If you have been granted service connection for a disability by the VA, you will have received a rating sheet which 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. 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.
So how do diagnostic codes work?
Each body system contains a series of diagnoses, and each of those diagnosis has its own numerical code. Then for each diagnostic code, there are different percentages of disability. 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 38 Code of Federal Regulations), 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.
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. Again, for a disability such as diabetes mellitus, 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. 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, the lower rating will be applied. As you may guess, this is an argument veterans often must make because 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.
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. If there is more than one diagnostic code that applies to a veteran’s disability, the VA is obligated to assign the diagnostic code that will grant the veteran the highest evaluation.