If you have been granted a service connection for a disability by the VA, you will have received a rating sheet that breaks down the different aspects of your claim. Today we are going to talk about one small, but important, part of that rating sheet – the four-digit diagnostic code assigned to your disability. Whether you have post-traumatic stress syndrome, military service-caused ulcers, issues with your digestive system, or any other impairment you will be assigned a four-digit diagnostic code.
This diagnostic code is important because it tells you exactly what aspects of your disability the VA took into account when it assigned you a rating. This can be useful in the future if you plan on appealing a rating decision because it tells you what the VA is looking for when it rates your particular disability.
The Department of Veterans Affairs uses diagnostic codes in order to provide an explanation of exactly how VA Rating Authorities choose to rate a veteran’s impairment in relation to a service connection.
What are VA diagnostic codes?
As defined by the VA, a diagnostic code is a set of “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).
There are 15 categories in which a veterans’ disability can be rated. Each body system contains a series of diagnoses, and each of those diagnoses has its own numerical code. While it is true that not all diagnoses’ have a specific code, most of the more common ones do including a required amputation, epilepsy, visual impairment, issues with the respiratory system, and more.
The VASRD (Veterans Affair Schedule for Rating Disabilities) is a federal regulation that lists all of the detailed requirements for any veteran to be assigned a rating for military disability. Each rating is assigned to define the level of functional impairment or unemployability that each veteran carries with them on a daily basis. These combined ratings translate directly to the amount of compensation the military veteran will receive.
How VA diagnostic codes work
For each diagnostic code, there are different percentages of disability that correspond to a schedule of ratings. These percentages are always in 10 percent increments, but it is important to note that many disabilities do not have ratings for each 10 percent.
For instance, the only available ratings for a mental disorder are 0, 10, 30, 50, 70, or 100 percent. In the rating schedule (which can be found in Part 4 of the 38 Code of Federal Regulations – 38 U.S.C), a description of the symptomatology is provided for each available degree of disability. A typical diagnostic code progresses from 10 percent for mild symptoms, 30 or 50 percent for moderate symptoms, and 70 or 100 percent for severe symptoms, but this varies greatly depending on the nature of the disability.
What do VA diagnostic codes mean for me?
When service connection has been granted and it is time to rate a disability, the first step is determining the correct diagnostic code for the disability. This is easier for some disabilities than others. For instance, if a veteran has been diagnosed with diabetes mellitus, a commonly rated condition, it will be rated under DC 7913. But if a veteran’s disability does not fit neatly into one of the diagnostic codes, the VA will assign an analogous rating. If an analogous rating has been assigned, it will be listed on the rating sheet as two four-digit numbers separated by a hyphen.
Once the diagnostic code has been assigned, the VA will then determine what rating percentage is appropriate for that veteran’s current symptomatology based on their medical records as well as other evidence. For example, if you have one of many neurological conditions accepted by the VA you will likely need a test and diagnosis from a neurologist proving dysfunction.
Again, for a disability such as diabetes mellitus, infectious diseases, or nephritis that determination is relatively straightforward. But for other disabilities, there is more room for questioning which level of disability most accurately reflects a veteran’s symptoms. This is particularly true when it comes to mental conditions, where, for example, a veteran may have some symptomatology from the 50 percent rating level and some from the 70 percent rating level. These conditions are not as straightforward as the loss of use of hands or the limitation of motion.
It is important to remember that if there is a question as to which of two rating percentages apply, the VA is obligated to assign the higher rating if the veteran’s disability more nearly approximates the criteria for the higher rating. Otherwise, a lower rating will be applied which in some cases could cost a veteran a total disability rating.
As you may have already guessed, this is an argument veterans often must make in cases where the VA fails to assign the higher rating in the first instance. Therefore, it is important to present all the evidence you have and make the argument that you are entitled to the higher rating because that rating most nearly approximates your disability. A higher rating can lead to special monthly compensation and increased benefits based on the VA disability qualifications.
Is an incorrect VA Diagnostic code ever given?
Even with the number of cases that the VA has processed in the past, it is still difficult to assign the appropriate diagnostic code to some medical conditions. Some medical conditions such as specific cardiovascular system diseases or muscle injuries are not assigned a specific code which complicates things even more.
If you believe that the VA has assigned the wrong diagnostic code, it is important to make that argument because many disabilities are able to be rated under several diagnostic codes. Per their duty to military service members, the VA is always required to assign the diagnostic code that will grant that veteran the highest amount of VA compensation.
Final Thoughts on Rating Codes
At this point, you should understand that diagnostic codes are an important part of assigning a percent evaluation and can directly affect the value of benefits any veteran receives. If you have any questions about the diagnostic code your medical condition was assigned or disability compensation in general, it is important that you contact a disability rights attorney as soon as possible.
