Intro

Welcome to our Military Disability blog! We encourage participation. Please feel free to comment on any post, including questions. We want to make sure we give you the information you need, so feel free to ask us anything about military disability, and we'll add it to our blog queu.

Our goal for this blog is to jump deeper into specific issues than we can on our website, www.MilitaryDisabilityMadeEasy.com. The site should still be the first place you go, though. It has an immense amount of information, and should be able to address the majority of your questions very well. If not, please let us know.

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Last but not least, this blog is going to deal just strictly with the specifics of the Military Disability system that is functioning right now. You might also want to follow our Top News stories for all current news about and future plans for the disability system.

Wednesday, August 30, 2017

Multiple Sclerosis and the VA

--Here's another great guest article from our friends at Hill & Ponton--

What is MS?

Multiple Sclerosis, or MS, is an autoimmune and neurological disease that affects the central nervous system of the body. When your body sends a message to another part of the body, it does so through nerve cells. The nerve cells transmit these signals through fibers to ensure that every electrical impulse gets to its intended target. In a healthy nerve, the electrical impulses travel easily from one nerve cell to the other. In someone with MS, there is a disruption. MS causes the body to destroy the coating protects the fibers, leaving them exposed and damaged. Nerve impulses now travelling down these fibers experience distortion or interruptions, often producing a variety of symptoms. MS is like having your electrical wires crossed, you expect one thing, and sometimes get something else.  According to a study conducted by the VA in 2012, almost 13% of all veterans are diagnosed with MS. This is a higher rate than the general population and no one really knows exactly why. 
                 
How can I get VA Compensation for MS?

To be eligible for any benefit from the VA you must meet certain criteria:
·       Be separated or discharged from Active Duty by other than dishonorable conditions
·       Have a diagnosed disability
·       That disability was caused by, during, or aggravated by or during your active duty service (i.e. service-connected)

MS is rated at a minimum of 30% based on the VA rating schedule.  Symptoms of MS include loss of coordination, weakness, difficulty eating, muscle spasms or tics, difficulty breathing, nerve paralysis, double vision, depression, and other mental disorders. MS is presumptive if it is diagnosed during active duty or to a compensable level within 7 years of discharge from Active Duty service. Applying for VA Compensation within this period is imperative if you have been diagnosed during service or the seven years post discharge. Presumptive means that you do not need a nexus statement, something linking your disability to your service. If you do not file during the presumptive time, you will need a nexus from a doctor and an in-service event or exposure to link the MS to active duty service.

What if I am not service connected? Can I still get benefits?


Yes, whether service connected or not, the VA also offers other benefits to all veterans who have MS. Veterans who are non-service connected for MS are still eligible for benefits in several ways. First, of course, check to see if you are within the presumptive period and apply for disability compensation, or, if you or your doctor can link symptoms back to that presumptive period, even if you were not yet diagnosed, go ahead and file a claim. You don’t have anything to lose.

The VA has Multiple Sclerosis Centers of Excellence to serve these veterans with specifically targeted treatments, benefits, and care.   The VA created the Multiple Sclerosis Centers of Excellence to serve these veterans with specifically targeted treatments, benefits, and care.

Now, without receiving disability compensation, veterans with MS are may also be eligible for an array of other services.
  • Medical Care: even under non-service connected status, many veterans may be eligible for health care for their MS
  • Prosthetic and Sensory Aids: this includes devices such as hearing aids, eyeglasses, speech and communication devices, home dialysis, orthopedic, wheelchairs, respiratory aids, hospital beds, and other daily-living aids.
  • Home Improvement Grants: there are several types of grants veterans can apply for to modify or purchase specially adaptive homes due to severely debilitating diseases such as MS.
  • Mobility Benefits: this includes referrals for Physical Medicine and Rehabilitation Services or
    other interdisciplinary specialties and evaluation of needs for mobility such as power chairs.
  • Driver Rehabilitation: Service such as driver retraining and assessments to help veterans maintain independence
  • Modifications: automobile adaptive grants cover the one time purchase of adaptive equipment for such items as van lifts.
  • Clothing Allowance: Veterans may receive an annual monetary allowance to assist with the purchase of clothing that is damaged due to orthopedic appliances such as wheelchairs, etc.
  • Prescription medications: MS medications are expensive, and sometimes insurance copays are almost as expensive when the medications are Tier three or not covered at all, based on eligibility, VA prescriptions may be able to help with those costs.
  • Aid and Attendance: Veterans and survivors who are eligible for pension and require the aid and attendance of another person due to being housebound or inability to care for themselves alone, may be eligible for additional monetary payment
  • Mental Health Services: All mental health services are available to eligible veterans, and there is legislation to expand those services to all veterans soon. MS victims have the extra burden of emotional issues due to the neurological damage that MS wreaks on the person’s brain.
  • Respite Care: everyone needs a break now and then, and while we recognize that the person suffering from MS never gets a break, those who care for them need those breaks from time to time to deal with not only the physical demands, but the emotional ones as well. Respite is an often under-utilized service that is available to those eligible for it.


For Caregivers:

The MS Centers for Excellence also provide services for caregivers. Whether they are part time, full time, family members, friends, or paid; they have a responsibility that outweighs every other; the responsibility of another person’s well-being and health. For all caregivers, this is an enormous responsibility and one that often wears them down emotionally over time. However, with those caring for MS patients, it can often be extra difficult due to the emotional issues.

People with MS often experience lack of emotional filtering, this is especially true when there is damage or an active lesion to the nerves that are in the brain stem areas. The brain stem is the part of the brain that deals with emotion and instinct. Couple this with any issues in the regulation parts of the brain, and you have someone who says everything they think, good or bad, no matter what the consequences; and it can sometimes be very hurtful if you are a loved one caring for them. Having support for caregivers is a much needed service for those who care for Veterans with MS due to this unique aspect of the disease.

