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Tuesday, October 15, 2019

-NEW- Proposed Changes to the Ratings of the Genitourinary System

On July 28th, 2017, the VA published proposed changes to the ratings of the Genitourinary System, but they withdrew those proposed changes in March of this year because there were errors in the rating criteria.

Today, October 15th, 2019, the VA published their revised proposal for changes to the ratings of the Genitourinary System. Since it will be too confusing to discuss the differences between the original proposal as well as the differences between the current system, I am only going to focus on the changes that will occur if these new proposed changes go into effect. If curious, you can find the original proposal here

With each set of proposed changes, the VA allows a period in which comments can be submitted. The VA then takes each comment into consideration and makes any additional changes that are warranted before publishing the final ruling. 

We encourage you to submit any comments you might have on these proposed changes to us either by commenting on this post or by contacting us through our website. All comments must be received by December 1st, 2019. We will then compile all of your comments into a single report and submit it on your behalf to the VA, just as we did for the other sections (see the Female Reproductive System Comments). This is a great opportunity to really make a difference, so please let us know your thoughts. 

The following are the VA’s new proposed changes to the ratings for the Genitourinary System. The changes to the current system are fairly extensive, so I’ll walk through them, one at a time.

For each condition, the small, indented parts are the codes as they are right now. Click on the links to be taken to the discussion of that code on our site. After the current code, I’ll discuss the proposed changes and the VA’s justification. 
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The Urinary Rating Systems remain exactly the same. No changes proposed. 
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All Urinary Conditions (codes 7512, 7515, 7516, 7517, 7518, and 7519) are staying the same, except: 

-Current- Code 7542: A Neurogenic Bladder occurs when a person looses control over urination because of damage to the nerves or the brain. This condition is rated on the Urinary Rating System. 

-Proposed- Code 7542: A Neurogenic Bladder occurs when a person looses control over urination because of damage to the nerves or the brain. This condition is rated on either the Urinary Rating System or as a Urinary Tract Infection, whichever gives the higher rating. 

The only change to this code is allowing it to be alternatively rated as a urinary tract infection. This is because neurogenic bladders have a high rate of urinary tract infections, so if that is the predominant disability and would offer a higher rating, that should be an alternative rating option. 

-NEW Proposed Code- Code 7545: Diverticulum of the bladder occurs when the wall of the bladder weakens and a portion protrudes, creating a pouch. This causes urine to get trapped in the pouch, leading to voiding dysfunction and/or infection. It can be rated either on the Urinary Rating Systems or as a Urinary Tract Infection, whichever is the main disability.

The VA proposes to add this new code to cover diverticulum of the bladder. Currently, there aren’t any codes that truly reflect the disability of this condition. Thus it needs its own code. 
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-Current- The ratings: 

A 30% rating is given if the condition causes regular infections that require hospitalization 3 or more times a year, or if it requires serious continuous treatment. 

A 10% rating is given if the condition requires regular drug therapy, 1 or 2 hospitalizations a year, or if it requires serious continuous treatment.

If any of these conditions that are rated as urinary tract infections also cause renal problems, then only one or the other can be rated. If the renal problems are more severe, then the condition should be rated under the renal rating system.

-Proposed- The ratings: 

A 30% rating is given if the condition causes regular infections that require a stent or nephrostomy tube to be implanted for drainage, if the condition requires hospitalization 3 or more times a year, or if it requires serious continuous treatment. 

A 10% rating is given if the condition requires suppressive drug therapy for 6 months or more, or 1 or 2 hospitalizations a year.

A 0% rating is given if the condition is recurrent and requires treatment of suppressive drug therapy for less than 6 months or antiobotic therapy, and does not require hospitalizations. 

If any condition rated as a urinary tract infection also causes renal problems, then only one or the other can be rated unless they are diagnosably separate with clearly separate symptoms. If the renal problems are more severe, then the condition should be rated under the renal rating system (see new one below).

The changes to the 30% simply specify that the infection must require drainage by more than a catheter in order to be rated at this level. Catheter drainage does not require surgery and rarely requires significant hospitalization. 

The changes to the 10% more clearly define the required treatment. The VA argues that suppressive drug therapy for at least 6 months suggests a significant chronic condition appropriate for this rating level. 

A 0% rating was added to enforce that anything less than the requirements for the 10% should be given a 0%. 
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Conditions Rated As Urinary Tract Infections

Code 7501 for abscess of the kidney remains the same. 

-Current- Code 7525Chronic Epididymo-orchitis is pain in the epididymis. If the pain is caused by tuberculosis, it is rated as nonpulmonary tuberculosis.

-Proposed- Code 7525: The following chronic infections are all rated under this code: epididymitis (infection/inflammation of the epididymis), prostatitis (infection/inflammation of the prostate gland, urethritis (infection/inflammation of the urethra), and orchitis (infection/inflammation of the testicles—one or both).  If the condition is caused by tuberculosis, it is rated as nonpulmonary tuberculosis.

-Current- Code 7527Prostate Gland conditions (any) are either rated as urinary tract infections or by the urinary rating system, whichever better defines the symptoms of the condition.

-Proposed- Code 7527Prostate Gland conditions (all except prostatitis) and bladder outlet obstruction are rated under this code either as urinary tract infections or under the urinary rating system, whichever better defines the symptoms of the condition.

The VA recognized that there were quite a few infections that were not technically covered under the current codes, and so decided to add them in order to avoid improper analogous ratings. Thus, now code 7525 covers four conditions instead of just epididymitis. All of these conditions should have been rated under this code anyway, since they cause similar symptoms, but now it is official. No change in how they are rated. 

