The Blog at Military Disability Made Easy

The Blog at Military Disability Made Easy: March 2014

Monday, March 31, 2014

What Conditions will the DoD Rate for Military Disability?

What conditions can or cannot be rated for military disability is decided by the laws of the VASRD. Both the VA and the DoD use the VASRD, but each organization also has additional laws that apply just to them. It can be a bit confusing and frustrating to find out that a condition can be rated by the VA, but not the DoD, or vice-versa. So, I'll try to help clarify this a bit. This week, I'll address what conditions can be rated for DoD Disability, and next week, I'll address what conditions can be rated for VA Disability

The DoD will only give military disability for conditions that make a service member Unfit for Duty, i.e. unable to perform his job or be deployed. For example, if a service member has a skin allergy, it normally would not be ratable. If, however, that skin allergy makes it impossible for him to wear his helmet, then it would be ratable since he can't be deployed if he can't wear a helmet.

A condition must also be service-connected to qualify for DoD disabilityTo be service-connected, a condition must be the direct result of your military duties (like being injured in combat, being exposed to chemicals, etc.) or it must have first occurred while you were in the military (broke your ankle while playing basketball off-duty, diagnosed with a heart condition, etc.). Anything that occurred or was diagnosed before you entered the military, like genetic conditions, cannot be rated since the military did not cause those conditions. More info on preexisting conditions and the exceptions to the rule can be found on our EPTS (Existed Prior to Service) page.

For the DoD to rate your condition, you MUST also have gone to see a doctor while you were in the military. If you never went to see a physician about the condition, the DoD will not rate it since there is no solid proof that it even happened while in the military. Official paper evidence must be available for the Rating Authorities to even consider a condition for rating.

The DoD will also NOT rate the following:
  • Personality Disorders
  • Minor Speech Problems
  • Substance Abuse
  • Gender Disorders
  • Learning Disorders
  • STDs
  • Genetic Conditions
  • Sexual Dysfunctions

See our Conditions That Are Not Ratable page for more detailed information on all the conditions the DoD will not rate.

Monday, March 24, 2014

Rating Ehlers-Danlos Syndrome (EDS) for Military Disability

We have run up against another tough condition to assign a Military Disability Rating to for military disability

Ehlers-Danlos Syndrome, or EDS, is a genetic condition that a person is born with. It is a condition where collagen is not produced correctly. Collagen is essential to the proper growth of the tissues. Without it, or if it is faulty, the tissues are more stretchy, causing them to have trouble keeping their shapes and perform their proper functions. The worst part about this is that any part of the body can be affected, including the joints, skin, muscles, ligaments, and organs. It is also has no cure.

So now that we know what it is, how to rate it. Because EDS is genetic, it technically cannot be rated since military disability is not given by either the DoD or the VA for any genetic conditions. This is because you would have had the condition regardless of whether or not you served in the military. This does not mean, though, that it cannot receive a rating and disability compensation in certain instances. 

First, all genetic conditions are treated like EPTS (existed prior to service) conditions. For it to qualify to receive disability, the EDS condition (and all other EPTS conditions) must have gotten significantly worse because of military service than it would have if you had not been in the military. Common causes could be demanding physical training, exposure to chemicals, etc.

For example, let’s say that Bob has EDS that mainly affects his joints. The doctors think that it would be reasonable to expect Bob to start having trouble controlling his joint movements by the time he turned 40 (this is extremely unrealistic, but I’m using it just for the sake of keeping the example as simple and straightforward as possible). Bob joined the military when he was 20, and had significant physical demands that caused him to start experiencing trouble controlling his joint movements when he was 30. The doctor’s think it is pretty logical to assume that he would not have begun having symptoms that early had he had a desk job with low physical demands. Thus, Bob’s EDS does qualify for rating since it was clearly made worse by his military service.

Remember, this example is very simplified. For the majority of cases, it will be much harder to determine whether or not an EDS condition was indeed worsened by service. Ultimately, this judgment is up to the physicians performing your exams and the Rating Authorities that determine your disability ratings. You can help your case, however, by getting as much definite proof as possible for both your physician’s and the Rating Authorities.

Alright, now that we know the condition can be rated, things get even more tricky when actually trying to rate it. Rating genetic conditions totally makes me feel like this guy.
If a genetic condition qualifies for rating, it can be rated, but only on how much it was worsened by military service. So, in Bob’s case the symptoms that he did have at age 30 would be compared to the symptoms he should have had at that age, and then the difference would be rated.

Let’s further the example by saying that the condition affected his right elbow. If at age 30 he should have been able to bend it all the way to 90°, but could only actually bend it to 60°, then it would be rated on the difference, 30° (90 – 60 = 30). That is how much the military worsened his condition, and thus, that is what they will compensate.

Do you feel like this guy yet?

That’s the basic rule for all genetic conditions and EPTS conditions, although very simplified.