The caregiver program, MS Caregivers, provides a toll free hotline, up to 30 days of respite care per year, a support network including the Caregiver REACH program (one specifically designed for those caring for Veterans with MS); and telephone and in person based support groups. There is a huge amount of resources from the VA and the MS Foundation for caregivers to utilize.

Studies and Treatment

There are also studies and treatment available. The MS Foundation has a booklet available for free download called Disease Modifying Therapies for MS that is found on the VA’s website and goes through all of the main 13 current treatment modalities so that Veterans can discuss them with their doctors.  This brochure covers injectables, orals, and infused medications and reviews pros, cons, and approvals.

The MS Centers of Excellence also offer a Smartphone App for Apple iPhone, Android, and Blackberry Torch. The app links Veterans to med information, coverage information on adaptive equipment, caregiver resources, and other VA benefits, symptom management, and VA resources. Instructions for downloading can be found here. 

The MS Centers of Excellence also works hard at keeping up with the latest therapies, advancements in research, and technology. Below are links to their site and some others that are valuable to anyone with Multiple Sclerosis.

                  MS Centers ofExcellence – Veteran’s Administration
                  National MS Society
                  Multiple Sclerosis Association of America
                  Multiple Sclerosis Foundation
      Veterans with MS













Thursday, August 10, 2017

Official Changes to the Ratings for Dental and Oral Conditions

On August 3, 2017, the VA published their final changes to the ratings for Dental and Oral Conditions. Of the nine sets of changes that have been proposed as part of the VA’s complete rewrite of the VASRD, this is only the second to have been made official and final.

The other finalized changes were to the ratings for Mental Disorders in 2014. Other proposed changes include the Hemic and Lymphatic System, the Female Reproductive System, The Eyes, the Endocrine System, the Skin, the Genitourinary System, and the Musculoskeletal System.

The following changes will go into effect September 10, 2017, and we’ll officially update all the information on our website at that time. Any Dental and Oral Conditions rated on or after September 10th will be based on these new ratings.

The following are the changes to the ratings for Dental and Oral Conditions. The indented bits are the codes as they are now. I’ll then discuss the changes after. If you click on the code number, it will take you to the discussion of that code on our site which includes additional definitions and anatomical images.

The VA’s first change is to add a few explanatory notes to the beginning of this section.

Some dental and oral conditions require that they be diagnosed via “imaging studies.” The first note specifies that “imaging studies” means tests like X-rays, CT scans, MRIs, PETs (positron emission tomography), radionuclide bone scans, and ultrasonographies. While these tests are specifically listed, the note also states that these are not the only acceptable tests, just the most common. Any test that can clearly and fully provide enough data to diagnose the condition and its severity is acceptable, but proof of these tests must be included in the medical evidence in order for the condition to be fully ratable.

The second note states that any loss of smell, loss of taste, nerve damage, respiratory problems, loss of the ability to speak, and other additional symptoms caused by any of these conditions can be rated separately. These codes are basically just for any physical and mechanical conditions of the mouth and teeth (loss of bone, inability to chew, etc.). All other symptoms can be rated separately.

That’s it for the notes. Now on to the conditions.
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Code 9900: Osteomyelitis or osteoradionecrosis of the mandible or maxilla is rated under code 5000, osteomyelitis.

-New- Code 9900: Osteomyelitis, osteoradionecrosis, or osteonecrosis (a.k.a. “ONJ”) of the mandible or maxilla is rated under code 5000, osteomyelitis.

The only change to this code is to add osteonecrosis as a condition that is rated here in addition to osteomyelitis and osteoradionecrosis. Osteonecrosis of the jaw (a.k.a. ONJ) is a condition where the gum recedes and exposes the jaw bone (maxilla or mandible). This decreases the blood flow to the bone, which in turn causes the bone to weaken and deteriorate. Just as the other two conditions under this code, it will also be rated as osteomyelitis under code 5000.
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Code 9901 remains exactly the same.
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Code 9902: If about half of the mandible is missing and the jaw is unable to move or is limited in its movement, then it is rated 50%. If the jaw motion is not affected, then it is rated 30%.

This code is expanded quite a bit in order to better rate the varying degrees of disability that occur when any amount of the mandible is missing, not just half, and in instances where the loss can and can’t be replaced by a prosthesis. Currently, there are two separate codes (9906 and 9907) that rate any loss of the ramus (the back part of the mandible), but since the ramus is a part of the mandible, having separate codes for it doesn’t really make sense. Thus, the VA proposes to remove the two ramus codes and instead combine all ratings for the entire mandible under just this one code.

Additionally, the VA recognizes that loss of the mandible affects many different aspects of the mouth, including the tongue, the ability to chew, and the ability to swallow, and can cause significant disfigurement of the face. Because of this, the VA has added higher ratings than currently allowed to better cover the significant disability that comes with this condition. Disfigurement can, of course, be rated in addition to a rating under this code.

The new code 9902 is as follows:

-New- Code 9902: Any partial loss of the mandible, including the ramus, is rated under this code.

If at least half or more of the mandible is missing, it is rated 70% if it interferes with the ability to chew and cannot be replaced by a prosthesis, 50% if it interferes with the ability to chew but can be replaced by a prosthesis, 40% if it does not interfere with the ability to chew and cannot be replaced by a prosthesis, and 30% if it does not interfere with the ability to chew and can be replaced by a prosthesis.