For code 7527, they decided to move prostatitis to 7525 because it is closer to the other infections covered by that code. All other prostate conditions are still covered under this code. The VA also decided to add bladder outlet obstruction because it is often caused by a prostate condition and can produce similar symptoms. Thus, it needs the option to be rated as a urinary tract infection as well. 

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-Current- A 100% rating is given if at least one of the following is present:
– The condition requires regular dialysis.
– The body cannot perform any physical activity because of persistent edema or because of albuminuria.
– A BUN of more than 80 mg/dL.
– A creatinine level of 9 mg/dL or more in the blood.
– A severely decreased functioning of the kidneys or other organs due to kidney dysfunction.
An 80% rating is given if one or more of the following is present:
– Persistent edema and albuminuria with a BUN of 40 to 80 mg/dL.
– A creatinine level of 4 to 8 mg/dL in the blood.
– Overall poor health with symptoms like lethargy, weakness, anorexia, weight loss, or the inability to exert much energy.
A 60% rating is given if one or more of the following is present:
– Constant albuminuria with some edema.
– A definite decrease in kidney function.
– Hypertension with the average diastolic pressure (the smaller number on the bottom in the blood pressure reading) of 120 or more.
A 30% rating is given if one or more of the following is present:
– Hypertension with the average diastolic pressure (the smaller number on the bottom) of 100 or more, or with the average systolic pressure (the larger number on top) of 160 or more.
– Albumin is present in the urine with either hyaline and granular casts or red blood cells.
A 0% rating is given if:
– Hypertension with the average diastolic pressure of less than 100, or with the average systolic pressure of less than 160.
– Albumin and casts are present in the urine with a history of nephritis.

-Proposed- In order to qualify for ratings 30%-100%, a chronic kidney disease must be diagnosed. 
 A 100% rating is given if at least one of the following is present:
– A GFR (glomerular filtration rate) less than 15mL/min/1.73 mfor a minimum of 3 consecutive months
– The condition requires regular dialysis.
– A kidney transplant has been performed
An 80% rating is given if the GFR is between 15 and 29 mL/min/1.73 mfor a minimum of 3 consecutive months
A 60% rating is given if the GFR is between 30 and 44 mL/min/1.73 mfor a minimum of 3 consecutive months.
A 30% rating is given if the GFR is between 45 and 59 mL/min/1.73 mfor a minimum of 3 consecutive months
A 0% rating is given in the following symptoms are present for at least 3 consecutive months, even if a chronic kidney disease has not yet been diagnosed:
– The GFR is between 60 and 89 mL/min/1.73 m2 and there are recurrent red blood cell casts, white blood cell casts, or granular casts
– The GFR is between 60 and 89 mL/min/1.73 m2 and there are abnormalities in the kidneys structure (cysts, obstruction, etc.)
– The GFR is between 60 and 89 mL/min/1.73 m2 and the albumin/creatinine ratio (ACR) is 30 mg/g or more 
Note: Both estimated GFR (eGFR) and creatinine based approximations of GFR will be accepted for GFR ratings as long as they are calculated by a qualified physician. 

These are by far the biggest changes proposed. The VA feels that the current renal ratings are based on out-dated medical tests and other vague standards. The glomerular filtration rate is now the medical standard used to measure how well kidneys are filtering the blood. As it is a more accurate test of kidney health, the VA proposes to use it as the standard for rating criteria. 

The VA recognizes that the additional rating criteria is necessary to ensure that the full picture of the disease is taken into account for rating purposes. This is especially important for the 0% ratings, as a high GFR may not mean that the kidney isn’t impaired and causing symptoms. Thus additional symptoms are taken into account to reflect the increased risk for the development of chronic kidney disease. 

The 100% rating for individuals post-kidney transplant is another important addition. 
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Renal (Kidney) Conditions

The following conditions will still be rated on the renal rating system, but the new one proposed above. 

Code 7500 for nephrectomy remains the same.

Code 7502 for nephritis remains the same, except that the note stating that only nephritis or a heart disease caused by the same condition (note both) could be rated is now extended to ALL renal conditions. So…

NEW NOTE FOR ALL RENAL CONDITIONS:

Renal disease is often closely related to heart diseases. If renal disease is present and a heart disease is present and both are caused by the same general condition, then only one rating can be given even though there are two organs affected by the condition. Only the condition that rates the highest is used. The heart disease can, however, be rated separately if one kidney was removed because of renal disease but the remaining kidney is healthy. Then the heart disease warrants its own rating and the removed kidney can receive its own rating under code 7500. The heart disease could also be rated separately if the renal disease is severe enough to need regular dialysis.

All renal conditions are often closely related to heart conditions, so to limit this rule to just cases of nephritis doesn’t make sense. If the heart condition is caused by the same thing as the renal condition, then it applies. 

Code 7504 for pyelonephritis remains the same. 

Code 7507 for nephrosclerosis remains the same. 

Code 7530 for any kidney disease that requires regular dialysis remains the same. 

Code 7531 for a kidney transplant remains the same. 

Code 7532 for renal tubular conditions remains the same. 

-Current- Code 7533: Any cystic disease of the kidney is rated under this code. A cyst is a sac most often containing fluid that can grow anywhere in the body. Many do not cause problems, but some can seriously affect the functioning of the organs.


