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Monday, June 26, 2017

Rating Myositis for DoD and VA Disability

Myositis is a condition where the muscles swell, causing weakness and often pain. Myositis can be caused by medications, medical conditions like cancer, etc., but in the majority of cases, the cause is unknown.

Before discussing rating options, it should be noted that in addition to general myositis, there are a few specific types of myositis that present with special symptoms.

        - Polymyositis affects numerous muscles all over the body, and in its severe form, can lead to other serious condition such as difficulty swallowing, lung disease, and heart disease.
        - Dermatomyositis is similar to polymyositis but it also includes the skin, causing rashes along with the muscle weakness and other symptoms.
        - Inclusion-body myositis is very similar to polymyositis. There are, of course, differences, but they are pretty technical and aren’t relevant to ratings, so we won’t get into the medical jargon here.

On to the ratings.

The VASRD code for Myositis is code 5021. For most cases of myositis, regardless of type, this will be the main code assigned. Code 5021 is rated on limited motion of the affected joints. So if the condition causes limited motion of the elbow and knee, then two ratings will be given: one for limited motion of the elbow, and one for limited motion of the knee.

Now as mentioned above, myositis can cause many other symptoms in addition to limited motion, like skin rashes and heart disease. In cases where there are symptoms other than limited motion that cause significant impairment, they can be rated separately.

For example, let’s say Shawn has dermatomyositis. His symptoms include rashes around his eyes and on his neck, weakness in the shoulders that limits his ability to raise his arms, and supraventricular arrhythmia (a heart condition).

Of these symptoms, only the shoulders will be rated under code 5021 (the code for myositis) since those are the only joints that have limited motion. As both shoulders are affected, he will then receive two ratings under code 5201 for limited motion of the shoulder. Next, Shawn’s rashes will be rated as psoriasis under code 7816. And finally, his arrhythmia will be rated under code 7010 for supraventricular arrhythmia.

In total, Shawn will receive 4 separate ratings for his dermatomyositis: shoulder, shoulder, skin, heart. The final codes for these ratings will look like this:

        5021-5201: left shoulder limited motion
        5021-5201: right shoulder limited motion
        5021-7816: psoriasis
        5021-7010: supraventricular arrhythmia

The hyphenated codes are used to define the condition properly. The first four digits defines the condition as myositis, and the second indicates how it is rated (limited motion of the shoulder, psoriasis, etc.). See Analogous Ratings for more info.


So ultimately when rating myositis, additional ratings can be given for each separate symptom caused by any type of myositis as long as none of the symptoms are rated more than once (the Pyramiding Principle).