If less than half of the mandible is missing, it is rated 70% if it interferes with the ability to chew and cannot be replaced by a prosthesis, 50% if it interferes with the ability to chew but can be replaced by a prosthesis, 20% if it does not interfere with the ability to chew but cannot be replaced by a prosthesis, and 10% if it does not interfere with the ability to chew and can be replaced by a prosthesis.
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Code 9903: If the mandible has been broken and did not heal back together, then it is rated 30% for a severe limitation and 10% for a moderate limitation.

-New- Code 9903: If the mandible has been broken and did not heal back together correctly (nonunion or fibrous union), then it is rated 30% if there is abnormal or additional motion at the point of the break and 10% if there isn’t any additional or abnormal motion.

This condition must be clearly shown and diagnosed by an imaging study.

This code was adjusted to more clearly define the “limitation” caused by nonunion of the bone. The “severe limitation” and “moderate limitation” terms used in the current code are rather vaguely defined, and so left up to interpretation. Under the new code, however, the higher rating will simply be applied any time there is additional or abnormal motion at the point of the break, and the lower rating will be applied if there isn’t any abnormal motion at the point of the break.
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Code 9904: If the mandible has been broken and did heal, but not correctly so that there is a definite disfigurement to the bone, then it is rated 20% for severe, 10% for moderate, and 0% for slight.

-New- Code 9904: If the mandible has been broken and did heal, but not correctly so that there is a definite disfigurement to the bone (malunion), it is rated under this code. If the disfigurement causes a large gap between either the front teeth or the back teeth when the jaw is closed, it is rated 20%. If it causes a small gap between either the front teeth or the back teeth when the jaw is closed, it is rated 10%. If it does not cause a gap between the teeth at all, then it is rated 0%.

Just as with the last code, the rating requirements for this code are currently not clearly defined. To better understand a “severe”, “moderate”, and “slight” condition, the VA proposes to better define the expected disability resulting from a malunion by basing the rating on the main symptoms, a gap between the front or back teeth when the jaw is closed that thus interferes with the ability to chew.
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Code 9905: All other jaw joint conditions (including TMJ) are rated based on limited motion of the joint. The jaw can move in two directions: open and closed, and side-to-side. Only one direction of motion can be rated. If the jaw can’t move side-to-side or open and close, then only the one that will give the higher rating is used.

If the jaw can’t move side-to-side more than 4 millimeters (mm), then it is rated 10%.

If the jaw can’t open more than 10 mm (about 0.4 of an inch), then it is rated 40%. If it can open between 11 and 20 mm (about 0.4 to 0.8 of an inch), it is rated 30%. Between 21 and 30 mm (about 0.8 to 1.2 inches) is rated 20%, and between 31 and 40 mm (about 1.2 to 1.6 inches) is rated 10%.

-New- Code 9905: Temporomandibular disorder, (known as “TMD” and also incorrectly referred to as “TMJ”) is rated based on limited motion of the joint and the ability to eat regular or mechanically altered food.

“Mechanically altered foods” include liquid, blended, chopped, pureed, ground, mashed, soft, and semisolid foods. A physician must record that your condition requires you to eat only mechanically altered foods in order for it to be rated. If a medical record does not state this, then it’ll be assumed that you are able to eat normally. 

For limited motion, the jaw can move in two directions: open and closed, and side-to-side. Only one direction of motion can be rated. If the jaw is limited in both directions, then only the one that will give the higher rating is used.

Only unassisted motion is used to rate limited motion, so even if the jaw could open further with help, it is only rated on how far it can move naturally without assistance. 

If the jaw can’t move side-to-side more than 4 millimeters (mm), then it is rated 10%.

If the jaw can’t open more than 10 mm (about 0.4 of an inch), then it is rated 50% when only able to eat mechanically altered food, and 40% when able to eat normally.

If it can open between 11 and 20 mm (about 0.4 to 0.8 of an inch), it is rated 40% when only able to eat mechanically altered food, and 30% when able to eat normally.

If it can open between 21 and 29 mm (about 0.8 to 1.1 inches), it is rated 40% when restricted to full liquid and pureed foods only, 30% when limited to soft and semi-solid foods only, and 20% when able to eat normally.

If it can open between 30 and 34 mm (about 1.2 to 1.3 inches), it is rated 30% when restricted to full liquid and pureed foods only, 20% when limited to soft and semi-solid foods only, and 10% when able to eat normally.

The VA made quite a few changes to this code. This condition is still technically rated on limited motion, but additional factors, like the types of food that can be eaten because of the limited motion, is also used when rating. The new code also specifies that the measurements are for unassisted opening, meaning that the jaw could open further by pulling down on the jaw or other assisted means, but by itself, it is limited to these measurements.

The ratings for side-to-side limited motion and the requirement that only side-to-side or open-and-closed motion, not both, can be rated remain the same.
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Code 9906: If more than half of the ramus is missing and the ability to chew or move the jaw is limited, then it is rated 30% for one side and 50% for both sides. If the ability to chew or move the jaw is not limited, then it is rated 20% for one side and 30% for both sides.

This code is deleted since any loss of the ramus is now covered under code 9902.
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Code 9907: If less than half of the ramus is missing but the jaw function is not limited, then it is rated 10% for one side and 20% for both sides.

This code is deleted since any loss of the ramus is now covered under code 9902.
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Code 9908 remains the same.
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Code 9909 remains the same.
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Code 9911: If half or more of the hard palate is missing and cannot be replaced by a prosthesis, then it is rated 30%. If it can be replaced by a prosthesis, then it is rated 10%.

