The Blog at Military Disability Made Easy

The Blog at Military Disability Made Easy: August 2014

Monday, August 25, 2014

Changes in Mental Disorders for Military Disability

Congress changed the Mental Disorders section of the VASRD on August 4, 2014.

The VA has always used the Diagnostic and Statistical Manual of Mental Disorders (DSM) as reference, and recently the manual’s newest edition, the 5th edition, was published.

In the 5th edition, many of the terms used to describe mental disorders have been changed to reflect the most commonly accepted terms used today in medicine. These changes are meant to present “the most current classification of mental disorders with associated criteria designed to facilitate more reliable diagnosis of these disorders.”

The legislation stated, “VHA clinicians, as well as all mental health providers, have a professional duty as licensed medical practitioners to use the most current medical guidelines, in this case DSM-5. In addition, the Institute of Medicine has encouraged VBA to review the VASRD to ensure that it relies on current medical science.”

To stay true to this manual, the VA updated all their terms in the VASRD to reflect the new terms in the 5th edition. For example, “somatization disorder” is now “somatic symptom disorder”.

Additionally, the VA also removed the mental disorder category titles, like “Anxiety Disorders”, “Psychotic Disorders”, etc., from the VASRD. Not exactly sure why. They are rather useful. Because of this, we’ve chosen to keep them on our site just because of how much easier they make it to find specific conditions. 

With the re-namings and such, the VA also had to change some of the VASRD Codes.

Finally, DSM-5 has officially gotten rid of the Global Assessment of Functioning (GAF) scores. These have never had a huge impact on rating mental disorders, so this really doesn’t change anything, but now they will no longer be used at all.

So, what does all this mean? Basically, some of the mental disorder codes and names of conditions have changed, but the Military Disability Ratings for mental disorders have NOT. So, although the name the condition may have changed, the rating for it has not changed.

How does this affect you? If you already had your ratings before August 4th, this does not affect you one bit. Your codes, names, ratings, etc., will not change at all. If your VA Rating Decision was not made or your PEB Process was not completed before August 4th, then once your ratings are decided, they will automatically reflect these new changes.

Here is a list of all the Mental Disorder codes and how they’ve changed. If a code was deleted or seriously altered, we’ve also included instructions on how those conditions will now be coded.

You can click on the code number to take you to our explanation of the code on our site.

Code 9440: Chronic Adjustment Disorder has not changed.

Code 9416: They got rid of “fugue” and changed the condition name to “Dissociative amnesia and dissociative identity disorder”. Fugue is still rated under this code, however. They just took it out of the title.

Code 9417: Derealization disorders were added in addition to Depersonalization disorders. All derealization disorders are now rated under this code as well.

Code 9421: The title was changed from “somatization disorder” to “somatic symptom disorder”. Somatization disorder is still rated here, they just call it something different.

Code 9422: Was changed from Pain Disorder to any somatic condition that has a definite title, like Pain Disorder, but isn’t officially diagnosed as somatic symptom disorder.

Code 9423: This is pretty much the same as before, but they changed the wording to mean any other somatic condition that is not rated under code 9421 or 9422.

Code 9424: “Functional neurological symptom disorder” was added to the title just to further define it. Doesn’t change anything.

Code 9425: The term “hypochondriasis disorder” was changed to “illness anxiety disorder”. All hypochondriasis is still rated here.

Code 9431: Cyclothymic disorder has not changed.

Code 9432: Bipolar disorder has not changed.

Code 9433: Dysthymic disorder is now called “persistent depressive disorder”. Dysthymic disorder is still rated here.

Code 9434: Major depressive disorder has not changed.

Code 9435: All “other mood disorders” are still rated here, but they changed the word “mood” to “depressive”.

Code 9201: This code was changed to be the single code for all Schizophrenia conditions.

Codes 9202-9205: All these were types of schizophrenia. These codes have been permanently deleted. Now all schizophrenia is rated under code 9201.

Code 9208: Delusional disorder has not changed.

Code 9211: Schizoaffective disorder has not changed.

Code 9210: “Unspecified schizophrenic disorders” was added in addition to “all other psychotic disorders”. It’s basically the exact same thing. Anything that doesn’t fit under another psychotic code goes here.

Code 9300: Delirium has not changed.

Codes 9301-9310, 9312 and 9326: All these codes previously used the term “dementia”. This has been changed to “neurocognitive disorders” to make sure that the code is not just limited to dementia. Dementia is, however, still rated under these codes.

Code 9327: Organic mental disorders was deleted. All of these are now included under the term “neurocognitive disorders” and can be rated under one of the previous codes.

Code 9400: Generalized anxiety disorder has not changed.

Code 9403: “Social anxiety disorder (social phobia)” was added to this code for all phobias.

Code 9404: Obsessive-compulsive disorder has not changed.

Code 9412: Panic disorder and agoraphobia has not changed.

Code 9410: This was changed to “all other specific anxiety disorders” to differentiate it from the new 9413. All other anxiety disorders that have definite titles can be rated here.

