When military members prepare to leave their life in uniform and start a career as a civilian, one step in that process is filing a medical claim where appropriate with the VA for service-related medical issues that may affect the veteran after leaving military service and the ability to get care in the military medical system.
The Department of Veterans Affairs uses a “schedule” as part of its process to evaluate a veteran’s medical claims. This document covers a variety of conditions, injuries, and diagnoses broken down into separate categories based on regions of the human body.
Each category in the schedule includes guidance on how VA rating officials should proceed with specific types of medical conditions. In some cases, certain medical issues may occur in tandem with others. Some patients may have one single issue, others may have multiple or comorbid issues.
It’s important to remember that no publication can comprehensively address every single type of medical condition, so in cases where further development of a claim is needed, the VA may or may not require additional time, documentation, or other information to properly review a medical claim.
Subpart A medical evaluation categories include:
- Musculoskeletal System
- Organs of Special Sense
- Impairment of Auditory Acuity
- Infectious Diseases, Immune Disorders, Nutritional Deficiencies
- Respiratory System
- Cardiovascular System
- Digestive System
- Genitourinary System
- Gynecological Conditions, Disorders of the Breast
- Hemic and Lymphatic Systems
- Endocrine System
- Neurological Conditions and Convulsive Disorders
- Mental Disorders
- Dental / Oral Conditions
What follows is a review of the medical conditions and review criteria for these categories. When using this page, you can look up each category to reference VA guidelines for evaluating these conditions.
The first section of VASRD are policy-oriented details about the VA approach to rating medical issues for the purpose of assigning disability ratings for each condition. The remaining sections are focused on the conditions and ratings criteria for them.
VASRD Subpart A: General Policy in Rating
This critical portion of the VA Schedule for Rating Disabilities guide covers the basic VA approach to evaluating veterans and their medical conditions. It includes basic policy in areas including, but not limited to:
- Essentials of Evaluative Rating
- Interpretation of Examination Reports
- Resolution of Reasonable Doubt/Evaluation of evidence/Higher of two evaluations/Congenital or developmental defects
- Functional Impairment/Effect Change of Diagnosis
- Avoidance of Pyramiding/Total Disability Ratings
- Total Disability Ratings for Compensation Based on Unemployability of the Individual
- Total Disability Ratings for Pension Based on Unemployability and Age of the Individual
- Misconduct Etiology/Unemployability
The VA rating schedule is described on the VA official site as “a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service.”
There is an emphasis in VASRD on representing “as far as can practicably be determined the average impairment in earning capacity” that is the result of these medical conditions. The VA goal is to “compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability.”
VA ratings, as discussed in this guide, may not remain the same over the entire duration of the veteran’s lifetime as some conditions require re-evaluation. In such cases, it’s best to assume that a VA claim may be paid in the short-term when the VA feels it is warranted, but long-term benefits may not be available or offered in a more limited fashion if the condition appears to be improving.
The veteran’s compensation claims are always subject to review. In cases that show a condition has improved the VA may revise the original rating. This is also true if the condition in question gets worse over time since the original rating–but much depends on how the change in the condition affects the veteran’s ability to perform self-care, keep a job, etc.
In any case, to effectively use the schedule, the VA requires the process to include “accurate and fully descriptive” medical examinations are necessary.
Variation In Rating
The Department of Veterans Affairs recognizes that different medical professionals may evaluate medical conditions differently. The “variation in rating” section addresses this concern.
“Different examiners, at different times, will not describe the same disability in the same language. Features of the disability which must have persisted unchanged may be overlooked or a change for the better or worse may not be accurately appreciated or described,” according to the VA official site.
It’s written VA policy that the evaluator has a responsibility to rate a veteran’s medical issues, “in the light of the whole recorded history” with the goal of reconciling various medical reports into a coherent medical picture to make sure the current VA disability rating process is accurate and relevant “from the point of view of the veteran working or seeking work.”
VA diagnoses that are not supported by findings of a VA exam, and those that do not have enough information may be rejected by a medical rating board as insufficient to draw a medical conclusion for the purpose of assigning a disability rating.
Concerns In The VA Rating Process
Resolution of reasonable doubt is a serious concern in the evaluation process. What happens if the facts in a given VA medical claim don’t provide a conclusive finding for awarding a medical disability rating? What does the VA choose to do in cases where there is a reasonable doubt as to the degree of disability?
VA policy in this area is written (according to VASRD Subpart A) to favor the service member. VA policy clearly states, “When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant.”
Another serious concern in the process is how medical evidence is evaluated. “Every element in any way affecting the probative value to be assigned to the evidence in each individual claim” must be reviewed as part of the VA claims process. The written policy of the VA is to examine all aspects of a claim and leave no part of it unaddressed.
And this leads us to a third concern addressed in Subpart A: What happens when two VA evaluations do not agree?
Subpart A requires the higher evaluation of the two to be assigned in cases where “…the disability picture more nearly approximates the criteria required for that rating.” Otherwise, Subpart A tells us, the lower rating will be assigned.
Factoring In Congenital Defects Or Related Conditions
What the Department of Veterans Affairs describes in Subpart A as “mere congenital or developmental defects, absent, displaced or supernumerary parts, refractive error of the eye, personality disorder and mental deficiency” are not allowed to be considered as part of a VA disability rating review process.
VASRD Subpart A states, that these “…are not diseases or injuries in the meaning of applicable legislation for disability compensation purposes.”
Nuances In the VA Rating System
It is not possible to get a 100% service-connected disability rating for certain types of medical issues. For example, regardless of the severity of the condition, at the time of this writing you cannot be awarded a 100% disability rating for tinnitus or related conditions of the ear.
Some types of medical issues may actually be eligible for a 0% rating. No matter how vexing or personally troubling that issue may be, the VA-imposed cap on certain ratings can never be exceeded unless changed by legislation, program changes, or other factors.
Over time, certain medical issues have been reconsidered or re-evaluated by VA officials. You may find that some past medical issues that were hotly contested or controversial (Agent Orange exposure, Gulf War Syndrome) are now listed in groups of “presumptive conditions” and are given priority.
Some conditions are specifically listed with a 0% rating depending on the severity of the issue, and other zero percent ratings are possible in situations such as the one described in Section 4.31 of Subpart A:
“In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met.”
Some conditions may not be permanent, but are severe enough to warrant temporary VA ratings that may expire after a certain amount of time. Such ratings may expire upon review of the condition at a later date if sufficient improvement is noted. Not all VA ratings are permanent, and VA ratings are given for conditions that may improve and require re-evaluation over time.
Nuances In The VA Ratings For Conditions Aggravated By Military Service
In cases where the claim is being made for a medical condition that was present before military service, the military member will be compensated (where applicable) based on the percentage of the condition the VA determines was aggravated by military service.
The VA rules here say “the rating will reflect only the degree of disability over and above the degree existing at the time of entrance into the active service” and that is true even in cases where a condition was not observed or recorded at the time of entry into military service.
These decisions, whether in favor of the veteran or not, may be appealed after the official determination is made. There are no guarantees that an appeal will be approved or denied, but it is important to know that the VA claims process does permit appeals and is not a one-decision, one-outcome process.
Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter for Air Force Television News
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