-New- Code 9911: If any portion of the hard palate is missing, it is rated under this code. If half or more has been lost and it cannot be replaced by a prosthesis, it is rated 30%. If less than half has been lost and it cannot be replaced by a prosthesis, it is rated 20%. If half or more has been lost and it can be replaced by a prosthesis, it is rated 10%, and if less than half has been lost and it can be replaced by a prosthesis, it is rated 0%.

All they did to this code was combine it with code 9912. The ratings and requirements are exactly the same, just under one code now instead of two.
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Code 9912: If less than half of the hard palate is missing and cannot be replaced by a prosthesis, then it is rated 20%. If it can be replaced, it is rated 0%.

This code is removed and instead, all hard palate ratings are covered under code 9911.
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Codes 9913-9915 remain the same.
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Code 9916: If the maxilla has been broken and hasn’t healed back together or has healed incorrectly, then it is rated based on how severely the bone has been disfigured and thus limits its ability to function. If it is severely disfigured, it is rated 30%. If it is moderately disfigured, it is rated 10%. If it is slightly disfigured, it is rated 0%.

-New- Code 9916: If the maxilla has been broken and, after treatment, hasn’t healed back together (nonunion) or has healed incorrectly, causing definite disfigurement to the bone (malunion), it is rated under this code.

For nonunion, if there is abnormal motion at the point of the break, then it is rated 30%. If there is no motion at the point of the break, then it is rated 10%. To qualify for rating, a nonunion must be clearly shown and diagnosed by an imaging study.

For malunion, if the disfigurement causes a large gap between either the front teeth or the back teeth when the jaw is closed, it is rated 30%. If it causes a medium gap between either the front teeth or the back teeth when the jaw is closed, it is rated 10%. If it causes only a small gap between the front teeth or the back teeth, then it is rated 0%.

The current rating requirements for this code are rather vague, basing its ratings on “severe”, “moderate”, or “mild” disfigurement. To make the requirements more clear and more applicable to the true disability associated with this condition, the new code separates and establishes different rating requirements for nonunion and malunion, as is done for the mandible under codes 9903 and 9904.

The new rating requirements are also similar to the ratings for the mandible, with nonunion based on the presence of any abnormal motion and malunion based on the presence of a gap between the teeth. In fact, the ratings for nonunion under this code are identical to the ratings for nonunion of the mandible under code 9903.
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-New- Code 9917: All benign neoplasms (tumors or oral lesions) of the mouth and teeth are rated on the main structures of the mouth that they affect. So if the tumor affects the teeth, it would be rated under code 9913. If it affects the hard palate, it is rated under code 9911 or 9912. If it causes disfigurement, it is rated under code 7800, etc.  

Currently there aren’t any codes specifically for cancer that affects the mouth and teeth, so the VA is adding two new codes (this one and code 9918) to cover all cancer, both benign and malignant. It is basically just rated on any symptoms or functional impairment (inability to chew, etc.) that it causes.
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-New- Code 9918: All malignant neoplasms (tumors and lesions) of the mouth and teeth are rated 100% while the condition is active and undergoing treatment. This 100% rating will continue for 6 months following the last treatment, at which point the VA will re-examine the condition and rate it based on any remaining symptoms, like loss of teeth or disfigurement.

Just like code 9917, the VA is adding this new code to cover malignant cancer of the mouth and teeth.



Monday, August 7, 2017

Proposed Changes to the Ratings of the Musculoskeletal System

Again, in only a matter of days, the VA published a second section of proposed VASRD changes—after almost a year break—apparently trying to make up for lost time. On August 1st, the proposed changes to the ratings of the Musculoskeletal System were made public.

The rewrite of the VASRD began in 2014 with the goal to be finished by the end of 2016. With significant delays, and many more sections left to go, there is no longer any clear timeframe as to when veterans can expect these changes to be finalized, although if they continue releasing changes at this rate, it won’t be much longer.

So far, only the ratings for Mental Disorders have officially been updated, although the VA just published the final ruling for the changes to Dental and Oral Conditions a few days ago. We’ll have info regarding those coming up soon. Those changes will go into effect in September.  


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 20th, 2017. 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 Musculoskeletal System. The Musculoskeletal System is so vast, that we’ve broken it down into multiple pages on our site. Use the links below to find our discussions of the current ratings for these conditions.

            Amputations                           The Elbow and Forearm
            The Skull                                The Wrist
            The Spine                               The Hand
            The Ribs                                 The Hip and Thigh
            The Shoulder and Arm           The Knee and Leg
            The Ankle                               Diseases of the Musculoskeletal System
            The Foot                                 Cancer of the Musculoskeletal System
            Torso and Neck Muscles        Shoulder and Upper Arm Muscles
            Facial Muscles                        Buttock, Hip, and Thigh Muscles
            Muscle Hernias                       Forearm and Hand Muscles
            Foot and Lower Leg Muscles

The changes are fairly extensive, so I’ll walk through each, one at a time. If you don’t want to have to plod through them all, it might be most effective to just search for keywords (command-F works great!).

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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Code 5000 for osteomyelitis remains exactly the same.
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Code 5001 for tuberculosis of the musculoskeletal system remains exactly the same.
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-Current- Code 5002: Rheumatoid arthritis is the destruction of the soft tissues in a joint because of swelling. 

Regardless of how many joints are affected, if the arthritis is severe enough that you cannot function, but are completely incapacitated and bedridden, then it is rated 100%. 

If there is significant weight loss, anemia, and overall severe decrease in health but not complete incapacitation, or if severe incapacitating episodes happen 4 or more times a year, then it is rated 60%. 

If there is a definite decline in overall health, or if incapacitating episodes happen 3 or more times a year, then it is rated 40%. 

One or two episodes a year rates 20%.