Code 9413: This code used to be “neurosis” but is now all other unspecific anxiety disorders. So if the anxiety disorder does not have a definite title, it is rated here. All neuroses are now rated either under code 9410 or 9413.

Code 9411: Post-traumatic stress disorder. The code and name have not changed, but DSM-5 did change how PTSD is diagnosed. The basic idea is that the previous requirements for diagnosing PTSD were too restrictive. The new requirements should now allow more veterans to be officially diagnosed with PTSD. For full details, see our PTSD page.

That’s it. Remember that the ratings for all Mental Disorders have not changed. So even if your code changed, your Military Disability Rating will not.

All these changes are now on our Mental Disorders page, and the discussion on all the Mental Disorders before these changes has been moved to the Historic VASRDs page.

Monday, August 18, 2014

"Aid and Attendance" for Military Disability

The term “Aid and Attendance” is used in VA Disability to describe Disabled American Veterans who require the regular care given by another person. The caregiver does not have to be a professional to qualify. Aid and Attendance can be given by family, friends, etc. The caregiver also does not have to be with the veteran constantly, just regularly to help with specific tasks.

To qualify for Aid and Attendance, one of the following must apply:
  • The person must need assistance every day to dress, wash himself, eat, use the restroom, adjust prosthetic devices, etc.
  • The person’s disability must require the regular care of another person to prevent harm of self or others.
  • The person must have to ALWAYS and permanently be in bed, not just on bed-rest for a period of time.

A person does NOT qualify for Aid and Attendance if he is in a care institution or hospital. This is because there are other laws in place that cover people in official care facilities. Aid and Attendance is only for home care.

Aid and Attendance comes into play for VA Disability in two ways. First, if a veteran has extra severe disabilities that require Aid and Attendance, he may be able to receive the Aid and Attendance category of Special Monthly Compensation. Second, additional compensation is given to veterans if their spouse requires Aid and Attendance. See our VA Disability Chart page for complete details.

Monday, August 4, 2014

Rating Musculoskeletal System Conditions for Military Disability

The Musculoskeletal System is vast and complex. It is made up of every bone, joint, muscle, tendon, ligament, and soft tissue in the body. Because of this, a lot of things can go wrong.

Assigning Military Disability Ratings to conditions of the musculoskeletal system for Military Disability, however, is pretty simple as long as you understand the rules of the VASRD, the law that determines how conditions are rated for DoD Disability and VA Disability.

We cover everything on our site, but to make it a bit easier, here is a quick breakdown:

Limited motion of a joint is the most common musculoskeletal rating BY FAR. If any condition, no matter what it is, causes a joint to have less motion than normal, that condition will be rated on limited motion most of the time. There are a few exceptions that are clearly noted on our site, but just always think limited motion first, and you’ll be right the majority of the time.

All the information on rating amputations can be found on our Amputations page.

All the information on rating cancer and tumors can be found on our Cancer and Tumors of the Musculoskeletal System page.

Diseases: Each disease is rated a bit differently, but all can be found on our Diseases of the Musculoskeletal System page. Do note that many of these diseases, especially Degenerative Arthritis, are always rated on limited motion of the joint that is affected unless there is no limited motion.

We’ve divided the ratings for the bones, joints and tendons into pages for each body part:

           The Foot
           The Ankle
           The Knee and Lower Leg
           The Hip and Thigh
           The Spine
           The Ribs
           The Shoulder and Arm
           The Elbow and Forearm
           The Wrist
           The Hand
           The Skull

Each joint can be rated separately unless specifically noted. This means that if you have a knee condition that later causes you to also have an ankle condition, both the ankle and the knee can be rated separately.

Surgeries: Joint replacements have their own ratings on the various body part pages. Surgeries for tendons or ligaments, however, do not have their own ratings. They are rated on limited motion of the affected joint. For example, the VASRD does not have a code for an ACL tear. The ACL is a ligament in the knee, and an ACL tear is most commonly treated by surgery. This condition is rated on the motion that remains in the knee after the surgery. Is there too much motion? Limited motion? All ligament or tendon conditions are rated on the main joint that they affect.

The muscles are all divided into different groups that control the various parts of the body:

           The Facial Muscles
           The Torso and Neck Muscles
           The Diaphragm

All muscle conditions are either rated on the limited motion of the affected body part or on the Slight to Severe scale, whichever gives the higher rating. So if you have a muscle condition in your thigh that limits the motion of your knee, then check both the muscle rating under the Slight to Severe scale and limited motion of the knee to find which gives you a higher rating.

It is very rare to get a rating for the muscles and a rating for the related joint, but it is possible in more extreme or special cases. It is all up to the Rating Authorities, however, so it’s impossible for me to say definitively one way or the other. Normally just one rating under either limited motion of the joint or the Slight to Severe scale, not both.

All the information on rating muscle hernias can be found on our Muscle Hernias page.

That’s it. If you are unable to find your musculoskeletal condition, it will be rated analogously under the condition that is closest to it, but it’s never a bad idea to think limited motion first.