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Friday, October 1, 2021

Changes coming November 2021 to the Ratings of the Genitourinary System


On September 30th, 2021, the VA published their final changes to the ratings of the Genitourinary System and Cardiovascular System (discussed in a separate blog article).   

The rewrite of the VASRD began in 2014 with the goal to be finished by the end of 2016. To date, these are the tenth and eleventh sections to be finalized, with many still to go.  

 

So far, finalized changes have also been made to the ratings of the Hematologic and Lymphatic Systems, the Skin, the Female Reproductive System, the EyesDental and Oral Conditions, the Endocrine SystemMental DisordersMusculoskeletal System, and Infectious Diseases, Immune Disorders, and Nutritional Deficiencies.

 

The following Genitourinary changes will go into effect November 14th, 2021, and we’ll officially update all the information on our website at that time. These new ratings will automatically apply to any new claims for genitourinary conditions submitted on or after November 14th.

 

The following are the VA’s final changes to the ratings for the Genitourinary System. 

 

The changes are fairly extensive, so I’ll walk through each, one at a time.

 

For each condition, the ones labeled -Current- 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 final changes and then the VA’s justification.

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The Urinary Rating Systems will remain exactly the same. 

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All Urinary Conditions (codes 7512, 7515, 7516, 7517, 7518, and 7519) are all staying the same, except: 

 

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

 

-Final- Code 7542: A Neurogenic Bladder occurs when a person loses control over urination because of damage to the nerves or the brain. This condition is rated either on 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 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 is adding this new code to cover diverticulum of the bladder. Currently, there aren’t any codes that truly reflect the disability of this condition. Thus, having its own code will make it easier to rate consistently.

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Urinary Tract Infection

 

-Current- 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.

 

 

-Final- 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 but 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 have clearly separate symptoms. If the renal problems are more severe, then the condition should be rated under the renal rating system.

 

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.

 

-Final- 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.

 

-Final- Code 7527Prostate Gland conditions (all except prostatitis, code 7525) 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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The Renal Rating System

 

-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.

 

-Final- 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 at least 3 consecutive months within the past 12 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 at least 3 consecutive months within the past 12 months.

A 60% rating is given if the GFR is between 30 and 44 mL/min/1.73 mfor at least 3 consecutive months within the past 12 months.

A 30% rating is given if the GFR is between 45 and 59 mL/min/1.73 mfor at least 3 consecutive months within the past 12 months.

A 0% rating is given if at least one of the following is present for at least 3 consecutive months within the past 12 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 kidney’s 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. 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 will be using 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 are currently rated and the Renal Rating System. They will continue to be, but now on the new Renal Rating System. 

 

Code 7500 for nephrectomy remains the same. 

 

Code 7502 for nephritis remains the same.

 

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.

 

-Final- Code 7533: Any cystic disease of the kidney is rated under this code, including polycystic disease, uremic medullary cystic disease, medullary sponge kidney, Alport’s syndrome, cystinosis, primary oxalosis, Fabry’s disease, and more.

 

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. 

 

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.

 

-Final- 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 is making sure 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.

 

-Final- 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.

 

 

-Final- 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. 

 

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

 

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

 

-NEW 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 is adding this 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.

 

-Final- Code 7508Nephrolithiasis (also known as “kidney stones”), Ureterolithiasis, and Nephrocalcinosis are all rated under this code.  

 

Nephrolithiasis is the presence of stones in the kidney, Ureterolithiasis is the presence of stones in the ureter, and Nephrocalcinosis is the buildup of calcium in the kidneys that can lead to stone formation. These stones block the flow of urine. 

 

If stones are repeatedly formed and it requires removal surgeries or procedures 3 or more times each year, it is rated 30%. Otherwise, it is rated as hydronephrosis, code 7509.

 

The VA is combining codes 7508 and 7510 into a single code since both deal with the formation of stones that block the urinary tract. They are also adding nephrocalcinosis to this code to ensure it is properly rated. 

 

The ratings for these conditions are mostly stay the same, but dietary and drug treatments have not proven ineffective, so the VA is removing them as rating options. 

 

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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%.

 

-Final- 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. 

 

-Final- 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.

 

For both of these codes, the VA is removing 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 the penis can 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%.

 

-Final- Code 7522: Erectile dysfunction, for any reason, is rated 0%. 

 

Any scarring or deformity of the penis as the result of an injury is also rated under this code as erectile dysfunction.

 

These conditions may qualify for SMC-K as loss of use of a creative organ. 

