tag:blogger.com,1999:blog-41620416410309313792024-03-13T08:06:27.463-07:00The Blog at Military Disability Made EasyThe Blog at Military Disability Made EasyMDMEhttp://www.blogger.com/profile/08807695915566004972noreply@blogger.comBlogger106125tag:blogger.com,1999:blog-4162041641030931379.post-7694565718134086912022-09-19T17:25:00.002-07:002022-09-19T17:25:59.208-07:00What does my VA Disability Rating mean? <p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBUyU45KeGkdYKDDm3-Kv_dv2t-iZchFbAb2AP0OnD3b2N68SGqaVSBa7OqMnOpjORPXsZPl1g6UfwftgdYwvlcQucvW19IloSxVS5nCk_bdmonGhJi7GhJlf4RoiY6VkCmJi4qo9l1lMD_QCRysRpFuegOxHM95eGKdsxZE_vLpXc6jACMBSBrk4L/s459/va-disability-ratings.gif" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="459" data-original-width="459" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBUyU45KeGkdYKDDm3-Kv_dv2t-iZchFbAb2AP0OnD3b2N68SGqaVSBa7OqMnOpjORPXsZPl1g6UfwftgdYwvlcQucvW19IloSxVS5nCk_bdmonGhJi7GhJlf4RoiY6VkCmJi4qo9l1lMD_QCRysRpFuegOxHM95eGKdsxZE_vLpXc6jACMBSBrk4L/s320/va-disability-ratings.gif" width="320" /></a></div><span style="font-family: Calibri, sans-serif;"><a href="https://militarydisabilitymadeeasy.com/va-disability-rating.html" target="_blank">VA Disability Ratings</a> can be confusing and complex.</span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;"> <br /></span><p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">After submitting your <a href="https://militarydisabilitymadeeasy.com/va-disability-claim.html" target="_blank">VA Disability Claim</a> and waiting months for the results, you get your <a href="https://militarydisabilitymadeeasy.com/vadisabilityprocess.html#decision" target="_blank">Rating Decision</a> only to find different ratings for each of your conditions and a <a href="https://militarydisabilitymadeeasy.com/va-disability-rating.html#total" target="_blank">Total Combined Rating</a> that doesn’t seem to relate to the other ratings at all. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">So what do these VA Disability Ratings really mean? Let’s break it down by first discussing what VA Disability Ratings are, then we’ll discuss the individual condition ratings, followed by the Total Combined Rating, and finish with how the ratings translate into VA Disability Benefits. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><b>What are VA Disability Ratings?</b><o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">VA Disability Ratings are percentages assigned to each <a href="https://militarydisabilitymadeeasy.com/service-connection.html" target="_blank">service-connected</a> condition claimed for<a href="https://militarydisabilitymadeeasy.com/va-disability.html" target="_blank"> VA Disability</a>. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">The percentage is intended to reflect the severity of the condition—how significantly the condition interferes with the veteran’s ability to work, function in daily life, etc. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">A 0% rating indicates that the condition affects the veteran’s functioning very little if at all. The VA Disability Ratings then increase in 10% increments (10%, 20%, 30%, etc.) until they reach 100%. A 100% rating means that the condition makes the veteran entirely unable to work or properly care for themselves. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">VA Disability Ratings are determined by the Veterans Affairs Schedule for Rating Disabilities (the <a href="https://militarydisabilitymadeeasy.com/vasrd.html" target="_blank">VASRD</a>), a federal regulation that assigns detailed requirements for the rating levels for each condition based on how the condition presumably limits your earning capacity.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">After you submit your claim, the VA adjudicator will use the VASRD and the information from the medical records and other evidence you submitted to assign each of your service-connected conditions a VA Disability Rating. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><b>VA Disability Ratings for Conditions</b><o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">VA Disability Ratings are given for every <a href="https://militarydisabilitymadeeasy.com/service-connection.html" target="_blank">service-connected</a> condition you have. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">After determining which of the conditions on your claim qualify as service-connected, the VA adjudicator will assign a rating based on the rules of the <a href="https://militarydisabilitymadeeasy.com/vasrd.html" target="_blank">VASRD</a>. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Every condition will receive its own rating as long as the <a href="https://militarydisabilitymadeeasy.com/vasrd-principles.html#pyram" target="_blank">Pyramiding Principle</a> is obeyed. The Pyramiding Principle states that no disability can be rated more than once, so if two different conditions cause the same symptoms, then they cannot be rated separately. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">The VASRD has various other circumstantial rules that limit whether conditions can be rated separately as well as a few exceptions to the Pyramiding Principle. These can all be found throughout our discussion of the ratings for each condition on our <a href="https://militarydisabilitymadeeasy.com" target="_blank">site</a>. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">When deciding the VA Disability Rating for a condition, the adjudicator will compare the details of your condition found in the evidence you submit along with your claim to the rating requirements for that condition.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Every condition is rated differently. Some are rated on current symptoms, others on symptoms over time, others on treatments, others on current test results, etc. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">When preparing your claim, it is very important that you get and submit the exact evidence necessary to properly rate your conditions. If you submit test results for a condition, but that condition is actually rated on a different test, then it isn’t going to be rated correctly.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">You can <a href="https://militarydisabilitymadeeasy.com/search.html" target="_blank">Find Your Condition</a> on our site to see the current rating requirements for your condition. Once you understand how it is rated, you will be able to ensure that the correct evidence needed to rate your condition is submitted along with your claim. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Once you receive your Rating Decision, you will find a list of your conditions, their service-connected status, and the ratings the VA adjudicator assigned for each one. If you disagree with any of the decisions, you can <a href="https://militarydisabilitymadeeasy.com/va-appeals.html" target="_blank">submit an appeal</a>. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">VA Disability Ratings can change over time, so if your conditions worsen and now qualify for higher ratings, you can apply for an increased evaluation. The VA will also call you in for periodic examinations to track the progress of your conditions and may adjust your ratings accordingly if your conditions have changed. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">You now understand the individual VA Disability Ratings, but there is one more percentage on your Rating Decision that you need to understand: the Total Combined Rating. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><b>What is the Total Combined Rating?</b><o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">After each of your <a href="https://militarydisabilitymadeeasy.com/service-connection.html" target="_blank">service-connected</a> conditions are assigned a VA Disability Rating, the ratings are combined using VA Math to get the <a href="https://militarydisabilitymadeeasy.com/va-disability-rating.html#total" target="_blank">Total Combined Rating</a>. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">VA Math is rather confusing, so check out our <a href="https://militarydisabilitymadeeasy.com/va-math.html" target="_blank">VA Math page</a> to get a full understanding of how it works. Just know that the ratings are not added together, they are combined. Thus 30% combined with 30% does not equal 60%, but 50%.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">The Total Combined Rating is used to determine the amount of monthly benefits you will receive. You can find all of the current amounts for each Total Combined Rating in our <a href="https://militarydisabilitymadeeasy.com/va-disability-chart.html#chart" target="_blank">VA Disability Chart</a>. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><b>What benefits will I receive for my VA Disability Rating?</b><o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">The VA pays monthly benefits based on your <a href="https://militarydisabilitymadeeasy.com/va-disability-rating.html#total" target="_blank">Total Combined Rating</a>.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">For a 10% and 20% rating, there is a set monthly amount you will receive regardless of how many dependents you have. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">For a 30%-100% rating, the amount changes based on the number of dependents you have. For example, currently a 30% with no dependents receives $467.39. With one child, however, the amount increases to $504.39.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">You can find all of the current rates on our <a href="https://militarydisabilitymadeeasy.com/va-disability-chart.html#chart" target="_blank">VA Disability Chart</a>. </p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">In addition to the monthly payment, each of your rated conditions is eligible for full medical care from the VA. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">But what if your condition will only be rated 0%? Should you even bother to submit a claim?<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">If you have a Total Combined Rating of 0%, then you will not receive a monthly payment. A 0% rating does, however, mean that the VA acknowledges that the condition is <a href="https://militarydisabilitymadeeasy.com/service-connection.html" target="_blank">service-connected</a>, and as long as a condition is service-connected, it will qualify for medical care. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">So even without a monthly payment, a 0% rating is far better than no rating at all. With it, the condition will receive full medical care, and it will be simpler for the VA to increase the rating if your condition worsens in the future. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">In the end, our advice is to always <a href="https://militarydisabilitymadeeasy.com/va-disability-claim.html" target="_blank">claim your conditions</a>, even if you know they will only rate 0% right now. It’ll make life much easier in the future. <br /> <o:p></o:p></p>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com0tag:blogger.com,1999:blog-4162041641030931379.post-77085661683914512292022-07-15T05:49:00.003-07:002022-07-15T05:53:10.506-07:00VSOs vs. Claims Agents vs. Attorneys - Getting Help with Your VA Disability Claim<p><span style="font-family: Calibri, sans-serif;"></span></p><div class="separator" style="clear: both; text-align: right;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd_b7y9rItyjsajmqDRPtww5_4mFSW2_sxks0AkEa9OtbLtmOWSDaI8j9kUovMjXKKEXQp_K3rAFbGhCr5gcuSe866J6U-OHbtidQPP3bZBx4SW7RBnw-9EFvq7F7hf0MnIcdnTTMtBrXzosbI_MisyO5gSltnUNkYaWY0xNUkD_e-QuAF2tzrR104/s640/vso.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="404" data-original-width="640" height="202" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd_b7y9rItyjsajmqDRPtww5_4mFSW2_sxks0AkEa9OtbLtmOWSDaI8j9kUovMjXKKEXQp_K3rAFbGhCr5gcuSe866J6U-OHbtidQPP3bZBx4SW7RBnw-9EFvq7F7hf0MnIcdnTTMtBrXzosbI_MisyO5gSltnUNkYaWY0xNUkD_e-QuAF2tzrR104/s320/vso.png" width="320" /></a></div>The purpose of <a href="http://www.militarydisabilitymadeeasy.com" target="_blank">Military Disability Made Easy</a> is to give you all the knowledge and tools you need to successfully submit and <a href="https://militarydisabilitymadeeasy.com/va-appeals.html" target="_blank">appeal</a> your <a href="https://militarydisabilitymadeeasy.com/va-disability-claim.html" target="_blank">VA Disability Claim</a> yourself.<span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;"> </span><p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">However, we understand that sometimes your case may be extra complicated or you may feel like you simply do not have the time to research and prepare the claim or appeal alone. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">In these cases, there are qualified people you can turn to that can help you submit your claim or appeal. These are claims agents, veteran service officers (VSOs), and attorneys. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">But of all the options out there, how do you know which are legitimate and which are the best for your particular case? <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Here are things you can do to ensure that your case is in good hands.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><b>1. Check for VA Accreditation<o:p></o:p></b></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">First and foremost, if someone is helping you submit your claim or appeal, then they are acting as your representative before the VA, and in order to legally do this, they must be accredited by the VA. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">To be accredited, the individual must pass an exam and a background check, and take regular continuing-education courses to keep up to date on the latest from the VA. All accredited representatives agree to abide by standards of conduct that ensure that they act honestly, diligently, legally, and competently in all their dealings with both the veteran and the VA.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Accredited individuals fall into three categories: VSOs, claims agents, and attorneys. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><b>2. Decide Between a VSO, Claims Agent, or Attorney<o:p></o:p></b></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">So how do you know which one is right for the job? <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Let’s discuss the difference between VSOs, claims agents, and attorneys. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;">VSOs<o:p></o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><b>Veterans Service Officers</b> (VSOs, a.k.a. “veterans service representatives”) are individuals employed by a government office (like a county or state office) or by a Veterans Service Organization (also called a “VSO”—we know, not at all confusing). <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Veterans Service Organizations are non-profits authorized by the VA to employ VSOs to assist veterans with their claims. Not all Veterans Service Organizations can help with claims, but many can, including AMVETS, the DAV, The American Legion, VFW, Vietnam Veterans of America, Paralyzed Veterans of America, and more. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Since VSOs are employed by an entity, they represent veterans for free and cannot charge for any of their services, which means that they can assist on all types of claims, from initial claims to advanced appeals. This also means, though, that they often have too many cases and not enough time. It’s most common for VSOs to work primarily on initial claims and basic appeals.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;">Claims Agents<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><b>Claims agents</b> are basically VSOs, but they function independently and are not usually associated with an authorized organization. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Since they are not employed by an organization, they usually charge a fee for their services. This means that claims agents can choose to take on smaller case-loads and spend more focused time on each case.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">The VA does not allow anyone to charge for services provided before an initial claim is processed (we’ll discuss this more below), so claims agents usually only assist veterans with appeals, supplemental claims, etc., though they can choose to take on initial claims pro bono if they want to.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;">Attorneys<o:p></o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><b>Attorneys</b> can provide similar service as claims agents and VSOs, but usually specialize in appeals and other higher-level dealings before the VA, the Board of Veterans Appeals (BVA), or other US Courts. Like claims agents, they also charge a fee, and so do not usually work on initial claims. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Because of their legal expertise, attorneys are the best option when trying to fight a complicated case or get a decision made that is contrary to the current laws/regulations. If you are appealing to courts beyond the BVA, it’s often a good idea to have an attorney.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Unlike VSOs and claims agents, attorneys do not have to take an examination to be accredited by the VA, but they do have to show that they are in good standing with their State bar. Because of this, it is important to make sure your attorney has sufficient experience working in veterans disability law to ensure your claim is satisfactorily represented by someone versed in these complicated laws. <o:p></o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><b>3. Find a Representative<o:p></o:p></b></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Once you know whether you are looking for a VSO, claims agent, or attorney, you can search in the VA’s database of Accredited Representatives. It can be accessed through <a href="https://www.va.gov/ogc/apps/accreditation/index.asp" target="_blank">VA.gov</a> or <a href="https://www.ebenefits.va.gov/ebenefits/vso-search" target="_blank">eBenefits</a>. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">It’s ideal to find someone who practices within your Regional VA district so they can more easily assist you with local services (transportation to appointments, etc.), but location is not a requirement for representation. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Depending on the demand in your area, you may need to contact multiple representatives until you find one that has the time to take on your case and has sufficient experience with the similar cases.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><b>4. Sign a Fee Agreement<o:p></o:p></b></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Accredited representatives cannot charge you for any services they provide before your initial claim is decided. They can only charge a fee for services provided (notice of disagreements, appeals, supplemental claims, etc.) after the VA makes a decision on your initial claim. Because of this, VSOs are usually the only representatives to help with an initial claim since they will get paid their salary from their organization regardless of the type of claim. Most initial claims, however, are submitted without the assistance of a representative.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Once fees are allowed, they are usually charged on a contingent basis, meaning that you only pay your representative after you win your claim/appeal. Your representative could also choose to charge you an hourly or flat-rate fee, but this is rare. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">The amount of the fees depends on the complexity of your case, but the VA considers up to 20% of your <a href="https://militarydisabilitymadeeasy.com/va-disability-back-pay.html" target="_blank">back pay</a> (the amount you are given for the time between your effective date and the date of the Rating Decision) a reasonable fee for most claims. Anything over 33.3%, even for most complex cases, is considered unreasonable. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">You must sign a Fee Agreement with your representative in advance in order for them to charge you. The representative will then officially file the Fee Agreement once you register them as your representative. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><b>5. Register Your Representative<o:p></o:p></b></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">In order to represent you, the representative must be officially registered as your legal representative with the VA. To appoint your representative, you need to submit <a href="https://www.va.gov/find-forms/about-form-21-22/" target="_blank">VA Form 21-22</a> (for reps from Veterans Service Organizations) or <a href="https://www.va.gov/find-forms/about-form-21-22a/" target="_blank">VA Form 21-22a</a> (for all others) to your Regional VA Office. You can also appoint them through your online VA.gov or eBenefits account. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> <br /></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">By registering them, you are giving your representative the Power of Attorney to act on your behalf before the VA in matters relating to your claims and benefits. You can choose to remove or change your representative at any time as long as you officially register the change with the VA. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Once your representative is registered, they can begin working on getting you the benefits you deserve, helping you prepare and submit your claim/appeal, and keeping you updated throughout the process.<o:p></o:p></p>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com0tag:blogger.com,1999:blog-4162041641030931379.post-12526772017709097272022-06-09T10:34:00.002-07:002022-06-09T10:34:12.489-07:00The Promise to Address Comprehensive Toxics Act (PACT Act)—The Facts<p><span face="Calibri, sans-serif"></span></p><div class="separator" style="clear: both; text-align: center;"><span face="Calibri, sans-serif"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8540WraIRzv2TPm6J_KWbrwJOuh041W1f7XQiDfU-k_ftJkoVuo322dh39N1cfI29oix8cKHlm0SrKyNu9fuKC1aCj5GSaajjRHVOjeYdRxTy5PR3AYbzCSq9TKPsevQq7E9BA_wKXRtW9n44hkxUMFELCG8LXzK5r314A0WcRmJfbOmedYgrGgWj/s979/toxic%20exposure.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="664" data-original-width="979" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8540WraIRzv2TPm6J_KWbrwJOuh041W1f7XQiDfU-k_ftJkoVuo322dh39N1cfI29oix8cKHlm0SrKyNu9fuKC1aCj5GSaajjRHVOjeYdRxTy5PR3AYbzCSq9TKPsevQq7E9BA_wKXRtW9n44hkxUMFELCG8LXzK5r314A0WcRmJfbOmedYgrGgWj/s320/toxic%20exposure.jpg" width="320" /></a></span></div><span face="Calibri, sans-serif"><br /><style class="WebKit-mso-list-quirks-style">
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</style><p class="MsoNormal" style="font-size: medium;">Almost a year ago, the Honoring our Promise to Address Comprehensive Toxics Act of 2021 (known as “<a href="https://www.congress.gov/bill/117th-congress/house-bill/3967?q=%7B%22search%22%3A%5B%22honoring+our+promise%22%5D%7D&r=3&s=2" target="_blank">Honoring our PACT Act of 2021</a>”) was first introduced to the House of Representatives. The House passed the PACT Act with a strong majority in March of this year, and the Act was read into the Senate at the end of May. </p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The purpose of the PACT Act is “to improve health care and benefits for veterans exposed to toxic substances, and for other purposes.” But what really does that mean? What are the “other purposes”? And what can we expect to see happen if the Senate passes the Act and the President signs it into law?<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Well, the Honoring our PACT Act will make changes in 7 key areas. Below, I’ve discussed the facts of the 7 areas and provided my personal thoughts on each. The Senate can still propose amendments, so things may be adjusted between now and the final law. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><b><span lang="EN-GB">Title I</span></b><span lang="EN-GB">: <u>Expansion of Health Care Eligibility.</u> This Title grants: <o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l4 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB">1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Eligibility for mammography screenings for veterans who served in locations where burn pits were used. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l4 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB">2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">An extended deadline for health care enrollment from 5 to 10 years for combat veterans. This includes a 1-year open enrollment period for those who missed their 10-year window. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l4 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB">3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Eligibility for full medical care, including nursing home care, for any illness for toxic-exposed veterans. To qualify, the veterans must have been discharged between August 2, 1990 and December 31, 2018, and either<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l6 level2 lfo4; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB">a.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">served in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, or the United Arab Emirates on or after August 2, 1990<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l6 level2 lfo4; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB">b.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">served in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, Uzbekistan, or the Philippines on or after September 11, 2001<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l6 level2 lfo4; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB">c.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">deployed in support of a contingency operation (Operation Enduring Freedom, Operation Freedom’s Sentinel, Operation Iraqi Freedom, Operation New Dawn, Operation Inherent Resolve, and Resolute Support Mission); or<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l6 level2 lfo4; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB">d.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">participated in an activity that risked toxic exposure. The activity must have been officially recorded or be on a list that the VA is currently compiling.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><i><span lang="EN-GB">Thoughts: This will give access to VA health care to many veterans who do not currently qualify, so great news all around. The only vague area that could be troublesome is the toxic exposure activity qualification. If a veteran has to have participated in an activity that was officially recorded or on a list, this could end up excluding many instances of exposure. Now, to give the VA and DoD credit, they are working to improve the exposure reporting system for current service members and to go back and record historic exposures of which they have evidence, but we already know that the DoD was notoriously awful at recording exposures, so the likelihood of them catching all instances is low. It’ll be interesting to see how comprehensive the list is that the VA is currently compiling. Regardless, this is great news for many veterans. </span></i><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><b><span lang="EN-GB">Title II</span></b><span lang="EN-GB">: <u>Toxic Exposure Presumption Process.</u> This Title makes multiple changes that are focused on improving the toxic exposure presumption process. It will:<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]-->1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Establish a Formal Advisory Committee on Toxic Exposure. This Committee will compile and review all available evidence regarding toxic exposures, including scientific research, known cases, news, veteran’s statistics, etc. Based on this review, the Committee will then:<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo2; text-indent: -.25in;"><!--[if !supportLists]-->a.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Identify new and emerging exposures<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo2; text-indent: -.25in;"><!--[if !supportLists]-->b.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Recommend formal studies of the health effects of certain exposures if it seems that these studies could change the current understanding of the health outcomes of such exposures<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo2; text-indent: -.25in;"><!--[if !supportLists]-->c.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Recommend ways to fix the exposure recording system <o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo2; text-indent: -.25in;"><!--[if !supportLists]-->d.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Recommend which previous veterans’ cases of toxic exposure should be re-reviewed<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo2; text-indent: -.25in;"><!--[if !supportLists]-->e.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Recommend how the <a href="https://militarydisabilitymadeeasy.com/vapresumptivelist.html" target="_blank">Presumptive List</a> should be adjusted based on the evidence<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]-->2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><span lang="EN-GB">Require the VA Secretary within 2 years to create a list that details likely exposures to substances, chemicals, and airborne hazards for veterans who served during specific times in various key locations. This list will be broader and more comprehensive than any current list.</span><o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]-->3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><span lang="EN-GB">Require the VA Secretary to conduct official research based on the Committee’s recommendations. Based on the results of such research, the Secretary will then update the Presumptive Lists accordingly. If this results in the removal of a current presumptive illness, the veterans already awarded for that illness will continue receiving those benefits.</span><o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]-->4.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><span lang="EN-GB">Allow veterans whose toxic exposure claims have previously been denied to elect to re-open their claim. If awarded benefits under the new lists, they will be compensated back to the original effective date of their claim.</span><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><i><span lang="EN-GB">Thoughts: Yes, this is an essential step to getting toxic-exposed veterans their deserved benefits. There is currently little official research regarding the health effects of various toxic exposures, so by performing this research, creating new lists, and re-opening claims, the likelihood is that thousands of veterans will finally start receiving their benefits. Great news all around.</span></i><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><b><span lang="EN-GB">Title III</span></b><span lang="EN-GB">: <u>Improving the VA’s <a href="https://militarydisabilitymadeeasy.com/service-connection.html" target="_blank">Service-Connection</a> Process for Toxic Exposure.</u> This Title will: <o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l7 level1 lfo3; text-indent: -.25in;"><!--[if !supportLists]-->1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><span lang="EN-GB">Require the VA to conduct exams specifically meant to determine if there is a likelihood that a veteran’s condition was caused by toxic exposure when the veteran does not have sufficient evidence to prove toxic exposure. </span><o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l7 level1 lfo3; text-indent: -.25in;"><!--[if !supportLists]-->2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Establish that veterans will be presumed to have been exposed to substances, chemicals, and airborne hazards (burn pits) if they: <o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l7 level2 lfo3; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB">a.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">served in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, or the United Arab Emirates on or after August 2, 1990<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l7 level2 lfo3; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB">b.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">served in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, Uzbekistan, or the Philippines on or after September 11, 2001<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><i><span lang="EN-GB">Thoughts: Again, no complaints here. This will expand the number of veterans eligible for the <a href="https://militarydisabilitymadeeasy.com/vapresumptivelist.html#burnpit" target="_blank">Burn Pit Presumptive List</a>, which is great. Requiring the VA to conduct exams for those veterans who do not have enough evidence is also a really good thing. Instead of just denying the claim, they must get a qualified medical opinion that could end up granting service-connection for the veteran if the physician feels that the condition is “at least as likely as not” caused by the exposure. </span></i><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><b><span lang="EN-GB">Title IV</span></b><span lang="EN-GB">: <u>Presumptions of Service-Connection</u>. This Title will make the following changes to the current Presumptive Lists:<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l5 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]-->1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->For <a href="https://militarydisabilitymadeeasy.com/vapresumptivelist.html#radiation" target="_blank">Radiation Exposure</a>, veterans who participated in cleanup activities or nuclear responses in Palomares, Spain (between January 17, 1966 and March 31, 1967), Thule, Greenland (between January 21, 1968 and September 25, 1968), and Enewetak Atoll (between January 1, 1977 and December 31, 1980) will be added to the list.<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l5 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]-->2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->For <a href="https://militarydisabilitymadeeasy.com/vapresumptivelist.html#herbicide" target="_blank">Agent Orange Exposure</a>, veterans who served in Thailand on a US or Royal Thai base (between January 9, 1962 and June 30, 1976), Laos (between December 1, 1965 and September 30, 1969), Cambodia at Mimot or Krek (between April 16, 1969 and April 30, 1969), Johnston Atoll (between January 1, 1972 and September 30, 1977), or Guam or American Samoa (between January 9, 1962 and July 31, 1980) will be added to the list. The end date for service in Vietnam will also be extended to May 7, 1975. Finally, two conditions will be added to the Agent Orange List: hypertension and monoclonal gammopathy of undetermined significance.<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l5 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]-->3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->For <a href="https://militarydisabilitymadeeasy.com/vapresumptivelist.html#gulf" target="_blank">Persian Gulf veterans</a>, veterans who served in Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan will be added to the list. The conditions will also no longer be required to manifest to a certain severity within a certain time frame. It will be “to any degree at any time.” The VA will also be required to have their medical examiners use a new Gulf War Illness <a href="https://militarydisabilitymadeeasy.com/dbq.html" target="_blank">DBQ</a> to ensure that the veteran is properly examined to consider the effects of service in the Persian Gulf.<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="mso-list: l5 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]-->4.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->For <a href="https://militarydisabilitymadeeasy.com/vapresumptivelist.html#burnpit" target="_blank">Burn Pit Exposure</a>, 24 conditions will be added to the list, including asthma, chronic bronchitis, chronic obstructive pulmonary disease, constrictive or obliterative bronchiolitis, emphysema, granulomatous disease, interstitial lung disease, pleuritis, pulmonary fibrosis, sarcoidosis, chronic sinusitis, chronic rhinitis, glioblastoma, head cancer, neck cancer, respiratory cancer, gastrointestinal cancer, reproductive cancer, lymphoma cancer, lymphomatic cancer, kidney cancer, brain cancer, melanoma, and pancreatic cancer.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><i><span lang="EN-GB">Thoughts: These changes will allow thousands of veterans to have their conditions service-connected, so this is great. With all the research the earlier Titles will require, these types of changes will become more frequent in the future. </span></i><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><b><span lang="EN-GB">Title V</span></b><span lang="EN-GB">: <u>Research Matters.</u> This Title will:<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo6; text-indent: -.25in;"><!--[if !supportLists]-->1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Implement measures to improve data collection between the VA and DoD by creating an interagency working group to facilitate collaboration in toxic exposure research.<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo6; text-indent: -.25in;"><!--[if !supportLists]-->2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Commission studies and various types of data collection to understand health trends of Post 9/11 veterans, health trends of toxic exposure, health effects of the Manhattan Project, health effects of jet fuels, incidents of cancer among the veteran population, and to determine whether it is feasible to provide healthcare to the dependents of veterans. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><i><span lang="EN-GB">Thoughts: There definitely needs to be more research and data sharing. No question. The issue is that besides creating this work group, there are no other clear instructions on how to make this happen. The VA and the DoD have been trying to implement new strategies to share data for years now, but it clearly is still not enough since they need to create another work group. I’m a bit sceptical on how effective this will be, but hopeful that the work group will at least be able to come up with some successful data-sharing techniques. With modern tech, it really shouldn’t be as hard as the VA and DoD seem to have made it.</span></i><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><b><span lang="EN-GB">Title VI</span></b><span lang="EN-GB">: <u>Resources and Training for Toxic Exposure</u>. This Title will:<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l3 level1 lfo7; text-indent: -.25in;"><!--[if !supportLists]-->1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Require the VA to create a training program for all employees dealing with toxic exposure claims to ensure proper medical examinations and claims processing. This includes a toxic-exposure questionnaire for physicians.<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l3 level1 lfo7; text-indent: -.25in;"><!--[if !supportLists]-->2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Require the VA to provide resources to veterans who have or may have been exposed to toxics.<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="mso-list: l3 level1 lfo7; text-indent: -.25in;"><!--[if !supportLists]-->3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Require the DoD and VA to create guidelines to use in active duty training to educate service members of the risks and prevention of exposures.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><i><span lang="EN-GB">Thoughts: Definitely necessary if these changes are going to be implemented seamlessly into the system. Employees need to know what’s up and veterans deserve to know what they are entitled to.</span></i><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><b><span lang="EN-GB">Title VII</span></b><span lang="EN-GB">: <u>Registries, Records, and Other Matters</u>. This Title will:<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]-->1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Create a registry for AFFF/PFAS exposure<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]-->2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Create a health registry for service at Fort McClellan<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]-->3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Update and fix errors in the Burn Pit Registry<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]-->4.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Update and fix errors in exposure records<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]-->5.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->Allow <a href="https://militarydisabilitymadeeasy.com/vapresumptivelist.html#lejeune" target="_blank">Camp Lejeune toxic water</a> veterans to file tort claims. Tort claims are filed against the Unites States for a negligent or wrongful act. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><i><span lang="EN-GB">Thoughts: Any way that the VA can get organized and collect the data they need to properly compensate disabled veterans is a good thing. </span></i><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">That’s it. If passed into law, the PACT Act of 2021 will definitely make amazing improvements within the VA and DoD for toxic-exposed veterans, allowing many to finally receive the benefits they deserve. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">As of June 8<sup>th</sup>, a few Senators proposed minor amendments so hopefully it’ll be passed quickly and head to the President’s desk. </span></p></span><div><style class="WebKit-mso-list-quirks-style">