These ratings cannot be used in addition to ratings for limited motion. One or the other. Any rheumatoid arthritis less severe than noted above is just rated upon its symptoms, such as limited motion. In these cases individual joints can be rated. So, if three joints are involved, but there are no incapacitating episodes, all three can be rated separately on limited motion. A minimum of 10% is given for every joint that at least has pain with motion.

-Proposed- Code 5002Multi-joint systemic arthritis includes any arthritis diseases (including rheumatoid arthritis, psoriatic arthritis, etc.) that affect multiple joints in the body and could affect other body systems as well. To be rated under this code, there must be a definite diagnosis, the arthritis must be active, and at least 2 joints must be affected. This code does not cover post-traumatic arthritis or gout.

If the arthritis is severe enough that you cannot function, but are completely incapacitated and bedridden, then it is rated 100%. 

If there is significant weight loss, anemia, and overall severe decrease in health but not complete incapacitation, or if severe incapacitating episodes happen 4 or more times a year, then it is rated 60%. 

If there is a definite decline in overall health, or if incapacitating episodes happen 3 or more times a year, then it is rated 40%. 

One or two episodes a year rates 20%.

Any arthritis no longer active or less severe than noted above is rated under code 5003 as degenerative arthritis. Multiple ratings, however, cannot be given. Any rating under this code cannot be combined with ratings for degenerative arthritis or limited motion in the same joints. Instead, the code that can offer the higher rating is used.

Although the ratings themselves did not change, the VA wanted to expand this code to cover all systemic arthritis, not just rheumatoid arthritis. The only other significant change was to rate lesser conditions as degenerative arthritis instead of just on limited motion.
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The only change for Code 5003 for degenerative arthritis is to adjust the name of the code to specify that this is for all degenerative arthritis except post-traumatic degenerative arthritis. The ratings remain exactly the same.
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Codes 5004-5008 for gonorrheal arthritis, pneumococcic arthritis, typhoid arthritis, syphilitic arthritis, and streptococcic arthritis, continue to be rated under code 5002 for any active disease and code 5003 for anything that doesn’t qualify for those ratings.
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-Current- Code 5009: All other arthritis is rated under this code.

-Proposed- Code 5009: All other diseases of the joints (except gout) are rated under this code. All active diseases are rated under code 5002, systemic arthritis. Anything that doesn’t qualify for a rating under that code is rated under code 5003, for degenerative arthritis.

The VA adjusted this code to include any other disease that would affect the joints, not just arthritis.
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-Current- Code 5010Post-traumatic arthritis is arthritis that is due to an accident or injury. This code doesn’t have its own ratings, but is rated as degenerative arthritis. The final code for this condition will look like this: 5010-5003. The first four-digit code defines the condition as traumatic arthritis, and the second four-digit code tells how it is rated.

-Proposed- Code 5010Post-traumatic arthritis is arthritis caused by an accident or injury. This condition is rated as limited motion, dislocation, or instability of the joint affected, whichever one is ratable for that joint and gives the higher rating. Multiple ratings for a single joint cannot be combined unless the codes specifically state that they can (as is the case for instability of the knee). Each joint receives its own rating.

Degenerative arthritis is just rated on limited motion of the joint, so the changes to this code allow instability and dislocation to be considered as a legitimate rating option instead of just limited motion.
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-Current- Code 5011Caisson disease is the premature death of bone and marrow cells, often caused by compressed air most often seen in divers. It is rated based on its most prevalent symptom. For example, if it affects the spinal cord and causes limited motion in the hip, it would be rated under that symptom. Common symptoms include deafness, arthritis in the joints, loss of motion, etc. Only the symptom that can give the highest rating can be rated for this condition. The final code for this condition would look like this: 5011-5261. The first four-digit code identifies the condition as caisson disease, and the second four-digit code tells what symptom the condition is rated under.

-Proposed- Code 5011Decompression sickness (a.k.a. caisson disease, divers’ disease, or the bends) occurs when gas bubbles form in the body because of decompression. The most common symptom is joint pain, however, since the bubbles can form in any part of the body, a variety of symptoms can occur, including arthritis, nerve and/or brain damage, hearing loss, skin damage, lung damage, and more. This condition is rated on its symptoms. So if it causes a rash on the skin and joint pain, it would be rated under arthritis and dermatitis. Each symptom receives its own rating as long as a single symptom is not rated twice (see the Pyramiding Principle).

The VA intends to expand this code to include any symptom caused by decompression sickness, not just ones related to the musculoskeletal system.
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Code 5012 for malignant bone cancer essentially remains the same. They updated some wording to modern medical jargon, but it has no effect on interpretation or rating. 
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Both code 5013, for osteoporosis, and code 5014, for osteomalacia, are basically remaining the same. The VA simply added “residuals of” to the requirements to show that the conditions themselves aren’t ratable—it’s the symptoms that they cause in the joints that are ratable. Ultimately, nothing really changes. This principle was already basically accepted and applied in ratings, they just wanted to make it super clear.
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Code 5015 for non-cancerous bone growth (“neoplasms”) remains the same.
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Codes 5016, 5019, and 5021 for osteitis deformans, bursitis, and myositis remain the same.
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Code 5017 for gout is currently rated under code 5002, rheumatoid arthritis. Under the proposed changes, it says that it should be rated under code 5003, which is the code for degenerative arthritis. We believe that this is a typo on the VA’s part, as they do not comment on such a large change, and in fact, state that no real change occurred to this code. We believe that it will continue to be rated under code 5002.
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The VA proposes to remove the following codes:

-Current- Code 5018: Intermittent hydrarthrosis is the periodic swelling most commonly of major joints, although other joints could also be affected, on a regular and predictable schedule.

