The Blog at Military Disability Made Easy

The Blog at Military Disability Made Easy: March 2015

Monday, March 30, 2015

How to Rate Conditions that aren't in the VASRD

Analogous Ratings are by far the most complicated area of rating conditions for Military Disability. I’ve blogged on this topic before, but I want to go a little more in depth because of how common and how important analogous ratings are.

So what is an analogous rating?

When the lawyers and doctors got together to create the VASRD, the regulation that determines exactly how conditions are rated, they realized that they had a literally impossible task. How was this group supposed to provide rating criteria for every single condition that a person could possibly get? There are hundreds of thousands, if not millions, of different ways in which the body can malfunction. To cover every single condition, the group would have needed many years and lots of coffee. Plus, the resulting VASRD would have been so massive and hard to use that it would have made the rating process even more complicated and lengthy.

Their solution to this epic conundrum was analogous ratings.

The Analogous Rating Principle basically states that a condition that is not included in the VASRD is to be rated “under a closely related disease or injury” that is in the VASRD. Basically, the condition should be rated under the condition in the VASRD that is as close to the actual condition as possible. While this seems simple, it can get pretty complicated in some cases, especially when there are numerous possible options to choose from.

There are a few important key ideas to consider when choosing the appropriate analogous code to rate a condition under. Try making a list as you answer these questions:
  • First, which conditions in the VASRD affect the same body functions as the original condition?
  • Second, which conditions in the VASRD have the same symptoms as the original condition?
  • Third, which conditions in the VASRD are caused by the same things as the original condition?
  • Finally, which conditions in the VASRD require the same treatments as the original condition? 

Anytime all three of these questions are easily answered by the same condition, the best analogous rating option should be obvious. Rarely, however, will all three questions be answered by the same condition. In these instances, best judgment must be used to determine which of the optional conditions is closest or best defines the overall disability of the original condition.

There are no right or wrong answers when it comes to analogous ratings. There are simply bad options, good options, and better options.

We’ve provided a list of the most common analogous ratings for many conditions on our Analogous and Equivalent Codes page. This list is simply the most commonly used option for a condition, not the ONLY option.

The Rating Authorities, who make the actual rating decisions, have the right to choose whatever analogous code they think best fits a condition. While they are supposed to follow the principles I’ve outlined, they have the authority to choose anything they want as long as the choice can be logically supported. Because of this, it’s impossible to predict exactly what analogous code the Rating Authorities will ultimately choose for a condition. We can probably come up with a very likely option, but ultimately, the choice is up to them.

Let’s walk through a simple example to better see how to apply the principles of choosing an analogous code discussed thus far.

Beth has chronic renal failure, a condition that is not in the VASRD. Her chronic renal failure was caused by exposure to a chemical and makes it so that her kidneys don’t filter her blood properly. Let’s answer the questions in order.

The first question, which conditions affect the same body function (in this case, the functioning of the kidney), would lead you to our list of Kidney Conditions that are in the VASRD.

Question 2: Which conditions have the same symptoms? Any condition that also causes the kidney to not filter blood properly will cause the same type of symptoms. Of the Kidney Conditions, nephritis, interstitial nephritis, nephrosclerosis, toxic nephropathy, glomerulonephritis, and renal amyloid disease all affect the kidney’s ability to filter blood.

Question 3: Which conditions have the same cause? This question allows us to weed out all but one of the conditions on the list. Since Beth’s condition was caused by chemical exposure, then toxic nephropathy becomes the only remaining option. (It looks like we have our analogous code, but let’s answer question 4, just to be thorough.)

Question 4: Which conditions require the same treatments? All conditions that affect the kidney’s ability to filter the blood will be treated very similarly, so this question in this case doesn’t really factor in. Toxic nephropathy is still the best option.

So, Beth’s chronic renal failure will be rated analogously as toxic nephropathy, code 7535. Note that this is a different code than the most common analogous code for chronic renal failure that we have listed on our Analogous and Equivalent Codes page. While nephritis is the most common condition to rate chronic renal failure under, in Beth’s case, because of her exposure to a chemical, the best code for her condition is toxic nephropathy.  

Believe it or not, Beth’s case was fairly straightforward. Let’s walk through another example that is a bit more complicated.

Bob has artery stenosis, a condition where an artery narrows, limiting or blocking the flow of blood through that artery. Bob’s stenosis is located in his vertebral arteries that lead from the heart to the brain. Let’s start with the questions:

Question 1: Which conditions in the VASRD affect the same body functions?

This is by far the most vital question for rating artery stenosis. Your first reaction might be, “It’s artery stenosis, so it would be rated on a code for the arteries. On The Arteries and Veins page, there is a section for Blood Flow Restrictions and Blocks. Stenosis blocks the flow of blood, so it must be rated on one of the codes in this section.” 