-Proposed- Code 7533: Any cystic disease of the kidney is rated under this code. A cyst is a sac most often containing fluid that can grow anywhere in the body. Many do not cause problems, but some can seriously affect the functioning of the organs. Some conditions rated under this code include poycystic diseases, uremic medullary cystic disease, medullary sponge kidney, Alport’s syndrome, cystinosis, primary oxalosis, Fabry’s disease, and more.

Again, the VA is just adding more conditions to this code to make sure that they are rated under the most appropriate code.

-Current- Code 7534Atherosclerotic renal disease (also known as renal artery stenosis or atheroembolic renal disease) is a condition where the artery to the kidney narrows and decreases the blood flow to the kidney.

-Proposed- Code 7534Atherosclerotic renal disease (also known as renal artery stenosisatheroembolic renal disease, or large vessel disease) is a condition where the artery to the kidney narrows and decreases the blood flow to the kidney.

Similarly, the VA just wants to make sure that large vessel disease is properly rated under this code. 

Code 7535 for toxic nephropathy remains the same. 

Code 7536 for glomerulonephritis remains the same. 

-Current- Code 7537: Interstitial nephritis occurs when the spaces between the tubules in the kidney swell. This reduces the ability of the kidneys to filter blood.

-Proposed- Code 7537: Interstitial nephritis occurs when the spaces between the tubules in the kidney swell. This reduces the ability of the kidneys to filter blood. This code also covers gouty nephropathy(the decrease of kidney function caused by high levels of uric acid due to gout) and disorders of calcium metabolism (the inability to properly metabolize calcium). 

The VA feels that code 7537 is the best rating option for gouty nephropathy and disorders of calcium metabolism and so adds them here. 

Code 7538 for papillary necrosis remains the same. 

-Current- Code 7539Renal amyloid disease is caused by the buildup of protein in the kidney, which may result in the kidney not being able to filter blood.

-Current- Code 7541Renal Involvement in other conditions. So, if the kidneys are affected by conditions like sickle cell anemia, lupus, or diabetes, it can be rated separately from those conditions.


-Proposed- Code 7539Renal amyloid disease is caused by the buildup of protein in the kidney, which may result in the kidney not being able to filter blood. 

In addition, renal involvement in other systemic conditions is rated under this code. This includes renal involvement in conditions such as lupus, sickle cell disease, Henoch-Schonlein syndrome, and other systemic conditions. 

-Proposed- Code 7541Renal involvement in diabetes mellitus is rated under this code. So if a veteran is diagnosed with either type I or type II diabetes, and it causes a decrease in renal function, it would be rated under this code. 

For these two codes, the VA basically combined them all under code 7539. They only left diabetes mellitus separate because they wanted to be able to more accurately track the rate of this condition in the veteran population. Thus code 7541 is now just for renal involvement in diabetes. 

-NEW Proposed Code- Code 7544: Renal disease caused by viral infections, such as HIV and Hepatitis B or C, are rated under this code. This code includes renal disease caused by the treatment of such viral infections as well. 

The VA proposes to add a new code to specifically cover diseases caused by viral infections. While this code is not limited to HIV and Hepatitis B or C, for other viral infections to qualify, there must be regular clinical proof that the infection itself or its treatment causes kidney disease. For this reason, Hepatitis A is not included as there is clinical proof that it does not cause kidney disease. 

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Code 7509 for hydronephrosis remains exactly the same.
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-Current- Code 7508Nephrolithiasis (also known as kidney stones) is the presence of stones in the kidney or ureter. These stones block the flow of urine through the tubes. This condition is rated as hydronephrosis unless stones are repeatedly formed and it requires either drug therapy, diet therapy, or removal surgeries or procedures 3 or more times each year. If this is the case, it is rated 30%. Otherwise, rate as hydronephrosis.

-Current- Code 7510Ureterolithiasis is the presence of stones in the ureter. These stones can block the flow of urine through the tubes. This condition is rated as hydronephrosis unless stones are repeatedly formed and it requires either drug therapy, diet therapy, or removal surgeries or procedures 3 or more times each year. If this is the case, it is rated 30%. Otherwise, rate as hydronephrosis.

-Proposed- Code 7508Nephrolithiasis (also known as kidney stones) is the presence of stones in the kidney. Ureterolithiasis is the presence of stones in the ureter. Nephrocalcinosis is the buildup of calcium in the kidneys that can lead to stone formation. These stones block the flow of urine through the tubes. 

If stones are repeatedly formed and it requires removal surgeries or procedures 3 or more times each year, it is rated 30%. Otherwise, rate as hydronephrosis.

The VA proposes combining codes 7508 and 7510 into a single code since both deal with the formation of stones that block the urinary tract. They also suggest adding nephrocalcinosis to this code to ensure its proper rating. The ratings for this would mostly stay the same, but dietary and drug treatments for stone have not proven pertinent to this condition, so they suggest removing them. 

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Code 7511 for ureteral stricture remains exactly the same.
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-Current- Code 7520: If half or more of the penis is removed, then it is rated 30%. This condition can also be rated under the urinary rating system if that can result in a higher rating than 30%.

-Current- Code 7521: If the glans is removed, it is rated 20%. This condition can also be rated under the urinary rating system if that can result in a higher rating than 20%.

-Proposed- Code 7520: If half or more of the penis is removed, then it is rated 30%. This condition may qualify for SMC-K as loss of use of a creative organ. 

-Proposed- Code 7521: If the glans is removed, it is rated 20%. This condition may qualify for SMC-K as loss of use of a creative organ.