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</style>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com0tag:blogger.com,1999:blog-4162041641030931379.post-78410437729275179902022-04-11T08:53:00.000-07:002022-04-11T08:53:01.015-07:00Comments Submitted to the VA on the Changes to the Ratings for the Respiratory System and the Ears, Nose, and Throat<p><span style="font-family: Calibri, sans-serif;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIkj5NQ3T4irACu8xcuK02DdP-9knEKB1RoEpU7c_gF7k_KH6jOlKa5ysLRIOUf2jRQTqQytbI-iuLW1FLNDbe7fNiU9iZ-DU3b4xmRi6BIbu8keIk-zw1jTpiTLSzFBehVYZvp5MczlrX7HjQIGh6NPXVBXAJ35KtkLTOdkRk8rg0yR3oxf7TqMob/s2676/respiratory%20system%202%20copy.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="2676" data-original-width="2356" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIkj5NQ3T4irACu8xcuK02DdP-9knEKB1RoEpU7c_gF7k_KH6jOlKa5ysLRIOUf2jRQTqQytbI-iuLW1FLNDbe7fNiU9iZ-DU3b4xmRi6BIbu8keIk-zw1jTpiTLSzFBehVYZvp5MczlrX7HjQIGh6NPXVBXAJ35KtkLTOdkRk8rg0yR3oxf7TqMob/s320/respiratory%20system%202%20copy.png" width="282" /></a></div><br />The following are the comments we submitted on your behalf to the VA in regards to the proposed changes to the ratings of the <a href="https://blog.militarydisabilitymadeeasy.com/2022/03/new-proposed-changes-to-ratings-of.html" target="_blank">Respiratory System</a> and the <a href="https://blog.militarydisabilitymadeeasy.com/2022/03/new-proposed-changes-to-ratings-of-ears.html" target="_blank">Ears, Nose, and Throat</a>. <p></p><p><span style="font-family: Calibri, sans-serif;">After the VA publishes their proposed changes, they always allow a period for comments. Thank you for submitting your comments to us so that we could submit them in a unified front to the VA. Hopefully, we will be able to effect change and make the rating system fairer for all veterans.</span><span style="font-family: Calibri, sans-serif;"> </span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">Here are the comments we submitted for the Respiratory System and the Ears, Nose, and Throat:</span><o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">We at <a href="http://www.militarydisabilitymadeeasy.com/" style="color: #954f72;">www.MilitaryDisabilityMadeEasy.com</a> would like to submit the following comments on behalf of our staff and veterans in response to the proposed changes to the ratings of the Respiratory System and Ears, Nose, and Throat.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">Comment #1. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">The addition of the 100% rating for peripheral vestibular disorders, code 6204, will be a huge benefit to veterans with very severe conditions. However, this leaves a large hole between the 30% and 100% rating. With the acknowledgement of a wide-range of symptoms and severities, it seems like these rating options will under-rate many conditions that interfere with work/self-care more significantly than the 30% rating requires but not completely, like the 100% requires. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Additional rating levels would greatly benefit veterans who may require occasional assistance with tasks, but who can accomplish tasks themselves with modifications/accommodations other times. Perhaps a more tiered rating system that allows for task-interference a percentage of the time (ex. requires modification and/or accommodation 50% of the time, requires assistance of others 25% of the time, etc.), like the recently proposed changes to the mental disorder ratings, would allow for ratings that more accurately reflect the impact of the condition on work and daily life.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Comment #2. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">For the proposed General Rating Formula for Respiratory Conditions, the 100% ratings for acute respiratory failure and outpatient oxygen therapy are not included. However, in §4.96 paragraph C, the notes regarding not requiring PFTs when there is acute respiratory failure or outpatient oxygen therapy remain. These notes imply that these conditions can be rated without the need for PFTs, but the ratings for them have been removed. Without these tests performed, what is the intention for rating acute respiratory failure and the need for oxygen therapy? If the intent is for them to not be independently rated, then removing them from §4.96 (c) would ensure the PFTs needed to rate the conditions are performed. Otherwise, there is no system in place to correctly rate them.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Comment #3. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">The removal of an independent rating for tinnitus based on the assertion that tinnitus is a symptom only and not an independent condition is not fully supported by medical research. There are a number of studies that acknowledge the presence of tinnitus in the absence of hearing loss or other identifiable underlying conditions, and a 2017 publication summarized that “the majority of tinnitus patients are affected by chronic idiopathic tinnitus.” <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">In order to ensure that veterans are properly compensated for tinnitus in cases without a ratable underlying cause, we ask the VA to consider retaining an independent tinnitus code, but possibly adding instruction that limits the application of the code when an underlying condition (like Meniere’s or hearing loss) is identified and rated. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><a href="https://pubmed.ncbi.nlm.nih.gov/27995315/" style="color: #954f72;">https://pubmed.ncbi.nlm.nih.gov/27995315/</a><o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><a href="https://pubmed.ncbi.nlm.nih.gov/31644709/" style="color: #954f72;">https://pubmed.ncbi.nlm.nih.gov/31644709/</a><o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com0tag:blogger.com,1999:blog-4162041641030931379.post-8922843900787498692022-03-11T15:44:00.001-08:002022-03-11T15:44:36.568-08:00Comments Submitted to the VA on the Changes to the Ratings for the Digestive System<p><span style="font-family: Georgia, Utopia, "Palatino Linotype", Palatino, serif; font-size: 16.5px;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhaVF1112nVzDQQndEJWoJ6ihCuRoiF2ajPDi6I2DdxBqwf80sRJcz5-sJnUnH0VcCwo9ebHraBe_ntSfcUEW8kArSWX7jlfC_gcH4yKi2y9Jh__ZU60D8EL76qO0apXFjQ1p3rzaLkfyOwkg8ow_FptPLAbISf-jVCrSmDhSkSLWwMJ4WB9tW5DfRg=s1982" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1981" data-original-width="1982" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEhaVF1112nVzDQQndEJWoJ6ihCuRoiF2ajPDi6I2DdxBqwf80sRJcz5-sJnUnH0VcCwo9ebHraBe_ntSfcUEW8kArSWX7jlfC_gcH4yKi2y9Jh__ZU60D8EL76qO0apXFjQ1p3rzaLkfyOwkg8ow_FptPLAbISf-jVCrSmDhSkSLWwMJ4WB9tW5DfRg=s320" width="320" /></a></div><br />The following are the comments we submitted on your behalf to the VA in regards to th<span style="background-color: white; font-family: Georgia, Utopia, "Palatino Linotype", Palatino, serif; font-size: 16.5px;">e <a href="https://blog.militarydisabilitymadeeasy.com/2022/01/new-proposed-changes-to-ratings-of.html" target="_blank"><span style="color: #000099;">proposed changes to the ratings of the D</span>igestive System</a>.</span><span style="font-family: Georgia, Utopia, "Palatino Linotype", Palatino, serif; font-size: 16.5px;"> </span><span style="font-family: Georgia, Utopia, "Palatino Linotype", Palatino, serif; font-size: 16.5px;">After the VA publishes their proposed changes, they always allow a period for comments. Thank you for submitting your comments to us so that we could submit them in a unified front to the VA. Hopefully, we will be able to effect change and make the rating system more fair for all veterans.</span><span style="font-family: Georgia, Utopia, "Palatino Linotype", Palatino, serif; font-size: 16.5px;"> </span><p></p><div class="post-body entry-content" id="post-body-4503125490222268630" itemprop="description articleBody" style="font-family: Georgia, Utopia, "Palatino Linotype", Palatino, serif; font-size: 16.5px; line-height: 1.4; position: relative; width: 620px;"><div class="MsoNormal"><br /></div><div class="MsoNormal"><span lang="EN-GB">Here are the comments we submitted for the Digestive System:</span></div><div class="MsoNormal"><span lang="EN-GB"><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">We at <a href="http://www.militarydisabilitymadeeasy.com/" style="color: #954f72;">www.MilitaryDisabilityMadeEasy.com</a> would like to submit the following comments on behalf of our staff and veterans in response to the proposed changes to the ratings of the Digestive System.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Comment #1. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">For code 7203, Esophagus, stricture of, the definition of “refractory” requires at least 5 dilation treatments at 2-week intervals. With the rating requirements, the minimum rating this would qualify for would be 50%, since that requires 3 or more dilation treatments/year. Yet, refractory strictures are included on the 30% rating, though by definition they cannot qualify. Please adjust the requirements to clarify exactly how many dilation treatments are required for the various rating levels and for the condition to be considered refractory.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Comment #2.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">The rationale for rating both GERD (code 7206) and Hiatal Hernia (code 7346) under code 7203 states that “these criteria consider symptoms of esophageal obstruction and irritation.” This is not the case, however. The wording of code 7203 only includes dysphagia as a ratable symptom. The 0% and 10% ratings both require no other symptoms and the 30% rating requires dilation. Under the current rating requirements these conditions could both easily qualify for a 30% based on heartburn, reflux, pain, etc., but there is no clear way to rate these symptoms on the proposed requirements for 7203. Both of these conditions, therefore, will have no way to be properly rated on the symptoms they cause. Please consider adjusting the rating options so that these symptoms can continue to contribute to the ratings for these conditions.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Comment #3.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">For code 7329, the proposed ratings for 60% and 100% are inconsistent. The 60% rating simply states a “total colectomy without high-output syndrome.” A logical 100% rating would then simply be a total colectomy <u>with</u> high-output syndrome. Instead, additional requirements are included in order to achieve the 100% rating (ileostomy, 3 or more episodes of dehydration, etc.). <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Because of the significant jump between rating requirements, inconsistent ratings are likely to be applied in cases that fall between these two requirements. For instant, a total colectomy with high-output syndrome, but no ileostomy. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">We request that the VA clarify the rating requirements to ensure appropriate ratings between the 60% and 100% levels, with the potential to add an intermediary 80% rating to cover the cases that fall between. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Comment #4.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Under the 60%, 30%, and 10% ratings for code 7332, the incontinence requires “wearing” a pad a specific number of times each week or month. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">The “wearing” requirement for the pads is a bit difficult to distinguish unless the incontinence episodes are 100% predictable. If there are two episodes/week, the patient would likely wear pads every day since they wouldn’t be able to predict when the episodes would occur. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">The 100% rating uses “changing” as the pad requirement instead of just “wearing.” A similar wording of the 60% and 30% would then allow pads to be worn regularly, just in case, but only the need to change them <u>after an episode</u>would qualify for the rating. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Comment #5. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Dietary modification is used as rating criteria under a number of codes, but the phrasing is inconsistent. “Prescribed dietary modification,” “dietary intervention,” “dietary restriction,” etc. In order to clarify and ensure consistent application, we request that the terms are either standardized throughout if all mean the same thing, or clearly defined if there are differences. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Similarly, though numerous important terms are clearly defined in 4.112, these terms are not consistently used throughout the proposed ratings. For example, under code 7355, “weight loss resulting in wasting and nutritional deficiencies” does not clearly specify weight loss as defined in 4.112. Similarly, the term “malabsorption syndrome” is used in this code, but not defined in the rating schedule. It ultimately results in undernutrition, so “undernutrition” could be used in place of it since the defining symptoms support the accompanying ratings. Again, consistency in terminology throughout will greatly help reduce confusion and aid consistent application. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Comment #6.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">For code 7347, a 60% rating requires hospitalization for complications of pain or enteral feeding. Enteral feeding is not included in any of the other rating options for this code. Under other proposed codes, enteral feeding is rated 80% with no caveats for number of hospitalizations or complications. Further clarification is needed on how to rate this condition if it requires enteral feeding, regardless of whether or not that feeding causes complications. Please also consider applying the 80% rating for enteral feeding in order for it to align with the rest of the proposed ratings.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Comment #7.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Under code 7356, the wording for the 50% rating is unclear. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">“With recurrent emergency treatment for episodes of intestinal obstruction or regurgitation due to poor gastric emptying, abdominal pain, recurrent nausea, or recurrent vomiting.” <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Is the emergency treatment only for the intestinal obstruction or also for the regurgitation? Is the obstruction also “due to poor gastric emptying, abdominal pain, recurrent nausea, or recurrent vomiting” or is that only for the regurgitation? Adjusted wording for further clarification would be appreciated. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Similarly, the 30% rating requires symptoms of CIPO and intestinal motility disorder, but CIPO <i>is</i> an intestinal motility disorder, so this is repetitive and misleading, implying that these conditions are separate and distinct with different symptoms. Please clarify for clarity and correct application.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; font-size: medium; margin: 0in 0in 0.0001pt;">Thanks for considering our comments on the proposed changes to the ratings of the Digestive System. <o:p></o:p></p></span></div></div>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com0tag:blogger.com,1999:blog-4162041641030931379.post-52912327762653379752022-03-09T10:54:00.001-08:002022-03-09T10:54:57.316-08:00 -NEW- Proposed Changes to the Ratings of the Respiratory System <p><span style="font-family: Cambria, serif;">On February 15th, 2022, the VA published proposed changes to the ratings of the <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#top" target="_blank">Respiratory System</a>.</span></p><p><span style="font-family: Cambria, serif;">These were published along with changes to the Ears, Nose, and Throat which we discuss<a href="https://blog.militarydisabilitymadeeasy.com/2022/03/new-proposed-changes-to-ratings-of-ears.html" target="_blank"> here</a>. </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhqv9oaKls7ZxnYFdLIzDIOsTvxNHgG-1lSvenH_Jxy_K9IUW8qIe3c81Qm7RgPiMZBW6Ud4BUXt4s6A6pf6VPWa_ZyZvvm_rDVQ-M2XzgYMcxKuojWELqV7_ksNXq2eef-CWDWjXYGenpo9etSH2-VpRUM2moLk4ctcZ4oczXSjkU0dJ60gSvKZ_r5=s2161" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="2083" data-original-width="2161" height="308" src="https://blogger.googleusercontent.com/img/a/AVvXsEhqv9oaKls7ZxnYFdLIzDIOsTvxNHgG-1lSvenH_Jxy_K9IUW8qIe3c81Qm7RgPiMZBW6Ud4BUXt4s6A6pf6VPWa_ZyZvvm_rDVQ-M2XzgYMcxKuojWELqV7_ksNXq2eef-CWDWjXYGenpo9etSH2-VpRUM2moLk4ctcZ4oczXSjkU0dJ60gSvKZ_r5=s320" width="320" /></a></div><br /> <p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">The current <a href="https://militarydisabilitymadeeasy.com/vasrd.html" target="_blank">VASRD</a> does not include an Ears, Nose, and Throat section. Instead, the Ears have their own section, and the Nose and Throat are included in the Respiratory section. The VA proposes to move the Nose and Throat conditions out of the Respiratory System and combine them with the Ears since they are associated together in modern medicine. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">With these changes, the VA only has one more section left, the <a href="https://militarydisabilitymadeeasy.com/centralnervoussystemratings.html" target="_blank">Nervous System</a>, until they complete the full rewrite of the VASRD that began in 2014. In addition to the Ear, Nose, and Throat and Respiratory System, the VA has not yet published the final changes to the <a href="https://blog.militarydisabilitymadeeasy.com/2022/01/new-proposed-changes-to-ratings-of.html" target="_blank">Digestive System</a> and <a href="https://blog.militarydisabilitymadeeasy.com/2022/02/new-proposed-changes-to-mental-disorder.html" target="_blank">Mental Disorders</a>. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">With each set of proposed changes, the VA allows a period in which comments can be submitted. The VA then takes each comment into consideration and makes any additional changes that are warranted before publishing the final ruling. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">We encourage you to submit any comments you might have on these proposed changes to the Respiratory System to us either by commenting on this post or by <a href="https://militarydisabilitymadeeasy.com/contactus.html" target="_blank">contacting us</a> through our website. All comments must be received by April 1st, 2022. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">We will then compile all of your comments into a single report and submit it on your behalf to the VA, just as we’ve done for the other sections (see the <a href="https://blog.militarydisabilitymadeeasy.com/2016/10/comments-submitted-to-va-on-changes-to.html" target="_blank">Skin Comments</a>). This is a great opportunity to really make a difference, so please let us know your thoughts. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">The following are the VA’s new proposed changes to the ratings for the Respiratory System. The changes are fairly extensive, so we’ll walk through each, one at a time.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">For each condition, the small, indented parts are the codes as they are right now. Click on the links to be taken to the discussion of that code on our site. After the current code, we’ll discuss the proposed changes and the VA’s justification.<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">Nose and Throat Conditions<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;">The VA currently includes conditions of the nose and throat in the Respiratory System section of the VASRD. <o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;">They are proposing to move the codes for nose and throat conditions from the Respiratory System section to the Ear section of the VASRD, creating an Ear, Nose, and Throat section. <o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;">The ear, nose, and throat (ENT) are commonly treated together in the medical community, and this change would align the VASRD with that standard.<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;">You can find all the proposed changes to the Nose and Throat conditions in our post discussing the <a href="https://blog.militarydisabilitymadeeasy.com/2022/03/new-proposed-changes-to-ratings-of-ears.html" target="_blank">Ear, Nose, and Throat section</a>.<span lang="EN-GB"><o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-align: justify;"><i><span lang="EN-GB"> </span></i></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#system" target="_blank">Respiratory Rating System</a><o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in; text-align: justify;"><i><span lang="EN-GB"> </span></i></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: justify;"><span lang="EN-GB">The Respiratory Rating System is fairly extensive, so we aren’t going to reproduce the entire thing here. You can find the current system on our site via the link above.</span><i><span lang="EN-GB"><o:p></o:p></span></i></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-align: center;"><i>-Proposed-</i> <b>Respiratory Rating System<o:p></o:p></b></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><b> </b></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;">The Respiratory Rating System is used to rate all respiratory conditions unless otherwise noted. <o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;">Only a single respiratory condition can be rated. If multiple conditions are present, the one that causes the main disability is rated. If, however, the overall respiratory picture is more severe than is covered by this rating, the rating can be increased to the next highest rating. <o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;">The only condition that can be rated in addition to other respiratory conditions is Sleep Apnea. <o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;">Ratings for respiratory conditions are based on how well the lungs take in air, absorb oxygen into the blood, and then exhale the left-over gases. Pulmonary function tests (PFTs) are performed to record the proper functioning of the lungs and their effects on the entire body.<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;">Every PFT is not required when the VO2 Max has been tested and is 20 ml/kg/min or less, there has been one or more episodes of respiratory failure, or when regular oxygen therapy is needed outside of a medical facility.<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;">When deciding which test result to use to rate the condition, the one that the examining physician feels most closely reflects the nature of the condition must be used. If they all accurately reflect the condition, then the one that gives the highest rating can be used. If any of the test results are not consistent with the other tests or overall condition, then the examining physician must explain why that test result should not be used to rate the condition.<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;">If there is a heart condition in addition to the respiratory condition, only one can be rated using METs. The other condition must be rated on other rating criteria. <o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-align: center;">The ratings:<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><b> </b></p><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; color: black; margin-left: 0.5in;"><tbody><tr><td style="border: 1pt solid windowtext; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;"><b>Test/Requirement<o:p></o:p></b></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;"><b>Result/Condition<o:p></o:p></b></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;"><b>Rating<o:p></o:p></b></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FVC<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Less than 50%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">100%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FVC<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">50-64%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">60%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FVC<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">65-74%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">30%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FVC<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">75-80%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">10%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Less than 45%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">100%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">45-55%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">60%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">56-70%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">30%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">71-80%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">10%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">DLCO (SB)<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Less than 40%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">100%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">DLCO (SB)<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">40-55%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">60%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">DLCO (SB)<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">56-65%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">30%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">DLCO (SB)<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">66-80%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">10%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1/FVC<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Less than 40%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">100%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1/FVC<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">40-55%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">60%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1/FVC<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">56-70%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">30%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1/FVC<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">71-80%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">10%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">VO2 Max<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Less than 10.5 ml/kg/min<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">100%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">VO2 Max<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">10.5-17.5<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">60%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">VO2 Max<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">17.6-24.5<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">30%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">METs<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">3 or less<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">100%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">METs<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">3.1-5.0<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">60%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 103.25pt;" valign="top" width="138"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">METs<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 180.05pt;" valign="top" width="240"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">5.1-7.0<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 131.2pt;" valign="top" width="175"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">30%<o:p></o:p></p></td></tr></tbody></table><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;">The VA is proposing significant changes to the Respiratory Rating System in order to update the tests, ratings, and practices to modern medical understandings. <o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;">The ratings themselves will not change very much, but the VA is removing the heart condition ratings, so those can be rated separately, and the rating for oxygen use since this no longer accurately reflects the level of disability. They are also adding rating options for additional PFTs, as well as METs, which are already used to rate heart conditions related to respiratory conditions. This will align the respiratory and heart ratings to create more consistency.<span lang="EN-GB"><o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#r" target="_blank">6600</a>, <b>chronic bronchitis</b>, continues to be rated on the Respiratory Rating System. <o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#u" style="color: purple;"><b><span lang="EN-US" style="font-size: 10pt;">6601</span></b></a></span><span style="font-size: 10pt;">: <b>Bronchiectasis</b> is a condition where part of the bronchial tree becomes enlarged and causes obstruction of the airflow. This is a permanent condition that cannot be reversed.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;">It is either rated on the </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#system" style="color: purple;"><span lang="EN-US" style="font-size: 10pt;">Respiratory Rating System</span></a></span><span style="font-size: 10pt;"> or on incapacitating episodes below, whichever provides the highest rating. The definition of an “incapacitating episode” for rating this condition is a period where there is an active infection in the lungs, and it requires bed rest and treatment by a physician.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;">If there are a total of at least 6 weeks of incapacitating episodes each year, it is rated 100%.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;">If there are a total of 4 to 6 weeks of incapacitating episodes each year, <i>or</i> if there is constant coughing of mucous mixed with puss or blood that requires near-constant antibiotic treatment with anorexia and weight loss, it is rated 60%.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;">If there are a total of 2 to 4 weeks of incapacitating episodes each year, or if there is daily coughing occasionally of muscous mixed with puss or blood that requires between 4 to 6 weeks of antibiotic treatment 3 or more times a year, it is rated 30%.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;">If there is occasional coughing with infections requiring antibiotics 2 or more times a year, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><i>-Proposed-</i><b> Code 6601</b>: <b>Bronchiectasis</b> is a condition where part of the bronchial tree becomes enlarged and causes obstruction of the airflow. This is a permanent condition that cannot be reversed. It is rated on the Respiratory Rating System.<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;">The VA proposes to remove rating requirements based on vague incapacitating episodes and simply rate this condition on the new Respiratory Rating System. <o:p></o:p></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">Codes <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#s" target="_blank">6603</a>, <b>pulmonary emphysema</b>, and <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#t" target="_blank">6604</a>, <b>chronic obstructive pulmonary disease</b>, continue to be rated on the Respiratory Rating System. <o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">The VA is proposing very few changes for code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#v" target="_blank">6602</a>, <b>asthma</b>, so we won’t reproduce the entire thing here. The only significant change is to update the FEV-1 requirements for the 100% rating to less than 45% and the 60% rating to 45-55%. Everything less remains the same. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; color: black; margin-left: 0.5in;"><tbody><tr><td style="border: 1pt solid windowtext; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;"><b>Test/Requirement<o:p></o:p></b></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;"><b>Result/Condition<o:p></o:p></b></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: solid solid solid none; border-top-color: windowtext; border-top-width: 1pt; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;"><b>Rating<o:p></o:p></b></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Less than 45%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">100%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">45-55%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">60%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">56-70%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">30%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">71-80%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">10%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1/FVC<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Less than 40%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">100%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1/FVC<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">40-55%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">60%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1/FVC<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">56-70%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">30%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">FEV-1/FVC<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">71-80%<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">10%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Medical Care<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">2 or more attacks per week with respiratory failure that requires immediate medical care<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">100%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Medical Care<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Requires monthly doctor visits<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">60%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Medication<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Requires daily HIGH doses of corticosteroids or immunosuppressive medications taken by mouth or by injection<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">100%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Medication<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Requires the use of corticosteroid medications taken by mouth or by injection 3 of more times a year<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">60%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Medication<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Requires occasional use of inhaled anti-inflammatory medication<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">30%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Medication<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Requires daily bronchodilator therapy taken by mouth or inhaled<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">30%<o:p></o:p></p></td></tr><tr><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-left-color: windowtext; border-left-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid; padding: 0in 5.4pt; width: 113.75pt;" valign="top" width="152"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Medication<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 175.15pt;" valign="top" width="234"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">Requires occasional bronchodilator therapy taken by mouth or inhaled<o:p></o:p></p></td><td style="border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; border-style: none solid solid none; padding: 0in 5.4pt; width: 125.6pt;" valign="top" width="167"><p align="center" class="MsoNormal" style="font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; text-align: center;">10%<o:p></o:p></p></td></tr></tbody></table><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#ss" target="_blank">6730</a> for <b>active pulmonary tuberculosis</b> remains the same. <o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in; text-align: center;"><span lang="EN-GB" style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#tt" style="color: purple;"><b><span lang="EN-US" style="font-size: 10pt;">6731</span></b></a></span><span style="font-size: 10pt;">:<b> Inactive pulmonary tuberculosis</b> is rated on the lasting symptoms or complications. If it causes restrictive heart disease or interstitial lung disease, then it will be rated on those conditions. Obstructive lung disease is rated as chronic bronchitis under code </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#r" style="color: purple;"><span lang="EN-US" style="font-size: 10pt;">6600</span></a></span><span style="font-size: 10pt;">, and a Thoracoplasty is rated under code </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/ribratings.html#a" style="color: purple;"><span lang="EN-US" style="font-size: 10pt;">5297</span></a></span><span style="font-size: 10pt;">.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB">-Proposed- <b>Code 6731: Inactive pulmonary tuberculosis</b> is rated on the Respiratory Rating System. If a thoracoplasty was performed, it is rated under code 5297.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">The VA proposes to rate inactive tuberculosis on the new Respiratory Rating System as they feel this system accurately covers the residuals of pulmonary tuberculosis. <o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#rr" target="_blank">6732</a> for <b>tuberculous pleurisy</b> remains the same. <o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#gg" style="color: purple;">6817</a></span></b><span style="font-size: 10pt;">: All <b>pulmonary vascular diseases</b> are rated under this code. These conditions affect the blood vessels leading to and from the lungs.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;">If the condition causes Pulmonary hypertension, Chronic Pulmonary Thrombo-embolism with pulmonary hypertension, Right Ventricular Hypertrophy, right heart failure, or pulmonary hypertension with right heart failure or right ventricular hypertrophy caused by the blockage of arteries or veins in the lungs, it is rated 100%.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;">If the condition causes pulmonary thrombo-embolism that requires anticoagulant therapy, it is rated 60%. A 60% rating is also given if surgery has been done on the Inferior Vena Cava and there is no evidence of pulmonary hypertension or any other problems with the right ventricle.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;">If there has been a pulmonary embolism and it has been treated and cleared, but the conditions still causes symptoms, it is either rated 30% under this code or it can be rated under the code of the symptom (like <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#r" style="color: purple;">6600</a> for bronchitis or <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#p" style="color: purple;">6844</a> for pleural effusion or fibrosis), whichever provides the highest rating. Only one code can be used, however, even if there are multiple symptoms. If there are no symptoms, it is rated 0%.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> Code 6817: Pulmonary thromboembolic disease occurs when blood clots travel to the blood vessels leading to and from the lungs.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB">A 100% rating is given if the arteries or veins are consistently blocked and there is either pulmonary hypertension or right ventricular hypertrophy.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB">A 60% rating is given if the condition requires anticoagulant therapy <i>or</i> if surgery has been done on the Inferior Vena Cava and there is no evidence of pulmonary hypertension or any other problems with the right ventricle.<br /><br /><o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB">A 30% rating is given if the clot has been cleared, but the condition still causes symptoms. If it provides a higher rating, the condition can instead be rated under the code of the main symptom (like 6600 for bronchitis or 6844 for pleural effusion or fibrosis). Only one code can be used, however, even if there are multiple symptoms. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB">A 0% rating is given if the clot has been cleared and there are no symptoms.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB">This condition cannot be rated in addition to a heart condition, so when both are present, a single rating is given for the main disability. The only respiratory condition that can be rated in addition to this code is sleep apnea.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">The VA proposes to change the name of this condition to “pulmonary thromboembolic disease” stating that this is the more commonly used name in modern medicine. The ratings are not significantly changing, but the 100% rating for primary pulmonary hypertension is being removed as this condition will now be rated under its own code (see below), and the overall criteria simplified to focus on the main disabilities caused by this condition.<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><i><span lang="EN-GB">-Proposed NEW Code-</span></i><span lang="EN-GB"> <b>Code 6849: Chronic pulmonary hypertension</b> is high blood pressure between the lungs and the heart. The condition can cause the right ventricle of the heart to swell, resulting in poor lung and heart function. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB">It is rated on the size of the right ventricle and pulmonary/cardiovascular test results: VO2 Max, METs, and BNPs. VO2 Max and METs are discussed in the<a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#system" target="_blank"> Respiratory Rating System</a>. Brain natriuretic peptides (BNP) are a type of protein made by the heart when it is failing. The higher the number, the worse the heart failure.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB">A 100% rating is given if the right ventricle is more than 4 cm <i>and</i> either the VO2 Max is less than 15 or there are 3 METs or less.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB">A 60% rating is given if the right ventricle is more than 4 cm <i>and</i> either the VO2 Max is 15-20, there are 3.1-5.0 METs, <i>or</i> the BNP is greater than 500.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB">A 30% rating is given if the right ventricle is 3-4 cm <i>and</i> either there are 5.1-7.0 METs or the BNP is 100-500.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB">A 0% rating is given if either the VO2 Max is greater than 20 or the BNP is less than 100.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB">This condition cannot be rated in addition to a heart condition, so when both are present, a single rating is given for the main disability. The only respiratory condition that can be rated in addition to this code is sleep apnea.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">The VA proposes to add a new code for pulmonary hypertension as it is currently rated analogously, but none of the current codes fully cover the unique symptoms it can cause. The new rating system considers how the condition affects both the lungs and the heart. <o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#vv" style="color: purple;">6819</a></span></b><span style="font-size: 10pt;">: Any <b>malignant cancer</b> of the respiratory system (not including skin growths) is rated 100% while it is active. This 100% rating continues for 6 months following the last treatment. The condition is then re-evaluated and any left-over symptoms or complications are rated separately.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#ww" style="color: purple;">6820</a></span></b><span style="font-size: 10pt;">: Any <b>tumor</b> of the respiratory system is rated on any systems or functions that it affects. For example, if the tumor pushes on the Larynx and makes it hard to speak, then it would be rated as aphonia, code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#i" style="color: purple;">6519</a>.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><i>-Proposed-</i> <b>Code 6819</b>: Any <b>malignant cancer</b> of the respiratory system (not including skin growths) is rated 100% while it is active. This 100% rating continues for 6 months following the last treatment. The condition is then re-evaluated and rated on the Respiratory Rating System.<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><i>-Proposed-</i> <b>Code 6820</b>: Any <b>tumor </b>of the respiratory system is rated on the Respiratory Rating System.<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;">The only proposed change to these codes is for any residuals to be rated on the Respiratory Rating System.<o:p></o:p></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;">For all <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#inter" target="_blank">Interstitial Lung Diseases</a>, the VA proposes removing the current rating system, and instead rating all of these conditions (codes 6825-6833 and 6846) on the Respiratory Rating System. The current system is already similar, but with fewer rating options, so this will broaden the rating requirements. <o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;">The proposed ratings also add an additional 10% to any rating for these conditions if they are being treated either with more than 20mg of oral prednisone daily or with daily non-steroidal immunosuppressive medications. <o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;">Non-steroidal immunosuppressives include, but are not limited to, azathioprine, cyclophosphamide, colchicine, penicillamine, and etanercept.<o:p></o:p></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">Codes <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#fungal" target="_blank">6834-6839</a> for <b>Mycotic Lung Diseases</b> remain the same. <o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;">For all <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#restrict" target="_blank">Restrictive Lung Diseases</a>, the VA proposes removing the current rating system, and instead rating all of these conditions (codes 6840-6845) on the Respiratory Rating System. The current system is already similar, but with fewer rating options, so this will broaden the rating requirements. <o:p></o:p></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#qq" style="color: purple;">6847</a></span></b><span style="font-size: 10pt;">: Any <b>sleep apnea syndrome</b> is rated under this code. Sleep apnea is a disorder that occurs while asleep. There is either a pause when breathing that can last up to a few minutes or there is very shallow, low breathing. Central sleep apnea is caused by a decrease in the “action” of breathing—the body doesn’t try as hard to breathe properly. Obstructive sleep apnea is caused by a block in the airways, like a narrowing of the airway passages or an excess of mucus. This causes severe snoring. Mixed sleep apnea is a combination of both central and obstructive.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;">Sleep apnea can cause a significant impairment of the heart and respiratory system by limiting the amount of air that is taken in during the hours of sleep.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;">If the condition continues over a long period of time and causes respiratory failure with right heart ventricle failure or with too much carbon dioxide in the blood stream, or if it requires a Tracheotomy, it is rated 100%.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;">If it requires the use of breathing machines like a continuous positive airway pressure (CPAP) machine during sleep, it is rated 50%.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;">If it causes serious sleepiness during the daytime or not feeling rested after sleeping, it is rated 30%.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="font-size: 10pt;">If it is diagnosed by a sleep test, but it doesn’t cause any significant symptoms, it is rated 0%.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><i>-Proposed-</i> <b>Code 6847</b>: Any <b>sleep apnea syndrome</b> is rated under this code. Sleep apnea is a disorder that occurs while asleep. There is either a pause when breathing that can last up to a few minutes or there is very shallow, low breathing. <o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;">Central sleep apnea is caused by a decrease in the “action” of breathing—the body doesn’t try as hard to breathe properly. Obstructive sleep apnea is caused by a block in the airways, like a narrowing of the airway passages or an excess of mucus. This causes severe snoring. Mixed sleep apnea is a combination of both central and obstructive.<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;">Sleep apnea can cause a significant impairment of the heart and respiratory system by limiting the amount of air that is taken in during the hours of sleep.<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;">A 100% rating is given if there is end-organ damage (damage of the heart, kidneys, brain, or eyes) and the condition does not respond to treatment or cannot be treated.<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;">A 50% rating is given if the condition does not respond to treatment or cannot be treated.<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;">A 10% rating is given if the symptoms are only partially resolved with treatment.<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;">A 0% rating is given if the symptoms are fully resolved with or without treatment.<o:p></o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;">The VA is proposing huge changes for sleep apnea. Currently, it is rated on the treatments required for management. However, the purpose of the ratings is to compensate veterans for loss of earning capacity. The VA therefore proposes instead to rate sleep apnea on any symptoms that remain after treatment. This does put these ratings more in line with the ratings for other conditions, but will make it harder to receive a higher rating under this code. <o:p></o:p></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><i><span lang="EN-GB">-Proposed NEW Code-</span></i><span lang="EN-GB"> <b>Code 6848: Lung transplants</b> are rated under this code. The condition is rated 100% for 1 year following discharge from the hospital after the surgery. It is then rated on the Respiratory Rating System based on any remaining symptoms with a minimum 30% rating. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB">The VA proposes adding a code for lung transplants in order to ensure consistent and correct ratings.<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB"> </span></p>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com1tag:blogger.com,1999:blog-4162041641030931379.post-86497779100065631472022-03-03T08:58:00.004-08:002022-03-03T09:40:27.900-08:00-NEW- Proposed Changes to the Ratings of the Ears, Nose, and Throat <p class="MsoListParagraph" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiGnEaZ3QWwpuC-sRbpa_H-vFtM_L6Rq6w_ao3IMDHm_GDm4isY7r5JlsaEoVnm30QVO8sJh4lXT2Bx8LLhRylQPgZ2p9vEWWSe84VEGmud1cK_N0hWBMGM-gIjGokEKX76W_lwYISeJp3rjerpEG6MdWrSXaOsdLddqnggZwekPKnX8so_-tyvkIeI=s2676" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="2676" data-original-width="2356" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEiGnEaZ3QWwpuC-sRbpa_H-vFtM_L6Rq6w_ao3IMDHm_GDm4isY7r5JlsaEoVnm30QVO8sJh4lXT2Bx8LLhRylQPgZ2p9vEWWSe84VEGmud1cK_N0hWBMGM-gIjGokEKX76W_lwYISeJp3rjerpEG6MdWrSXaOsdLddqnggZwekPKnX8so_-tyvkIeI=s320" width="282" /></a></div><br />On February 15th, 2022, the VA published proposed changes to the ratings of <a href="https://militarydisabilitymadeeasy.com/earratings.html" target="_blank">Ears</a>, <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#nose" target="_blank">Nose</a>, and <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#throat" target="_blank">Throat</a>.<o:p></o:p><p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">These were published along with changes to the entire <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html" target="_blank">Respiratory System</a>, which we are currently writing up and will post about shortly. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">The current <a href="https://militarydisabilitymadeeasy.com/vasrd.html" target="_blank">VASRD</a> does not include an Ears, Nose, and Throat section. Instead, the Ears have their own section, and the Nose and Throat are included in the Respiratory section. The VA proposes to combine these conditions together into their own section since they are associated together in modern medicine. <span> </span><o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">With these changes, the VA only has one more section left, the <a href="https://militarydisabilitymadeeasy.com/centralnervoussystemratings.html" target="_blank">Nervous System</a>, until they complete the full rewrite of the VASRD that began in 2014. In addition to the Ear, Nose, and Throat and Respiratory System, the VA has not yet published the final changes to the <a href="https://blog.militarydisabilitymadeeasy.com/2022/01/new-proposed-changes-to-ratings-of.html" target="_blank">Digestive System</a> and <a href="https://blog.militarydisabilitymadeeasy.com/2022/02/new-proposed-changes-to-mental-disorder.html" target="_blank">Mental Disorders</a>. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">With each set of proposed changes, the VA allows a period in which comments can be submitted. The VA then takes each comment into consideration and makes any additional changes that are warranted before publishing the final ruling. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">We encourage you to submit any comments you might have on these proposed changes to the Ears, Nose, and Throat to us either by commenting on this post or by <a href="https://militarydisabilitymadeeasy.com/contactus.html" target="_blank">contacting us </a>through our website. All comments must be received by April 1st, 2022. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">We will then compile all of your comments into a single report and submit it on your behalf to the VA, just as we’ve done for the other sections (see the <a href="https://blog.militarydisabilitymadeeasy.com/2016/10/comments-submitted-to-va-on-changes-to.html" target="_blank">Skin Comments</a>). This is a great opportunity to really make a difference, so please let us know your thoughts. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">The following are the VA’s new proposed changes to the ratings for the Ears, Nose, and Throat. The changes are fairly extensive, so we’ll walk through each, one at a time.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">For each condition, the small, indented parts are the codes as they are right now. Click on the links to be taken to the discussion of that code on our site. After the current code, we’ll discuss the proposed changes and the VA’s justification.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">________________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p align="center" class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Note on Nose and Throat Conditions<o:p></o:p></span></p><p align="center" class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>The VA currently includes conditions of the nose and throat in the Respiratory System section of the VASRD. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>They are proposing to move the codes for nose and throat conditions from the Respiratory System section to the Ear section of the VASRD, creating an Ear, Nose, and Throat section.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>The ear, nose, and throat (ENT) are commonly treated together in the medical community, and this change would align the VASRD with that standard.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>Just be aware that in the following discussion of the proposed changes, you’ll see the code numbers for nose and throat conditions change because of this move.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">_____________________________________________________________</span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><br /></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><a href="https://militarydisabilitymadeeasy.com/earratings.html#system" target="_blank">The Hearing Loss Rating System</a></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>The VA isn’t changing the hearing loss ratings at all, but is proposing to update some of the terminology and clarify vague principles already being used. Here are the most important changes:<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><br /></span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 41.1pt; mso-add-space: auto; mso-list: l0 level1 lfo19; text-indent: -0.25in;"><!--[if !supportLists]--><span style="mso-ansi-language: EN-US; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><span>Instead of “speech discrimination test,” the VA proposes changing it to “word recognition test,” a more commonly-used term. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 41.1pt; mso-add-space: auto; mso-list: l0 level1 lfo19; text-indent: -0.25in;"><!--[if !supportLists]--><span style="mso-ansi-language: EN-US; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><span>VA proposes to clarify that the puretone audiometry test used for rating purposes is the air conduction test, not the bone conduction test used only for diagnosis.<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 41.1pt; mso-add-space: auto; mso-list: l0 level1 lfo19; text-indent: -0.25in;"><!--[if !supportLists]--><span style="mso-ansi-language: EN-US; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><span>In regards to the word recognition test, it is not to be used when there are language difficulties, inconsistent scores, etc. The VA proposes to further clarify that the “language difficulties” particularly applies to veterans who are not fully fluent in English. They also propose to add that this test is not to be used for veterans with cognitive impairments that interfere with their ability to process language, since a large population of veterans have TBIs and other conditions that result in cognitive language impairments. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/earratings.html#a" style="color: purple; text-decoration: underline;">6100</a>: Hearing loss </span></b><span style="font-size: 10pt;">that is not caused by another condition is rated under this code. This condition is rated based on the <a href="https://militarydisabilitymadeeasy.com/earratings.html#system" style="color: purple; text-decoration: underline;">hearing loss rating system</a>.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b><span>Code 6100: Hearing loss</span></b><span> that is not caused by another condition is rated under this code. This condition is rated based on the hearing loss rating system.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><span><o:p> </o:p></span></b></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>If tinnitus (the ringing sound in the ear that often comes after exposure to serious aural trauma like explosions) is present along with the hearing loss, the minimum rating is 10%. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><span lang="EN-GB"><o:p> </o:p></span></b></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">The only proposed change to this code is to include a provision for a minimum 10% rating if tinnitus is present. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">The only proposed change to code <a href="https://militarydisabilitymadeeasy.com/earratings.html#g" target="_blank">6200</a> for <b>chronic suppurative otitis media </b>is to remove tinnitus as a separate rating option since it will be covered by the hearing loss rating. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">_______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/earratings.html#h" target="_blank">6201</a> for <b>chronic nonsuppurative otitis media with effusion</b> will not change.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">________________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-family: "Times New Roman", serif; font-size: 10pt;">-</span><i><span style="font-family: "Times New Roman", serif; font-size: 10pt;">Current-</span></i><span style="font-family: "Times New Roman", serif; font-size: 10pt;"> <b>Code <a href="https://militarydisabilitymadeeasy.com/earratings.html#b" style="color: purple; text-decoration: underline;">6202</a>: Otosclerosis </b>is an abnormal growth of bone in the middle ear. This condition is rated based on the <a href="https://militarydisabilitymadeeasy.com/earratings.html#system" style="color: purple; text-decoration: underline;">hearing loss rating system</a>.<b> <o:p></o:p></b></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB" style="font-family: "Times New Roman", serif;"><o:p> </o:p></span></i></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB" style="font-family: "Times New Roman", serif;">-Proposed-</span></i><span lang="EN-GB" style="font-family: "Times New Roman", serif;"> </span><b><span>Code 6202: Otosclerosis </span></b><span>is an abnormal growth of bone in the middle ear. This condition, including any remaining symptoms after a stapedectomy or stapedotomy is performed, is rated based on the hearing loss rating system. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">The only proposed change to this code is to clarify that post-surgical residuals are also covered under this code. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span style="font-size: 10pt;">-Current-</span></i><span style="font-size: 10pt;"> <b>Code <a href="https://militarydisabilitymadeeasy.com/earratings.html#i" style="color: purple; text-decoration: underline;">6204</a>: Peripheral vestibular disorders </b>are conditions that affect the ears’ ability to sense proper body balance. Symptoms include dizziness, sense of being in motion or spinning, wooziness, or motion sickness. Before a condition can be rated under this code, definite evidence of the exact condition and a firm diagnosis must be made. A sense of being off-balance on its own is not ratable. If the diagnosed condition also causes hearing loss or liquid coming out the ear, then those symptoms <i>can</i> be rated in addition to a rating under this code.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;">If there is dizziness that occasionally causes staggering when walking, it is rated 30%. If there is occasional dizziness, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span>-Proposed-</span></i><span> <b>Code 6204: Peripheral vestibular disorders </b>are conditions that affect the ears’ ability to sense proper body balance. It can affect one or both ears. Symptoms include dizziness, sense of being in motion or spinning, wooziness, or motion sickness. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>Before a condition can be rated under this code, definite evidence of the exact condition and a firm diagnosis must be made. A sense of being off-balance on its own is not ratable. If the diagnosed condition also causes hearing loss or liquid coming out the ear, then those symptoms can be rated in addition to a rating under this code.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>This condition is rated on how it affects your ability to work and perform self-care activities, including dressing, bathing/hygiene, eating, moving around, and getting from place to place. All limitations must be noted by your doctor in your medical records. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 100% rating is given if the condition causes symptoms during the past 6 months that have made it impossible to work and/or perform self-care activities without daily assistance from another person.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 30% rating is given if the condition causes symptoms during the past 6 months that require regular effort and modifications or accommodations to accomplish work and/or self-care activities without assistance.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 10% rating is given if the condition causes symptoms during the past 6 months that require occasional modifications, but do not interfere significantly with work and/or self-care activities.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>The VA is proposing significant changes to this code. The current rating system only considers dizziness and staggering, but peripheral vestibular disorders can cause a wide-range of symptoms that can significantly affect all aspects of work and self-care. These changes will rate all symptoms based on how they affect work and self-care. They also add a 100% rating level for conditions so severe that it’s impossible to work or take care of yourself on your own. <span> </span><o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">_____________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/earratings.html#j" style="color: purple; text-decoration: underline;">6205</a>: Meniere’s syndrome </span></b><span style="font-size: 10pt;">(endolymphatic hydrops) is a disorder of the inner ear that affects both hearing and balance. Symptoms include hearing loss, tinnitus, and dizziness or wooziness. This condition can be rated one of two ways: once under this code, <i>or</i> three ratings, one under <a href="https://militarydisabilitymadeeasy.com/earratings.html#e" style="color: purple; text-decoration: underline;">tinnitus</a>, one under <a href="https://militarydisabilitymadeeasy.com/earratings.html#system" style="color: purple; text-decoration: underline;">hearing loss</a>, and one as a <a href="https://militarydisabilitymadeeasy.com/earratings.html#i" style="color: purple; text-decoration: underline;">peripheral vestibular disorder</a>, can be combined. Choose the rating option that gives the higher rating.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;">If there is hearing loss with episodes of dizziness and staggering while walking that occur more than once a week, whether or not there is tinnitus, it is rated 100%. If there is hearing loss with episodes of dizziness and staggering while walking that occur one to four times a month, whether or not there is tinnitus, it is rated 60%. If there is hearing loss with episodes of dizziness less than once a month, whether or not there is tinnitus, it is rated 30%.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span>-Proposed-</span></i><b><span> Code 6205: Meniere’s syndrome</span></b><span> (endolymphatic hydrops) is a disorder of the inner ear that affects both hearing and balance. Symptoms include hearing loss, tinnitus, and dizziness or wooziness. This condition can be rated one of two ways: <span> </span>once under this code, or once for hearing loss and once as a peripheral vestibular disorder. Choose the rating option that gives the higher combined rating.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>In order to qualify to be rated under this code, Meniere’s must be officially diagnosed by an otolaryngologist or neurologist. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 100% rating is given if there is hearing loss (with or without tinnitus) <i>and</i> either episodes of dizziness five or more times each month during the past 6 months <i>or</i> continually feeling unbalanced and staggering while walking. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 60% rating is given if there is hearing loss (with or without tinnitus) <i>and</i> episodes of dizziness one to four times each month during the past 6 months.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 30% rating is given if there is hearing loss (with or without tinnitus) <i>and</i> episodes of dizziness less than once a month during the past 6 months.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>The VA isn’t proposing many changes to this code. The ratings are staying essentially the same, although the proposed changes make the requirements more specific to ensure correct rating application. They are also removing tinnitus as a separate rating option since it will be covered under the hearing loss rating or a rating under this code. <span> </span><o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Codes <a href="https://militarydisabilitymadeeasy.com/earratings.html#c" target="_blank">6207</a> (<b>loss of auricle</b>), <a href="https://militarydisabilitymadeeasy.com/earratings.html#l" target="_blank">6208</a> (<b>malignant tumors</b>), <a href="https://militarydisabilitymadeeasy.com/earratings.html#k" target="_blank">6209</a> (<b>benign tumors</b>), <a href="https://militarydisabilitymadeeasy.com/earratings.html#f" target="_blank">6210</a> (<b>chronic otitis externa</b>), and <a href="https://militarydisabilitymadeeasy.com/earratings.html#d" target="_blank">6211</a> (<b>ear drum tear</b>) will not change.<o:p></o:p></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">_______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">The VA proposes to remove code <a href="https://militarydisabilitymadeeasy.com/earratings.html#e" target="_blank">6260</a> for<b> tinnitus</b> since tinnitus is not a condition in and of itself, but is a symptom of another condition. As such, the VA is proposing changes to the ratings of conditions that commonly cause tinnitus in order to cover tinnitus under those ratings. Anyone currently rated under this code will continue to receive their 10% rating. <o:p></o:p></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">____________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">The ratings for code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#a" target="_blank">6502</a>, <b>deviation of the nasal septum,</b> will not change, but the code number will change to 6220. <o:p></o:p></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">____________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#b" style="color: purple; text-decoration: underline;">6504</a>: Loss of part of the nose or significant scarring </span></b><span style="font-size: 10pt;">is rated 30% if both nasal passages are exposed or 10% if there is an obvious disfigurement. It can either be rated under this code or under code <a href="https://militarydisabilitymadeeasy.com/scarratings.html#a" style="color: purple; text-decoration: underline;">7800</a> for disfigurement if it would give a higher rating.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB" style="font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span>-Proposed-</span></i><b><span> Code 6221: Loss of part of the nose</span></b><span> or<b> significant scarring of the nose </b>is rated under this code. The degree of injury and the ability to wear a prothesis must be documented by a qualified specialist.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 30% is given if half or more is missing and a prosthesis cannot be used. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 20% is given if less than half is missing and a prosthesis cannot be used. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 10% is given for any loss of the nose where a prosthesis can be used. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 0% is given if a prosthesis is not required or recommended. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>The condition can either be rated under this code or under code 7800 for disfigurement if it would give a higher rating.</span><span lang="EN-GB"><o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><span><o:p> </o:p></span></b></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>The VA is proposing to change the ratings for this condition to better reflect the work and social impact of the condition based on the actual loss/disfigurement and the ability to wear a prosthesis.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">___________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b><span lang="EN-GB"><o:p> </o:p></span></b></p><p align="center" class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span style="font-size: 10pt;">-Current-</span></i><span style="font-size: 10pt;"> Sinusitis Rating System<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;">Sinusitis occurs when the sinuses swell and is most often caused by infection or allergy. Most sinusitis is easily cleared up within 2 weeks, and so it is only ratable if it is Chronic. Sinusitis can occur in each of the different sinuses or in all at the same time (“pansinusitis”). Treatments range from medication to surgery.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;">If the sinusitis is constant or near-constant with headaches, tenderness to the touch, and the discharge of puss or crusting after repeated surgeries, <i>or</i> if a Radical Surgery was performed and there is ongoing infection in the facial bones (osteomyelitis), it is rated 50%.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;">If there are 3 or more Incapacitating Episodes each year that requires 4 to 6 weeks of antibiotic treatment, <i>or</i> if there are more than 6 episodes (not incapacitating) each year of headaches, tenderness and the discharge of puss or crusting, it is rated 30%.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;">If there are 1 or 2 incapacitating episodes each year that requires 4 to 6 weeks of antibiotic treatment, <i>or</i> if there are 3 to 6 episodes each year of headaches, tenderness, and the discharge of puss or crusting, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;">Anything less is rated 0%.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;"><a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#f" target="_blank">Sinusitis codes</a>:<o:p></o:p></span></p><p class="MsoNormal" style="margin-left: 99pt; mso-list: l20 level1 lfo21; tab-stops: list .5in left 58.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><b><span style="font-size: 10pt;">Code 6510: Pansinusitis</span></b><span style="font-size: 10pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-left: 99pt; mso-list: l20 level1 lfo21; tab-stops: list .5in left 58.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><b><span style="font-size: 10pt;">Code 6511: Ethmoid sinusitis</span></b><span style="font-size: 10pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-left: 99pt; mso-list: l20 level1 lfo21; tab-stops: list .5in left 58.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><b><span style="font-size: 10pt;">Code 6512: Frontal sinusitis</span></b><span style="font-size: 10pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-left: 99pt; mso-list: l20 level1 lfo21; tab-stops: list .5in left 58.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><b><span style="font-size: 10pt;">Code 6513: Maxillary sinusitis</span></b><span style="font-size: 10pt;"><o:p></o:p></span></p><p class="MsoNormal" style="margin-left: 99pt; mso-list: l20 level1 lfo21; tab-stops: list .5in left 58.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><b><span style="font-size: 10pt;">Code 6514: Sphenoid sinusitis</span></b><span style="font-size: 10pt;"><o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p align="center" class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> Rhinosinusitis Rating System<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Rhinosinusitis occurs when the sinuses and nasal cavity swell, making it difficult to breathe through the nose. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Most cases of rhinosinusitis are easily cleared up in less than 12 weeks. These cases are not ratable. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Only cases of rhinosinusitis that have symptoms lasting 12 weeks or more during the past year—Rhinosinusitis (CRS) and Recurrent Acute Rhinosinusitis (RARS)—can be rated. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Symptoms of rhinosinusitis include inflammation proven by radiographic imaging or by visual confirmation of purulent mucus or polyps <i>and</i> at least two of the following:<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1in; mso-add-space: auto; mso-list: l16 level1 lfo22; tab-stops: 58.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-GB">Mucus drainage<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; mso-add-space: auto; mso-list: l16 level1 lfo22; tab-stops: 58.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-GB">Congestion<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; mso-add-space: auto; mso-list: l16 level1 lfo22; tab-stops: 58.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-GB">Facial pressure/pain/fullness<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1in; mso-add-space: auto; mso-list: l16 level1 lfo22; tab-stops: 58.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-GB">Decreased sense of smell<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">A 50% rating is given if the condition requires antibiotic treatment 12 weeks or more during the past year <i>and</i> is unresponsive to surgical treatments. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">A 30% rating is given if the condition requires antibiotic treatment 12 weeks or more during the past year.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">A 10% rating is given if the condition requires antibiotic treatment for 4-12 weeks during the past year.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">A 0% rating is given if the condition requires antibiotic treatment less than 4 weeks during the past year.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Rhinosinusitis codes:<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Code 6222: Pansinusitis<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Code 6223: Ethmoid rhinosinusitis<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Code 6224: Frontal rhinosinusitis<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Code 6225: Maxillary rhinosinusitis<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Code 6226: Sphenoid rhinosinusitis<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">-NEW CODE- Code 6233: Allergic or vasomotor rhinosinusitis<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">The VA is proposing multiple changes to the sinusitis ratings, including updating the terminology to current standards and clearly clarifying what kinds of rhinosinusitis can qualify for ratings. They are also getting rid of the vague “incapacitating episodes” requirements and basing the ratings on measurable periods of time where antibiotics were required to treat the condition.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">The VA is also proposing adding a new rhinosinusitis condition to ensure accurate ratings.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">____________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">The following codes will be changing numbers, but their ratings will not change: <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#uu" target="_blank">6515</a> for <b>tuberculous laryngitis</b> will become code 6227.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#g" target="_blank">6516</a> for <b>chronic laryngitis</b> will become code 6228.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#h" target="_blank">6518</a> for a <b>total laryngectomy</b> will become code 6229.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#i" target="_blank">6519</a> for <b>complete aphonia</b> will become code 6230.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB"><o:p> </o:p></span></i></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#j" style="color: purple; text-decoration: underline;">6520</a></span></b><span style="font-size: 10pt;">: <b>Stenosis of the larynx</b> is when the larynx narrows and the opening to the trachea becomes unusually small, causing difficulty speaking and breathing. If the larynx was injured, then any <b>leftover symptoms from the injury</b> can also be rated under this code. These conditions are either rated on the following system, or as the inability to speak, code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#i" style="color: purple; text-decoration: underline;">6519</a>, whichever is most appropriate for the condition and provides the higher rating.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-size: 10pt;">If the <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#fev1" style="color: purple; text-decoration: underline;">FEV-1</a> is less than 40% and the <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#loop" style="color: purple; text-decoration: underline;">Flow-Volume Loop</a> shows an upper airway obstruction, or if there is a Permanent Tracheostomy, then it is rated 100%. If the FEV-1 is 40-55% and the Flow-Volume Loop shows an upper airway obstruction, it is rated 60%. If the FEV-1 is 56-70% and the Flow-Volume Loop shows an upper airway obstruction, it is rated 30%. If the FEV-1 is 71-80% and the Flow-Volume Loop shows an upper airway obstruction, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span><o:p> </o:p></span></i></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> <b>Code<span> <span>6231: Stenosis of the larynx</span></span></b><span> is when the larynx narrows and the opening to the trachea becomes unusually small, causing difficulty speaking and breathing. If the larynx was injured, then any leftover symptoms from the injury can also be rated under this code. <o:p></o:p></span></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">These conditions are either rated on the following system, or as the inability to speak, code 6230, whichever is most appropriate for the condition and provides the higher rating.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">A 100% rating is given if the larynx is completely blocked and requires a permanent tracheostomy to breathe.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">A 70% rating is given if 50% or more of the larynx is blocked.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">A 50% rating is given if 25-49% of the larynx is blocked.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB"><o:p> </o:p></span></i></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">A 30% rating is given if less than 25% of the larynx is blocked.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Currently, larynx stenosis is rated on the results of breathing tests, but the VA is proposing to rate it solely on the amount the larynx has narrowed. They argue that other conditions can result in similar test results, so the disability resulting from only the stenosis can better be determined simply by measuring the blockage. <span> </span></span><span lang="EN-GB"><span> </span></span><span><o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">__________________________________________________________</span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB"><br /></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">Code<a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#k" target="_blank"> 6521</a> for <b>injuries of the pharynx </b>will become code 6232. The ratings will not change.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">_______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB"><o:p> </o:p></span></i></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#c" style="color: purple; text-decoration: underline;">6522</a></span></b><span style="font-size: 10pt;">: <b>Allergic or vasomotor rhinitis</b> is the swelling of the tissues lining the nasal passage because of allergies or other inhaled triggers like smoke, fumes, etc. This causes the nose to become stuffy and runny. If the rhinitis is fairly constant and there are growths forming in the tissues, it is rated 30%. If there are no growths in the tissues, but 50% of the nasal passages on both sides or 100% on one side is blocked, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span>-Proposed-</span></i><span> <b>Code 6240: Allergic or vasomotor rhinitis</b> is the swelling of the tissues lining the nasal passage because of allergies or other inhaled triggers like smoke, fumes, etc. This causes the nose to become stuffy and runny. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 30% rating is given if there are growths (“polyps”) forming in the tissues. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 10% rating is given if it requires continuous medication, like corticosteroids and antihistamines.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>If the condition results in chronic or recurrent rhinosinusitis, it is rated under code 6233. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>The VA is only proposing to change the 10% rating to be based solely on whether or not continuous medication is needed for the condition. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">___________________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span><o:p> </o:p></span></i></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#d" style="color: purple; text-decoration: underline;">6523</a></span></b><span style="font-size: 10pt;">: <b>Bacterial rhinitis</b> is the swelling of the tissues lining the nasal passage because of a bacterial infection, causing congestion and a runny nose. If the condition causes Rhinoscleroma, it is rated 50%. If there is rhinitis and the Nasal Concha grows abnormally into the nasal passages and causes 50% of both or 100% of one to be blocked, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB"><o:p> </o:p></span></i></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB">- Proposed-</span></i><span lang="EN-GB"> <b>Code 6234: Rhinosinusitis caused by infection </b><span>is the swelling of the tissues lining the nasal passage because of a bacterial or fungal infection. It is rated under the Rhinosinusitis Rating System. <o:p></o:p></span></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><div style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-style: none none solid; caret-color: rgb(0, 0, 0); color: black; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; orphans: auto; padding: 0in 0in 1pt; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><p class="MsoNormal" style="border: none; font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; padding: 0in;"><span>The VA is proposing to change the name of this condition so it is clear that it includes both bacterial and fungal infections. It will then be rated on the new Rhinosinusitis Rating System.<o:p></o:p></span></p><p class="MsoNormal" style="border: none; font-family: Cambria, serif; font-size: 12pt; margin: 0in 0in 0.0001pt; padding: 0in;"><span><o:p> </o:p></span></p></div><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span style="font-size: 10pt;">-Current-</span></i><span style="font-size: 10pt;"> <b>Code <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html#e" style="color: purple; text-decoration: underline;">6524</a>: Granulomatous rhinitis </b>is the swelling of the tissues lining the nasal passage with abnormal cell growths that are not caused by bacteria. If the condition is lethal midline Wegener’s granulomatosis, it is rated 100%. This condition causes the blood vessels in the nose to swell and lumps to form that often cause deformities to form and the airways to become blocked. The condition is not curable, but it is treatable and not always lethal. Any other type of rhinitis that causes lumps to form in the nose is rated 20%.<b><o:p></o:p></b></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 1in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b><span>Code 6235: Rhinosinusitis </span></b><span>(<b>granulomatous, autoimmune, or other</b>) is the swelling of the tissues lining the nasal passage with abnormal cell growths caused by fungal infections, autoimmune disorders, etc. The rhinosinusitis rated under this code is very severe and can be life-threatening. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 100% rating is given while the condition is being treated with systemic immunosuppressive medications. The 100% rating continues for 6 months following the last treatment. It is then rated under the Rhinosinusitis Rating System. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>All other cases are rated under the Rhinosinusitis Rating System.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>Lethal midline granuloma and all other cancerous conditions are rated under code 6238.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">The modern medical understandings and treatments of these conditions have changed significantly, so the VA is proposing to adjust the ratings and conditions rated under this code in order to more correctly and accurately rate these conditions.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 6236</b><span>: <span> </span></span><b>Vocal cord paralysis</b><span> occurs when nerves that control the vocal cords are damaged. It is rated either under code 6228, laryngitis, or code 6230, aphonia, whichever best describes the resulting disability.<o:p></o:p></span></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">The VA is proposing to add a new code for vocal cord paralysis in order to ensure correct and consistent ratings for veterans with this condition.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 6237</b><span>: <span> </span></span><b>Benign tumors affecting the nose, throat, and/or sinuses </b></span><span>are rated on how they affect the functioning of the affected part. It is rated under the code that most closely describes the resulting symptoms. <span> </span><o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 6238</b><span>: <span> </span></span><b>Malignant tumors affecting the nose, throat, and/or sinuses </b></span><span>are rated 100% while they are active. The 100% rating continues for 6 months following the final treatment of the condition. It is the re-evaluated and rated under the code that most closely describes the remaining symptoms. <span> </span><o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">The VA is proposing to add new codes specifically for tumors of the nose, throat, and sinuses in order to better track these conditions in the veteran population. No changes are being made to the ratings for these conditions.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">________________________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 6239</b><span>: </span><b>Salivary gland conditions </b></span><span>affect the production of the saliva and often result in dry mouth and other symptoms. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 20% rating is given if there is dry mouth, altered sense of taste, and difficulty chewing and swallowing food, leading to either weight loss or tooth decay.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 10% rating is given if there is dry mouth, altered sense of taste, and difficulty chewing and swallowing food, but no weight loss or tooth decay. A 10% is also given if the salivary gland always swells and hurts when eating <i>or</i> if there are blocks or strictures in the salivary gland. <span> </span><o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>A 0% rating is given if there is dry mouth, but no pain or difficulty eating.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.5in; orphans: auto; text-align: justify; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span>Facial nerve damage, code 8207, and disfigurement, code 7800, can be rated separately.<o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB"><o:p> </o:p></span></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span lang="EN-GB">The VA is proposing to add a new code for conditions of the salivary gland, which currently doesn’t have a satisfactory rating option. <o:p></o:p></span></p><p class="MsoNormal" style="-webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Cambria, serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; text-align: center; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span lang="EN-GB">_______________________________________________________________________</span></p><style class="WebKit-mso-list-quirks-style">
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/* List Definitions */
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</style>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com0tag:blogger.com,1999:blog-4162041641030931379.post-16482632302619614882022-02-18T11:00:00.002-08:002022-02-18T11:00:42.629-08:00 -NEW- Proposed Changes to the Mental Disorder Ratings<p><span style="font-family: Cambria, serif;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEg3Rl39GRQmcAP6eAoHjNMNyrP-Z3I58VEdQlznQ9zWQyF08CPD2Z9hKfpzMDMGAHABCgzpqn7tJnGxL6NWffzR_oa_-_pqvSe6G2PZMFycBk1l3LhbskWlEwkoi51ISWfmyvQ5uysBcOiotngR5wbBer2ftxwC_jh16ku5Iu3m5kYx1sxo0SMXZCg3=s1075" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1075" data-original-width="1014" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEg3Rl39GRQmcAP6eAoHjNMNyrP-Z3I58VEdQlznQ9zWQyF08CPD2Z9hKfpzMDMGAHABCgzpqn7tJnGxL6NWffzR_oa_-_pqvSe6G2PZMFycBk1l3LhbskWlEwkoi51ISWfmyvQ5uysBcOiotngR5wbBer2ftxwC_jh16ku5Iu3m5kYx1sxo0SMXZCg3=s320" width="302" /></a></div><br />On February 15th, 2022, the VA published proposed changes to the <a href="https://militarydisabilitymadeeasy.com/mentaldisorderratings.html" target="_blank">Mental Disorder </a>ratings.<span style="font-family: Cambria, serif;"> </span><p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA last changed this section of the <a href="https://militarydisabilitymadeeasy.com/vasrd.html" target="_blank">VASRD</a> in 2015 when they updated the terminology to reflect the newly-published (at that time) Diagnostic and Statistical Manual of Mental Disorders, 5<sup>th</sup> edition (DSM-5). They didn’t, however, change the Psychological Rating System. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA is now proposing changes to the Psychological Rating System in order to update it to better reflect modern treatments, understandings, and functional disabilities resulting from Mental Disorders. Research has shown that the current system does not properly compensate veterans for the loss of earning capacity, so the changes are also designed to more fairly and completely compensate veterans based on a more accurate measurement system.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">With each set of proposed changes, the VA allows a period in which comments can be submitted. The VA then takes each comment into consideration and makes any additional changes that are warranted before publishing the final ruling. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">We encourage you to submit any comments you might have on these proposed changes to the Mental Disorder ratings to us either by commenting on this post or by <a href="https://militarydisabilitymadeeasy.com/contactus.html" target="_blank">contacting us</a> through our website. All comments must be received by April 1st, 2022. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">We will then compile all of your comments into a single report and submit it on your behalf to the VA, just as we’ve done for the other sections (see the <a href="https://blog.militarydisabilitymadeeasy.com/2016/10/comments-submitted-to-va-on-changes-to.html" target="_blank">Skin Comments</a>). This is a great opportunity to really make a difference, so please let us know your thoughts. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The following are the VA’s new proposed changes to the Psychological Rating System. The changes are based on two assessment systems that are widely used today: WHODAS 2.0 and CAPS-5. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">WHODAS 2.0 (World Health Organization Disability Assessment Schedule 2.0) “assesses the ability to perform tasks in six functional domains by measuring the impact of a disability across various life functions and assigning a score for each domain.”<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">CAPS-5 (Clinician-Administered PTSD Scale for DSM-5) “is a 30-item structured interview... that is used to render a diagnosis of PTSD and assess the severity of the 20 PTSD symptoms.” <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">By combining the principles used in these two systems, the VA feels that it will “create a common language between clinicians and adjudicators, which VA believes will lead to more efficient and accurate adjudication of claims for mental disorders.”<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA also states that the new “criterion should generally lead to more generous compensation for veterans than the current rating formula.” And this is true. You will find that the new changes will allow for higher ratings for mental disorders across the board, with less strict requirements for the higher ratings and a required minimum rating of 10% for any diagnosed mental disorder. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">So let’s jump in to the changes and see how the new system works.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">First change: Currently Eating Disorders are rated differently than all other Mental Disorders. The VA proposes to eliminate the <a href="https://militarydisabilitymadeeasy.com/mentaldisorderratings.html#eat" target="_blank">separate rating system for Eating Disorders</a> and simply rate them along with all other Mental Disorders on the proposed Psychological Rating System to ensure consistent, fair ratings based on how they impact daily functioning. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Since none of the condition codes will be changing, we’ll simply present the proposed rating system below. You can find the current <a href="https://militarydisabilitymadeeasy.com/mentaldisorderratings.html#system" target="_blank">Psychological Rating System </a>on our site to compare the changes. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_____________________________________________________________________</span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB"><br /></span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> <b><a href="https://militarydisabilitymadeeasy.com/mentaldisorderratings.html#prin" target="_blank">Important Rating Principles</a></b><o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;">Only a single rating can be given for your overall psychological condition. If multiple mental disorders are diagnosed, they will be combined into a single condition when rating and all of the psychological symptoms will be used together to assign the rating.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">Mental disorders are rated based on how they affect your social and occupational functioning. Can you hold a steady job? Do you have committed or stable relationships? The more the condition affects your social and occupational life, the higher the rating.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The severity of the condition over the past month is used to determine the rating. Because of this, you want to make sure that this month is clearly and thoroughly documented by your mental health provider. In most cases, this month will be the month prior to claim submission for the VA, and the month prior to referral to the MEB for the DoD. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">All ratings are based on the symptoms that remain after treatment, so if medication decreases your symptoms, then the ratings will be based on the decreased symptoms, not on the symptoms that would be present without medication.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">If a condition has both a mental and physical aspect, then it is rated under the mental <b>or </b>the physical, whichever best defines the overall disability. The exception to this rule is neurocognitive disorders (dementia), which can be rated in addition to a physical condition from the same cause (i.e. head injury, etc.).<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><i><span lang="EN-GB">-Proposed-</span></i><b><span lang="EN-GB"> The Psychological Rating System<o:p></o:p></span></b></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">A 100% rating is given if a Level 4 is given in one or more domains <b>or</b> if a Level 3 is given in two or more domains.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">A 70% rating is given if a Level 3 is given in one domain <b>or</b> if a Level 2 is given in two or more domains.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">A 50% rating is given if a Level 2 is given in one domain. <b><o:p></o:p></b></span></p><p class="MsoNormal" style="font-size: medium;"><b><span lang="EN-GB"> </span></b></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">A 30% rating is given if a Level 1 is given in two or more domains.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The minimum rating for any diagnosed Mental Disorder is 10%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><b><span lang="EN-GB">Criterion for Determining Domain Levels<o:p></o:p></span></b></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">All domains are evaluated based on symptoms present over the past month. Compare the criteria for each domain to the levels of impairment to assign a level to each of the 5 domains. Then use these domain levels to assign a rating based on the ratings noted above.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><i><span lang="EN-GB"> </span></i></p><p class="MsoNormal" style="font-size: medium;"><i><span lang="EN-GB">NOTE: If a single symptom applies to multiple domains, it can only be used to assign a level to one of the domains, whichever results in the higher level.<o:p></o:p></span></i></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><u><span lang="EN-GB">Levels of Impairment<o:p></o:p></span></u></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><u><span lang="EN-GB"> </span></u></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 103.5pt; margin-right: 68.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Level 4</span></b><span lang="EN-GB">. Total impairment 25% or more of the time.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 103.5pt; margin-right: 68.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Level 3</span></b><span lang="EN-GB">. Severe impairment 25% or more of the time, <b>or </b>total impairment less than 25% of the time.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 103.5pt; margin-right: 68.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Level 2</span></b><span lang="EN-GB">. Moderate impairment 25% or more of the time, <b>or </b>severe impairment less than 25% of the time.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 103.5pt; margin-right: 68.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Level 1</span></b><span lang="EN-GB">. Any mild impairment, <b>or </b>moderate impairment less than 25% of the time.<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 103.5pt; margin-right: 68.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Level 0</span></b><span lang="EN-GB">. No impairment.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><u><span lang="EN-GB">Domain Criteria<o:p></o:p></span></u></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><b><span lang="EN-GB">Domain 1. Cognition.</span></b><span lang="EN-GB"> This domain covers mental processes having to do with learning, communicating, and understanding. It includes things like memory, concentration, attention, goal setting, speed of information processing, planning, organizing, prioritizing, problem solving, judgment, making decisions, and the ability to adapt.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">Criteria<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Total Impairment</span></b><span lang="EN-GB">: Incapable of even the most basic tasks in one or more aspects of cognitive functioning. These symptoms do not respond to treatment and completely interfere with tasks, activities, or relationships. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Severe Impairment</span></b><span lang="EN-GB">: Serious difficulties in one or more aspects of cognitive functioning. These symptoms significantly interfere with tasks, activities, or relationships.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Moderate Impairment</span></b><span lang="EN-GB">: Obvious difficulties in one or more aspects of cognitive functioning. These symptoms interfere with tasks, activities, or relationships.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Mild Impairment</span></b><span lang="EN-GB">: Slight difficulties in one or more aspects of cognitive functioning. These symptoms <i>do not</i> interfere with tasks, activities, or relationships.<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">No Impairment</span></b><span lang="EN-GB">: No difficulties in any aspect of cognitive functioning.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><b><span lang="EN-GB">Domain 2. Interpersonal interactions and relationships.</span></b><span lang="EN-GB"> This domain covers mental processes having to do with participation in society (being involved in social activities like church, book club, sports teams, politics, etc.) and interacting with other people, whether formally (co-workers/supervisors) or informally (friends/strangers). <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">Criteria<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Total Impairment</span></b><span lang="EN-GB">: Incapable of even the most basic tasks in one or more aspects of interpersonal functioning. These symptoms do not respond to treatment and completely interfere with tasks, activities, or relationships. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Severe Impairment</span></b><span lang="EN-GB">: Serious difficulties in one or more aspects of interpersonal functioning. These symptoms significantly interfere with tasks, activities, or relationships, even with coping techniques or things being done to try to ease the social situations.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Moderate Impairment</span></b><span lang="EN-GB">: Obvious difficulties in one or more aspects of interpersonal functioning. These symptoms interfere with tasks, activities, or relationships.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Mild Impairment</span></b><span lang="EN-GB">: Slight difficulties in one or more aspects of interpersonal functioning. These symptoms <i>do not</i> interfere with tasks, activities, or relationships.<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">No Impairment</span></b><span lang="EN-GB">: No difficulties in any aspect of interpersonal functioning. Able to have relationships and social interactions.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><b><span lang="EN-GB">Domain 3. Task completion and life activities.</span></b><span lang="EN-GB"> This domain covers mental processes having to do with completing tasks and performing activities, whether at work, school, home, socially, caregiving, etc.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">Criteria<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Total Impairment</span></b><span lang="EN-GB">: Incapable of even the most basic tasks in one or more aspects of task and activity functioning. Profound difficulties in two or more aspects of task and activity functioning, one of which must be vocational. Tasks were not able to be completed even with accommodations because of overwhelming stress.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Severe Impairment</span></b><span lang="EN-GB">: Serious difficulties in two or more aspects of task and activity functioning. Tasks were able to be completed with significant stress <i>and</i> accommodations.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Moderate Impairment</span></b><span lang="EN-GB">: Obvious difficulties in one or more aspects of task and activity functioning. Tasks were able to be completed with significant stress <i>or</i> accommodations.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Mild Impairment</span></b><span lang="EN-GB">: Slight difficulties in one or more aspects of task and activity functioning. Tasks were able to be completed with minor stress <i>or</i> minor accommodations.<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">No Impairment</span></b><span lang="EN-GB">: No difficulties in any aspect of task and activity functioning. No accommodations needed.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><b><span lang="EN-GB">Domain 4. Navigating environments.</span></b><span lang="EN-GB"> This domain covers mental processes having to do with getting around and dealing with spatial environments, including leaving home, independently moving in surroundings, navigating new environments, driving, using public transportation, being in confined or crowded spaces, etc. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">Criteria<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Total Impairment</span></b><span lang="EN-GB">: Incapable of even the most basic tasks in one or more aspects of navigating environments. These symptoms do not respond to treatment and completely interfere with tasks, activities, or relationships. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Severe Impairment</span></b><span lang="EN-GB">: Serious difficulties in one or more aspects of navigating environments. These symptoms significantly interfere with tasks, activities, or relationships, even with coping techniques or assistance.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Moderate Impairment</span></b><span lang="EN-GB">: Obvious difficulties in one or more aspects of navigating environments. These symptoms interfere with tasks, activities, or relationships.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Mild Impairment</span></b><span lang="EN-GB">: Slight difficulties in one or more aspects of navigating environments. These symptoms <i>do not</i> interfere with tasks, activities, or relationships.<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">No Impairment</span></b><span lang="EN-GB">: No difficulties in any aspect of navigating environments. Able to navigate and function in any type of environment.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><b><span lang="EN-GB">Domain 5. Self-care.</span></b><span lang="EN-GB"> This domain covers mental processes having to do with taking care of yourself, including things like dressing, eating, hygiene, etc. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">Criteria<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Total Impairment</span></b><span lang="EN-GB">: Incapable of even the most basic tasks in one or more aspects of self-care. These symptoms do not respond to treatment and completely interfere with tasks, activities, or relationships, even with coping techniques or assistance. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Severe Impairment</span></b><span lang="EN-GB">: Serious difficulties in one or more aspects of self-care. These symptoms significantly interfere with tasks, activities, or relationships, even with coping techniques or assistance.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Moderate Impairment</span></b><span lang="EN-GB">: Obvious difficulties in one or more aspects of self-care. Without assistance or coping techniques in place, these symptoms interfere with tasks, activities, or relationships.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">Mild Impairment</span></b><span lang="EN-GB">: Slight difficulties in one or more aspects of self-care. These symptoms <i>do not</i>interfere with tasks, activities, or relationships.<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 0.75in; margin-right: 37pt; text-indent: -0.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span lang="EN-GB">No Impairment</span></b><span lang="EN-GB">: No difficulties in any aspect of self-care. Able to appropriately care for themselves.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><style class="WebKit-mso-list-quirks-style">