If you did think this, you’re reasoning is quite logical. But upon closer inspection, you might find that the four codes in this section are mostly for blood flow restrictions to the arms and legs, and that none have anything to do with the brain.

Question 2: Which conditions in the VASRD have the same symptoms?

Already, all of the conditions on our list are ruled out. None of the conditions in the Blood Flow Restrictions and Blocks section will have the same symptoms as blood flow restriction to the brain. What now?

Let’s think a bit more about the symptoms that would be caused by restricted blood flow to the brain. It’s really the brain, not the arteries, that will ultimately be affected by this condition. Less blood in the brain will ultimately lead to brain damage. So, since we haven’t found an artery code that would work, let’s head over to the Conditions of the Brain section on the Central Nervous System page to see if we can find any brain conditions that would be similar to Bob’s vertebral artery stenosis.

Question 3: Which conditions in the VASRD are caused by the same things as the original condition?

We are now ready to compare the brain conditions to Bob’s blood flow condition. If we read through all the different options here, we find that there are two conditions that deal directly with blood flow to the brain: Embolism of the blood vessels in the brain, and thrombosis of the blood vessels in the brain.

In both cases, the limited blood flow is caused by blood clots, not the case with Bob’s stenosis. However, the fact that the blood flow is limited to the brain, causing the same types of symptoms in all the conditions, makes the exact cause of the restricted blood flow unimportant.

We are now down to two possible analogous codes. In this case, it could easily be rated on either one, and it wouldn’t make a single difference, especially since the rating criteria is the same for both. The most commonly used code would be thrombosis of the blood vessels, code 8008, since this doesn’t include a traveling blood clot, but it really doesn’t matter in this instance. Either code would give Bob a fair rating.

Question 4: Which conditions in the VASRD require the same treatments?

This question is again not a factor in this case. Treatments are important only in certain situations. For example, if someone has a respiratory condition that is not asthma, but requires the use of an inhaler, then it could be rated as asthma since both require the same treatment. Treatments are the least important of the four questions in the majority of cases, but are always considered just in case it offers a better rating option.

Hopefully, I’ve given a better idea of how analogous codes are applied to conditions that are not included in the VASRD. It can definitely get complicated, especially with the more complex and rare conditions, but the system allows the flexibility necessary to provide fair ratings for all conditions, which is the ultimate goal.

Check out our Analogous and Equivalent Codes page for a list of the most common analogous codes. Remember, that these are not the only options for these conditions, just the most commonly used ones. The final choice is always up to the Rating Authorities.

Monday, March 9, 2015

When to Stop Fighting for Military Disability

I approach this topic today with great hesitance. The entire goal of is to teach vets how to fight better and more effectively for the Military Disability Benefits that they deserve. There is nothing more rewarding in this career than knowing that by helping a vet get their proper compensation, we’ve ensured a better future for them and their family.

But what happens when there is simply no chance? Is it wise or healthy to continue to fight a losing battle? The last thing I want to do is to deprive people of hope, but there are instances where fighting will only bring frustration, malcontent, and a very expensive lawyer who probably won’t succeed either.

Instead of putting yourself through that, it might be a healthier, wiser choice to accept the situation as it is.

Regardless, the choice is ultimately up to you. I do believe that change can be achieved by standing up for what you believe. But it may not be possible without a long, drawn out lawsuit. Is it worth the hassle? Maybe yes, maybe no. Only you can decide that.

All we can do is advise you on whether or not your fight will be successful against the laws as they currently stand. The following are various situations when it might be best to not pursue the fight.

1. No military medical records documenting the condition. Documentation is by far the most essential aspect of getting both DoD Disability and VA Disability. If you did not go to the doctor and have your condition recorded while you were IN THE MILITARY, there is no way to prove that your condition was caused by military service (i.e. “service-connected”), and thus it is not eligible for Military Disability. (This is an over-simplification of service-connection. See our website for other ways a condition can be considered service-connected. This is, however, the main rule that is fully applicable in the vast majority of cases.)

This is why we stress that it is essential to get all of your conditions documented before you leave the military. We have seen far too many cases where people didn’t think it was serious enough, or didn’t want to complain, or didn’t want to be viewed as weak or a wimp, etc. Then, down the road, after they leave the military, the mild knee pain that they had worsens until they have to have a knee replacement. They know that the original knee pain began after twisting the knee in an exercise while in the military, so they think that they will qualify for disability. Wrong. They have NO PROOF that the knee pain started while in the military since it wasn’t documented by a physician. No proof = no compensation.

If you do not have proof, it is a complete waste of time to try to get disability compensation. It sucks for those of you who are honestly caught in this snag, since this rule is designed to keep the liars and cheaters from abusing the system, but it’s the just the way it is. Sorry. No amount of begging or story telling will change their minds. They legally MUST have solid proof.