Next we need to discuss the basics of rating EDS specifically.

Since EDS can cause so many different symptoms, it isn’t given just a single rating. Instead, each of the symptoms is rated separately. For example, let’s say Bob’s EDS causes limited motion in his elbow and affects the functioning of the liver. Both of these conditions are separately rated. He would get two ratings: one for the elbow and one for the liver. Just find the condition that most closely describes each symptom. But remember, for each of these conditions, they are only rated by how much worse military service made them.

That’s it. Just remember, if your symptoms would have been the same if you hadn't been in the military, they can’t be rated. Don't waste your time and effort trying to get a rating that simply won't be given.

Unfortunately, it’s impossible to determine exactly how your EDS condition will be rated. It is completely up to the Rating Authorities. There are so many ways to interpret things, that there isn’t really much you can do to help your case besides making sure the Rating Authorities have complete medical information about every symptom you have. In this post, I have simply outlined the laws and processes they are required to use when determining the ratings for your EDS. Hope this helps.

Find out more about your military disability and your military disability benefits on our site.

Monday, March 17, 2014

Three Diagnosed Conditions, Only One Military Disability Rating

Last week, we discussed the Pyramiding principle. Today I want to further that discussion by giving another example of how pyramiding works.

The VASRD is the law that governs how to assign a Military Disability Rating to a condition for military disability. The VASRD has numerous principles that guide how it should be applied in special circumstance. 

It is vital to your peace of mind to understand exactly how the Pyramiding principle works. You may think that because the doctor has diagnosed three conditions you should get three ratings, but when you end up getting only one rating, you'll pretty much feel like this guy.

The bottom-line rule of Pyramiding: A single symptom can only be rated once. One symptom, one rating. This means that if three diagnosed conditions cause the same one symptom, then only one will get a rating, whichever gives the highest rating.

On to our example. Bert has three diagnosed conditions: Hiatal Hernia, Gastroesophageal Reflux Disease (GERD), and Barrett’s Esophagus.

A Hiatal Hernia is a condition where the stomach pushes up into the chest cavity through the diaphragm. It can cause chest pain, trouble swallowing, and heartburn (GERD).

GERD (or “heartburn”) is a condition where the acid in the stomach shoots up into the esophagus, often causing burning and scaring of the lining of the esophagus. 

Barrett’s Esophagus is a condition where the lining of the esophagus changes and could become cancerous. It is caused by GERD. 

Hopefully with these definitions you can already see the problem we face with these three conditions. Each one causes the next. A hiatal hernia causes GERD, and GERD causes Barrett’s Esophagus. It can then be deduced that a hiatal hernia causes both GERD and Barrett’s Esophagus, so they are both just symptoms of the hiatal hernia. Only a single rating can be given in this case. A symptom can only be rated once, and a single rating for the hiatal hernia already encompasses all the symptoms of the other two.

Bert would only get one rating under code 7345, Hiatal Hernia. Three diagnosed conditions, but only one rating.

Monday, March 10, 2014

Pyramiding: The Dos and Don’ts of Combining Conditions

Trying to figure out what symptoms/conditions should be rated for military disability can be very complicated. In addition to the qualifications for each condition, there are also many principles that change how the rules of the VASRD are applied in different circumstance. 

One of these wonderful little principles is called “Pyramiding”. Trying to figure out exactly how this principle works in different circumstances can definitely make me feel like this guy.

Let’s start my explanation with a parable, of sorts. You are building a pyramid, and you have a single big block of stone that is the same size as all the other stones. It needs to be added to the pyramid. Now, you wouldn’t cut the stone in half and then put half of it on top of the other before adding it; it would no longer be the right size. Plus, each half of the stone is not a distinct and separate thing. They both make up the same big stone. You can even give them two different names, but they are still the same big stone. Similarly, you wouldn’t separate the symptoms of a single condition, give them two different names and then say that they are indeed distinct and separate. They are still the exact same condition. (Wow, this parable is a bit rocky, no pun intended, and I completely lost the valuable take-home message. Let’s see if I can do better.)

The basic rule of pyramiding is that you cannot rate a single symptom more than once. There are many different conditions that can cause the same symptoms. If you have two different conditions that cause the exact same symptoms, then only one of them can be rated. In cases like this, you’d pick the condition that gives you the higher rating. For example, if you have tendonitis in your elbow that limits how much you can move it, and you have a muscle condition that affects the muscles that move the elbow and also causes limited motion in the same elbow, then only one can be rated since they both cause the limited motion in the elbow. You don’t get two ratings—one for the muscle and one for the tendonitis—just one rating. Pick the condition that gives the highest rating.

Now the symptoms have the be the EXACT same for this rule to apply. If you have two back conditions, one causes pain down the arms, and the other causes pain down the legs, they can be rated separately since the symptoms are NOT the same. They affect two totally different areas of the body even though they are both back conditions. Make sense? Hope so, cause it’s about to get worse.