The VA proposes to remove the option to rate these conditions as urinary dysfunction since most of the circumstances around urinary dysfunction (like leakage, use of a pad, etc.) don’t really apply. These both, however, might qualify for Special Monthly Compensation, Category K (SMC-K) since they may result in the loss of use of the creative organ, if it no longer can function in that way. 
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-Current- Code 7522: If the penis is deformed and cannot erect, then it is rated 20%.

-Proposed- Code 7522: Erectile dysfunction, for any reason, is rated 0%. This condition may qualify for SMC-K as loss of use of a creative organ. 

This is the change that is going to cause the most waves. The VA proposes to no longer rate erectile dysfunction at all. They justify this change by claiming that they offer compensable ratings for conditions that interfere with the veteran’s ability to work. Erectile dysfunction does not interfere with the veteran’s ability to work, and so should not be rated more than 0%. 

This condition may, however, still qualify for Special Monthly Compensation, Category K (SMC-K) since it is considered loss of use of a reproductive organ.
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Code 7505 for tuberculosis of the kidney remains exactly the same.

Code 7523 for atrophy of the testicles remains exactly the same.

Code 7524 for removal of the testicles remains exactly the same.

Code 7528 for malignant cancer remains exactly the same.

Code 7529 for benign tumors remains exactly the same.

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-NEW Proposed Code- Code 7543: Varicocele (enlarged veins in the scrotum) and hydrocele (the build-up of fluid around the testicles) are both rated 0% under this code. These conditions may qualify for SMC-K as loss of use of a creative organ if they result in infertility.

The VA proposes adding a new code to cover varicocele and hydrocele—both conditions that are not currently addressed in the VASRD. These conditions do not interfere with the ability of the veteran to work, and so the VA proposes only a 0% rating. However, if they lead to infertility, they would qualify for SMC-K
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Wednesday, September 18, 2019

Cardiovascular System Changes Comments

The following are the comments we submitted on your behalf to the VA in regards to the proposed changes to the ratings of the Cardiovascular System

Every time the VA publishes their proposed changes for a section of the VASRD, they include a comment period in which veterans and organizations can provide feedback on the coming changes. Thank you for submitting your comments to us regarding the Cardiovascular System so that we could submit them in a unified front to the VA. Hopefully, we will be able to effect change and make the rating system fairer for all veterans. 

Here are the comments we submitted for the Cardiovascular System: 

We at www.MilitaryDisabilityMadeEasy.com would like to submit the following comments on behalf of our staff and veterans in response to the proposed changes to the ratings for the Cardiovascular System. 

Item #1

For Code 7019, please clarify the one-year time periods required for the rating and the mandatory evaluation. It doesn’t make sense to have two different one-year time periods for this code. The 100% rating starts on the date of admission to the hospital while the mandatory examination is 1-year from the date of discharge. If the 100% rating can only be for a year, then immediately upon its end, a re-evaluation must take place in order to provide a new rating. If this is to account for the amount of time the person is hospitalized, it might be better to have the 100% start upon admission saying nothing about the 1-year limit. Then specify that the 100% rating will only continue for 1-year following discharge whereupon there must be a mandatory evaluation in order to award the new rating. 

Item #2

For Code 7110, there is a bit of confusion regarding that “ands” and “ors” in this code. The first part separates the size of the aneurysm from the need for symptoms or surgery, suggesting that the size itself rates 100%. If it is smaller, but causes symptoms and requires surgery, then it is also rated 100%. The 0% code, however, also includes an “or” that would make rating confusing. The wording suggests that any aneurysm less than 5 cm is rated here regardless of the severity of symptoms. Does that mean that a small aneurysm requiring surgery is only rated 0%? Clearly not, so an adjustment in the language would help clarify how these ratings should be applied to ensure proper rating. Potentially, “If less than 5 cm and surgical correction not recommended.”


Thanks for considering these comments.

Saturday, August 3, 2019

Proposed Changes to the Ratings of the Cardiovascular System


On August 1st, 2019, the VA published a new section of proposed VASRD changes, this time to the ratings of The Cardiovascular System (The Heart and The Arteries and Veins).

The rewrite of the VASRD began in 2014 with the goal to be finished by the end of 2016. While they clearly haven’t met their goal, the VA continues to slowly release proposed and finalized changes. 

So far, finalized changes have been made to the ratings of Infectious Diseases, Immune Disorders, and Nutritional Deficiencies, the Skin, the Female Reproductive System, the Eyes, the Dental and Oral Conditions, the Endocrine System, and Mental Disorders.

Other proposed changes that have not yet been finalized include the Musculoskeletal System.

With each set of proposed changes, the VA allows a period in which comments can be submitted. The VA then takes each comment into consideration and makes any additional changes that are warranted before publishing the final ruling. 

We encourage you to submit any comments you might have on these proposed changes to us either by commenting on this post or by contacting us through our website. All comments must be received by September 30th, 2019. We will then compile all of your comments into a single report and submit it on your behalf to the VA, just as we did for the other sections (see the Female Reproductive System Comments). This is a great opportunity to really make a difference, so please let us know your thoughts. 

The following are the VA’s proposed changes to the ratings for the Cardiovascular System. The changes are fairly extensive, so I’ll walk through each, one at a time.

For each condition, the small, indented parts are the codes as they are right now. Click on the links to be taken to the discussion of that code on our site. After the current code, I’ll discuss the proposed changes and the VA’s justification. 
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The majority of heart conditions are rated based on a set rating system.