-Current- Code 5020: Synovitis is the swelling of a membrane that lines synovial joints.

-Current- Code 5022Periostitis is the swelling of the tissue that surrounds the bones.

Based on modern medical practices, these conditions are actually symptoms of larger conditions, like rheumatoid arthritis, and so should not be treated as stand-alone conditions. Instead, any disability they cause is already covered by the rating of the main condition.
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Codes 5023 for myositis ossificans remains the same, but the name is changed to heterotopic ossification. This is the term for this condition that is currently the accepted norm.
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The name for code 5024 is changed to include not only tenosynovitis, but also tendinitis, tendinosis, and tendinopathy. All of these conditions should already be rated under this code, but this makes it more clear exactly where these conditions are intended to be rated.
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Code 5025 for fibromyalgia remains the same.
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Prosthetic Implants and Resurfacing

For all codes 5051-5056 for the prosthetic replacement of joints and resurfacing, a note is added that specifies that no other musculoskeletal rating can be given in addition to this code. Separate ratings can be given for nerve conditions or scars caused by these procedures, but not for arthritis, limited motion, etc. Only one musculoskeletal rating per condition.

Besides the above note, codes 5051-5053 and 5056 for shoulder, elbow, wrist, and ankle replacements remain the same.

-Current- Code 5054: If either the entire head of the femur or entire head of the acetabulum has been replaced by a false joint prosthesis, then the condition is rated 100% for the first year after the surgery. (This period is mainly for the VA, but the DoD will also use it if the veteran is placed on TDRL before being permanently separated). After the 1-year period, the condition is given a permanent rating. If there is weakness and severe pain with motion that requires the use of crutches, then it is rated 90%. If there is weakness and severe pain, but it does not require crutches, then it is rated 70%. If the pain is not severe, but does limit the range of motion, then it is rated 50%. The minimum rating for a hip replacement is 30%. 

If your condition rates 90% under this code, you may also qualify for additional compensation by the VA. Please see the Special Monthly Compensation page for more information.

-Proposed- Code 5054: If the hip has been resurfaced or if either the entire head of the femur or entire head of the acetabulum has been replaced by a false joint prosthesis, then the condition is rated 100% for the first 4 months after the surgery. (This period is mainly for the VA, but the DoD will also use it if the veteran is placed on TDRL before being permanently separated). After the 4-month period, the condition is given a permanent rating.

For joint replacements: If there is weakness and severe pain with motion that requires the use of crutches, then it is rated 90%. If there is weakness and severe pain, but it does not require crutches, then it is rated 70%. If the pain is not severe, but does limit the range of motion, then it is rated 50%. The minimum rating for a hip replacement is 30%. 

If your condition rates 90% under this code, you may also qualify for additional compensation by the VA. Please see the Special Monthly Compensation page for more information.

For resurfacing: All remaining symptoms are rated as limited motion of the hip, too much motion or dislocation of the hip, no motion (frozen joint) of the hip, or issues with the hip bones. The code that best describes the overall symptoms and provides the highest rating is assigned.

-Current- Code 5055: If the entire knee joint has been replaced by a prosthesis, then the condition is rated 100% for the first year after the surgery. (This period is mainly for the VA, but the DoD will also use it if the veteran is placed on TDRL before being permanently separated). After the 1-year period, the condition is given a permanent rating. If there is weakness and severe pain with motion, then it is rated 60%. If the pain is not severe, but does limit the range of motion, then it is rated under code 5256 if it is frozen, or under codes 5261 or 5262, discussed below, if it is not frozen. The minimum rating for a total knee replacement, however, is 30% regardless of how much motion it has.

Note: This code is only for total knee replacements. Partial replacements are rated on any symptoms that they cause, like limited motion.

-Proposed- Code 5055: If the knee has been resurfaced or If the entire knee joint has been replaced by a prosthesis, then the condition is rated 100% for the first 4 months after the surgery. (This period is mainly for the VA, but the DoD will also use it if the veteran is placed on TDRL before being permanently separated). After the 4-month period, the condition is given a permanent rating.

For replacements: If there is weakness and severe pain with motion, then it is rated 60%. If the pain is not severe, but does limit the range of motion, then it is rated under code 5256 if it is frozen, or under codes 5261 or 5262, discussed below, if it is not frozen. The minimum rating for a total knee replacement, however, is 30% regardless of how much motion it has.

Note: This code is only for total knee replacements. Partial replacements are rated on any symptoms that they cause, like limited motion.

For resurfacing: All remaining symptoms are rated as limited motion of the knee, too much motion or instability of the knee, no motion (frozen joint) of the knee, cartilage removal or dislocation, or issues with the lower leg bones. The code that best describes the overall symptoms and provides the highest rating is assigned.

Joint resurfacing is now a common alternative for joint replacements for the hip and the knee.  While they provide similar disability as a joint replacement, they do not qualify under the current rating requirements. Thus the VA proposes to adjust code 5054 and 5055 to include resurfacing. Resurfacing, however, creates a shorter convalescent period and fewer long-term disabilities. Thus, they propose only a 4 month 100% rating period and then alternative rating options for remaining symptoms after the resurfacing.
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Code 5104, 5105, and 5108 for hand and foot combination amputation/loss of use remains the same.
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Code 5106 for both hand amputation remains the same.
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Code 5107 for both foot amputation remains the same.
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Code 5109 for loss of use of both hands remains the same.
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Code 5110 for loss of use of both feet remains the same.
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Code 5111 for loss of use of one hand and one foot remains the same.
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-Current- Code 5120: If the entire arm is amputated from the shoulder joint down, it is rated 90% for either arm.

