch tendons, broken bones, and nerve conditions, you know, a lot of repetitive use activities might cause the flat foot condition.
And VA rates this condition under the musculoskeletal framework, so 38 CFR 4.71a. The diagnostic code is 5276 and the ratings range from 10 to 20 to 30 or 50.
And number 19 is anxiety.
Alyse: Yes. So, coming here to the end now, we’re at 19. So, anxiety is defined as an intense, excessive, persuasive, persistent worry and fear about everyday situations. Symptoms can include restlessness, trouble concentrating, muscle tension, difficulty sleeping, but also things that you might not necessarily think of as associated with anxiety, such as irritability, memory loss, those type of things.
Anxiety is going to be rated very similarly to the way that PTSD and depression are rated, which we previously talked about both of those during the CCK Live. They are all going to be rated under section 4.13O and assigned ratings ranging from 0 to 100%, again, based on your social and occupational impairment.
So, finally, we have number 20, which is going to be secondary conditions with Nick.
Nick: So, this, like cancer, is sort of an umbrella category. It’s catch-all for many different conditions with the idea being that, not only are veterans entitled to service-connection for certain primary diagnoses but also any secondary conditions that develop as a result.
Some of the ones we talked about earlier are secondary conditions in and of themselves like sciatica or radiculopathy, secondary to a back condition. You might also see peripheral neuropathy, secondary to diabetes as one common example.
Many veterans suffer from hypertension that’s caused or aggravated by their PTSD. There are all sorts of conditions that might be related to the underlying diagnosis, and oftentimes veterans can’t necessarily know what condition is related to what because they don’t have medical expertise or training. So, when filing your claims and pursuing these things, make sure to report any symptom and every condition that you’re aware of because it might be related to something and you wouldn’t necessarily know that.
So, secondary conditions can cover a wide range of things and it’s just important to make sure that you’re claiming any symptoms that you think might be related to your service-connected conditions.
Kevin: Great. Well, thanks, Nick, and thank you, Alyse. We want to thank you all for joining us.
We know that this was kind of a, you know, a real quick overview of each of the 20 conditions, but we wanted to, you know, we thought it might be helpful to run through, you know, a nice variety of conditions that most veterans might experience.
So, we do have a ton of resources on our website and our blog that expands a lot more on each one of these. So, please feel free to go on there and take a look at those, and please don’t forget to subscribe to our YouTube channel. We’d like to thank you all again for joining and thanks.