 

The VA will no longer be rating erectile dysfunction more than 0%. They justify this change by claiming that the purpose of compensable ratings is to compensate 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 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 is 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 is giving only a 0% rating. However, if they lead to infertility, they would qualify for SMC-K.

Thursday, September 30, 2021

Changes coming November 2021 to the Ratings of the Cardiovascular System

On September 30th, 2021, the VA published their final changes to the ratings of the Cardiovascular System and Genitourinary System (discussed in a separate blog article).  


The rewrite of the VASRD began in 2014 with the goal to be finished by the end of 2016. To date, these are the tenth and eleventh sections to be finalized, with a number still to go.  


So far, finalized changes have also been made to the ratings of the Hematologic and Lymphatic Systems, the Skin, the Female Reproductive System, the EyesDental and Oral Conditions, the Endocrine SystemMental Disorders, Musculoskeletal System, and Infectious Diseases, Immune Disorders, and Nutritional Deficiencies.

 

The following Cardiovascular changes will go into effect November 14th, 2021, and we’ll officially update all the information on our website at that time. These new ratings will automatically apply to any new claims for cardiovascular conditions submitted on or after November 14th.

 

The following are the VA’s final 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 ones labeled -Current- 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 final changes and then VA’s justification.

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-Final- General Rating Formula for Heart Conditions

 

All heart conditions are rated on this General Rating Formula unless otherwise noted. 

 

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. The only time an MET test is not required is if it is medically contraindicated or if a 100% rating can be made without it. For all other cases, it is essential to 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 General Rating Formula:

 

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

 

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

 

A 30% rating is given if there is one or more of the following:

1) An MET test causes symptoms (like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting) at 5.1 to 7.0 METs.

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 causes symptoms (like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting) at 7.1 to 10.0 METs.

2) Continuous medication is required for control.

 

The VA is adjusting the heart’s General Rating Formula 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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-Final 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 General Rating Formula. If there are no symptoms, it cannot be rated more than 0%.

 

The VA is adding 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 compensable 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.

 

-Final- 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.

 

The condition is rated 30% if it requires intravenous pharmacologic adjustment, cardioversion, and/or ablation to relieve symptoms 5 or more times a year.

 

The condition is rated 10% if it requires one or more of the following:

1) intravenous pharmacologic adjustment, cardioversion, and/or ablation to relieve symptoms 1 to 4 times a year

2) continuous use of oral medication to control symptoms

3) vagal maneuvers (vagus nerve stimulation) to control symptoms

 

The VA is changing the name of this code from arrhythmia, which could be any type of abnormal heart rhythm, to tachycardia, abnormally fast heart rhythms. In reality, this code has always been used just for tachycardias, so this change will help clarify that. 

 

The VA is also changing 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 measurable 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.

 

-Final- 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 a 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 General Rating Formula.

 

The only change to this code is to establish a 6-month period after hospital discharge for a re-evaluation by the VA.

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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%. 

 

-Final- 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 General Rating Formula

 

A non-benign condition is much more severe and includes Second-Degree (Type II) and Third-Degree. It is rated under the General Rating Formula unless it requires a pacemaker, then it is rated under code 7018.

 

The VA is adjusting 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.

 

-Final- 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 underlying 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).

 

-Final- 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. 

 

It is rated 100% if it meets one or more of the following:

1) the aneurysm is 5 cm or larger

2) the aneurysm causes symptoms (like the inability to perform moderately strenuous activities for fear of rupture) 

3) a physician recommends surgery

 

If it does not meet any of these requirements, it is rated 0%. 

 

In the case of a physician recommending surgery, the 100% rating starts from the date of the physician’s recommendation and will be re-evaluated 6 months after discharge from the hospital post-surgery. After that, any remaining heart symptoms are rated on the General Rating Formula. All other symptoms can be rated separately on the body system affected. 

 

The VA is eliminating the 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 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 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.

 

-Final- Code 7111: If an aneurysm in any large artery (except the aortic artery, code 7110) 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 re-evaluated and 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%.

 

-Final- 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, but 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 or stasis 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.

 

-Final- 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 is updating the name of this condition to the one more commonly used today. They also are expanding 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.

 

 

-Final- 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 is changing 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 will now have have 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.

 

-Final- 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 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 the entire hand or foot is just rated once.

 

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 only change to this code is 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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-Final NEW CODE- Code 7124:  Raynaud’s Disease (a.k.a. “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 is creating a new code for Raynaud’s disease.