-Proposed- Code 5120: If the entire arm is amputated from the top of the humerus down, it is rated 90% for either arm. If the amputation includes the shoulder, including the scapula, clavicle, and/or ribs, it is rated 100% for either arm.

The VA proposes adding a 100% rating option for amputees with more than just the shoulder joint and arm removed. The further removal of ribs and the shoulder results in a higher level of disability as prosthetics are much more difficult, if not impossible, to use.
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Codes 5121-5156 for various amputations of the arms, hands, and fingers remain the same.
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-Current- Code 5160: If the entire leg is amputated at the hip joint, it is rated 90%.


-Proposed- Code 5160: If the entire hip is amputated from the top of the femur down, it is rated 90%. If the amputation includes any part of the pelvic bones as well, it is rated 100%.

If the amputation causes any bladder or bowel problems, they can be rated separately.

The VA proposes adding a 100% rating option for amputees with more than just the hip joint and leg removed. The further removal of the pelvis results in a higher level of disability as prosthetics are much more difficult, if not impossible, to use.
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Codes 5161-5167 and 5171-5173 for various amputations of the legs, feet, and toes remain the same.
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-Current- Code 5170: If all of the toes are amputated, not including the ball of the foot, it is rated 30%.

-Proposed- Code 5170: If all of the toes are amputated, not including the ball of the foot, it is rated 30%. This can include up to half of the metatarsals, but less than the entire ball of the foot.

The VA wants to clarify that anything more than all of the toes but less than the ball of the foot should be rated under this code.
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Code 5200 for a frozen shoulder joint remains the same.
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The VA changed some of the phrasing in code 5201 for limitation of motion of the shoulder, but it effectively remains exactly the same.
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Code 5202 for dislocation of the humerus and other humerus bone conditions effectively remains the same.
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Codes 5203-5213 for all other conditions of the shoulder and arm remain the same.
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Codes 5214-5215 for conditions of the wrist remain the same.
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Codes 5216-5230 for conditions of the hand remain the same.
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Codes 5235-5241 for conditions of the spine remain the same.
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Code 5242 for degenerative arthritis of the spine is further expanded to include degenerative disc disease and all other disc conditions (except intervertebral disc syndrome). The ratings remain the same.
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Code 5243 for intervertebral disc syndrome remains the same.
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-NEW Proposed- Code 5244: Both paraplegia and quadriplegia are rated under this code. Paraplegia is the complete paralysis of the legs and lower body. It is rated 100% under code 5110, complete loss of use of the feet. This condition is also entitled to Special Monthly Compensation.

Quadriplegia is the complete paralysis of both the arms and the legs. It is given two ratings: 100% under code 5110 for complete loss of use of the feet, and 100% under code 5109 for complete loss of use of the hands. Having two 100% ratings qualifies the veteran for a higher level of Special Monthly Compensation.
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Codes 5250-5254 for limited motion of the hip, no motion of the hip, and too much motion of the hip remain the same.
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-Current- Code 5255: Any problems with the femur or femoral neck bones are rated under this code. If either is completely broken through and it causes loose or erratic leg motion, then it is rated 80%. If it is broken through but the leg motion is not loose and the leg can support weight with the help of a brace, then it is rated 60%. If it is fractured and has a false joint, it is rated 60%. 

All other femur bone conditions are rated by how they affect the hip or knee joint. If they cause serious problems (can barely use the joint at all), then it is a 30% rating. If the joints can be used, but the condition significantly limits the amount of activity, then it is rated 20%. If the hip or knee joint is affected only slightly, then it is rated 10%.

-Proposed- Code 5255: Any problems with the femur or femoral neck bones are rated under this code. If either is completely broken through and it causes loose or erratic leg motion, then it is rated 80%. If it is broken through but the leg motion is not loose and the leg can support weight with the help of a brace, then it is rated 60%. If it is fractured and has a false joint, it is rated 60%. 

All other femur bone conditions are rated by how they affect the hip or knee joint, whichever results in a higher rating. Rating options for the knee include code 5256, code 5257, code 5260, or code 5261. Rating options for the hip include, codes 5250-5254. Only one code can be assigned for this condition.

The VA recognizes that the current language for these ratings is rather vague. It’s hard for “marked” to be regularly defined by every rating authority, etc. Because of this, ratings for femur bone conditions aren’t standard across the board. To fix this, the VA suggests rating it instead on exactly how the knee or hip are affected, thus eliminating guesswork.
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Code 5256 for no motion of the knee remains the same.
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-Current- Code 5257: The knee can have too much motion (instability) from side to side or dislocate regularly. This can happen when the tendons and cartilage are damaged and can no longer support the knee joint properly. If there is only slight instability, then it is rated 10%. If there is more instability that might cause the knee to buckle or dislocate every now and then, then it is rated 20%. If, however, it is so unstable that it gives out or dislocates regularly, it is rated 30%.

Code 5257: The knee can also have too much motion (instability) from side to side or dislocate (subluxation) regularly. This can happen when the tendons and cartilage are damaged and can no longer support the knee joint properly. Similarly injuries can cause the kneecap instability, causing it to shift out of position.

For general instability and subluxation:

If surgery was performed, there is still 11mm or more of abnormal joint motion, and a physician prescribed both a brace and a device to help with walking (crutch, walker, cane, etc.), it is rated 30%.

If surgery wasn’t performed, there is 11mm or more of abnormal joint motion, and a physician prescribed both a brace and a device to help with walking (crutch, walker, cane, etc.), it is rated 20%.

With any amount of abnormal motion, if a physician prescribes either a brace or a device to help with walking, it is rated 10%.

