How Are VA Disability Rates for Conditions Determined?

The Department of Veterans Affairs assigns VA disability rates for conditions that are service-connected. The VA’s disability benefits program covers a diverse range of physical and mental conditions. Each condition is rated based on severity, according to the Schedule for Rating Disabilities. 

The overall rating you receive plays a big part in how much monthly compensation you’ll get. With countless medical conditions affecting hundreds of thousands of veterans, what does a VA claims processor look for, to be able to rate conditions accurately? 

Today we highlight key factors the VA considers when reviewing disability claims. With a clearer idea of what VA rating authorities are looking for, you can produce the right information and build a competent, strategic claim and maximize the benefits you deserve. 

VA Disability Rates for Conditions Are Based on Major Body Systems.

The VA uses a collection of federal regulations called the VA Schedule for Rating Disabilities (VASRD). The Rating Schedule is broken down into 15 human body systems:

The VASRD schedule is a massive disability rating chart hundreds of pages long that instructs VA claims processors on how to evaluate the severity of disabilities and assign disability ratings.

You can find the complete Schedule for Rating Disabilities at 38 CFR Part 4.

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VA Disability Rates for Conditions Are Scaled from 0% to 100% 

Each impairment is given a disability rating as a percentage. Ratings are scaled from 0%—100% in terms of severity.  VA disability percentages climb in 10% increments to represent how much each condition affects your overall health and ability to function. The degrees of disability are considered proportionate to your loss of working capacity.

For example, you suffer service-connected ulcerative colitis.  The VARSD lists this condition under the main category The Digestive System, and subcategory Colitis, ulcerative which uses Diagnostic Code 7323.

Diagnostic Code 7323 rating rules are as follows:

As you can see, there is a wide percentage difference in VA disability rates for this one condition.

Even the difference between a 10% and 30% rating can be crucial. A veteran who is rated below 30% for all conditions may only collect benefits as a single veteran with no dependents (child, spouse, a dependent parent). Only at the 30% (and above) disability rating does a veteran get additional compensation with dependents.

Another example is tinnitus, one of several conditions where VA disability rates are limited, in this case only up to 10 percent. Tinnitus is one of the most claimed disabilities by veterans. 

The VASRD lists this impairment under the main category Diseases of the Ear, and subcategory Tinnitus, recurrent which uses Diagnostic Code 6260. Note the VA examiner is instructed to take both ears into account in the rating.

Diagnostic Code 6260 rating rules are as follows:

What About VA disability rates for conditions secondary to a service-connected disability you already have? 

Veterans often develop conditions that result as a consequence of the original service-connected disability. These are known as secondary conditions and are tremendously important in securing a veteran’s fully justified VA rating. 

Let’s take our tinnitus example (that allows only a 10% rating) one step further. Tinnitus often leads to debilitating secondary conditions like depression, sleep loss, or migraine headaches. If the veteran can prove secondary service-connection for a secondary condition, the veteran may obtain a higher overall rating, and thus increase his or her VA compensation. Unfortunately, veterans often disregard or fail to service-connect secondary conditions.

How Are VA Disability Rates for Multiple Conditions Determined?

VA assigns a separate rating for each service-connected condition. When a veteran has more than one condition, VA will use each separate rating to calculate a combined VA disability rate for all conditions as one final score.However, ratings for multiple conditions are not simply added up to produce a sum total.  For Veterans with more than one disability, the VA applies its “VA math” and uses the combined ratings table to calculate your disability percentage into one overall score.

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What if I Got a Zero Percent Rating for My Condition?

A 0% VA disability rating is by law considered “non-compensable” and therefore does not result in monthly compensation. The VA acknowledges that your condition exists, but the symptoms are not severe enough to warrant a higher rating.

There are certain benefits with 0% ratings. 

First, you are eligible for no-cost VA healthcare and travel reimbursement for the condition.

Second, a 0% rating for a condition means the VA has granted service connection for the condition, which is often half the battle. A non-compensable rating can open the door for: 

• Filing a claim for an increased rating as the non-compensable impairment worsens;
• Appealing the decision because the condition should be rated at a higher percentage. 

Many factors will come into play here, and a good veteran’s claim attorney can help you through them.