Note: It is very important that the physician performing your exam gets an MET (metabolic equivalent of task) test done for ANY heart condition. An MET test, more often known as an exercise test, checks for how much oxygen is being used by the body to perform increasingly strenuous tasks. 1 MET equals the amount of oxygen a person uses when at rest. An MET test is only not required if it is medically contraindicated or if a 100% rating can be made without it. For all other cases, it is essentialto getting a proper heart rating. Be proactive and make sure an MET test is done!

It is also vital that the need for medication for the condition and whether or not there is hypertrophy or dilation is clearly recorded by the physician.

The basic rating system:

A 100% rating is given if an MET test results in 3.0 METs or less and causes symptoms like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting.

A 60% rating is given if an MET test results in 3.1 to 5.0 METs and causes symptoms like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting.

A 30% rating is given if there is one or more of the following:
1) An MET test results in 5.1 to 7.0 METs and causes symptoms like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting.
2) Evidence (echocardiogram, multigated acquisition scan, MRI, etc.) of hypertrophy or dilatation. 

A 10% rating is given if there is one or more of the following:
1) An MET test results in 7.1 to 10.0 METs and causes symptoms like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting.
2) Continuous medication is required.

The VA is proposing to adjust the Basic Heart Rating System by focusing mostly on MET test results and removing congestive heart failure and ejection fractions as rating options. This is because both congestive heart failure and ejection fractions can be affected by things unrelated to the heart condition itself. Instead, an MET test gives a more accurate reflection of the heart condition itself.
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Codes 7000 for valvular heart disease, 7001 for endocarditis, 7002 for pericarditis, 7003 for pericardial adhesions, 7004 for syphilitic heart disease, 7005 for coronary artery disease, code 7006 for myocardial infarction, code 7007 for hypertensive heart disease, code 7008 for hyperthyroid heart disease remain exactly the same.
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-Proposed NEW CODE- Code 7009: Bradycardia (i.e., bradyarrhythmia, including sinus bradycardia, sinoatrial block, atrioventricular junctional escape rhythm, AV heart block or dissociation, atrial fibrillation/flutter, and idioventricular escape rhythm) is an abnormally slow heart rate below 60 beats per minute (bpm). 

If the condition requires the implantation of a permanent pacemaker, it is rated 100% for the first month after discharge from the hospital and then rated on the Basic Rating System.

As long as the condition causes clear symptoms, it is rated on the Basic Rating System. If there are no symptoms, then the condition cannot be considered service-connected.

The VA proposes to add this new code to cover all cases of bradycardia. This will be very beneficial as there is currently not a decent code to analogously rate these conditions, making rating choices difficult and inconsistent. Bradycardia isn’t always a problematic condition, however. Healthy, athletic adults and people sleeping often have low heart rates with no negative symptoms. Because of this, only cases of bradycardia that cause negative symptoms can be considered a service-connected disability.
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-Current- Code 7010: Supraventricular arrhythmias are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two upper chambers. If episodes of abnormal heart rhythms occur 5 or more times a year, then it is rated 30%. A 10% rating is given if episodes of abnormal rhythm occur 1 to 4 times a year or if there is permanent atrial fibrillation with no evidence of other heart diseases or conditions. All episodes must be properly documented by an ECG test.

-Proposed- Code 7010: All types of Supraventricular tachycardia are rated under this code. These are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two upper chambers. The condition must be confirmed by an ECG test.

If the condition requires intravenous pharmacologic adjustment, cardioversion, and/or ablation to relieve symptoms 5 or more times a year, then it is rated 30%. If the condition requires intravenous pharmacologic adjustment, cardioversion, and/or ablation to relieve symptoms 1 to 4 times a year, then it is rated 10%.

The VA is proposing to change the name from arrhythmia, which could be any type of abnormal heart rhythm, to tachycardia, abnormally fast heart rhythms. This code has always been intended to be used just for tachycardias, and this change will help clarify that. The VA is also proposing to change the rating requirements from recorded episodes to required treatments. There can be episodes of tachycardia that do not cause any symptoms and so do not cause a measureable disability. By rating the condition based on needed treatments, the ratings will more properly reflect the disability caused by a symptomatic condition. 
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-Current- Code 7011: Sustained ventricular arrhythmias are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two lower chambers. These rhythms can come and go and are usually treated with medication or electric therapy. This condition receives the 100% rating the entire time it is being treated in the hospital or the entire time an implantable defibrillator is in place. If a pacemaker is implanted, then it is rated under code 7018.

-Proposed- Code 7011: Sustained ventricular arrhythmias are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two lower chambers. These rhythms can come and go and are usually treated with medication or electric therapy. This condition receives the 100% rating the entire time it is being treated in the hospital or the entire time an implantable defibrillator is in place. If a pacemaker is implanted, then it is rated under code 7018. Six months after discharge from the hospital, the condition will be re-evaluated and re-rated based on the Basic Rating System. 

The only change to this code is to establish a 6-month period after hospital discharge for a re-evaluation. 
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-Current- Code 7015: Atrioventricular block occurs when the electrical impulses that allow the different parts of the heart to communicate and function are blocked. This must be associated with other evidence of heart disease to be considered unfitting. It is rated on the basic rating system with one addition: if a pacemaker is required, it is rated 10%. 

-Proposed- Code 7015: Atrioventricular block occurs when the electrical impulses that allow the different parts of the heart to communicate and function are blocked. There are two different types of atrioventricular block: benign and non-benign. A benign condition is less severe and includes First-Degree and Second-Degree (Type I). It is rated on the Basic Rating System. A non-benign condition is much more severe and includes Second-Degree (Type II) and Third-Degree. If it requires a pacemaker, it is rated under code 7018.