2. You believe you deserve more even though you are getting the right amount the law dictates.

All right now, guys. Let’s chat about this. The VASRD is the law that determines the exact rating each condition should receive. The VASRD is far from perfect. There are many things that don’t really make sense or seem unfair.

For example, hearing loss is rated on how bad your hearing is without a hearing aid. Vision loss, however, is rated on how bad your vision is WITH glasses. How is that fair? If someone with glasses sees perfectly fine, they will get a 0% rating, even if they would have received a 30% rating without glasses. At the same time, someone with a hearing aid might hear perfectly fine, but still gets 30%. In my opinion, both should either get a rating based on the severity with a corrective device or both should be rated based on the severity without a corrective device.

Regardless of my personal opinions, however, that’s the law, and so that is what must be followed. “But the law's unfair!” you might exclaim. Yes, absolutely. You’ll get no argument from me.

But there is nothing you can do about it unless you want to wage a legal war against the system to get the laws changed. If you do, go for it! I’m all for making the laws more fair. If you want to fight that battle, kudos!

Most vets, however, don’t have the resources available for this epic undertaking. Submitting appeal after appeal won’t get them anywhere. The law is the law. There are still options, however, for these individuals.

Currently, the VASRD is being entirely rewritten with the new updates being released section by section throughout 2015 and 2016. When each section is ready for review, they accept comments about the suggested changes before finalizing them. SUBMIT COMMENTS! Now is the time for us to let our voices be heard and make changes happen without having to wage war. As each section is published, we’ll post a full article about it here with info on how to submit comments.

If you don’t bother to do this, then it’s a huge waste of time to submit appeals. The laws won’t change that way.

3. You are not properly educated. If you are not properly educated about the disability system, just quit right now. There is no point. The majority of denied claims and appeals are the result of the veteran being ignorant about the system and thus asking for the wrong things.

When I worked on the PDBR, time and again I would see vets making foolish claims simply because they were clueless. If you insist on remaining this guy, just quit now. Your efforts are completely worthless.

“But it’s complicated, and people keep telling me different things.” Yep, I totally get that. It was in response to these clueless veterans’ claims that I assembled my team to create The majority of clueless vets are completely innocent. They are just not able to find the information they need in a thorough and understandable format.

With our website at your fingertips, though, you no longer have this excuse. We’ve provided information on practically every aspect of Military Disability, from the Medical Evaluation Board (MEB) to the exact ratings for asthma, and continue to further improve and expand the information to help you guys know exactly how things work, what you rightly deserve, and how to get it.

There is a lot of information, and it will take time, but with the info readily available to you, if you insist on remaining uneducated, then just quit now.

Monday, March 2, 2015

Proposed Changes to the Ratings for the Female Reproductive System Are Now Open to Comments

Last Friday, the 27th, Congress published their proposed changes to the Military Disability Ratings for the Female Reproductive System. The entire VASRD is currently being updated and rewritten, one section at a time, in order to update the criteria to current medical standards and to provide better, more accurate and fair compensation. The rewrites are scheduled to be completed sometime in 2016. The Female Reproductive System is the second section posted so far. The Mental Disorders section was updated in August 2014.

Comments are currently being accepted regarding the proposed changes to the Female Reproductive System. The deadline for submitting comments is April 28, 2015. We will be compiling and submitting comments on your behalf, so if you would like for your voice to be heard, please comment on this blog or Contact Us directly through our site before April 15, 2015. This is a great opportunity for us to make positive changes for the future, so please share your thoughts with us, especially you female veterans who deserve proper compensation for your conditions.

After April 28th, the rule makers will review all of the comments and determine if any additional changes should be made based on the arguments received. They will then post the final version of the new ratings for the Female Reproductive System, along with an official date for the new ratings to take affect. Once the changes are official, we’ll get that info to you as soon as possible. 

Below are the proposed changes. Not every condition/code has been changed, so if it is not listed below, then it will remain the same and can be found on our current Female Reproductive System page. I’ve started by listing the current code as it is right now. The proposed changes to each code are discussed directly after.

Code 7610: Diseases or injuries of the vulva (the part of the female genitals that are on the outside of the body).

The proposed change to code 7610 is super simple: to specify that this code includes the clitoris. The clitoris is already a part of the vulva, and all clitoris conditions should already be rated here, but I guess some people have been getting all confused. Thus the word “clitoris” is being specifically added in addition to “vulva” to get rid of any confusion. The ratings stay the same.

Code 7615: Diseases, injuries or adhesions of the ovaries.

The only change to this code will be a note specifying that dysmenorrhea (severe pain during menstruation) or secondary amenorrhea (the normal menstrual cycle is interrupted and menstruation stops completely for at least 6 months) caused by any of these problems with the ovaries will be rated under this code. The ratings stay the same.

