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