The VA proposes to adjust these ratings to ensure that the severity of the condition is properly rated. Most, if not all, non-benign conditions require a permanent pacemaker, so it makes sense to rate it directly under code 7018. 
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Codes 7016 for heart valve replacement, and code 7017 for coronary bypass surgery remain exactly the same.
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-Current- Code 7018: Cardiac pacemakers are implanted if the rhythm of the heart is too slow. This condition is rated 100% for the first 2 months following the surgery. After that, it is rated under the base condition that caused the irregular heart rhythm: supraventricular arrhythmiasventricular arrhythmias, or an atrioventricular block. The minimum rating for a condition requiring a pacemaker is 10%. If a defibrillator is implanted, then it is rated under code 7011.

-Proposed- Code 7018: Cardiac pacemakers are implanted if the rhythm of the heart is too slow. This condition is rated 100% for the first month following discharge from the hospital after the surgery. After that, it is rated under the base condition that caused the irregular heart rhythm: supraventricular arrhythmiasventricular arrhythmias, or an atrioventricular block. The minimum rating for a condition requiring a pacemaker is 10%. If a defibrillator is implanted, then it is rated under code 7011.

The only change to this is to allow a 1 month 100% rating after hospital discharge following the surgery instead of 2 months after the surgery itself. The VA justifies this change by stating that new surgical techniques require a much shorter recovery period. Since less time is needed a month should cover most recovery needs. For those with more serious cases that need longer hospital stays, they’ll still be covered by the Hospital Ratings Principle that rates long hospital stays (21 days+) 100% anyway. 
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Codes 7019 for heart transplant, 7020 for cardiomyopathy, and 7101 for hypertension remain the same.
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-Current- Code 7110If an aneurysm in the aortic artery is corrected by surgery, then it is rated 100% from the day of admittance to the hospital. This rating continues for the first 6 months after discharge from the hospital. The condition is then reevaluated and rated accordingly. If the condition is active and causes symptoms such as pain or hemorrhaging, or if it is 5 centimeters or larger in diameter, then it is rated 100%. If the condition is serious enough that you cannot perform moderately strenuous activities (lifting weights or running), then it is rated 60%. If the condition does not qualify for these ratings, then it is rated based on the existing symptoms in the affected organ (e.g. if it caused erratic heart beats, then it would be rated as arrhythmia).

-Proposed- Code 7110: Aneurysms in the thoracic, abdominal, or ascending aortic artery are rated under this code. Aneurysms occur when the aorta significantly expands with the potential of bursting. 

If the aneurysm is 5 cm or larger, it is rated 100%. If it causes symptoms (like the inability to perform moderately strenuous activities for fear of rupture) and a physician recommends surgery, it is rated 100% from the date of the physician’s recommendation until 6 months after discharge following the surgery. After that, any remaining heart symptoms are rated on the Basic Rating System. All other symptoms can be rated separately on the body system affected. 

If the aneurysm is less than 5 cm and surgery is not recommended, it is rated 0%. 

The VA proposes to eliminate a 60% rating, stating that any condition causing symptoms is serious enough to need surgery to avoid a medical emergency and so should be rated 100%. The addition of the 0% rating allows conditions without symptoms to be increased more quickly if they worsen and require surgery quickly. 
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-Current- Code 7111If an aneurysm in any large artery (except the aortic artery) is surgically corrected, then it is rated 100% from the date of admission to the hospital. This rating continues for the first 6 months after discharge from the hospital. The condition is then reevaluated and rated accordingly. A 100% rating is given if there is pain in the limbs (claudication) and tears in the skin of the limbs from lack of oxygen orif there is pain in the limbs and the ankle brachial index is 0.4 or less.

A 60% rating is given if you cannot walk further than 25 yards without limping because of pain and one or more of the following: there is coldness in the limb that does not respond to warming methods, there are one or more tears in the skin of the limb, or the ankle brachial index is 0.5 or less.

A 40% rating is given if you have limping because of pain when walking between 25 and 100 yards and one or more of the following: there are 1.) changes to the hair, skin, or nails of the affected limb, or 2.) the ankle brachial index is 0.7 or less.

A 20% rating is given if you have limping because of pain when walking more than 100 yards and one or more of the following: the pulse in the limb is diminished, or the ankle brachial index is 0.9 or less.

Note: These ratings are for a single limb only. If more than one limb has an aneurysm, then rate each separately.

-Proposed- Code 7111: If an aneurysm in any large artery (except the aortic artery, above) causes symptoms (like the inability to perform moderately strenuous activities for fear of rupture), it is rated 100%. If a physician recommends surgery, it is rated 100% from the date of the physician’s recommendation until 6 months after discharge following the surgery. After that, it is rated under code 7114.  

These changes clarify how the 100% rating should be applied. By eliminating the remaining rating options and instructing for further ratings to be done under code 7114, the VA is hoping to simplify the process. Code 7114, for peripheral artery disease, causes similar symptoms as post-surgical aneurysms. 
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Code 7112 for small artery aneurysms remains the same.
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-Current- Code 7113: A traumatic arteriovenous fistula is an abnormal passageway between an artery and a vein. They are most often caused by penetrating wounds that affected nearby arteries or veins, thus causing the body to create a false passageway to continue blood flow. They can cause the heart to have to work harder to provide the necessary blood to all regions of the body, thus leading to various heart conditions. It can also cause loss of blood flow to the limbs resulting in pain, infection, swelling, skin changes, or amputation.

