The VASRD Principles

Topics:

General VASRD Principles:
The Essentials of Rating
A Change in Diagnosis
Is Age Considered When Rating?
Exceptional and Rare Cases (DoD    ONLY!)
The Rating Authorities & Their Decision-Making:
Medical Evidence and Correspondence
Interpretation of Exam Reports
Probative Value
A Tie Goes to the Veteran
Reasonable Doubt

Rating Authorities’ Attitudes
The Use of Diagnostic Codes:
The Coding Basics
Analogous Ratings
Veteran’s Behavior that can Affect Their Ratings:
Treatment Outside the Military Medical     System
Failure to Comply with Prescribed    Treatment
Misconduct
The Ratings:
Pyramiding
Zero-Percent and Minimum Ratings

Total Disability Ratings
Unemployability
Prestabilization Ratings
Hospital or Observation Treatment    Ratings
Convalescent Ratings
Principles of the Systems:
The Musculoskeletal System
The Respiratory System
The Digestive System
The Genitourinary System
The Skin
Neurological Conditions and    Convulsive Disorders
Mental Disorders

 

The VASRD is governed by principles that dictate how the Rating Authorities should assigned Military Disability Ratings in various circumstances. These principles are meant to make up for any shortcomings or holes in the rating schedule and to create equality and fairness when applying the ratings. Some principles are specific to single conditions (these will be discussed on the individual condition pages), and some can be applied to all.

The principles in the VASRD were originally meant to govern only VA Disability cases, and so when the VASRD began being officially used for DoD Disability as well, the DoD had to make a few changes to the principles in order to apply them successfully in the DoD system. Everything below applies to both the DoD and the VA unless it is clearly stated.

 


General VASRD Principles

The Essentials of Rating (§4.1 & §4.10): The intent of the VASRD is to properly rate every service-connected condition that a service member has. The ratings should properly reflect the difficulty the veteran would have to work or find work because of the veteran’s conditions. The basic idea is that a veteran who will have more trouble finding and keeping a job than another should receive more compensation for his condition.

EVERY service-connected condition a veteran has can be rated for VA Disability. Some of these conditions may not be severe enough to rate more than a 0%, but all conditions the VA rate are eligible to be re-evaluated and re-rated if they worsen in the future.

DoD Disability is only given for service-connected conditions that also make a service member Unfit for Duty. The DoD also only rates conditions at the time of separation. Thus, if a condition worsens in the future, the DoD rating will not change.

A Change in Diagnosis (§4.13): This principle applies only to the VA. Since the VA can change a VA Disability Rating if the condition worsens or improves, it can also change the diagnosis of the condition. The VASRD principle, however, states that changing the diagnosis of a condition should only be done if the current diagnosis does not sufficiently rate the severity of the condition.

Since the DoD does not change its ratings, the diagnosis of the condition will not change from the diagnosis that was in effect at separation.

Is Age Considered When Rating? (§4.19): No. The age of the veteran is never taken into account when rating for a disability. If a veteran cannot get a job because of his age, that is not a matter for the disability Rating Authorities and will not be considered.

Exceptional and Rare Cases (DoD ONLY!): If a condition cannot be found in the VASRD and is so unique and rare that an analogous rating (see the Analogous and Equivalent Codes page) does not fully reflect the disability of the condition, then the Secretary of the Military Department concerned (Army, Navy, etc.) has the right to assign an appropriate rating for the condition. This is DoD-only and so rare that none of us have actually seen it happen. Analogous ratings are almost always sufficient.

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The Rating Authorities and Their Decision-Making

Medical Evidence and Correspondence (§4.24): Any exam, test, official statement, correspondence or even email that provides significant evidence about the service member’s condition should be submitted to the Rating Authorities. All information that is submitted will then be sifted through, and only those documents that have the highest probative value will be examined by each Rating Authority member before making their rating decision.

Note: It is YOUR job to ensure that the Rating Authorities have all the important information they need to best review your case.

Interpretation of Exam Reports (§4.2): It is the Rating Authorities’ responsibility to interpret all medical reports that are submitted to them. A physician may describe a condition and its symptoms differently than another, but the Rating Authorities must combine and analyze all of the data to determine a consistent picture of the condition in order to achieve an appropriate rating. If there is not enough data to properly rate a condition, then the Rating Authorities must request additional information. If no additional data can be found, then the Rating Authorities must rate the condition based on the principles of probative value and reasonable doubt in the benefit of the veteran.

Probative Value (§4.6): The Rating Authorities will use the most accurate data and the opinion of the most qualified medical provider as the best representative of the overall condition. This is called probative value. Basically, if an exam is done by a specialist using the most up to date and accurate tools available to him, that exam will hold a higher probative value than one done by a primary care doctor with a wooden ruler. So if there is any conflicting information in the exams, the Rating Authorities will base their ratings on the one with the most probative value. In the DoD’s case, since they base their ratings on the severity of the condition at the time of separation, the exams closest to that date are often the ones with the most probative value.