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Schedular Ratings vs Analogous Ratings: When a Condition Is Not in the Rating Schedule

The ratings for conditions in the VA Schedule for Rating Disabilities are known as Schedular Ratings. But many medical conditions are not in the schedule, and these are known as Analogous Ratings.

For conditions that are not in the VASRD, the VA generally rates those under a closely related injury or disease that is in the VASRD, where similar parts of the body are affected, and similar functions and symptoms are involved. Three common examples are:

• Crohn’s disease, also termed granulomatous colitis. This is a medical condition causing the bowls to become irritated and swell. It is rated under code 7323, ulcerative colitis. 
• Multiple myeloma, a cancer which develops in bone marrow. It is rated under code 7709, Hodgkin’s disease, or code 7703, leukemia.
• Pain disorder, a mental health disorder where an individual suffers severe pain in several parts of the body with no identifiable medical cause. The pain is real and can be incapacitating. It is rated under code 9422, Other specified somatic symptoms and related disorder.

For many conditions, it can be hard for the untrained eye to find the correct diagnostic code.  More than one code may apply to a condition; in such cases, the VA is instructed to assign the diagnostic code that will give the veteran the highest rating.

Factors that Impact VA Disability Rates for Various Conditions

It helps to know what clinical and functional factors the VA claims processors are instructed to apply to rate diverse conditions consistently and fairly. The following are just a few factors they must consider:

• Limitation of range of motion, extension, and flexion in many musculoskeletal conditions
• Evaluation of painful motion
• Number and frequency of incapacitating episodes the veteran experiences 
• Amputations
• Bilateral factor – When disability results from disease or injury of both arms, or of both legs, or paired skeletal muscles, VA combines the ratings for the disabilities of the left and right sides, and 10% of this value is added before continuing with further ratings
• Chronic, progressive conditions
• Impairments of dominant vs. non-dominant hands
• Presumptive conditions – Veterans suffering from chronic diseases connected to their active service may be able to win their VA claims by using the service connection by legal presumption.
• Location and percentage of body area affected – such as with skin disorders, scarring, and nerve disorders 

In most cases, VA disability rates for conditions that have stabilized over time are not re-evaluated.

Beyond medical evidence, what can you do to improve your VA ratings? 

You want the VA to understand the nature and severity of your impairments, and how your disability hinders your ability to care for yourself, work independently, and your quality of life.

There are several ways to present compelling evidence that supports a higher rating, including:   

• Your personal account of your disabling conditions and how they affect you every day. The VA examiner needs your detailed perspective that portrays your inability to work and earn a gainful living.
• Family and friends who are close to you can often provide invaluable points of view that bolster and add to your account.  
• VA Buddy Letter – a credible, well-written VA buddy statement (a.k.a. VA Statement In Support of Claim) can be of great help towards gaining top VA ratings. This could be someone who knew you well prior to service and has firsthand knowledge of how physically or mentally you have changed from pre-service to post-service. A buddy statement can also be from a fellow service member that can help tell your story with further specific information to support your claim.
• Past and present co-workers and employers may share helpful insights into the ways your disability affects your ability to function both physically and/or mentally. 

Getting the Maximum VA Disability Rates for Conditions

There are many things a VA-certified attorney can do to help you gain the full spectrum of the benefits you’re entitled to.  

• Several types of appeals are now available under the VA’s current AMA appeals system. We’ll help you take the appropriate path to appeal in your situation. 
• We help veterans file appeals if the VA made an error in calculating their disability rating (and any other errors.)
• We help you pursue VA disability rates for conditions that often fall by the wayside without legal representation, such as claiming secondary conditions and conditions based on aggravation (where an otherwise non-service connected condition is made worse as a result of military service). These conditions can be more costly and damaging than the original issue, and we can help you identify and pursue benefits accordingly. We represent claims to increase VA disability rates for conditions that worsen over time. 
• We will help you submit an appeal when there is evidence that you should be rated under a different analogous code. 

If you feel that your VA disability rating is inadequate and doesn’t reflect the true severity of your condition, contact Marc Whitehead & Associates for a free legal consultation.

We know what the VA needs to see in veterans’ disability claims. Our attorneys are prepared to help you counter any claim processing errors and argue your case to the VA from the standpoint of proof.

Call or text 800-562-9830 or complete a Free Case Evaluation form