For kneecap instability:

If the kneecap continues to be unstable after surgery is performed, it is rated 30%. The surgery must have been done specifically to fix the instability. Surgery to remove bone fragments or other knee surgeries that do not address the instability do not qualify.

If surgery was not performed, but there is regular kneecap instability and there are one or more abnormalities in the knee (damage to the ligaments, bone flakes in the knee, breaks or other issues with the kneecap itself, damage to the femoral trochlea, etc.), it is rated 20%.

If surgery was not performed, there is regular kneecap instability, but there are no other abnormalities, it is rated 10%.

The VA proposes more measureable rating requirements for instability of the knee. Since “mild,” “moderate,” and “severe” are difficult to uniformly define, more specific criteria is needed to eliminate inconsistent ratings. They also propose adding ratings specific to kneecap instability. The kneecap is not sufficiently addressed at all under the current ratings.
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Code 5258-5261 for conditions of the meniscus and limited motion of the knee remains the same.
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-Current- Code 5262: Any problems with the tibia or fibula bones in the lower leg are rated under this code. If there is a complete break in either bone that cannot heal and requires a brace, then it is rated 40%. All other conditions are rated by how they affect the knee or ankle joint. If they cause serious problems (can barely use the joint at all), then it is a 30% rating. If the joints can be used, but the condition significantly limits the amount of activity, then it is rated 20%. If the knee or ankle joint is affected only slightly, then it is rated 10%.

-Proposed- Code 5262: Any problems with the tibia or fibula bones in the lower leg are rated under this code.

If there is a complete break in either bone that cannot heal and requires a brace to stabilize, then it is rated 40%. 

Medial tibial stress syndrome (a.k.a. “MTSS” or “shin splints”) must be officially diagnosed by x-ray, bone scan, or MRI in order to qualify for a compensable rating.

If both legs are affected, it has been treated consistently for 12 months or more, and it is not responsive to any form of treatment, it is rated 30%.

If only one leg is affected, it has been treated consistently for 12 months or more, and it is not responsive to any form of treatment, it is rated 20%.

If one or both legs are affected, it has been treated consistently for 12 months or more, and it is only unresponsive to conservative treatments (like orthotics), it is rated 10%.

If the condition has been treated for less than 12 months, it is rated 0%.

All other conditions (including malunion) are rated by how they affect the knee or ankle joint, whichever results in a higher rating. Rating options for the knee include code 5256, code 5257, code 5260, or code 5261. Rating options for the ankle include, codes 5270-5271. Only one code can be assigned for this condition.

Again, the VA is trying to get rid of vague language that leaves too much up to interpretation. Thus instead of rating other conditions on “moderate,” etc., they suggest rating them on the actual impairment of the joints affected. The proposed ratings also add separate rating criteria for shin splints, a condition previously ignored in the ratings.
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Code 5263 for genu recurvatum remains the same.
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All ankle ratings, except code 5271 (below), remain the same.
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-Current- Code 5271: If the ankle is not frozen, but limited in motion, then it is rated under this code. Normal range of motion for the ankle is 0° to 20° dorsiflexion and 0° to 45° plantar flexion. A 20% rating is given for a markedly limited range of motion and a 10% is given for a moderately limited range of motion.

-Proposed- Code 5271: If the ankle is not frozen, but limited in motion, then it is rated under this code. Normal range of motion for the ankle is 0° to 20° dorsiflexion and 0° to 45° plantar flexion.

If dorsiflexion is less than 5° or plantar flexion is less than 10°, it is rated 20%. If dorsiflexion is between 5° and 14° or plantar flexion is between 10° and 29°, it is rated 10%.

The VA proposes to get rid of the vague “marked” and “moderate” requirements and instead define the exact range of motions necessary for the ratings.
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Code 5275 for shortening of the bones remains the same.
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All current foot codes remain the same.
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-NEW Proposed- Code 5285: Plantar fasciitis is a condition where the skin and tissues on the bottom of the foot swell and cause pain. If both feet are affected, and the symptoms are not responsive to any kind of treatment, including surgery, it is rated 30%. If only one foot is affected, and the symptoms are not responsive to any kind of treatment, including surgery, it is rated 20%. If the symptoms are treatable, it is rated 10%.

If the condition is not responsive to treatment and is so severe that the foot cannot be used at all, it is rated 40% under code 5167 for loss of use of the foot.

The VA proposes to add this code because plantar fasciitis is a common enough condition that it should be given its own rating system.
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Codes 5296-5298 for skull conditions, rib conditions, and conditions of the coccyx remain the same.
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All codes for Muscle Ratings remain the same except for the addition of the following two new codes:

-NEW Proposed- Code 5330: Rhabdomyolysis is a condition where the muscles break down rapidly, usually due to trauma or overuse. Each muscle group affected is rated separately. So if a crush injury causes rhabdomyolysis in the forearm and hand, affecting all three of the muscle groups in that area, it will be given three separate ratings. 

Additionally, as the muscles break down and are absorbed into the blood, the kidneys can be damaged. Because of this, any kidney damage caused by rhabdomyolysis can be rated separately.

-NEW Proposed- Code 5331: Compartment Syndrome is a condition where pressure builds up rapidly in the tissues, usually due to a trauma or overuse, and cuts off the blood supply to an area of muscle. Each muscle group affected is rated separately. So if a crush injury causes compartment syndrome in the forearm and hand, affecting all three of the muscle groups in that area, it will be given three separate ratings.

The VA proposes to add these two new codes to help the rating authorities know how best to rate these conditions. Currently they are rated analogously on any muscle groups that are damaged, but these codes make the requirements more clear. Hopefully it will avoid improper ratings.
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