A Tie Goes to the Veteran (§4.7 & §4.21): If there are two exams with conflicting information, then the Rating Authorities must base their rating on the one that will give the veteran the higher rating. This won’t happen, however, if one of the exams has less probative value than another. So if one exam notes measurements that would equal a 20% rating and another with the same probative value notes measurements that would equal a 30% rating, then the veteran would receive the 30% rating. Similarly, if a single condition could be rated under two different VASRD Codes, the Rating Authorities must assign the code that will give the highest rating for that condition.

Reasonable Doubt (§4.3): If a condition is not well documented in the medical records, the Rating Authorities may have trouble deciding how severe the condition truly is and what rating the condition should receive. In these cases, the Rating Authorities are required to award the higher rating for the veteran’s benefit.

Rating Authority Member’s Attitudes (§4.23): The Rating Authority members are required to not allow any personal feelings or attitudes to influence their rating decision. When the members review medical records, there is quite a lot of personal information in those files. We really get to know a lot more about a service member than we may want. Depending on the circumstances surrounding the conditions, the doctors who wrote the records may have very definite opinions about the service member’s motives, honesty, personality, etc. Based on the things they read, Rating Authority members may feel that a service member under review is a true victim who deserves a high rating since he’s a good person. On the other hand, they might feel that a service member is a lying son-of-a-biscuit who is trying to finagle the system. Regardless, the Rating Authorities can only rate each condition on the medical facts in evidence.

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The Use of Diagnostic Codes

The Coding Basics (§4.27): Every condition in the VASRD has a four-digit VASRD Code that identifies it. The Rating Authorities decide which code best reflects each condition. Often a single condition can easily be rated under different codes. For example, low back strain can be rated based on limited motion (code 5237) or under degenerative arthritis (5003).

Note: The Rating Authorities are required to pick the code that BEST defines the condition and all the symptoms.

It’s a bit like those vague multiple-choice questions on tests that ask you to pick the best answer (not necessarily the right one).

Analogous Ratings (§4.20): If a condition is not listed in the VASRD, then it must be rated analogously. An analogous code will be two four-digit codes connected by a hyphen (i.e. 5099-5003). The 99 at the end of the first code tells us that this is an analogous rating under the second code. So if the condition is a carpal bone injury (a condition that is not listed specifically in the VASRD), then it would be best rated as degenerative arthritis (5003). Thus, the code for this condition would be written as 5099-5003.

Now, if the first code in the two code number does not end in 99 (i.e. 5003-5240), it means that the condition was correctly described under code 5003, but the best rating for it is based on the symptoms of the condition, which are rated under the second code 5240. So, if the condition is correctly diagnosed as degenerative arthritis (5003), but the condition is so severe that the soldier can’t move his back at all, then a much higher rating can actually be achieved under code 5240, ankylosis of the spine.

See the Analogous and Equivalent Codes page for more information.

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Veteran’s Behavior that can Affect Their Ratings

Treatment Outside the Military Medical System: If you choose to have any medical procedures or treatments done outside of the military or VA medical system (this doesn’t include any referrals to civilian physicians–as long as it is done through the military or VA system, it’s fine) then that condition and any and all side effects of that treatment are not ratable.

Note: You cannot be rated for any conditions or symptoms that result from treatment outside the military or VA systems unless you were referred for the care by a military or VA physician.

The only exception to this would be if your choice of using civilian services can be proven to be a result of impaired judgment that is a result of a ratable condition. So if you are suffering from dementia and went to a doctor for a foot problem outside of the military because you couldn’t remember who your doctor was or where to go, then you could still be rated for the foot condition and it’s side effects, especially since dementia that severe is definitely unfitting and ratable.

Failure to Comply with Prescribed Treatment: A condition could also not be eligible for rating, or at least a high rating, if a soldier unreasonably refuses proper treatments and therapy. If a physician properly counsels the soldier about his condition and the various treatment options, but the soldier refuses to follow any guidance or treatments (diets, activities, not using alcohol or drugs, etc.), then the rating would be reduced. So if a soldier has asthma and is told to stop smoking, but continues and the asthma gets worse, then the rating for asthma would be reduced by how much the physicians and the Rating Authorities feel that the smoking made the asthma worse. So instead of receiving 30%, he may only receive 10%.

Misconduct: If a condition is the result of intentional misconduct, then no rating will be awarded. This includes the use of illegal or controlled substances. So if a soldier intentionally injures himself in an attempt to separate from the service or get more money at separation or with any other motive, then that condition will not be rated.