If the condition causes heart failure, then it is rated 100%. If the heart has not failed, but is enlarged with a rapid pulse and a wide pulse pressure, then it is rated 60%. If the heart is not affected, but in an arm there is swelling, stasis dermatitis, and either tears in the skin or a cellulitis infection, then it is rated 40%. If a leg has swelling, stasis dermatitis, and either tears in the skin or a cellulitis infection, it is rated 50%. If there is only swelling or stasis dermatitis in a leg, then it is rated 30%. If the swelling or stasis dermatitis is in an arm, it is rated 20%.

-Proposed- Code 7113: traumatic arteriovenous fistula is an abnormal passageway between an artery and a vein. They are most often caused by penetrating wounds that affected nearby arteries or veins, thus causing the body to create a false passageway to continue blood flow. They can cause the heart to have to work harder to provide the necessary blood to all regions of the body, thus leading to various heart conditions. It can also cause loss of blood flow to the limbs resulting in pain, infection, swelling, skin changes, or amputation.

If the condition causes heart failure, then it is rated 100%. If the heart has not failed, but is enlarged with a rapid pulse and a wide pulse pressure, then it is rated 60%. 

If the heart is not affected, there is constant swelling, stasis dermatitis, and either tears in the skin or a cellulitis infection in a leg then it is rated 50%. If the same symptoms are in an arm, it is rated 40%. 

If there is only constant swelling orstasis dermatitis in a leg, then it is rated 30%. If the same symptoms are in an arm, it is rated 20%.

The only real change to this code is to specify that the swelling must be chronic, or constant. 
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-Current- Code 7114: Arteriosclerosis obliterans (a.k.a. peripheral vascular disease) is the thickening and hardening of the tissues of a vessel that causes the vessel to narrow and develop blood clots. This condition most often affects the aortic artery in the abdomen and the small or medium vessels in the legs.

A 100% rating is given if there is pain in the limbs and tears in the skin of the limbs from lack of oxygen or if there is pain in the limbs and the ankle brachial index is 0.4 or less.

A 60% rating is given if you cannot walk further than 25 yards without limping because of leg pain (claudication) and one or more of the following: there is coldness in the limb that does not respond to warming methods, there are one or more tears in the skin of the limb, or the ankle brachial index is 0.5 or less.

A 40% rating is given if there is limping because of leg pain when walking between 25 and 100 yards and one or more of the following: there are 1.) changes to the hair, skin, or nails of the affected limb, or 2.) the ankle brachial index is 0.7 or less.

A 20% rating is given if there is limping because of leg pain when walking more than 100 yards and one or more of the following: the pulse in the limb is diminished, or the ankle brachial index is 0.9 or less.

Note: The above ratings are for a single limb only. If more than one limb is affected, then rate each separately.

-Proposed- Code 7114: Peripheral arterial disease is the thickening and hardening of the tissues of a vessel that causes the vessel to narrow and develop blood clots. This condition most often affects the aortic artery in the abdomen and the small or medium vessels in the legs. All symptoms remaining after an aortic bypass surgery or a large arterial bypass surgery are rated under this code.

For a 100% rating, there must be at least one of the following: 
·     ankle pressure less than 50mm Hg
·     toe pressure less than 30mm Hg
·     transcutaneous oxygen tension less than 30 mm Hg
·      ankle brachial index  0.39 or less

For a 60% rating, there must be at least one of the following: 
·     ankle pressure 50–65 mm Hg
·     toe pressure 30–39 mm Hg
·     transcutaneous oxygen tension 30–39 mm Hg
·      ankle brachial index is 0.40–0.53

For a 40% rating, there must be at least one of the following: 
·     ankle pressure 66–83 mm Hg
·     toe pressure 40–49 mm Hg
·     transcutaneous oxygen tension 40–49 mm Hg
·      ankle brachial index is 0.54–0.66

For a 20% rating, there must be at least one of the following: 
·     ankle pressure 84–99 mm Hg
·     toe pressure 50–59 mm Hg
·     transcutaneous oxygen tension 50–59 mm Hg
·      ankle brachial index is 0.67–0.79

Whichever test result allows for the higher rating is the test that should be used for rating purposes. 

Note: The above ratings are for a single limb only. If more than one limb is affected, then rate each separately.

The VA proposes to update the name of the condition to the one more commonly used today. They also propose to expand the rating options to include more wide-spread measurements that better reflect the overall disability of a condition. The ankle pressure is the systolic blood pressure measured at the ankle. The toe pressure is the systolic blood pressure measured in the big toe. The transcutaneous oxygen tension is a test that measures the amount of oxygen in the blood at the intercostal space on the foot.

The VA also makes it clear that symptoms remaining after large artery bypass surgery should be rated under this code. 
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-Current- Code 7115: Thrombo-angiitis obliterans (or “Buerger’s Disease”) is a disease where the blood vessels of the hands or feet become blocked due to the build up of plaque. It is mostly associated with the use of tobacco products. It causes pain and swelling in the hands and feet and could result in necessary amputation.

A 100% rating is given if there is pain in the limbs and tears in the skin of the limbs from lack of oxygen or if there is pain in the limbs and the ankle brachial index is 0.4 or less.

A 60% rating is given if you cannot walk further than 25 yards without limping because of leg pain (claudication) and one or more of the following: there is coldness in the limb that does not respond to warming methods, there are one or more tears in the skin of the limb, or the ankle brachial index is 0.5 or less.