Code 7619: the removal of one or both ovaries is rated 100% for the first 3 months after surgery. After that period, the complete removal of both ovaries is rated 30%. Anything less than the complete removal of both ovaries is rated 0%.

The change to this code is pretty awesome and too long in coming, if I say so myself. The change was made in order to make the female ratings for loss of the ovaries equal with the male ratings for loss of the testicles. It was acknowledged that the risk of future health problems due to the loss of the ovaries is just as severe as the risk of future health problems for men, so the ratings should be comparable. The new code with the changes will read as follows:

Code 7619: the removal of one or both ovaries is rated 100% for the first 3 months after surgery. After that period, the complete removal of both ovaries is rated 30%. A 30% rating is also given if a single service-connected ovary is removed and the other ovary has also been removed or doesn’t function at all, even if the problems with the second ovary are not related to service. Anything less than the complete removal or loss of use of both ovaries is rated 0%.

Code 7621: If the uterus slips down completely through the vagina, then it is rated 50%. If it slips down only partially through the vagina, then it is rated 30%.
Code 7622: If the uterus does not slip down, but is significantly out of place, then it is rated under this code. If the displacement causes constant or frequent problems with menstrual periods, then it is rated 30%. If the displacement causes adhesions (scar tissue that causes the organs to stick together), and the menstrual periods are irregular, then it is rated 10%.
Code 7623: If pregnancy causes the wall between the vagina and the rectum to tear, resulting in a rectocele (the rectum bulges into the vagina), or if it causes the wall between the bladder and the vagina to tear, resulting in a cystocele (the bladder bulges into the vagina), it is rated 50%. If the pregnancy causes the vagina to be loose or gaping, then it is rated 10%.

All three of these codes deal with the same basic thing: at least one of the pelvic organs (uterus, bladder, or rectum) is out of place and bulging into the vagina. Because of this, they are combining all three codes into a single code. Code 7622 and 7623 will not longer exist, and code 7621 will be changed as follows:

Code 7621: If any of the pelvic organs (the uterus, bladder, or rectum) are prolapsed (out of place) because of a disease, injury, or complications of pregnancy, it is rated under this code. This includes tears and bulges into the uterus or vagina, cystocele (the bladder bulges into the vagina), urethrocele (the urethra bulges into the vagina), rectocele (the rectum bulges into the vagina), enterocele (the small intestines and peritoneum bulge into the vagina), a perineal deficiency (the perineal muscles bulge into the vagina), or any combination. The ratings are based on how far the prolapsed organ protrudes into the vagina.

The severity of the prolapse is determined during examination by the Pelvic Organ Prolapse (POP) classification system as severe, moderate, or mild.

A 50% rating is given for a severe POP score where the prolapsed organ protrudes to within 2 cm of the vaginal opening.

A 30% rating is given for a moderate POP score where the prolapsed organ protrudes more than 1 cm past the hymen, but is more than 2 cm from the vaginal opening.

A 10% rating is given for a mild POP score where the prolapsed organ is within 1 cm below the hymen to 1 cm past the hymen.

Code 7627: Cancer of the female organs and breasts that is active is rated 100%. This 100% will continue for the first 6 months after the last treatment. The condition will then be reevaluated. If it is no longer active, then it will be rated on any lasting symptoms just like any benign condition.
Code 7628: Benign tumors of the female organs and breasts are rated based on how they affect the systems around them….

Both of these codes consider breast cancer to be a female-only condition, but men can also get breast cancer. To fix this, codes 7627 and 7628 will only be for cancer and tumors of the female organs (not including the breasts).

Two new codes, 7630 and 7631, will be added for all breast cancer, male or female:

Code 7630: Cancer of the breasts that is active is rated 100%. This 100% will continue for the first 6 months after the last treatment. The condition will then be reevaluated. If it is no longer active, then it will be rated on any lasting symptoms just like any benign condition.

Code 7631: Tumors and other injuries of the breast are rated based on any remaining symptoms or on how they affect the systems around them. This includes scars, disfigurement, muscle loss, nerve damage, and any other complications.

I want to draw your attention to the fact that code 7631 not only includes benign tumors, but also any and all other injuries of the breast, like blast-trauma, or any complications to other parts of the body due to breast surgery. These codes will NOT replace code 7626 for removal of the breast.

Another new code is also being proposed to get female ratings more in line with the male ratings:

Code 7632: Female sexual arousal disorder (FSAD) is the inability get and stay aroused during sex. It is rated 0% unless there is physical damage to the genitals, in which case, it is rated under the codes for damaged parts. FSAD may be entitled to additional compensation under Special Monthly Compensation K.

These are all of the proposed changes to the Female Reproductive System. Again, let us know your thoughts, and we’ll send in a report with suggested changes to the committee. We’ll also let you know when all the changes are finalized and in effect.