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The Ratings

Pyramiding (§4.14): A single condition/symptom can only be rated once! As we talked about under coding options, a single condition could fit a couple of different codes, but rating a single condition more than once under different codes is not allowed. Now there are some particular cases where, say, a low back condition that has very limited motion and also affects the nerve creating severe nerve pain down the leg could be rated as two separate conditions. The first would be the limited motion of the back itself and the second would be the nerve pain down the leg.

Note: For DoD only–Each part in and of itself must make the soldier Unfit for Duty for both to be rated.

Rating two aspects of the same condition really doesn’t happen that often. Most of the time a single rating satisfactorily covers all aspects of the condition. Overall, the main rule is only one rating per condition.

Zero-Percent and Minimum Ratings (§4.31): Zero-percent ratings are given when a condition is not severe enough to achieve the lowest rating listed for the condition. Some conditions have 0% listed as an option, but even if it is not listed, it can be given except when a minimum rating is required. A minimum rating is sometimes required for certain conditions. This means that as long as there is a diagnosis for that condition, it must be given at least the lowest compensable (gets money) rating for that condition (for most conditions that is 10%). We have listed any minimum rating requirements on the individual condition pages.

Total Disability Ratings (§4.15 & §4.16): 100% ratings are to be given when the veteran’s disability is so severe that he cannot work to support himself. Since one person may be able to find employment with an amputated leg and another may not, the ratings are to be based on the average person’s ability to work with that condition. Permanent total disability ratings can only be given if the condition is stable and expected to last throughout the veteran’s life. A 100% rating can be given for any condition, even if that rating is not noted under the condition in the VASRD, if it is severe enough that the veteran is unable to work or take care of himself. If there is only one condition that makes the veteran unable to work, then that condition must rate at least 60% alone in order for that condition to be eligible to rate 100% because of unemployability. Similarly, if there are two or more conditions that make the veteran unable to work, at least one must rate 40% or more by itself and the total combined rating of the conditions must be 70% or more.

Only when looking at total disability ratings can multiple conditions be combined (see the VA Math page) to make a single condition. Being able to combine them helps make the minimum requirements listed above more achievable. In these cases, conditions can be combined only when they include both upper or both lower extremities (including the bilateral factor), all resulted from a single incident, all affect a single body system (nerves, digestive, orthopedic, etc.), all were incurred in action, or all were incurred while a prisoner of war.

Unemployability (§4.17 & §4.18): A veteran is considered unemployable if they have been unable to find sufficient, stable work. Evidence must be provided to show that the veteran’s lack of work is directly related to his disability. Occasional odd jobs, intermittent work, unsuccessful employment lasting only a short time, employment terminating because of the disability, and any work that pays less than half the usual amount established by the US Department of Commerce is evidence that supports a veteran's unemployability and cannot be used to rule against this principle.

Prestabilization Ratings (§4.28): If a condition is not completely healed or not stable, meaning that it is still changing for better or worse, then a prestabilization rating should be awarded for the 12-month period directly following discharge from the military. A 50% rating should be given for any conditions where employment is very likely for the veteran once the condition heals. A 100% rating should be given for conditions that are not expected to improve enough for the veteran to get stable work.

For VA Disability, an examination must be performed before the end of the 12-month period. If the final permanent rating for that condition ends up being less than the amount awarded for the prestabilization period, then the higher rating will continue to the end of the 12-months before the lower rating begins. If, however, the permanent rating is higher than the prestabilization rating, then the higher rating will begin immediately.

For DoD Disability, this prestabilization period is the same as the TDRL period and is subject to all TDRL terms. If a surgical procedure or treatment is performed just before the service member is separated, then those procedures do NOT contribute to a TDRL period or permanent ratings unless they have adverse side effects that are expected to continue after separation.

Hospital or Observation Treatment Ratings (§4.29): If a veteran is hospitalized or under hospital observation for a service-connected condition for more than 21 consecutive days, then a total rating of 100% is awarded from the first day of hospitalization until the end of the month in which the veteran is discharged.

Convalescent Ratings (§4.30): This is VA-only. If a veteran must recover from a medical procedure or hospitalization for a service-connected condition at home, then a total rating of 100% is awarded for up to 3 months starting the first day of the month after he is discharged or begins treatment at home. To count as convalescence, the condition must be severe enough to keep the veteran from being able to work for the period of time he undergoes treatment. A back surgery that requires the veteran to lie flat for a month is an appropriate example of a convalescent condition. Convalescent periods can last longer than 3 months with approval from the Veterans Service Center Manager.

Note: The DoD does not give convalescent ratings.

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Principles of the Systems

There are some other principles that are only for certain conditions or groups of conditions. All of these principles are discussed along with the conditions they apply to except for the principles for the Musculoskeletal System. These can be found on the Musculoskeletal System Principles page. All of these principles apply to any condition of the bones, muscles, tendons, cartilage, joints, and ligaments.

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