The Blog at Military Disability Made Easy

The Blog at Military Disability Made Easy: July 2014

Monday, July 14, 2014

Rating Dysautonomia for Military Disability

Dysautonomia is a group of conditions that affects the nerves that control the automatic functions of the body, like the beating of the heart and digestion. Depending on what functions the dysautonomia affects, it can cause any number of serious symptoms.

It can be very confusing to assign Dysautonomia a Military Disability Rating for Military Disability. The VASRD doesn't give a code for it, so it has to be rated analogously under another Nervous System Disease. All of the nervous system diseases are rated exactly the same, so it doesn’t really matter what condition the Rating Authorities choose. It will get the same rating regardless.

All nervous system diseases are rated on the Central Nervous Rating System, so Dysautonomia is as well. Basically, each symptom that the dysautonomia causes will be rated separately as long as it isn’t rated twice.

This is an important rule that must be followed: a single symptom cannot be rated twice! If a rating for one condition includes one or more of the other symptoms, then those other symptoms cannot be rated separately. They have already been rated, so rating them separately would be rating them twice.

For example, let’s say that the dysautonomia causes migraines, vomiting, nausea, chest pain, and tachycardia. Migraines are known to cause nausea and vomiting, so a rating for migraines already covers the nausea and vomiting. They would not get a separate rating. Similarly, tachycardia (a.k.a. Supraventricular Arrhythmia) also causes chest pain. So in this example, only the migraines and tachycardia would be rated.

Now, there may be some symptoms that could be caused by another condition but are clearly not directly related and so can be rated separately. Continuing the example above, if the nausea and vomiting only occur when there is a migraine, then they are definitely connected. If, however, the nausea and vomiting also occur when a migraine isn’t present, then they are not directly connected and can be rated separately. 

We’re not done yet. Two different conditions could also cause the same symptoms, but a single symptom can still only be rated once. So if two conditions cause the same symptom, then only one can use that symptom in its rating.

A new example: Let’s say that the dysautonomia causes sleep disorders, tachycardia, and fatigue. Fatigue is a symptom of both sleep disorders and tachycardia, so it can only be used in rating one of those conditions. Both sleep disorders and tachycardia can be rated separately, but fatigue can be used in rating only one.

I’m going to explain this in more detail, but the example I’m using is simplified to show the basic concept.  This is not how these conditions would actually be rated. Hopefully, however, this will help explain the main idea. So, if tachycardia would get a 50% rating with the fatigue and a 30% without the fatigue, and the sleep disorders would get 20% with the fatigue and 10% without the fatigue, then only one can use the fatigue in its rating. The Rating Authorities will choose the one that will give the highest combined rating. (A combined rating is the final rating you get after “adding” the ratings of the two conditions together using VA Math to get one overall rating.) In this case, the highest combined rating would come from using the fatigue with the tachycardia: a combined rating of 60%.

Now you have all the rules for rating the conditions and symptoms caused by dysautonomia. Any conditions and symptoms that are not covered by other conditions and symptoms can be rated separately.

Once you know what conditions can be rated, you can then Find Your Conditions on our site to see how they are rated. If you can't find the exact condition/symptom, it can be rated analogously on the next closest condition. After you have all the ratings for each condition/symptom, you then combine them using VA Math to get your overall rating for dysautonomia.

One final thing: the DoD and the VA work a little differently when rating conditions for disability compensation. While VA Disability is given for every condition/symptom, DoD Disability is given only for conditions that make you unfit to do your job in the military. This principle is extended to the different symptoms/conditions that are caused by dysautonomia. The DoD will only rate the symptoms/conditions that make you unfit. So if you have a symptom that doesn't really limit your ability to do your job, then they will not rate it. For example, you could have very mild joint pain in your knee that is annoying, but doesn't really limit you. It would not be rated. If, however, the pain is so severe that it won’t allow you to be deployed, then it will definitely be rated. 

Ultimately, it is impossible for me to say exactly how each case of dysautonomia will be rated, but the Rating Authorities who review the cases must follow the principles that I've discussed here. While these principles give a great deal of guidance, there is still quite a bit left up to interpretation. The final rating will ultimately be up to them.

The most important thing for you to do to ensure your dysautonomia is properly rated is to make sure that your physician records each and every symptom you have. If a symptom is not noted in your medical records, then it cannot and will not be rated. This is vital!

Similarly, it is important for you to know how your conditions/symptoms are rated so that you can make sure that your physician records the necessary information or tests that are needed to rate each condition. For example, range of motion measurements are necessary to properly rate any joint pain. Many doctors unfortunately do not know how things are rated, so if you know what tests are needed, you can make sure that your physician properly performs all tests and records all necessary information. This will make your entire disability process go more smoothly and quickly.

Dysautonomia is a tricky condition to rate, but just take it step-by-step.

Sunday, July 6, 2014

The Importance of “Service-Connection” for Military Disability

Service-connection is a really important concept for Military Disability. Both DoD Disability and VA Disability require all medical conditions to be service-connected in order to qualify for disability compensation.

Service-connection means that a condition is related to or directly caused by military service. The exact rules to determine this are different for the Reserves than for Active Duty.

For Active Duty, a condition is considered service-connected if it occurred or was first diagnosed any time while on active duty. It does not have to have occurred while actually performing your job requirements.

For example, Joe served on active duty from 2008 to 2012. In 2009, he was deployed to Iraq and developed hearing loss from exposure to explosions. In 2010, after returning from Iraq, he broke his ankle in a basketball game with some of his civilian friends on the weekend. Since Joe was on active duty, BOTH conditions are considered service-connected, even though one was not a direct result of performing his duties. As long as it occurs or was diagnosed while in the military, it’s service-connected and eligible for benefits.

For Reserves, a condition is considered service-connected only if it occurred while actively participating in military service. This is referred to as Line of Duty (LOD). The Reservist’s commander is the one who determines if a condition occurred while in the Line of Duty. As long as the commander correctly submits a Line of Duty determination form, the condition will be eligible for disability benefits.

So, if Joe was a Reservist instead of active duty, his hearing loss would be eligible for disability, but his broken ankle would not.

Now, the VA will give VA Disability Benefits for conditions that develop after a disabled American veteran leaves the military as long as it can be proven that the condition itself is service-connected, is on the VA Presumptive List, or that it was caused by another condition that is service-connected.

For example, if active-duty-Joe’s ankle condition never fully heals and causes knee pain a few years after he leaves the military, the VA will consider his knee pain as service-connected since it is definitely caused by a service-connected condition. It will be eligible for VA Disability.

Similarly, if Joe starts developing PTSD symptoms years after he leaves the military (a very normal occurrence), the VA will consider it service-connected since he clearly experienced traumatic events while deployed to Iraq (this will have to be proved). So even though it didn’t show up until much later, it is still service-connected.

If, however, Joe develops a skin condition on his ear after he leaves the military, the VA won’t consider it service-connected since there is no medical proof that links skin conditions to hearing loss. Definitely not service-connected.

So, service-connection must be proven for every condition in order for it to be eligible to receive disability compensation. No exceptions.