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</style>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com1tag:blogger.com,1999:blog-4162041641030931379.post-53145243160123200962022-01-19T08:52:00.005-08:002022-01-19T08:52:56.147-08:00-NEW- Proposed Changes to the Ratings of the Digestive System <style class="WebKit-mso-list-quirks-style">
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</style><p class="MsoListParagraph" style="font-size: medium;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhuvId-AALRqqWBR3nrgasxtJ_img-mixyWJr_S6Imh6pQAxfcqIplHkRNL-wShxw99S1OYsaMf2CAVMKbB2PMvsmhmaUGGLDeoe3pOiJdJNbXKAVtOP6b-x2e_xP42clF5BEnQkcL3QJmUIVnjpPuPE9KsX9L2J9ZZm-zSPz1AfCfvYn3juN7CP0ex=s2909" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="2909" data-original-width="2237" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEhuvId-AALRqqWBR3nrgasxtJ_img-mixyWJr_S6Imh6pQAxfcqIplHkRNL-wShxw99S1OYsaMf2CAVMKbB2PMvsmhmaUGGLDeoe3pOiJdJNbXKAVtOP6b-x2e_xP42clF5BEnQkcL3QJmUIVnjpPuPE9KsX9L2J9ZZm-zSPz1AfCfvYn3juN7CP0ex=s320" width="246" /></a></div><br /> <p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">On January 11th, 2022, the VA published proposed changes to the ratings of the <a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html" target="_blank">Digestive System</a>. </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"><br /></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">With these changes, the VA only has three more sections left until they complete the full rewrite of the VASRD that began in 2014. The remaining sections are the Respiratory System, Neurological Conditions, and Organs of Special Sense (except the eye). <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">With each set of proposed changes, the VA allows a period in which comments can be submitted. The VA then takes each comment into consideration and makes any additional changes that are warranted before publishing the final ruling. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">We encourage you to submit any comments you might have on these proposed changes to the Digestive System to us either by commenting on this post or by <a href="https://militarydisabilitymadeeasy.com/contactus.html" target="_blank">contacting us</a> through our website. All comments must be received by March 1st, 2022. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">We will then compile all of your comments into a single report and submit it on your behalf to the VA, just as we’ve done for the other sections (see the <a href="https://blog.militarydisabilitymadeeasy.com/2016/10/comments-submitted-to-va-on-changes-to.html" target="_blank">Skin Comments</a>). This is a great opportunity to really make a difference, so please let us know your thoughts. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The following are the VA’s new proposed changes to the ratings for the Digestive System. The changes are fairly extensive, so we’ll walk through each, one at a time.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">For each condition, the small, indented parts are the codes as they are right now. Click on the links to be taken to the discussion of that code on our site. After the current code, we’ll discuss the proposed changes and the VA’s justification. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">First, we need to start with some definitions of terms used in many of the proposed rating requirements. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; mso-list: l15 level1 lfo3; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b>Baseline weight</b>: The average weight noted in your medical records for the 2 years before the start of the weight loss/illness. If that information is not available and you are within 2 years post-discharge, then the weight recorded at your discharge physical will be used. When neither of these options work, then it will be estimated using the BMI Table or the Hamwi Formula, whichever is most favorable to you.<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; mso-list: l15 level1 lfo3; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b>Minor weight loss</b>: The involuntary loss of 10-20% of your baseline weight. This weight loss must be present for at least 3 months to qualify, and there must be related symptoms like decreased food intake or an obvious decrease in the quality of self-care and work tasks.<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; mso-list: l15 level1 lfo3; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b>Substantial weight loss: </b> The involuntary loss of 21% or more of your baseline weight. This weight loss must be present for at least 3 months to qualify, and there must be an obvious decrease in the quality of self-care and work tasks.<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; mso-list: l15 level1 lfo3; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b>Inability to gain weight</b>: Substantial weight loss with the inability to regain it despite correctly following your doctor’s prescribed therapy.<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; mso-list: l15 level1 lfo3; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b>Undernutrition</b>: The inability of the body to get, keep, or utilize essential nutrients, resulting in abnormal tissues or organ function. Symptoms may include swelling, nerve pain, weakness, numbness, muscle wasting, a BMI below normal range, etc.<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: .75in; mso-add-space: auto; mso-list: l15 level1 lfo3; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b>Prescribed dietary modification</b>: Adjustments in your diet eaten via the mouth (liquids-only, etc.) that are officially prescribed by your physician. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">_______________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span lang="EN-GB" style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current Rule-</span></i><b><span style="font-size: 10pt;"> </span></b><span style="font-size: 10pt;">The following codes cannot be used together (only one of them can be used at a time): 7301-7329, 7331, 7342, and 7345-7348. If you have two or more of these conditions, use the code that best reflects the overall disability. In cases where a rating under the chosen code does not adequately rate the severity of the overall disability, then the rating may be raised to the next higher rating.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB">-Proposed Rule-</span></i><span lang="EN-GB"> </span>The following codes cannot be used together (only one of them can be used at a time): 7301-7329, 7331, 7342, 7345-7350, 7352, and 7355-7357. If you have two or more of these conditions, use the code that best reflects the overall disability. In cases where a rating under the chosen code does not adequately rate the severity of the overall disability, then the rating may be raised to the next higher rating.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The VA isn’t changing this rule itself, but proposes adding to it many of the new proposed codes we discuss below. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#a"><b><span lang="EN-US" style="font-size: 10pt;">7200</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">If there is an injury to the <b>mouth</b>, it is rated on how it affects the ability to chew food (see the</span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/themouthandteeth.html"><span lang="EN-US" style="font-size: 10pt;"> Mouth and Teeth</span></a></span><span style="font-size: 10pt;"> page) and/or on any visible disfigurement to the face (code </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/scarratings.html#a"><span lang="EN-US" style="font-size: 10pt;">7800</span></a></span><span style="font-size: 10pt;">). <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7200: </b>If there is a <b>soft-tissue injury to the mouth</b> (not including the tongue and lips), it is rated on how it affects the ability to chew food (see the<span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/themouthandteeth.html"><span lang="EN-US"> Mouth and Teeth</span></a></span> page) and/or on any visible disfigurement to the face (code <span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/scarratings.html#a"><span lang="EN-US">7800</span></a></span>). <b><o:p></o:p></b></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The only proposed change to this code is to clarify that it is for soft-tissue injuries of the mouth only. The tongue and lips already have their own separate codes, as do bone and dental conditions.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-family: "Times New Roman", serif; font-size: 10pt;">-</span><i><span style="font-family: "Times New Roman", serif; font-size: 10pt;">Current-</span></i><span style="font-family: "Times New Roman", serif; font-size: 10pt;"> <b>Code </b></span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#b"><b><span lang="EN-US" style="font-family: "Times New Roman", serif; font-size: 10pt;">7201</span></b></a></span><span style="font-family: "Times New Roman", serif; font-size: 10pt;">: Any injury to the<b> lips </b>is rated under code </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/scarratings.html#a"><span lang="EN-US" style="font-family: "Times New Roman", serif; font-size: 10pt;">7800</span></a></span><span style="font-family: "Times New Roman", serif; font-size: 10pt;"> as a disfiguring scar.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB" style="font-family: "Times New Roman", serif;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB" style="font-family: "Times New Roman", serif;">-Proposed-</span></i><span lang="EN-GB" style="font-family: "Times New Roman", serif;"> </span><b>Code 7201</b>: Any injury to the<b> lips </b>is rated either under code <span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/scarratings.html#a"><span lang="EN-US">7800</span></a>,</span> as a disfiguring scar, or code <span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/scarratings.html#painful"><span lang="EN-US">7804</span></a></span>, as a painful or unstable scar. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA proposes adding code 7804, painful or unstable scars, as a rating option. In reality, this has always been a rating option, but the change will make the option clearer to the rating authorities. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><span style="font-size: 10pt;"> <b>Code </b></span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#c"><b><span lang="EN-US" style="font-size: 10pt;">7202</span></b></a></span><span style="font-size: 10pt;">: The <b>tongue</b> can only be rated if a part of it has been lost. If half or more of the tongue is gone, then it is rated 60%. This rating can increase to 100% if the loss of the tongue makes it impossible to speak. If any amount of loss of the tongue causes significant trouble speaking, the minimum rating is 30%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Proposed-</i> <b>Code 7202</b>: The <b>tongue</b> can only be rated if some or all of it has been lost. If at least a part is missing, it is then rated on how the loss affects the ability to swallow. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 100% rating is given if the body cannot get any nutrition via the mouth because damage to the tongue is so severe that it is impossible to swallow.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 60% rating is given if swallowing is permanently impaired and requires prescribed dietary modification in order for the body to get nutrition via the mouth.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 30% rating is given if swallowing is permanently impaired but does not require prescribed dietary modification in order for the body to get nutrition via the mouth.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">This condition may qualify for <span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/special-monthly-compensation.html#k"><span lang="EN-US">Special Monthly Compensation</span></a></span> if it results in the inability to speak. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The VA proposes significant changes to this code. The current rating system rates the loss of the tongue on the amount lost and the ability to speak, but does not take into account the impact on the ability to eat food and thus provide nutrition to the body. The VA is proposing to adjust the ratings to reflect the greater disability the lack of nutrition can cause. The inability to speak will still be covered by SMC-K. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#e"><b><span lang="EN-US" style="font-size: 10pt;">7203</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">A <b>stricture of the esophagus</b> occurs when the esophagus narrows and tightens, making it hard to swallow. If it is so narrowed that only liquids can be swallowed, it is rated 50%. If only being able to swallow liquids also causes a serious decrease in overall health, then it is rated 80%. If the esophagus is seriously narrowed, but some things besides liquids can also be swallowed, then it is rated 30%.<b><o:p></o:p></b></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Proposed-</i><b> Code 7203: </b>A <b>stricture of the esophagus </b>occurs when the esophagus narrows and tightens, making it hard to swallow. Many conditions can cause strictures, so any condition where that is the main symptom is rated here, including esophagitis and any esophageal condition that requires sclerotherapy. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">In order to qualify for a rating under this code, there must be a clear history of strictures documented by an appropriate test (barium swallow, computerized tomography, or esophagogastroduodenoscopy).<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">The Ratings: <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">An 80% rating is given if the strictures are recurrent (the stricture returns within 4 weeks after it is resolved) or refractory (the stricture persists despite 5 or more dilation treatments performed at 2 week intervals), there is difficulty swallowing, it requires either surgical correction or a feeding tube placed directly into the stomach, <i>and</i> one or more of the following symptoms are present:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l7 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->aspiration (when something enters the airways or lungs by accident)<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l7 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->undernutrition <o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l7 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->substantial weight loss <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 50% rating is given if the strictures are recurrent or refractory, there is difficulty swallowing, <i>and</i> one or more of the following treatments are required:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l7 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->dilation (a procedure that widens the narrowed portion of the esophagus) 3 or more times/year<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l7 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->dilation using steroids at least once a year <o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l7 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->esophageal stent placement<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 30% rating is given if the strictures are recurrent or refractory and cause difficulty swallowing that requires dilation 1-2 times/year.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 10% rating is given if the condition requires daily medications in order to swallow normally and there are no other symptoms. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 0% rating is given if the condition does not cause daily symptoms <i>or</i> does not require daily medications.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><b> </b></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">If treatment of the condition results in damage to anything outside the digestive system, then that damage can be rated separately.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;">The VA is proposing massive changes to this code. The current rating requirements are a bit vague, so the VA’s proposed requirements remove a lot of the guesswork when applying the ratings. They are more specific and based on updated treatment options and common symptomology.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_______________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#f"><b><span lang="EN-US" style="font-size: 10pt;">7204</span></b></a></span><span style="font-size: 10pt;">: <b>Spasms of the esophagus</b> can occur when the muscles in the esophagus are unable to move food down to the stomach, often causing chest pain and various troubles eating. If this condition can be fixed with dilation treatment, then it is not ratable. If it cannot, then it is rated as a stricture of the esophagus, code 7203. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB" style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Proposed-</i><b> Code 7204</b>: <b>Esophageal motility disorder</b> (including <b><span lang="EN-GB">achalasia, DES, cork-screw esophagus, esophageal rings</span></b><span lang="EN-GB">, etc.)</span> occurs when the muscles in the esophagus are unable to move food down to the stomach. It is rated under code 7203. <span lang="EN-GB"><o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><b> </b></p><p class="MsoNormal" style="font-size: medium;">The main change for this code is to rename it from “spasms of the esophagus” to “esophageal motility disorder.” This title makes it clear that this code covers all conditions that affect the motion of the esophagus and its ability to deliver food to the stomach.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#g" target="_blank">7205</a> for diverticulum of the esophagus will not change.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 7206:</b> <b> Gastroesophageal reflux disease </b>(<b>GERD</b>) is a condition where the acid and food in the stomach travel up the esophagus. It is rated under code 7203. </span><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Currently, GERD does not have its own code but is rated analogously under the code for hiatal hernia, which gives a rating of 30% for “</span>regular episodes of pain in the upper abdomen, trouble swallowing, heartburn, the return of food into the back of the throat/mouth, and pain in the upper arm or shoulder.” The VA claims that GERD will be appropriately rated under the proposed ratings for 7203. This code, however, does not give ratings for any symptoms other than difficulty swallowing, so we are definitely going to bring this issue up in the comments we submit regarding these changes since the dominant symptoms of GERD are pain/heartburn/regurgitation, not difficulty swallowing, though that can result in more serious cases. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">___________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 7207:</b> <b> Barrett’s esophagus </b>is a condition where abnormal cells form in the lower part of the esophagus. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">If the build-up of cells causes the esophagus to narrow (stricture) or if the condition is no longer active due to treatment, it</span><span lang="EN-GB"> is rated under code 7203. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">If the esophagus is not narrowed, but the abnormal cells are precancerous (high-grade dysplasia), it is rated 30%. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">If the esophagus is not narrowed and the abnormal cells are not precancerous (low-grade dysplasia), it is rated 10%. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">If the condition becomes malignant, it is rated under code 7343. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><div style="border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-style: none none solid; padding: 0in 0in 1pt;"><p class="MsoNormal" style="border: none; padding: 0in;"><span style="font-size: 12pt;">Currently, Barrett’s Esophagus does not have its own code but is rated analogously under code 7203. The VA proposes to add this code in order to better cover the range of symptoms since not all cases cause strictures.</span><span style="font-size: 12pt;"> </span></p><div style="border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-style: none none solid; padding: 0in 0in 1pt;"><p class="MsoNormal" style="border: none; padding: 0in;"><o:p></o:p></p><p class="MsoNormal" style="border: none; padding: 0in;"><o:p> </o:p></p></div></div><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"><br /></span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><span style="font-size: 10pt;"> <b>Code </b></span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#ll"><b><span lang="EN-US" style="font-size: 10pt;">7301</span></b></a></span><span style="font-size: 10pt;">: <b>Adhesions of the peritoneum</b> are areas of scar tissue that cause the surface of the peritoneum to stick to the surface of organs. This can cause the organs to twist out of shape and thus function poorly. Adhesions are only ratable if abdominal surgeries have been performed or if injury or an infectious disease has affected the inside of the abdomen, and if two or more of the following is present: 1) a slowing down of digestive functioning, 2) the digestive tract is partially or completely blocked, 3) acid and fluids in the digestive tract come up into the esophagus (reflux), and 4) pain.</span><span style="font-size: 10pt;">If the adhesions develop after a ruptured appendix, an ulcer that burns the peritoneum, or a surgery that required drainage out of the abdomen, <i>and</i> they cause the digestive path to become partially blocked, with frequent episodes of swelling and pressure in the abdomen, <b>and</b> nausea or vomiting, it is rated 50%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If the adhesions cause the digestive path to become partially blocked, and it is proven by a Barium Meal Test, and there are only occasional episodes of pain, it is rated 30%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is tight pain when moving the abdomen (it feels like something is pulling inside), or if there are occasional episodes of swelling, bloating, nausea, and constipation, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If the condition is mild with few symptoms, it is rated 0%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7301</b>: <b>Adhesions of the peritoneum</b> are areas of scar tissue from injuries, surgeries, diseases, or infections, that cause the surface of the peritoneum to stick to the surface of organs. This can cause the organs to twist out of shape and thus function poorly. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">An 80% rating is given if the condition causes a partial bowel obstruction that cannot be fixed by surgery or treatment, or if it requires Total Parenteral Nutrition (a liquid mixture of essential nutrients injected directly into the blood).<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 50% rating is given if the condition is resistant to treatment or comes back after treatment, it requires hospitalization at least once a year, it requires prescribed dietary modification, <i>and</i> it has at least one of the following symptoms: stomach pain, nausea, vomiting, colic, constipation, or diarrhea.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 30% rating is given if the condition is resistant to treatment or comes back after treatment, it requires prescribed dietary modification, <i>and</i> it has at least one of the following symptoms: stomach pain, nausea, vomiting, colic, constipation, or diarrhea.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 10% rating is given if the condition is resistant to treatment or comes back after treatment, <i>and</i> it has at least one of the following symptoms: stomach pain, nausea, vomiting, colic, constipation, or diarrhea.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">If there are no symptoms, it is rated 0%.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The proposed changes to this code are meant to reflect the more common long-term disabilities caused by this condition with modern treatments. Because some cases are resistant to any treatment at all, the VA proposes adding an 80% rating option to ensure appropriate rating of the overall disability.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 7303</b>: All <b>Chronic side effects of surgeries </b>to the esophagus, stomach, pancreas, and small intestine (except resection, code 7328) are rated under this code.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">Note: If pancreatic surgery results in a vitamin or mineral deficiency, it is rated under the appropriate <a href="https://militarydisabilitymadeeasy.com/nutritionaldeficiencyratings.html" target="_blank">Nutritional Deficiency</a> code. <o:p></o:p></span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">The Ratings: <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">An 80% rating is given if the condition requires Total Parenteral Nutrition or </span>Enteral Nutrition <span lang="EN-GB">for more than 30 days in a row during the last six months.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">A 50% rating is given if one or more of the following is present:<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level1 lfo5; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Daily vomiting that cannot be controlled by medication or </span>prescribed dietary modification<span lang="EN-GB"><o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level1 lfo5; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Watery bowel movements 6 or more times/day<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level1 lfo5; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Unpredictable or uncontrollable explosive bowel movements<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level1 lfo5; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Light-headedness and sweating after eating <i>and</i> medications needed to treat dumping syndrome (the stomach passes food into the small intestine much faster than normal) or gastroparesis (the stomach passes food into the small intestine much slower than normal)<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">A 30% rating is given if two or more of the following is present:<o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level1 lfo5; tab-stops: .5in .75in 67.5pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Vomiting two or more times/week or vomiting that cannot be controlled by treatment<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level1 lfo5; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Discomfort/pain within an hour of eating, with </span>prescribed dietary modification<span lang="EN-GB"><o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level1 lfo5; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Watery bowel movements 3-5 times/day<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">A 10% rating is given if there is nausea or vomiting that can be controlled by ongoing treatment. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">A 0% rating is given if there are no symptoms. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA is proposing this new code to ensure that side effects of surgeries are properly and consistently rated based on their most common disabling symptoms. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">___________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> </span></b><span style="font-size: 10pt;">Both code 7304 and 7305 are rated by the same rating system.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><b><span style="font-size: 10pt;"> </span></b></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><b><span style="font-size: 10pt;">Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#oo"><b><span lang="EN-US" style="font-size: 10pt;">7304</span></b></a></span><b><span style="font-size: 10pt;">: A gastric ulcer </span></b><span style="font-size: 10pt;">is an ulcer in the stomach.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><b><span style="font-size: 10pt;"> </span></b></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><b><span style="font-size: 10pt;">Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#oo"><b><span lang="EN-US" style="font-size: 10pt;">7305</span></b></a></span><b><span style="font-size: 10pt;">: A duodenal ulcer </span></b><span style="font-size: 10pt;">is an ulcer in the lower part of the stomach and beginning of the small intestine (the duodenum).<b><o:p></o:p></b></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">The ratings:<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If the pain cannot be fully relieved by treatment, there is occasional vomiting, blood in the vomit or in the feces, anemia, weight loss and an overall serious decline in health, it is rated 60%. If there is a definite decrease in overall health with anemia and weight loss, <i>or</i> if there are repeated periods of required bed rest<i> prescribed by a physician</i> that average about 10 days or more at least 4 or more times a year, it is rated 40%. If there are repeated periods of severe symptoms that average about 10 days or more 2 or 3 times a year, <i>or</i> if there are constant moderate symptoms, it is rated 20%. If it is mild with episodes of symptoms once or twice a year, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><b><span style="font-size: 10pt;"> </span></b></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><b><span style="font-size: 10pt;">Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#pp"><b><span lang="EN-US" style="font-size: 10pt;">7306</span></b></a></span><b><span style="font-size: 10pt;">: A marginal ulcer </span></b><span style="font-size: 10pt;">in both the stomach and the small intestine is an ulcer caused by healthy cells dying.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is constant or periodic severe pain that cannot be relieved by treatment, occasional vomiting, blood in the vomit or feces, and weight loss that is completely disabling, it is rated 100%. If the same symptoms are present, but they are less frequent or severe and cause a serious but not complete disability, it is rated 60%. If there are episodes at least once a month that can be partially or completely relieved by treatment of vomiting, pain or blood in the feces, it is rated 40%. If there are moderate episodes several times a year, it is rated 20%. If there are mild or short episodes once or twice a year, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Proposed-</i><b> Code 7304: </b>Any <b>ulcer in the stomach or small intestine</b> (“<b>peptic ulcer</b>”) is rated under this code. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 60% rating is given if there is constant abdominal pain with either regular vomiting or occasional blood in the vomit or feces, <i>and</i> at least one hospitalization was required in the past 12 months for anemia. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 40% rating is given if there are four or more episodes in the past 12 months of abdominal pain, nausea, or vomiting. Each episode must have lasted for at least three days and required daily prescribed medication.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 20% rating is given if there are one to three episodes in the past 12 months of abdominal pain, nausea, or vomiting. Each episode must have lasted for at least three days and required daily prescribed medication.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 0% rating is given if there are no episodes of symptoms in the past 12 months.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">If the condition requires surgery to fix tears and/or bleeding, then it is rated 100% for the first three months after surgery. It is then re-evaluated and rerated on any remaining symptoms. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The VA proposes removing codes 7305 and 7306 and combining all the ratings for ulcers of the stomach and small intestine under code 7304. Modern medicine treats these ulcers similarly and they manifest with similar symptoms, so this would enable more consistent rating across the board. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#h"><b><span lang="EN-US" style="font-size: 10pt;">7307</span></b></a></span><b><span style="font-size: 10pt;">: Chronic hypertrophic </span></b><span style="font-size: 10pt;">gastritis is the swelling of the stomach and glands that continues over a long period of time and often leads to cancer. To be rated under this code, the condition must be diagnosed and confirmed by Endoscopy. If there is severe bleeding in the stomach or large tears or breaks (ulcers) in the stomach wall, it is rated 60%. If there are small tears or breaks in the stomach wall and symptoms like stomach pain, it is rated 30%. If there are nodular Lesions in the stomach and symptoms like stomach pain, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Proposed-</i><b> Code 7307: Chronic gastritis </b>(including<b> Helicobacter pylori infection</b>,<b> Zollinger-Ellison syndrome</b>, and<b> portal hypertensive gastropathy </b>with bleeding)<b> </b>is the swelling of the stomach and glands that continues over a long period of time and often leads to cancer. It is rated under code 7304. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA proposes to remove outdated medical testing and treatments from this code and to have it rated under the code for ulcers since gastritis presents similar symptoms. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#i"><b><span lang="EN-US" style="font-size: 10pt;">7308</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">A gastrectomy is the full or partial removal of the stomach which could lead to many<b> Postgastrectomy Syndromes</b>. If the syndromes are severe and cause nausea, sweating, problems with blood circulation after meals, diarrhea, low blood sugar symptoms like seizures or slow brain functioning, and weight loss with malnutrition and anemia, it is rated 60%. If the syndromes are moderate and cause occasional mild problems with blood circulation after meals, diarrhea and weight loss, it is rated 40%. If the syndromes are mild and only cause mild problems with blood circulation every now and then or if there are constant but mild symptoms like diarrhea, weight loss or low blood sugar, it is rated 20%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><i> </i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Proposed-</i><b> Code 7308: </b>A gastrectomy is the full or partial removal of the stomach which could lead to<b> Postgastrectomy Syndrome</b>. It is rated under code 7303. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Since the VA is wanting to create the new code 7303 for all symptoms remaining after surgeries, including stomach surgeries, then this code does not need to have its own rating system. It can simply be rated under code 7303.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#j"><b><span lang="EN-US" style="font-size: 10pt;">7309</span></b></a></span><b><span style="font-size: 10pt;">: Stenosis of the stomach </span></b><span style="font-size: 10pt;">is when the stomach becomes abnormally narrowed. This most commonly occurs at the lower part of the stomach (pyloris) where food passes from the stomach to the small intestine. This condition is rated as a </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#oo"><span lang="EN-US" style="font-size: 10pt;">gastric ulcer</span></a></span><span style="font-size: 10pt;">. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Proposed-</i><b> Code 7309</b>: <b>Stenosis of the stomach</b> is when the stomach becomes abnormally narrowed. This most commonly occurs at the lower part of the stomach (pyloris) where food passes from the stomach to the small intestine. This condition most often occurs after surgery. In these cases, it is rated under code 7303. Otherwise, it is rated as an ulcer, code 7304. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"> <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#k"><b><span lang="EN-US" style="font-size: 10pt;">7310</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">Any lasting symptoms after an<b> injury to the stomach </b>are rated as </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#ll"><span lang="EN-US" style="font-size: 10pt;">peritoneal adhesions</span></a></span><span style="font-size: 10pt;">, code 7301. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span lang="EN-GB" style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Proposed-</i><b> Code 7310: </b>Any lasting symptoms after an<b> injury to the stomach </b>are rated under code 7301 (adhesions are not required). If surgery has been performed, then it is rated under code 7303. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The only significant proposed change to these codes is to add code 7303 as a rating option after surgeries.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#w" target="_blank">7311</a> for symptoms remaining after injury to the liver remains exactly the same.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#s"><b><span lang="EN-US" style="font-size: 10pt;">7312</span></b></a></span><b><span style="font-size: 10pt;">: Cirrhosis of the Liver, Primary Biliary Cirrhosis</span></b><span style="font-size: 10pt;">, and the cirrhotic phase of<b> Sclerosing Cholangitis </b>are all rated under this code. For any of these conditions to qualify for a rating, proper tests like a biopsy and liver function test must be performed.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If the condition causes weakness, Significant Weight Loss, <i>and</i> continuous Jaundice, or if there is one or more of the following that cannot be fixed by treatment: 1) swelling in the abdomen, 2) mental disturbances like confusion, loss of consciousness and coma, or 3) bleeding in the abdomen from the blood vessels or Portal Gastropathy, it is rated 100%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If the condition has caused 2 or more episodes of swelling in the abdomen, mental disturbances, <i>or</i> bleeding in the abdomen with periods in between these episodes where the disease is not active, it is rated 70%. If the condition has caused 1 episode of swelling in the abdomen, mental disturbances, or bleeding in the abdomen, it is rated 50%. If there is high blood pressure in the Portal Vein and swelling in the spleen with weakness, anorexia, stomach pain, uneasiness, and minor weight loss, it is rated 30%. If there are symptoms like weakness, anorexia, stomach pain and uneasiness, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Proposed-</i><b> Code 7312: Cirrhosis of the Liver </b>is permanent damage to the liver, often caused by alcohol or hepatitis. In order to qualify, the liver dysfunction must be confirmed through radiology, biopsy, or biochemical studies.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">This condition is rated on the MELD Score (Model for End-Stage Liver Disease). If a MELD Score cannot be calculated, then it is rated on the symptoms. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">The MELD Score Ratings: <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 100% rating is given for a MELD Score of 15 or higher. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 60% rating is given for a MELD Score between 11.1 and 14.9. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 30% rating is given for a MELD Score of 10-11. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 10% rating is given for a MELD Score between 6.1 and 9.9. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">The Symptom Ratings: <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 100% rating is given if there are continuous debilitating symptoms, weakness, and at least one of the following:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Fluid in the abdomen<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->History of infected fluid in the abdomen (spontaneous bacterial peritonitis)<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Encephalopathy (brain dysfunction)<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Bleeding within the digestive tract<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Impaired ability to form blood clots<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Portal gastropathy (changes in the stomach lining)<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Hepatopulmonary syndrome (dilation in the lungs that affects oxygen absorption) <o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Hepatorenal syndrome (impairment of kidney function)<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 60% rating is given if there is daily fatigue and at least one episode/year of one the following:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Bleeding within the digestive tract<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Portal gastropathy (changes in the stomach lining)<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Encephalopathy (brain dysfunction)<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><b> </b></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 30% rating is given if there are signs of high blood pressure in the portal vein (like an enlarged spleen, fluid in the abdomen, etc.) and at least one of the following:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->weakness<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->anorexia<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->abdominal pain<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->malaise<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><b> </b></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 10% rating is given if there is at least one of the following:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->weakness<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->anorexia<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->abdominal pain<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->malaise<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><b> </b></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 0% rating is given if there are no symptoms. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>Note: If hepatocellular carcinoma occurs with cirrhosis, then only a single rating is given under code 7343 for malignant cancer. <o:p></o:p></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><b> </b></p><p class="MsoNormal" style="font-size: medium;">The VA is proposing significant changes to the ratings of cirrhosis in order to take into account the now widely-used MELD Score system. The ratings based on symptoms have also been updated to reflect modern symptomology based on current treatments, etc. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#n"><b><span lang="EN-US" style="font-size: 10pt;">7314</span></b></a></span><b><span style="font-size: 10pt;">: Chronic cholecystitis </span></b><span style="font-size: 10pt;">is the constant swelling of the gallbladder most often caused by gallstones. The most common symptom is severe pain near the bottom of the ribs on the right side. In most people, the gallbladder can be removed without serious side effects. If there are frequent severe attacks of pain, it is rated 30%. If there is heartburn and occasional attacks of severe pain, it is rated 10%. If there are only occasional mild symptoms, it is rated 0%.<b><o:p></o:p></b></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i> </i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7314</b><b>: Chronic biliary tract disease</b> is a group of conditions that affect the liver and gallbladder in the production and use of bile. Common conditions rated under this code include <b>cholangitis</b>, <b>biliary strictures</b>, <b>sphincter of Oddi dysfunction</b>, <b>bile duct injury</b>, <b>choledochal cyst</b>, etc. <b>Primary sclerosing cholangitis</b> is <i>not</i> rated under this code, but under code 7345.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB">The Ratings:<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB">“Attacks” is defined as episodes of upper right quadrant pain with nausea and vomiting. All attacks must be documented by a medical professional. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB">A 30% rating is given if there are 3 or more attacks in the past year, <i>or</i> if biliary tract strictures required widening at least once during the past year.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB">A 10% rating is given if there are 1-2 attacks in the past year.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB">A 0% rating is given if there have been no attacks in the past year.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;">All conditions that affect the biliary tract cause symptoms similar to cholecystitis, and so the VA proposes adjusting this code to cover all of these conditions. The adjustments to the ratings are intended to clarify currently vague requirements for more consistent ratings.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_________________________________________________________<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Code<a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#o" target="_blank"> 7315</a> for chronic cholelithiasis will continue to be rated under code 7314.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#o" target="_blank">7316</a> for chronic cholangitis will be removed as this condition will be covered under the proposed code 7314.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#q"><b><span lang="EN-US" style="font-size: 10pt;">7317</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">Any lasting symptoms after an<b> injury to the gallbladder </b>are rated as </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#ll"><span lang="EN-US" style="font-size: 10pt;">peritoneal adhesions</span></a></span><span style="font-size: 10pt;">.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Proposed-</i><b> Code 7317: </b>Any lasting symptoms after an<b> injury to the gallbladder </b>are rated as either peritoneal adhesions (code 7301, no adhesions required), biliary tract disease (code 7314), or side effects of gallbladder removal (code 7318), whichever best covers the disability.<b><o:p></o:p></b></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The VA proposes adding additional rating options for this code in order to ensure that the symptoms are appropriately rated. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in; text-align: justify;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#r"><b><span lang="EN-US" style="font-size: 10pt;">7318</span></b></a></span><b><span style="font-size: 10pt;">:</span></b><span style="font-size: 10pt;"> The<b> removal of the gallbladder </b>normally does not cause any serious side effects, but complications are always possible. If the removal of the gallbladder causes severe symptoms, like pain and nausea, it is rated 30%. If there are only mild symptoms, it is rated 10%. If there are no symptoms, it is rated 0%.<b><o:p></o:p></b></span></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i>-Proposed-</i><b> Code 7318: </b>The<b> removal of the gallbladder </b>normally does not cause any serious side effects, but complications are always possible. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 30% rating is given if there is frequent abdominal pain (especially after a meal or at night) <i>and</i> 3 or more watery bowel movements/day.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 10% rating is given if there is occasional abdominal pain <i>and</i> 1-2 watery bowel movements/day.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 0% rating is given if there are no symptoms.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; text-align: justify;">The VA proposes to make the rating requirements more specific for this code in order to avoid confusion and keep ratings consistent. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#x"><b><span lang="EN-US" style="font-size: 10pt;">7319</span></b></a></span><b><span style="font-size: 10pt;">: Irritable colon syndrome </span></b><span style="font-size: 10pt;">(a.k.a.<b> irritable bowel syndrome, spastic colitis, mucous colitis</b>, etc.) is a condition where there is significant stomach pain, bloating and often changes in the pattern of bowel movements with diarrhea or constipation. There is no known cause of this condition.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If it is severe with diarrhea, or if it alternates between diarrhea and constipation, with stomach pains, it is rated 30%. If there are frequent episodes of abnormal bowel movements with stomach pain, it is rated 10%. If there are mild abnormal bowel movements with occasional stomach pain, it is rated 0%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><b> </b></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Proposed-</i><b> Code 7319: Irritable bowel syndrome</b> (<b>IBS</b>) is a condition where there is significant stomach pain, bloating, and often changes in the pattern of bowel movements with diarrhea or constipation. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>Note: This code covers all conditions whose main symptoms are things like bloating, indigestion, constipation, and diarrhea. Conditions that affect the actual structures and functions of the bowels (paralysis/motility, strictures, etc.) are rated under the appropriate codes.<o:p></o:p></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 30% rating is given if there is stomach pain at least 1 day/week for the past 3 months, and two or more of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Change in bowel movement frequency (more often or less often)<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Change in stool form (harder or softer than usual)<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Change in stool passage (difficult to get out or comes out too easily)<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Bowel movements contain a large amount of mucus<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Physical stomach bloating<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Feeling bloated<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 20% rating is given if there is stomach pain at least 3 days/month for the past 3 months, and two or more of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Change in bowel movement frequency (more often or less often)<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Change in stool form (harder or softer than usual)<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Change in stool passage (difficult to get out or comes out too easily)<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Bowel movements contain a large amount of mucus<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Physical stomach bloating<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Feeling bloated<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 10% rating is given if there is stomach pain at least once in the past 3 months, and two or more of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Change in bowel movement frequency (more often or less often)<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Change in stool form (harder or softer than usual)<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Change in stool passage (difficult to get out or comes out too easily)<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Bowel movements contain a large amount of mucus<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Physical stomach bloating<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l17 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-GB">Feeling bloated<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA’s proposed changes for this code update terminology to modern usage (everyone just calls it IBS these days) and makes the rating requirements clearer and more specific than the currently vague severe/mild/frequent/etc.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; text-align: justify;">The VA proposes to remove codes <a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#cc" target="_blank">7321</a>, <a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#bb" target="_blank">7322</a>, and <a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#ee" target="_blank">7324</a> for various infectious intestinal conditions. When the VA changed the <a href="https://militarydisabilitymadeeasy.com/infectiousratings.html" target="_blank">Infectious Diseases</a> ratings in 2019, they created new codes that now cover these conditions, so these codes are no longer needed. The ratings would remain consistent for veterans already rated under these codes, the codes themselves would simply change. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#aa"><b><span lang="EN-US" style="font-size: 10pt;">7323</span></b></a></span><b><span style="font-size: 10pt;">: Ulcerative colitis </span></b><span style="font-size: 10pt;">(a.k.a.<b> inflammatory bowel disease</b>) is a disease of the colon where tears or open sores form in the tissues of the colon and cause bloody diarrhea.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If it is very severe and constant and causes serious malnutrition, anemia, and overall disabling bad health or if it causes a severe Liver Abscess, it is rated 100%. If it is severe, but not constant, with many attacks a year that cause malnutrition which then causes overall bad health that cannot be fully recovered during the periods in between attacks, it is rated 60%. If it is somewhat severe and causes some attacks a year, but less than a severe condition, it is rated 30%. If there are only occasional attacks, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><b> </b></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Proposed-</i><b> Code 7323: Ulcerative colitis</b>,<b> </b>a type of inflammatory bowel disease,<b> </b>is a disease of the colon where tears or open sores form in the tissues of the colon and cause bloody diarrhea. It is rated under code 7326. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The VA is proposing to create a new rating system under code 7326 specifically for inflammatory bowel disease, and so proposes to simply have all inflammatory bowel diseases, including ulcerative colitis, rated under that code since all present with similar symptoms and resulting disabilities.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#y"><b><span lang="EN-US" style="font-size: 10pt;">7325</span></b></a></span><b><span style="font-size: 10pt;">: Chronic enteritis </span></b><span style="font-size: 10pt;">is the constant swelling of the small intestine. Symptoms include stomach pain, cramping, diarrhea, dehydration and fever. It is rated as irritable colon syndrome, code </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#x"><span lang="EN-US" style="font-size: 10pt;">7319</span></a></span><span style="font-size: 10pt;"> above.<b><o:p></o:p></b></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><b> </b></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Proposed-</i><b> Code 7325: Chronic enteritis </b>is the constant swelling of the small intestine. Symptoms include stomach pain, cramping, diarrhea, dehydration, and fever. It is rated as irritable colon syndrome, code 7319, or inflammatory bowel disease, code 7326, whichever best covers the symptoms.<b><o:p></o:p></b></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">With the new proposed ratings under code 7326 for inflammatory bowel disease, the VA is proposing to add it as a second rating option for chronic enteritis in order to better cover the more severe symptoms this condition can sometimes cause. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">___________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#z"><b><span lang="EN-US" style="font-size: 10pt;">7326</span></b></a></span><b><span style="font-size: 10pt;">: Chronic enterocolitis </span></b><span style="font-size: 10pt;">is the constant swelling of the colon and small intestine. It is rated as </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#x"><span lang="EN-US" style="font-size: 10pt;">irritable colon syndrome</span></a></span><span style="font-size: 10pt;">.<b><o:p></o:p></b></span></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><i> </i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> <b>Code 7326: </b> </span><b>Inflammatory bowel disease</b><span lang="EN-GB"> (including <b>Crohn’s disease</b>) is </span>the constant swelling of any part of the gastrointestinal tract, most commonly the colon and small intestine. To be rated under this code, the condition must be diagnosed by an endoscopy or radiological studies.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 100% rating is given if the condition does not respond to treatment and requires at least 1 hospitalization/year. It also must either result in the inability to work or cause regular stomach pain with two or more of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Diarrhea six or more times/day<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Rectal bleeding six or more times/day<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Repeated episodes of incontinence<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Repeated episodes of stomach bloating<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 60% rating is given if <i>all</i> of the following are present: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Regular stomach pain <o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Diarrhea 4-5 times/day<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Repeated signs of toxicity (like fever, fast heart rate, or anemia)<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Requires treatment with immunosuppressants or other biologic agents<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 30% rating is given if <i>all</i> of the following are present: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Regular stomach pain <o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Diarrhea 1-3 times/day<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Occasional signs of toxicity (like fever, fast heart rate, or anemia)<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Requires treatment with oral or topical medications<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 10% rating is given if <i>all</i> of the following are present: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Regular stomach pain <o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Diarrhea 1-3 times/day<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->No signs of toxicity (like fever, fast heart rate, or anemia)<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo10; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Requires treatment with oral or topical medications<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i>Note: If a colostomy (a surgical procedure that creates a new passageway from the rectum or anus to the outside of the body) is performed, then the remaining symptoms can either be rated under this code or under code 7329, whichever gives a higher rating.<o:p></o:p></i></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Currently, the only rating option for enterocolitis is as irritable bowel syndrome, however, inflammatory bowel diseases present in significantly different ways. The VA therefore proposes creating a rating system specifically for inflammatory bowel diseases in order to ensure ratings that more appropriately reflect the most common symptoms of these conditions.</span><span lang="EN-GB"></span><o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#dd"><b><span lang="EN-US" style="font-size: 10pt;">7327</span></b></a></span><b><span style="font-size: 10pt;">: Diverticulitis </span></b><span style="font-size: 10pt;">is a disease of the colon that causes pouches outside the colon to form and then swell. It can cause fever, pain, nausea, diarrhea and high white blood cell count. It is either rated as </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#x"><span lang="EN-US" style="font-size: 10pt;">irritable colon syndrome</span></a></span><span style="font-size: 10pt;">, </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#ll"><span lang="EN-US" style="font-size: 10pt;">peritoneal adhesions</span></a></span><span style="font-size: 10pt;">, or </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#aa"><span lang="EN-US" style="font-size: 10pt;">ulcerative colitis</span></a></span><span style="font-size: 10pt;">, whichever most closely describes the overall condition and symptoms.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><i> </i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7327</b><b>: Diverticulitis </b>and<b> diverticulosis </b>are rated under this code.<b> </b>Diverticulosis is a disease of the colon that causes pouches to form in the walls of the colon. Diverticulitis occurs when the pouches become infected. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 30% rating is given if stomach pain, fever, and an elevated white blood cell count requires at least one hospitalization in the past year, <i>and</i> one of more of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l13 level1 lfo11; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Internal bleeding<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l13 level1 lfo11; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Blockage in the colon<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l13 level1 lfo11; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->A pus-filled infection (abscess)<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l13 level1 lfo11; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Swelling of the peritoneum<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l13 level1 lfo11; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Holes in the walls of the colon<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 20% rating is given if stomach pain, fever, and an elevated white blood cell count requires at least one hospitalization in the past year.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 0% rating is given if the symptoms can be fully managed by diet and medication.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i>Note: If a colostomy (a surgical procedure that creates a new passageway from the rectum or anus to the outside of the body) or colectomy (removal of a portion of the colon) is performed to treat the condition, then the remaining symptoms can either be rated under this code or under code 7329, whichever gives a higher rating.<o:p></o:p></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">Currently, diverticulitis does not have its own rating options but is rated under other codes. The VA acknowledges, however, that diverticulitis has unique symptoms and side effects that are not properly covered by these rating options and so proposing a set of rating criteria specifically for this condition. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The VA also proposes adding diverticulosis to this code. Diverticulosis rarely, if ever, causes ratable symptoms, however, many cases ultimately become diverticulitis. Allowing it to be claimed and rated 0% under this code will allow for faster and easier rating increases in cases that do develop into diverticulitis. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">___________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#xx"><b><span lang="EN-US" style="font-size: 10pt;">7328</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">A<b> resection of the small intestine </b>is a procedure where all or a part of the intestine is removed. If the small intestine can no longer absorb enough nutrients to sustain the body, causing the overall health of the body to seriously decline (significant weight loss, serious nutritional deficiencies, etc.), it is rated 60%. If the small intestine can still absorb some nutrients, but not enough to maintain a healthy weight, it is rated 40%. If the small intestine can absorb enough nutrients, but there is diarrhea, anemia, and the inability to gain weight, it is rated 20%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><i> </i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7328: </b>A <b>resection of the small intestine </b>is a procedure where all or a part of the intestine is removed. <b>Short bowel syndrome</b>, <b>post-bariatric surgery</b>, and <b>mesenteric ischemic thrombosis</b> are all rated under this code.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">An 80% rating is given if the resection results in undernutrition and anemia that requires Total Parenteral Nutrition.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 60% rating is given if the resection results in undernutrition and anemia that requires continuous medication, prescribed dietary supplements, and occasional Total Parenteral Nutrition.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 40% rating is given if the resection causes diarrhea four or more times/day, resulting in undernutrition and anemia that requires continuous medication and prescribed dietary supplements.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 20% rating is given if the resection causes diarrhea four or more times/day.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 0% rating is given if there are no symptoms.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i>Note: If the condition results in high-output syndrome (when the body doesn’t absorb enough fluids, often resulting in the loss of electrolytes and dehydration), it can be rated under this code or under code 7329, whichever provides a higher rating. <o:p></o:p></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The VA proposes updating these rating requirements to better reflect modern treatments and the more common long-term effects we see with these treatments, including adding a higher 80% rating level for severe cases. The VA also instructs additional conditions to be rated under this code for clarity and consistency.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#yy"><b><span lang="EN-US" style="font-size: 10pt;">7329</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">A <b>resection of the large intestine </b>is a procedure where all or a part of the intestine is removed. If the procedure causes severe symptoms, like the inability to pass feces or constant dehydration, that significantly affect the overall health, it is rated 40%. If is causes definite symptoms, like regular diarrhea and the need to drink more water than normal, it is rated 20%. If there are only mild symptoms, like increased thirst, it is rated 10%. If the symptoms are only caused by scar tissue from the procedure, the entire condition is rated under code 7301.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><i> </i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7329</b>: A<b> resection of the large intestine </b>(a.k.a.<b> </b>“<b>colectomy</b>”)<b> </b>is a procedure where all or a part of the intestine is removed. It can either be rated on the below criteria or under code 7326, whichever results in a higher rating.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 100% rating is given if the colon is completely removed and all of the following are present:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l16 level1 lfo12; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->An ileostomy (the end of the small intestine is routed to the outside of the abdomen)<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l16 level1 lfo12; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->High-output syndrome<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l16 level1 lfo12; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Dehydration requiring IV treatment three or more times in the last year<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 60% rating is given if the colon is completely removed but it doesn’t result in high-output syndrome.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 40% rating is given if a portion of the colon is removed and the remaining end is permanently routed to the outside of the abdomen (colostomy). <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 20% rating is given if the ileocecal valve (connects the small intestine and colon) and a portion of the colon is removed with the remaining ends of the intestines connected together, and there is diarrhea 3 or more times/day on a regular basis.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 10% rating is given if a portion of the colon is removed with the remaining ends connected together.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The current ratings for this code max out at a 40% rating, not properly reflecting the severity of disability resulting from a total colectomy. The VA proposes adding additional rating options for a total colectomy and to more clearly specify the rating requirements for partial colectomies. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">___________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#zz"><b><span lang="EN-US" style="font-size: 10pt;">7330</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">A<b> fistula of the intestine </b>(large or small intestine), is an abnormal passageway from the intestine to another organ or to the outside of the body. If surgery was attempted to repair the fistula, but the surgery was not fully successful or the fistula re-developed, it is ratable under this code. If the surgery successfully repaired it, then it is rated under code 7301.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If a very large amount of feces frequently moves through the fistula, it is rated 100%. If feces constantly or frequently move through the fistula, it is rated 60%. If a small amount of feces moves through the fistula every now and then, it is rated 30%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i> </i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7330: </b>A<b> fistula of the intestine </b>(large or small intestine), is an abnormal passageway from the intestine to the outside of the body. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 100% rating is given if it requires Total Parenteral Nutrition. This rating can also be given if it requires Enteral Nutrition (a liquid mixture of essential nutrients delivered through a feeding tube) and one or more of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l4 level1 lfo13; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Four or more ostomy bags worth of discharge every day<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l4 level1 lfo13; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Ten or more pad changes every day<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l4 level1 lfo13; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->BMI less than 16 and regular drainage for more than 1 month in the last year<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 60% rating is given if it requires Enteral Nutrition and one or more of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l4 level1 lfo13; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Less than four ostomy bags worth of discharge every day<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l4 level1 lfo13; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Less than ten pad changes every day<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l4 level1 lfo13; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->BMI between 16-18 and regular drainage for more than 2 months in the last year<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 30% rating is given if there is intermittent discharge with regular drainage for more than 3 months in the last year.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; text-align: justify;">The current ratings for this code are based on vague amounts of feces coming from the fistula. In order to more clearly reflect the real effect of this condition, including the nutritional implications, the VA is proposing these changes.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">___________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#mm" target="_blank">7331</a> for tuberculosis of the peritoneum remains exactly the same.