When the VA awards service-connection for a condition/disease, it has to determine how much to award for the condition/disease. To facilitate this process, the VA has created a ratings table that lists conditions and diseases, and how to rate them according to the severity of the symptoms. As extensive as this table is, it cannot possibly list every condition that can affect the human body. Therefore, in some instances, the VA has to use analogous ratings.
Analogous ratings are ratings for conditions that have no specific disability in the ratings table. In these instances, the VA must rate these conditions under a closely related disease or injury. Preferably, the unlisted and analogous rating should affect similar functions in the same part of the body and have similar symptoms.
For example, common conditions, such as Gastroesephegeal Reflux Disease (GERD), do not appear in the ratings table. In these cases, VA rating specialists have to find a diagnostic code that is analogous to the veteran’s symptoms. Aphasia, for instance, is a condition of the brain where someone is unable to understand and process language. If this was caused by an injury to the head, it is rated under Traumatic Brain Injury (TBI). But if it was caused by an illness or other condition, it is rated analogously under code 9305 (vascular dementia). A further example is Crohn’s disease. This is a condition that causes the bowels to become irritated and swell. This is rated under code 7323 (ulcerative colitis).
In circumstances in which the VA makes an analogous rating that does not accurately represent the veteran’s symptoms or the severity of the conditions, advocates can argue that a different diagnostic code be applied. For example, consider a veteran who has severe vertigo. Instead of rating it under the diagnostic code for Peripheral Vestibular Disorders (6294), an argument should be made for a rating under Meniere’s Syndrome (6205), which offers a 100% disability rating (provided that all the conditions are met).
Under 38 CFR § 4.20, the VA considers three factors in determining what analogous rating to use:
- The functions affected by the conditions
- The location of the conditions
- Whether the symptoms are similar
Once the VA makes an analogous rating, it must treat the disability as if it were the analogous condition. So if the rating schedule for the analogous condition changes, the veteran’s rating for the condition changes as well.
According to 38 USC § 5107 (a), when assigning a disability rating, and a question arises as to which diagnostic code to apply, the VA must apply the rating criteria that are most favorable to the veteran.