When there are many symptoms involved, and not all are shared, it gets a lot more complicated. Since you can’t rate the same symptom twice, you have to separate the shared ones. The easiest way to explain this is with an example. In this example, don't worry about the technical language: you don't need to understand what everything means to get the point of pyramiding.

There are two conditions:

An arteriovenous fistula is a condition where a new passageway is created between an artery and a vein. It causes the heart to work harder to get blood flowing. For this example, let’s say that it causes the following symptoms: swelling in the arms and right ventricular hypertrophy in the heart.

Chronic bronchitis is a condition where the bronchi in the lungs swell and restrict how much air the lungs can take in. Let’s say it causes an FEV-1 lung test measurement of 63%, a DLCO (SB) lung test measurement of 71%, and right ventricular hypertrophy.

Here’s the list of symptoms:

Fistula: right ventricular hypertrophy, arm swelling
Bronchitis: right ventricular hypertrophy, FEV-1 63%, DLCO (SB) 71%

Both conditions have some of their own unique symptoms, but they also share the most severe symptom: right ventricular hypertrophy. The hypertrophy can only be used for one of the conditions, whichever would benefit the most from it, meaning it would get a much higher rating.

So let’s look at the ratings for both conditions with their symptoms.

For the arteriovenous fistula, the condition with the hypertrophy would rate 60%. Without the hypertrophy, it would rate 20%. 

For the chronic bronchitis, it would rate 100% with the hypertrophy, and 30% without it.

A 100% rating is clearly much better than 60%, so in this case, the bronchitis would be rated 100% with the hypertrophy. The other condition can still be rated, but not with the hypertrophy, so it would be rated 20%.

Pyramiding can get very complicated, but take it step by step. Start by listing symptoms, and then see how the different conditions are rated. If they have their own symptoms, they can be rated separately.

Just remember: each symptom can only be rated once.

Monday, March 3, 2014

How Do You Rate Hypogammaglobulinemia for Military Disability?

Hypogammaglobulinemia (Really? Who thought of this name?! It’s basically the same as agammaglobulinemia, but that name’s not much better.) is a disease that affects the immune system.

The VASRD doesn’t have a Military Disability Rating for hypogammaglobulinemia, so we have the joy of trying to figure out how to rate it analogously. Yay. Some conditions are easy to rate analogously, but not this one.

The basic principle when rating conditions analogously is to choose the condition that is the most like your hypogammaglobulinemia. In other words, if your hypogammaglobulinemia has x, y, and z symptoms, then try to find another condition that has the same symptoms. If there is more than one condition that matches, choose the one that will have the same treatment as your hypogammaglobulinemia. If it requires infusions of IGG, pick a condition that also requires the same infusions.

Because there is so much room for interpretation when rating analogously, it is hard for us to tell you with any assurance exactly how the Rating Authorities will choose to rate your hypogammaglobulinemia. Ultimately, they have the power to interpret your condition and rate it however they think is best.

As it is, however, let’s discuss a few of the possible rating options for hypogammaglobulinemia.  Straight off there are two possible conditions that could be chosen since they also affect the immune system:

Lupus is a condition where the immune system attacks good cells. This condition is rated on how many episodes or attacks of this condition you have in a certain amount of time.

HIV is another condition that affects the immune system. In this case, the HIV attacks cells that are essential for the immune system to properly function.

While both of these are immune system conditions, they often do not have the same symptoms as hypogammaglobulinemia, and are rarely treated the same way hypogammaglobulinemia is treated.

These are also not the only options. If hypogammaglobulinemia caused heart damage, then rating it on a heart condition would probably be best. Similarly, if it causes damage to the lungs, then a lung condition would be best, etc. Remember, that if there are two possible codes that both could work, then the one that would give the highest rating is the one that should be chosen.

So how do you decide? This is when it gets a bit tough for the layman to figure out. It’s not easy to know exactly how various conditions are rated or their exact symptoms without a medical education. We’ve provided basic info, but you may need to do further research on your own to understand the specific details that would help you know how best to rate your condition.

Let’s say we’ve done that research for you for hypogammaglobulinemia. We’d like to present another condition besides Lupus and HIV that we feel would be the best way to rate hypogammaglobulinemia (your Rating Authorities, though, may not agree with us).

Agranulocytosis is a condition of the blood. While it is a blood condition, it does also affect the immune system by decreasing the number of white blood cells that help the immune system function. Like hypogammaglobulinemia, it is also treated with infusions of IGG.

How could you have known this or found this condition? I don’t really know. That’s why they have medical professionals decide the ratings since they are the ones most likely to know these specifics.

So what do you do? Do the best you can. Research. We try to give you the help you need, but if you get really stuck, you can always ask. We’ll try to help as much as possible.

If you've done your research and think your hypogammaglobulinemia condition was rated incorrectly, you can always submit an appeal to have your ratings reevaluated.