A 40% rating is given if there is limping because of leg pain when walking between 25 and 100 yards and one or more of the following: there are 1.) changes to the hair, skin, or nails of the affected limb, or 2.) the ankle brachial index is 0.7 or less.

A 20% rating is given if there is limping because of leg pain when walking more than 100 yards and one or more of the following: the pulse in the limb is diminished, or the ankle brachial index is 0.9 or less.

Note: The above ratings are for a single limb only. If more than one limb is affected, then rate each separately.

-Proposed- Code 7115: Thrombo-angiitis obliterans (or “Buerger’s Disease”) is a disease where the blood vessels of the hands or feet become blocked due to the build up of plaque. It is mostly associated with the use of tobacco products. It causes pain and swelling in the hands and feet and could result in necessary amputation.

If the condition affects the legs, it is rated under code 7114. If the condition affects the arms, it is rated under the following system:

A 100% rating is given if there are tears in the skin, death of the tissues from lack of oxygen, continual coldness in the limb, trophic changes, pain with use, and a weak pulse in the arm. 

A 60% rating is given if there is continual coldness in the limb, trophic changes, pain with use, and a weak pulse in the arm.

A 40% rating is given if there are trophic changes, numbness in the fingertips, and a weak pulse in the arm.

A 20% rating is given if there is a weak pulse in the arm.

Trophic changes include thinning of the skin, skin atrophy, hair loss, tears in the skin, fingernail deformities, etc. 

Note: The above ratings are for a single arm only. If more than one arm is affected, then rate each separately.

The VA proposes to change this code to better reflect the unique affect it has on the arms. The legs would still be rated under the same rating system as code 7114, but the arms would get their own rating system. 
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Code 7117 for Raynaud’s Syndrome (a.k.a. “Raynaud’s phenomenon” or “secondary Raynaud’s”) remains exactly the same except to specify that only Raynaud’s syndrome can be rated under this code. Raynaud’s disease would be rated under the new code 7124, below.
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Codes 7118 for angioneurotic edema, 7119 for erythromelalgia, 7120 for varicose veins, and 7121 for post-phlebitic syndrome remain the same.
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-Current- Code 7122: Frostbite and other conditions caused by overexposure to the cold can cause permanent damage to the arteries, nerves, and veins and are rated on the persistent symptoms of the condition.

A 30% rating is given if there is joint pain, numbness or sensitivity to the cold in the area affected and two or more of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, or other abnormalities proven by x-ray.

A 20% rating is given if there is joint pain, numbness or sensitivity to the cold in the area affected and one of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, or other abnormalities proven by x-ray.

A 10% rating is given if there is only pain, numbness or sensitivity to the cold in the affected area.

These ratings are for individual parts affected. So if a foot and a hand are both affected, then they each receive a separate rating. This does not include individual toes or fingers—if one or more fingers or toes are affected, then it is just rated once on the hand or foot.

Any other conditions resulting from overexposure to the cold not listed under this code are to be rated separately, including amputations, carcinomas and neuropathies.

-Proposed- Code 7122: Frostbite and other conditions caused by overexposure to the cold can cause permanent damage to the arteries, nerves, and veins and are rated on the persistent symptoms of the condition.

A 30% rating is given if there is joint pain, numbness or sensitivity to the cold in the area affected and two or more of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, inability to sweat, muscle atrophy, fibrosis, deformation of the toe or finger joints, loss of the pads in the toes or fingers, bone tissue death (necrosis), constant tears in the skin, carpal tunnel, tarsal tunnel, or other abnormalities proven by x-ray.

A 20% rating is given if there is joint pain, numbness or sensitivity to the cold in the area affected and one of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, inability to sweat, muscle atrophy, fibrosis, deformation of the toe or finger joints, loss of the pads in the toes or fingers, bone tissue death (necrosis), constant tears in the skin, carpal tunnel, tarsal tunnel, or other abnormalities proven by x-ray.

A 10% rating is given if there is only pain, numbness orsensitivity to the cold in the affected area.

These ratings are for individual parts affected. So if a foot and a hand are both affected, then they each receive a separate rating. This does not include individual toes or fingers—if one or more fingers or toes are affected, then it is just rated once on the hand or foot.

Any other conditions resulting from overexposure to the cold not listed under this code are to be rated separately, including amputations, carcinomas and neuropathies.

The VA proposes to expand the list of symptoms that cold exposure can cause. 
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Code 7123 for soft tissue sarcoma will remain the same.
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-Proposed NEW CODE- Code 7124:  Raynaud’s Disease (a.k.a. “primary Raynaud’s phenomenon” or “primary Raynaud’s”) is a condition that causes the blood vessels in the fingers and toes, and sometimes the nose and ears, to narrow and restrict blood flow when the person is stressed, emotionally upset, or cold.

Only one rating can be given under this code, regardless of the number of body parts affected. 

“Characteristic attacks” describes a period of time, at least a few minutes long, in which the color of the fingers or toes change in at least one limb, occasionally with pain and numbness.

Trophic changes include thinning of the skin, skin atrophy, hair loss, tears in the skin, fingernail deformities, etc. 

A 10% rating is given if there are characteristic attacks and trophic changes. If there are characteristic attacks, but no trophic changes, it is rated 0%. 

Raynaud’s disease is a less severe condition than Raynaud’s syndrome. Currently, Raynaud’s disease can only be rated under Raynaud’s syndrome, but the rating requirements under that code do not really reflect Raynaud’s disease symptoms. To fix this and avoid rating confusion, the VA proposes to create a new code for Raynaud’s disease.
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