</span><span lang="EN-GB"></span><o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">___________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#ff"><b><span lang="EN-US" style="font-size: 10pt;">7332</span></b></a></span><b><span style="font-size: 10pt;">: Poor sphincter control </span></b><span style="font-size: 10pt;">(a.k.a. “<b>incontinence</b>”) occurs when the sphincter muscle, a muscle that encircles the opening of the rectum and anus, cannot contract properly or be controlled, thus leading to feces exiting the body at unwanted times. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is no sphincter control at all, it is rated 100%. If there is a significant amount of stuff always leaking out of the anus and frequent uncontrollable bowel movements, it is rated 60%. If there are only occasional uncontrollable bowel movements that require a pad or other materials to be worn, it is rated 30%. If there are not any uncontrollable bowel movements, but there is constant slight leakage or occasional moderate leakage, it is rated 10%. If there is no leakage at all, it is rated 0%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is a loss of sphincter control and both legs are amputated or paralyzed, then a rating of 100% is always given, regardless of improvement with therapy. This is also the case if the loss of sphincter control is due to a spinal cord disease or injury.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i> </i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7332: Loss of sphincter control </b>(a.k.a. “<b>incontinence</b>”) occurs when the sphincter muscle, a muscle that encircles the opening of the rectum and anus, cannot contract properly or be controlled. This results in either the inability to expel feces when desired or feces exiting the body at unwanted times. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 100% rating is given if there is a complete loss of sphincter control and one or more of the following:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l5 level1 lfo14; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->The condition is unresponsive to a prescribed bowel program and requires surgery, medication (more than just laxatives), and prescribed dietary modification<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l5 level1 lfo14; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->The condition is unresponsive to a prescribed bowel program and requires the manual removal of feces (“digital stimulation”), medication (more than just laxatives), and prescribed dietary modification<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l5 level1 lfo14; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Every day, there are two or more uncontrolled liquid and/or solid bowel movements that require pads to be changed at least twice/day<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><b> </b></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 60% rating is given if there is a complete or partial loss of sphincter control and one or more of the following:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l5 level1 lfo14; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->The condition is partially responsive to a prescribed bowel program and requires surgery, medication (more than just laxatives), and prescribed dietary modification<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l5 level1 lfo14; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->The condition is partially responsive to a prescribed bowel program and requires the manual removal of feces (“digital stimulation”), medication (more than just laxatives), and prescribed dietary modification<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l5 level1 lfo14; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Every week, there are two or more uncontrolled liquid and/or solid bowel movements that require pads to be worn at least twice/week<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><b> </b></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 30% rating is given if there is a complete or partial loss of sphincter control and one or more of the following:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l5 level1 lfo14; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->The condition is responsive to a prescribed bowel program and requires the manual removal of feces (“digital stimulation”), medication (more than just laxatives), and prescribed dietary modification<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l5 level1 lfo14; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Every month, there are two or more uncontrolled liquid and/or solid bowel movements that require pads to be worn at least twice/month<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><b> </b></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 10% rating is given if there is a complete or partial loss of sphincter control and one or more of the following:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l5 level1 lfo14; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->The condition is responsive to a prescribed bowel program and requires medications<i> or</i> prescribed dietary modification<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l5 level1 lfo14; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Every 6 months, there are one or more uncontrolled liquid and/or solid bowel movements that require pads to be worn at least once.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 0% rating is given if there are no symptoms.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The VA proposes to adjust these ratings to get rid of vague terminology, clearly clarify that incontinence covers both unwanted leakage and the inability to expel feces when desired, and to align the ratings options with the Cleveland Clinic Incontinence Scale, which is widely used throughout the modern medical community. This Scale scores the severity of incontinence based not only on the incontinence itself, but on lifestyle modifications and medical treatments needed to treat it (dietary changes, surgeries, medications, etc.).<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">____________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#hh"><b><span lang="EN-US" style="font-size: 10pt;">7333</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">A<b> stricture of the rectum or anus </b>is a patch of scar tissue that narrows the openings of the rectum and anus, thus making it difficult or impossible for feces to pass through. If a colostomy, a surgical procedure that creates a new passageway from the rectum or anus to the outside of the body, is required, it is rated 100%. If the scar tissue seriously decreases the space in the rectum or anus, or if there is extensive leakage, it is rated 50%. If the scar tissue only moderately decreases the space in the rectum or anus, or if there is moderate but constant leakage, it is rated 30%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7333: </b>A <b>stricture of the rectum or anus </b>is a patch of scar tissue that narrows the openings of the rectum and anus, thus making it difficult or impossible for feces to pass through. <b>Dyssynergic defecation</b> and functional <b>constipation</b> are rated under this code. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i>Note: If an ostomy (a surgical procedure that creates a new passageway from the rectum or anus to the outside of the body) is performed, it is rated under code 7329. <o:p></o:p></i></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 100% rating is given if the anus is completely unable to open to expel solid waste. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 60% rating is given if the anus is only able to open less than 50% of the way and there is pain and straining during defecation. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 30% rating is given if the anus is able to open to 50% or more and there is straining during defecation. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 10% rating is given if the anus is narrowed, and there may be straining, but overall the symptoms are managed by dietary modification. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The VA proposes to adjust these ratings to get rid of vague terminology to ensure consistency in rating. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">___________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#ii"><b><span lang="EN-US" style="font-size: 10pt;">7334</span></b></a></span><span style="font-size: 10pt;">: A<b> prolapse of the rectum </b>occurs when the muscles or tissues holding the rectum in place weaken and the rectum slips out of place and may slip down out of the anus. If the rectum is completely out of the anus and stays out, it is rated 50%. If it doesn’t slip all the way out, but it stays out or slips out frequently, it is rated 30%. If it is only a little out of place and doesn’t slip out of the anus, but does cause leakage, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7334: </b>A<b> prolapse of the rectum </b>occurs when the muscles or tissues holding the rectum in place weaken and the rectum slips out of place and may slip down out of the anus. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">This condition is rated on the following criteria or under code 7332 if the loss of sphincter control is the main disability.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">If the condition can be repaired by surgery, it is rated 100%. The 100% rating continues for two months after the surgery. The condition is then rated on any remaining symptoms.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">For conditions that cannot be repaired by surgery:<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">A 100% rating is given if the prolapse cannot be put back in place. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">A 50% rating is given if the prolapse can be put back in place by hand, and it occurs at times other than bowel movements, exertion, or the Valsalva maneuver (blowing air forcefully out the mouth while holding the nose).<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">A 30% rating is given if the prolapse can be put back in place by hand, and it occurs only with bowel movements, exertion, or the Valsalva maneuver.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">A 10% rating is given if the prolapse resolves on its own.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The VA proposes getting rid of vague rating requirements and instead using measurable criteria that is known to reasonable reflect the level of functional impairment. These changes also add a 100% rating level to appropriately cover extremely severe cases. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#gg"><b><span lang="EN-US" style="font-size: 10pt;">7335</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">An<b> anal fistula </b>(or “<b>fistula-in-ano</b>”) is an abnormal passageway that connects the anus to other parts of the body or to an abnormal opening in the skin. This condition is rated as loss of </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#ff"><span lang="EN-US" style="font-size: 10pt;">sphincter control</span></a></span><span style="font-size: 10pt;">. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7335: </b>An<b> anal fistula</b> (or “<b>fistula-in-ano</b>”) is an abnormal passageway that connects the anus to other parts of the body or to an abnormal opening in the skin. This code also covers<b> anorectal abscesses.</b><o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 60% rating is given if there are three or more almost-constant fistulas with abscesses, drainage, and pain that do not respond to treatment. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 40% rating is given if there are one to two fistulas with abscesses, drainage, and pain.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 20% rating is given if there are two or more fistulas with drainage and pain.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 10% rating is given if there is one fistula with drainage and pain.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">Currently, this condition is rated under loss of sphincter control, but the VA argues that the main disability lies in pain, drainage, and abscesses, and so proposes a new rating system for this condition.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#jj"><b><span lang="EN-US" style="font-size: 10pt;">7336</span></b></a></span><b><span style="font-size: 10pt;">: Hemorrhoids </span></b><span style="font-size: 10pt;">are swollen veins inside or outside the body near the anus. They are created from a lot of pressure being used to pass feces and can be very painful. If the hemorrhoids cause constant bleeding that leads to significant blood loss and anemia, a decrease in the number of red blood cells, or if they cause Fissures, it is rated 20%. If there are blood clots inside the swollen veins, the swelling can’t go down, and there is a lot of Redundant Tissue, it is rated 10%. If they are only moderate with occasional bleeding, it is rated 0%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7336: Hemorrhoids </b>are swollen veins inside or outside the body near the anus. They are created from a lot of pressure being used to pass feces and can be very painful.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 20% rating is given for either internal or external hemorrhoids if there is regular bleeding that causes anemia. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 20% rating is also given for internal hemorrhoids that constantly protrude from the anus and cause blood clots three or more times/year. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 10% rating is given for internal hemorrhoids that constantly protrude from the anus and cause blood clots two or less times/year. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 10% rating is also given for external hemorrhoids that cause blood clots three or more times/year. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"> <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;">The current ratings for hemorrhoids rate both internal and external the same, even though they have different symptoms. The VA proposes removing vague rating terms and creating different rating options for internal and external hemorrhoids. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">___________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#kk"><b><span lang="EN-US" style="font-size: 10pt;">7337:</span></b></a></span><b><span style="font-size: 10pt;"> Pruritus ani </span></b><span style="font-size: 10pt;">is seriously itchy skin around the anus. This condition never develops by itself but is always a symptom of another condition. Because of that, the condition causing the itching is ratable, but the itching alone is not.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7337: Pruritus ani </b>is seriously itchy skin around the anus. If the itching results in tearing of the skin and bleeding, it is rated 10%. Otherwise, 0%. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">Currently, this condition isn’t actually rated, only the underlying condition causing it. The VA argues that this results in the itching itself not being appropriately rated, and so proposes creating new rating criteria just for the itching. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">___________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#qq"><b><span lang="EN-US" style="font-size: 10pt;">7338</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">An<b> inguinal hernia </b>is a hernia in the hole in the Inguinal Canal that allows the organs in the abdomen fall into the inguinal canal.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If a surgery was performed to fix a large hernia, but it re-herniated and another surgery cannot be performed, it is rated 60%. If a surgery was performed to fix a small hernia, but it re-herniated, or if it cannot be fixed at all, it is rated 30%. If a surgery was performed to fix the hernia, it re-herniated, but it is treatable and can be supported by a belt, it is rated 10%. If a surgery was not performed, but it is treatable, or if it is small and no organs are pushing through the hole, it is rated 0%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">Note: There are two inguinal canals, and so both can herniate. If they do, and both qualify for a rating, then the most severe of the two is rated on the requirements above, and then 10% is added for the second hernia. Both do not get full ratings. So, if one is rated 30%, and the other can be rated 60%, only 10% is added to the 60% (highest) to equal a single 70% rating. The two conditions are covered by the single hernia condition rating.<o:p></o:p></span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><b><span style="font-size: 10pt;">Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#ss"><b><span lang="EN-US" style="font-size: 10pt;">7339</span></b></a></span><span style="font-size: 10pt;">: A <b>ventral hernia</b> occurs when the abdominal organs push through a part of the abdominal wall. This condition is easily treated by surgery. If surgery has been performed, but there are still problems, the condition can then be rated on the following criteria.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If the hernia is really big, with a severe separation of the abdominal muscles, a destruction of the abdominal muscles over a large area, <i>or</i> with severe weakening of the muscles and tissues so that surgery would not be able to fix it, it is rated 100%. If the hernia is large and cannot be supported by a belt or brace, it is rated 40%. If it is small and cannot be supported by a belt or brace, <i>or</i> if the surgery worked and the wounds healed, but they are weak and need support by a belt or brace, it is rated 20%. If the surgery worked and the wounds healed well, it is rated 0%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><b><span style="font-size: 10pt;">Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#rr"><b><span lang="EN-US" style="font-size: 10pt;">7340</span></b></a></span><span style="font-size: 10pt;">: A <b>femoral hernia</b> occurs when the abdominal organs push through the femoral canal at the top of the thigh near the groin. This condition is rated as an </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#qq"><span lang="EN-US" style="font-size: 10pt;">inguinal hernia</span></a></span><span style="font-size: 10pt;">.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7338: </b>All <b>abdominal hernias</b> (except hiatal, code 7346) are rated under this code.<b></b><o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">If the hernia can or has been successfully repaired and there are no symptoms, it is rated 0%. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">All hernias that cannot be repaired are rated on the following: <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 100% rating is given if both of the following are present for 12 months or more:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l11 level1 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->The hernia is 15cm or more <o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l11 level1 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->There is pain with at least three of the following:<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Bending over<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Walking<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Climbing stairs<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Bathing/dressing/grooming/leaving home<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 60% rating is given if both of the following are present for 12 months or more:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l11 level1 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->The hernia is 15cm or more<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l11 level1 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->There is pain with at least two of the following:<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Bending over<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Walking<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Climbing stairs<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Bathing/dressing/grooming/leaving home<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 30% rating is given if both of the following are present for 12 months or more:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l11 level1 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->The hernia is between 3cm and 15cm<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l11 level1 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->There is pain with at least two of the following:<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Bending over<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Walking<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Climbing stairs<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Bathing/dressing/grooming/leaving home<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 20% rating is given if both of the following are present for 12 months or more:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l11 level1 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->The hernia is between 3cm and 15cm<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l11 level1 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->There is pain with one of the following:<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Bending over<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Walking<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Climbing stairs<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l11 level2 lfo15; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: "Courier New"; mso-ansi-language: EN-US; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Bathing/dressing/grooming/leaving home<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 10% rating is given if the hernia is less than 3cm for 12 months or more.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i>Note: There are two inguinal canals, and both can herniate. If they do, and both qualify for a rating, then the most severe of the two is rated on the requirements above, and then 10% is added for the second hernia, not to exceed 100%. Both do not get full ratings. So, if one is rated 30%, and the other can be rated 60%, only 10% is added to the 60% (highest) to equal a single 70% rating. The two conditions are both covered by the single rating.<o:p></o:p></i></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">Currently, the VA has four different codes for hernias. They argue, however, that all abdominal hernias, except hiatal, cause similar disabilities and so only need a single rating system. The VA proposes removing codes 7339 and 7340 and rating all abdominal hernias (except hiatal) under code 7338. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_____________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#nn" target="_blank">7342</a> for <b>visceroptosis</b> remains exactly the same.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#uu" target="_blank">7343</a> for <b>malignant cancer of the digestive system</b> remains exactly the same.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#vv" target="_blank">7344</a> for <b>tumors of the digestive system</b> remains exactly the same, except for adding specific instruction for lipoma, leiomyoma, colon polyps, and villous adenoma to be rated under this code when they affect the digestive system. They should already be rated under it anyway, but this instruction will ensure these conditions are correctly rated. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_____________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span lang="EN-GB" style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#t"><b><span lang="EN-US" style="font-size: 10pt;">7345</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">Any<b> chronic liver disease</b> that doesn’t have Cirrhosis is rated under this code. This includes diseases like <b>Hepatitis B, chronic active hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced hepatitis,</b> and others. Hepatitis C and bile duct disorders are not rated here.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">Note: If there are two different conditions and one rates under this code and another rates as Hepatitis C under code 7354, then the symptoms caused by the condition rated under code 7354 cannot count towards another rating under this code.<o:p></o:p></span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there are near-constant, completely disabling symptoms like fatigue, uneasiness, vomiting, anorexia, joint pain, and pain in the upper right abdomen, it is rated 100%. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is significant fatigue, uneasiness, anorexia with Significant Weight Loss or malnutrition, <i>and</i> swelling in the liver, <i>or</i> Incapacitating Episodes totaling 6 weeks or more in the past year that include symptoms like fatigue, uneasiness, nausea, vomiting, anorexia, joint pain and pain in the upper right abdomen, it is rated 60%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is significant fatigue, uneasiness, anorexia with weight loss <i>and</i> swelling in the liver, <i>or</i> if there are incapacitating episodes totaling 4 to 6 weeks in the past year that include symptoms like fatigue, uneasiness, nausea, vomiting, anorexia, joint pain, and pain in the upper right abdomen, it is rated 40%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is significant fatigue, uneasiness, <i>and</i> anorexia (without weight loss) that requires either a special diet or constant medication, <i>or</i> if there are incapacitating episodes totaling 2 to 4 weeks in the past year that include symptoms like fatigue, uneasiness, nausea, vomiting, anorexia, joint pain, and pain in the upper right abdomen, it is rated 20%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is occasional fatigue, uneasiness, <i>and </i>anorexia, <i>or</i> if there are incapacitating episodes totaling 1 to 2 weeks in the past year that include symptoms like fatigue, uneasiness, nausea, vomiting, anorexia, joint pain, and pain in the upper right abdomen, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If the condition does not have any symptoms, it is rated 0%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7345</b>: Any<b> chronic liver disease </b>that doesn’t have Cirrhosis is rated under this code. This includes diseases like Hepatitis B, primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune liver disease, Wilson’s disease, Alpha-1-antitrypsin deficiency, hemochromatosis, non-alcoholic steatohepatitis, drug-induced hepatitis, and more. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i>Note: Any condition caused by the liver disease can be rated separately as long as a single symptom is not rated more than once (see the Pyramiding Principle.)<o:p></o:p></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 100% rating is given if the condition is continuing to get worse and it requires both antiviral and immunomodulatory drugs administered through an IV. The 100% rating continues for 6 months following the end of treatment. It is then re-evaluated and rerated on any remaining symptoms. If the condition needs antiviral and immunomodulatory treatment, but it can’t be given because of other medical concerns, then the condition is rated under code 7312. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 60% rating is given if the condition is continuing to get worse, it requires continuous medication, there is substantial weight loss, <i>and</i> there are two or more of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Daily fatigue<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Malaise<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Anorexia<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Enlarged liver<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Itchy skin<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Stiffness in the joints<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 40% rating is given if the condition is continuing to get worse, it requires continuous medication, there is minor weight loss, <i>and</i> there are two or more of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Daily fatigue<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Malaise<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Anorexia<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Enlarged liver<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Itchy skin<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Stiffness in the joints<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 20% rating is given if there is one or more of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Occasional fatigue<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Malaise<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Anorexia<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Enlarged liver<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo16; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Itchy skin<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 0% rating is given if there are no symptoms.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">The VA is proposing these changes to get rid of vague terms and provide more clinically-measurable rating options for liver diseases based on updated medical understandings and treatments. With more specific rating criteria, the VA argues that having a 10% rating is no longer pertinent since there are clear distinctions between the remaining rating levels. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span lang="EN-GB" style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#ww"><b><span lang="EN-US" style="font-size: 10pt;">7346</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">A<b> hiatal hernia </b>is a hernia in the Diaphragm that allows the organs in the abdomen to move up into the chest cavity.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If the hernia causes pain, vomiting, significant weight loss, blood in the vomit or feces, and anemia, or if other symptoms cause a serious overall health disability, it is rated 60%. If there are regular episodes of pain in the upper abdomen, trouble swallowing, heartburn, the return of food into the back of the throat/mouth, and pain in the upper arm or shoulder, it is rated 30%. If two or more of the previous symptoms are present, but are not as severe, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span lang="EN-GB"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7346:</b> A<b> hiatal hernia</b> (including a <b>paraesophageal hernia</b>) is a hernia in the Diaphragm that allows the organs in the abdomen to move up into the chest cavity. It is rated under code 7203.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA is proposing to remove the ratings for a hiatal hernia and instead rate it under code 7203 for stricture of the esophagus. Hiatal hernias cause very similar symptoms to esophageal strictures, and so the VA feels that they are appropriately rated by these criteria. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span lang="EN-GB" style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#m"><b><span lang="EN-US" style="font-size: 10pt;">7347</span></b></a></span><b><span style="font-size: 10pt;">: Pancreatitis</span></b><span style="font-size: 10pt;"> is the swelling of the pancreas that occurs because the enzymes it produces become active while still in the pancreas. If diabetes and pancreatitis are both present, both cannot be rated. Rate only the one that gives the highest rating. If the whole or part of the pancreas is surgically removed, then rate any continuing symptoms on the following ratings, with the minimum rating of 30%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">Ratings: If there are seriously disabling attacks of stomach pain with very few pain-free periods, significant amounts of fat in the feces, the inability of the small intestine to absorb the necessary nutrients, diarrhea, <i>and</i> severe malnutrition, it is rated 100%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there are frequent attacks of disabling stomach pain, weight loss (lower than the average weight weighed over the last year),<i> and</i> other symptoms like diarrhea or significant amounts of fat in the feces, it is rated 60%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there are at least 4 to 7 attacks of disabling stomach pain each year, it is rated 30%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is at least 1 attack of disabling stomach pain each year, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span lang="EN-GB"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7347: Chronic pancreatitis </b>occurs when the pancreas is permanently damaged by the swelling of the pancreas (acute pancreatitis) that occurs because the enzymes it produces become active while still in the pancreas. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>Note: If pancreatic insufficiency causes diabetes, it is rated separately under code 7913.<o:p></o:p></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">To qualify for a rating, proper medical testing must confirm that the pain is located in the stomach or mid-back and definitely the result of the pancreatitis.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 100% rating is given if there are daily episodes of pain and all of the following:<o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l8 level1 lfo17; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Three or more hospitalizations each year<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l8 level1 lfo17; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Pain management by a physician<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l8 level1 lfo17; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Inability to properly digest nutrients<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l8 level1 lfo17; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Inability to properly absorb nutrients<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l8 level1 lfo17; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Required dietary restriction<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l8 level1 lfo17; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Required pancreatic enzyme supplementation<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 60% rating is given if there are three or more episodes of pain each year and at least one hospitalization each year to treat complications of either the pain or of Enteral Nutrition.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 30% rating is given if there is one or more episodes of pain each year that requires ongoing treatment for the pain, digestive problems, <i>or</i> for complications (like cysts, intestinal obstructions, etc.).<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA is proposing to specify that these rating options are for chronic pancreatitis since the acute condition is easily and successfully treated in most cases. It is only in cases of chronic pancreatitis that a long-term disability is established. For the ratings, the VA proposes to update them to reflect the more common disabling symptoms seen in relation to current medical treatments.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span lang="EN-GB" style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#l"><b><span lang="EN-US" style="font-size: 10pt;">7348</span></b></a></span><b><span style="font-size: 10pt;">: </span></b><span style="font-size: 10pt;">A <b>vagotomy </b>is a surgical procedure where the vagus nerve, which stimulates the production of stomach acid, is cut in order to reduce the amount of acid produced in the stomach. To qualify for a rating, the surgery must have been performed with either a Gastroenterostomy or a Pyloroplasty as well.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">After the surgery, if there continues to be significant problems with food passing from the stomach to the small intestine, it is rated 40%. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is a definite diagnosis of Alkaline Gastritis or regular diarrhea, it is rated 30%. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If the surgery was not successful in decreasing the amount of acid production and an ulcer forms or reforms, it is rated 20%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If the surgery was successful, but an ulcer reforms anyway, it is then rated under code </span><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#oo"><span lang="EN-US" style="font-size: 10pt;">7305</span></a></span><span style="font-size: 10pt;"> with the minimum rating of 20%. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7348</b>: A<b> vagotomy </b>is a surgical procedure where the vagus nerve, which stimulates the production of stomach acid, is cut either to reduce the amount of acid produced in the stomach or following a lung transplant. To qualify for a rating, the surgery must have been performed with either a Gastroenterostomy or a Pyloroplasty as well.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 40% rating is given if there continues to be significant problems with food passing from the stomach to the small intestine.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 30% rating is given if Alkaline Gastritis is diagnosed or if there is regular diarrhea. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 20% rating is given if the surgery was not successful in decreasing the amount of acid production.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">If the surgery was successful, but an ulcer reforms anyway, it is rated under code 7304 with the minimum rating of 20%. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">All other side effects not covered by a rating under this code are rated under code 7303. <span lang="EN-GB"><o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Only a few minor changes are being proposed for this code. The first is to remove the need for recurrent ulcers for the 20% rating since ulcers aren’t present in all cases that require vagotomies. The other substantial change is the instruction to rate side effects under code 7303. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_______________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span lang="EN-GB" style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 7350:</b> A <b>liver abscess </b>is a pus-filled infection in the liver. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 100% rating is given for the first 6 months following the date of diagnosis. It is then re-evaluated and rerated based on any remaining symptoms under the appropriate code. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA proposes adding a new code to cover all liver abscesses, regardless of the cause, in order to ensure that all are consistently rated and a sufficient rating given for an active infection.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">________________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span lang="EN-GB" style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#u"><b><span lang="EN-US" style="font-size: 10pt;">7351</span></b></a></span><span style="font-size: 10pt;">: If a<b> liver transplant </b>is performed, it is rated 100%. This 100% rating continues for 1 year following the date of hospital admission for the surgery. The condition is then re-evaluated, and the main residual symptom or complication is rated. The minimum rating for a liver transplant is 30%.<b><o:p></o:p></b></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7351</b>: If a<b> liver transplant</b> is performed, it is rated 100%. This 100% rating continues for 1 year following the date of hospital admission for the surgery. The condition is then re-evaluated and rerated on any remaining symptoms or complications. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">The minimum rating for a liver transplant is 30%. If the condition is waiting for a re-transplant, the minimum rating is 60%. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The only significant proposed change to this code is to add a minimum 60% rating if a new transplant is needed.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">________________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 7352</b>: If a<b> pancreas transplant</b> is performed</span>, it is rated 100%. This 100% rating continues for 1 year following the date of hospital admission for the surgery. The condition is then re-evaluated and rerated on any remaining symptoms or complications. The minimum rating for a pancreas transplant is 30%. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA proposes adding a new code to cover pancreas transplant, a surgery that wasn’t performed when this section was first published. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_________________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span lang="EN-GB" style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/digestivesystemratings.html#v"><b><span lang="EN-US" style="font-size: 10pt;">7354</span></b></a></span><b><span style="font-size: 10pt;">: Hepatitis C </span></b><span style="font-size: 10pt;">or any <b>hepatitis</b> that is not A or B can be rated under this code. Hepatitis C is an infection in the liver that most often does not show any symptoms. A worse case of hepatitis C can, however, lead to cirrhosis, liver cancer, and liver failure. For this condition to qualify for a rating, its presence must be proved by a serologic test.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">Note: If there are two different conditions and one rates under this code and another rates under, say 7345, then the symptoms caused the by condition rated under this code cannot count towards another rating under code 7345</span></i><span style="font-size: 10pt;">.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is near-constant, completely disabling symptoms like fatigue, uneasiness, vomiting, anorexia, joint pain, and pain in the upper right abdomen, it is rated 100%. If there is significant fatigue, uneasiness, anorexia with Significant Weight Loss or malnutrition, <i>and</i> swelling in the liver, <i>or</i> Incapacitating Episodes totaling 6 weeks or more in the past year that include symptoms like fatigue, uneasiness, nausea, vomiting, anorexia, joint pain and pain in the upper right abdomen, it is rated 60%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is significant fatigue, uneasiness, anorexia with weight loss, <i>and</i> swelling in the liver, <i>or</i> if there are incapacitating episodes totaling 4 to 6 weeks in the past year that include symptoms like fatigue, uneasiness, nausea, vomiting, anorexia, joint pain, and pain in the upper right abdomen, it is rated 40%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is significant fatigue, uneasiness, <i>and</i> anorexia (without weight loss) that requires either a special diet or constant medication, <i>or</i> if there are incapacitating episodes totaling 2 to 4 weeks in the past year that include symptoms like fatigue, uneasiness, nausea, vomiting, anorexia, joint pain, and pain in the upper right abdomen, it is rated 20%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If there is occasional fatigue, uneasiness, <i>and</i> anorexia, <i>or</i> if there are incapacitating episodes totaling 1 to 2 weeks in the past year that include symptoms like fatigue, uneasiness, nausea, vomiting, anorexia, joint pain, and pain in the upper right abdomen, it is rated 10%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If the condition does not have any symptoms, it is rated 0%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code 7354: Hepatitis C </b>or any <b>hepatitis </b>that is not A or B can be rated under this code. Hepatitis C is an infection in the liver that most often does not show any symptoms. A severe case of hepatitis C can, however, lead to cirrhosis, liver cancer, and liver failure. For this condition to qualify for a rating, it must be diagnosed by a serologic test. It is rated under code 7345.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;">Hepatitis C is already rated on the same criteria as chronic liver disease, code 7345, so the VA proposes simplifying things and simply instructing it to be rated under code 7345 instead of listing the ratings again under this code.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">__________________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 7355:</b> <b>Celiac disease</b> is a condition where the immune system reacts to eating gluten. In order to be rated, the condition must be officially diagnosed using a serum antibody test or endoscopy with biopsy. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><span lang="EN-GB">Most cases of Celiac disease can be fully managed by dietary changes, however, some cases do not properly respond to these changes. These cases can lead to Malabsorption Syndrome (the inability of the body to properly absorb nutrients).<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i>Note: If the main symptom is the inability to properly absorb nutrients, then it is either rated under this code or under code 7328, whichever gives a higher rating.<o:p></o:p></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">An 80% rating is given if there is Malabsorption Syndrome and all of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l12 level1 lfo18; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Weakness that interferes with bathing, dressing, eating, using the restroom, etc.<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l12 level1 lfo18; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Weight loss with wasting and nutritional deficiencies<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l12 level1 lfo18; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Systemic manifestations (weakness, fatigue, dermatitis, swollen lymph nodes, hypocalcemia, low vitamin levels, etc.)<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l12 level1 lfo18; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Anemia<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l12 level1 lfo18; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Lactase deficiency or pancreatic insufficiency resulting in episodes of stomach pain and diarrhea<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 50% rating is given if there is Malabsorption Syndrome and all of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l12 level1 lfo18; tab-stops: 0in .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Chronic diarrhea controlled by prescribed dietary modification<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l12 level1 lfo18; tab-stops: 0in .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Nutritional deficiencies caused by lactase deficiency and pancreatic insufficiency<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l12 level1 lfo18; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-indent: -.25in; text-justify: inter-ideograph;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Systemic manifestations (weakness, fatigue, dermatitis, swollen lymph nodes, hypocalcemia, low vitamin levels, atrophy of intestinal lining, etc.)<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="font-size: medium; margin-left: 1in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 30% rating is given if there is Malabsorption Syndrome and Chronic diarrhea controlled by prescribed dietary modification.<o:p></o:p></p><p class="MsoListParagraph" style="font-size: medium; margin-left: 1in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA proposes adding a new code to cover Celiac disease, a condition not currently appropriately covered by any existing code. This will enable consistent, fair ratings for Celiac disease. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">_________________________________________________________________</span></p><p class="MsoNormal" style="font-size: medium;"><i style="text-align: justify;"><span lang="EN-GB"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 7356:</b> <b>Gastrointestinal dysmotility syndrome</b> is a term that covers a wide range of conditions where the esophagus, stomach, and/or intestines have difficulty moving food throughout the digestive tract with no known reason. It is most common among Gulf War Veterans. A condition can only be rated under this code if it is not already covered under code 7319.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">An 80% rating is given if there is complete dependence on Total Parenteral Nutrition or continuous Enteral Nutrition. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 50% rating is given if it requires intermittent Enteral Nutrition and repeated visits to the ER for intestinal obstruction or regurgitation caused by stomach pain, nausea, vomiting, or poor gastric emptying. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 30% rating is given if the condition requires prescribed dietary modification and outpatient care for symptoms like stomach pain, physical stomach bloating, feeling bloated, nausea, vomiting, regurgitation, constipation, diarrhea, etc. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;">A 10% rating is given if there is regular stomach pain, physical stomach bloating, and feeling bloated.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA proposes adding a new code to cover all motility disorders not properly covered by other ratings and that have no known cause. This will especially help Gulf War Vets get fair ratings for their digestive motility conditions caused by their Gulf War service. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">___________________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-align: justify;"><i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 7357:</b> </span>A pancreatectomy is the full or partial removal of the pancreas which can result in <b>Post-pancreatectomy Syndrome</b>. This condition is rated under one of the following codes: <span lang="EN-GB">7347, 7303, 7328, 7319, 7326, or 7913. </span>Choose the code that gives the highest rating for its symptoms, with a minimum rating of 30%. <span lang="EN-GB"><o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: justify;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA proposes adding a new code to cover residuals after a pancreatectomy. While the code instructs rating under the code that gives the highest rating, giving it its own code will help the VA track cases in the veteran population and standardize rating options.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB">____________________________________________________________________</span></p><p><span style="font-family: Cambria, serif; font-size: medium;"> </span> </p>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com0tag:blogger.com,1999:blog-4162041641030931379.post-61322927515452733782021-10-01T11:03:00.005-07:002021-10-01T11:05:18.154-07:00Changes coming November 2021 to the Ratings of the Genitourinary System <p><span style="background-color: white;"><span style="font-family: Cambria, serif;"></span></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOPJ9BhsCpQ6DkLzwHVxlK8yGZum8F85mIkNCbdLglMM77gcGUWvq_uXLBetdiBdBL88attI3D1fVnqo9YE7jeSmI1TtorhWHt8vk1yy5gCNYDgUrLQZaZm7jMYO8fa05KsytmO1Zcm18/s2048/shutterstock_187694114.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1363" data-original-width="2048" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOPJ9BhsCpQ6DkLzwHVxlK8yGZum8F85mIkNCbdLglMM77gcGUWvq_uXLBetdiBdBL88attI3D1fVnqo9YE7jeSmI1TtorhWHt8vk1yy5gCNYDgUrLQZaZm7jMYO8fa05KsytmO1Zcm18/s320/shutterstock_187694114.jpg" width="320" /></a></div><br />On September 30<sup style="font-family: Cambria, serif;">th</sup><span style="font-family: Cambria, serif;">, 2021, the VA published their final changes to the ratings of the Genitourinary System and Cardiovascular System (discussed in a separate <a href="https://blog.militarydisabilitymadeeasy.com/2021/09/changes-coming-november-2021-to-ratings.html" target="_blank">blog article</a>).</span><span style="font-family: Cambria, serif;"> </span><span style="font-family: Cambria, serif;"> </span><span style="background-color: white; font-family: Cambria, serif;"> </span><p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">The rewrite of the <a href="https://militarydisabilitymadeeasy.com/vasrd.html" target="_blank">VASRD</a> began in 2014 with the goal to be finished by the end of 2016. To date, these are the tenth and eleventh sections to be finalized, with many still to go. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal">So far, finalized changes have also been made to the ratings of the <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theblood.html" target="_blank"><span lang="EN-US">Hematologic and Lymphatic Systems</span></a></span>, the <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theskin.html" target="_blank"><span lang="EN-US">Skin</span></a></span>, the <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/femalereproductive.html" target="_blank"><span lang="EN-US">Female Reproductive System</span></a></span>, the <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theeyes.html" target="_blank"><span lang="EN-US">Eyes</span></a></span>, <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/themouthandteeth.html" target="_blank"><span lang="EN-US">Dental and Oral Conditions</span></a></span>, the <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theendocrinesystem.html" target="_blank"><span lang="EN-US">Endocrine System</span></a></span>, <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/mentaldisorders.html" target="_blank"><span lang="EN-US">Mental Disorders</span></a>, <a href="https://blog.militarydisabilitymadeeasy.com/2020/11/changes-coming-february-2021-to-ratings.html" target="_blank">Musculoskeletal System</a>, and </span><span style="background-color: white;"><a href="https://militarydisabilitymadeeasy.com/infectiousratings.html" target="_blank">Infectious Diseases, Immune Disorders</a>, and <a href="https://militarydisabilitymadeeasy.com/nutritionaldeficiencyratings.html" target="_blank">Nutritional Deficiencies</a>.</span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;">The following <span lang="EN-GB">Genitourinary</span><span lang="EN-GB"> </span>changes will go into effect <b>November 14th, 2021</b>, and we’ll officially update all the information on our website at that time. These new ratings will automatically apply to any new claims for g<span lang="EN-GB">enitourinary</span><span lang="EN-GB"> </span>conditions submitted on or after November 14th.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"> <span lang="EN-GB"><o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">The following are the VA’s final changes to the ratings for the Genitourinary System. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">The changes are fairly extensive, so I’ll walk through each, one at a time.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;">For each condition, the ones labeled <i>-Current-</i> are the codes as they are right now. Click on the links to be taken to the discussion of that code on our site. After the current code, I’ll discuss the final changes and then the VA’s justification.<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;">____________________________________________________<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">The <b><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#urinary" target="_blank">Urinary Rating Systems</a> </b>will remain exactly the same. <o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;">____________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">All <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#urcon" target="_blank">Urinary Conditions</a> (codes 7512, 7515, 7516, 7517, 7518, and 7519) are all staying the same, except: <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#g" style="color: purple;"><b><span lang="EN-US" style="font-size: 10pt;">7542</span></b></a></span><span style="font-size: 10pt;">: A <b>Neurogenic Bladder </b>occurs when a person loses control over urination because of damage to the nerves or the brain. This condition is rated on the Urinary Rating System. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i><span lang="EN-GB">-Final-</span></i><span lang="EN-GB"> </span><b>Code </b><span lang="EN-GB"><b><span lang="EN-US">7542</span></b></span>: A <b>Neurogenic Bladder </b>occurs when a person loses control over urination because of damage to the nerves or the brain. This condition is rated either on the Urinary Rating System or as a Urinary Tract Infection, whichever gives the higher rating. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">The only change to this code is allowing it to be alternatively rated as a urinary tract infection. This is because neurogenic bladders have a high rate of urinary tract infections, so if that is the predominant disability and would offer a higher rating, that should be an alternative rating option. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i><span lang="EN-GB" style="font-family: "Times New Roman", serif;">-NEW Code-</span></i><span lang="EN-GB" style="font-family: "Times New Roman", serif;"> <b>Code 7545: Diverticulum of the bladder</b> occurs when the wall of the bladder weakens and a portion protrudes, creating a pouch. This causes urine to get trapped in the pouch, leading to voiding dysfunction and/or infection. It can be rated either on the Urinary Rating Systems or as a Urinary Tract Infection, whichever is the main disability.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">The VA is adding this new code to cover diverticulum of the bladder. Currently, there aren’t any codes that truly reflect the disability of this condition. Thus, having its own code will make it easier to rate consistently.<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;">_____________________________________________________<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;"> </span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span style="background-color: white;"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#tract" target="_blank">Urinary Tract Infection</a><o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><span style="font-size: 10pt;"> A 30% rating is given if the condition causes regular infections that require hospitalization 3 or more times a year, <u>or</u> if it requires serious continuous treatment. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white; font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white; font-size: 10pt;">A 10% rating is given if the condition requires regular drug therapy, 1 or 2 hospitalizations a year, or if it requires serious continuous treatment.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white; font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white;"><span style="font-size: 10pt;">If any of these conditions that are rated as urinary tract infections also cause renal p<a name="i"></a>roblems, then only one or the other can be rated. If the renal problems are more severe, then the condition should be rated under the </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#renal" style="color: purple;"><span lang="EN-US" style="font-size: 10pt;">renal rating system</span></a></span><span style="font-size: 10pt;">.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i>-Final-</i> A 30% rating is given if the condition causes regular infections that require a stent or nephrostomy tube to be implanted for drainage, if the condition requires hospitalization 3 or more times a year, <u>or</u> if it requires serious continuous treatment. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;">A 10% rating is given if the condition requires suppressive drug therapy for 6 months or more, <u>or</u> 1 or 2 hospitalizations a year.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;">A 0% rating is given if the condition is recurrent and requires treatment of suppressive drug therapy for less than 6 months but does not require hospitalizations. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;">If any condition rated as a urinary tract infection also causes renal problems, then only one or the other can be rated unless they have clearly separate symptoms. If the renal problems are more severe, then the condition should be rated under the <span lang="EN-GB"><span lang="EN-US">renal rating system</span></span>.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;">The changes to the 30% simply specify that the infection must require drainage by more than a catheter in order to be rated at this level. Catheter drainage does not require surgery and rarely requires significant hospitalization. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;">The changes to the 10% more clearly define the required treatment. The VA argues that suppressive drug therapy for at least 6 months suggests a significant chronic condition appropriate for this rating level. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;">A 0% rating was added to enforce that anything less than the requirements for the 10% should be given a 0%. <o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;">___________________________________________________<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span style="background-color: white;"><span lang="EN-GB">Conditions Rated As Urinary Tract Infections</span><span lang="EN-GB"><o:p></o:p></span></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#h" target="_blank">7501</a></span><span lang="EN-GB"> for abscess of the kidney remains the same. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="font-size: 10pt;"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#mm" target="_blank">7525</a></span></b></span><span style="font-size: 10pt;">: <b>Chronic Epididymo-orchitis</b> is pain in the epididymis. If the pain is caused by tuberculosis, it is rated as </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/tuberculosis.html" style="color: purple;"><span lang="EN-US" style="font-size: 10pt;">nonpulmonary tuberculosis</span></a></span><span style="font-size: 10pt;">.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white; font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i>-Final-</i><b> Code 7525</b>: The following chronic infections are all rated under this code: <b>epididymitis </b>(infection/inflammation of the epididymis), <b>prostatitis</b> (infection/inflammation of the prostate gland), <b>urethritis</b> (infection/inflammation of the urethra), and <b>orchitis</b> (infection/inflammation of the testicles—one or both). If the condition is caused by tuberculosis, it is rated as nonpulmonary tuberculosis.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white; font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="font-size: 10pt;"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#j" target="_blank">7527</a></span></b></span><span style="font-size: 10pt;">: <b>Prostate Gland</b> conditions (any) are either rated as urinary tract infections or by the urinary rating system, whichever better defines the symptoms of the condition.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB" style="background-color: white; font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i>-Final-</i><b> Code 7527</b>: <b>Prostate Gland</b> conditions (all except prostatitis, code 7525) and <b>bladder outlet obstruction</b> are rated under this code either as urinary tract infections or under the urinary rating system, whichever better defines the symptoms of the condition.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">The VA recognized that there were quite a few infections that were not technically covered under the current codes, and so decided to add them in order to avoid improper analogous ratings. Thus, now code 7525 covers four conditions instead of just epididymitis. All of these conditions should have been rated under this code anyway, since they cause similar symptoms, but now it is official. No change in how they are rated. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">For code 7527, they decided to move prostatitis to 7525 because it is closer to the other infections covered by that code. All other prostate conditions are still covered under this code. The VA also decided to add bladder outlet obstruction because it is often caused by a prostate condition and can produce similar symptoms. Thus, it needs the option to be rated as a urinary tract infection as well. <o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;"> </span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;">___________________________________________________<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;"> </span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span style="background-color: white;"><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#renal" target="_blank">The Renal Rating System</a></span><span lang="EN-GB"><o:p></o:p></span></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-align: center;"><span lang="EN-GB" style="background-color: white; font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><span style="font-size: 10pt;"> A 100% rating is given if at least one of the following is present:<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– The condition requires regular dialysis.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– The body cannot perform any physical activity because of persistent edema or because of albuminuria.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– A BUN of more than 80 mg/dL.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– A creatinine level of 9 mg/dL or more in the blood.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– A severely decreased functioning of the kidneys or other organs due to kidney dysfunction.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-indent: 0.5in;"><span style="background-color: white; font-size: 10pt;">An 80% rating is given if one or more of the following is present:<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– Persistent edema <u>and</u> albuminuria with a BUN of 40 to 80 mg/dL.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– A creatinine level of 4 to 8 mg/dL in the blood.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– Overall poor health with symptoms like lethargy, weakness, anorexia, weight loss, or the inability to exert much energy.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-indent: 0.5in;"><span style="background-color: white; font-size: 10pt;">A 60% rating is given if one or more of the following is present:<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– Constant albuminuria with some edema.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– A definite decrease in kidney function.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– Hypertension with the average diastolic pressure (the smaller number on the bottom in the blood pressure reading) of 120 or more.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-indent: 0.5in;"><span style="background-color: white; font-size: 10pt;">A 30% rating is given if one or more of the following is present:<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– Hypertension with the average diastolic pressure (the smaller number on the bottom) of 100 or more, <u>or</u> with the average systolic pressure (the larger number on top) of 160 or more.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– Albumin is present in the urine with either hyaline and granular casts or red blood cells.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-indent: 0.5in;"><span style="background-color: white; font-size: 10pt;">A 0% rating is given if:<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– Hypertension with the average diastolic pressure of less than 100, or with the average systolic pressure of less than 160.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white; font-size: 10pt;">– Albumin and casts are present in the urine with a history of nephritis.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i><span lang="EN-GB">-Final-</span></i><span lang="EN-GB"> In order to qualify for ratings 30%-100%, a chronic kidney disease must be diagnosed. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-indent: 0.5in;"><span style="background-color: white;">A 100% rating is given if at least one of the following is present:<span lang="EN-GB"><o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white;">– A GFR (glomerular filtration rate) less than 15mL/min/1.73 m<sup>2 </sup>for at least 3 consecutive months within the past 12 months<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white;">– The condition requires regular dialysis.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in;"><span style="background-color: white;">– A kidney transplant has been performed<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in; text-indent: -0.5in;"><span style="background-color: white;">An 80% rating is given if the GFR is between 15 and 29 mL/min/1.73 m<sup>2 </sup>for at least 3 consecutive months within the past 12 months.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in; text-indent: -0.5in;"><span style="background-color: white;">A 60% rating is given if the GFR is between 30 and 44 mL/min/1.73 m<sup>2 </sup>for at least 3 consecutive months within the past 12 months.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in; text-indent: -0.5in;"><span style="background-color: white;">A 30% rating is given if the GFR is between 45 and 59 mL/min/1.73 m<sup>2 </sup>for at least 3 consecutive months within the past 12 months.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.5in; text-indent: -0.5in;"><span style="background-color: white;">A 0% rating is given if at least one of the following is present for at least 3 consecutive months within the past 12 months, even if a chronic kidney disease has not yet been diagnosed:<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.75in;"><span style="background-color: white;">– The GFR is between 60 and 89 mL/min/1.73 m<sup>2</sup> <u>and</u><sup> </sup>there are recurrent red blood cell casts, white blood cell casts, <u>or</u> granular casts<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.75in;"><span style="background-color: white;">– The GFR is between 60 and 89 mL/min/1.73 m<sup>2</sup> <u>and</u> there are abnormalities in the kidney’s structure (cysts, obstruction, etc.)<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1.75in;"><span style="background-color: white;">– The GFR is between 60 and 89 mL/min/1.73 m<sup>2</sup> <u>and</u> the albumin/creatinine ratio (ACR) is 30 mg/g or more <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><i><span lang="EN-GB" style="background-color: white;">Note: Both estimated GFR (eGFR) and creatinine-based approximations of GFR will be accepted for GFR ratings as long as they are calculated by a qualified physician. <o:p></o:p></span></i></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">These are by far the biggest changes. The VA feels that the current renal ratings are based on out-dated medical tests and other vague standards. The glomerular filtration rate is now the medical standard used to measure how well kidneys are filtering the blood. As it is a more accurate test of kidney health, the VA will be using it as the standard for rating criteria. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">The VA recognizes that the additional rating criteria is necessary to ensure that the full picture of the disease is taken into account for rating purposes. This is especially important for the 0% ratings, as a high GFR may not mean that the kidney isn’t impaired and causing symptoms. Thus additional symptoms are taken into account to reflect the increased risk for the development of chronic kidney disease. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">The 100% rating for individuals post-kidney transplant is another important addition. <o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;">___________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span style="background-color: white;"><span lang="EN-GB">Renal (Kidney) Conditions</span><span lang="EN-GB"><o:p></o:p></span></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">The following conditions are currently rated and the Renal Rating System. They will continue to be, but now on the new Renal Rating System. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#k" target="_blank">7500</a></span><span lang="EN-GB"> for nephrectomy remains the same. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#k" target="_blank">7502</a></span><span lang="EN-GB"> for nephritis remains the same.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#n" target="_blank">7504</a></span><span lang="EN-GB"> for pyelonephritis remains the same. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#n" target="_blank">7507</a></span><span lang="EN-GB"> for nephrosclerosis remains the same.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#p" target="_blank">7530</a></span><span lang="EN-GB"> for any kidney disease that requires regular dialysis remains the same. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#p" target="_blank">7531</a></span><span lang="EN-GB"> for a kidney transplant remains the same. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#p" target="_blank">7532</a></span><span lang="EN-GB"> for renal tubular conditions remains the same. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#s" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7533</span></b></a></span><span style="font-size: 10pt;">: Any <b>cystic disease of the kidney</b> is rated under this code. <a name="u"></a>A cyst is a sac most often containing fluid that can grow anywhere in the body. Many do not cause problems, but some can seriously affect the functioning of the organs.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i>-Final-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7533</span></b></span>: Any <b>cystic disease of the kidney</b> is rated under this code, including <b>polycystic disease, uremic medullary cystic disease, medullary sponge kidney, Alport’s syndrome, cystinosis, primary oxalosis, Fabry’s disease</b>, and more.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;">A c<a>yst </a>is a sac most often containing fluid that can grow anywhere in the body. Many do not cause problems, but some can seriously affect the functioning of the organs. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;">Again, the VA is just adding more conditions to this code to make sure that they are rated under the most appropriate code.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#t" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7534</span></b></a></span><span style="font-size: 10pt;">: <b>Atherosclerotic renal disease</b> (also known as <b>renal artery stenosis</b> or <a name="v"></a><b>atheroembolic renal disease</b>) is a condition where the artery to the kidney narrows and decreases the blood flow to the kidney.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i>-Final-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7534</span></b></span>: <b>Atherosclerotic renal disease</b> (also known as <b>renal artery stenosis</b>, <b>atheroembolic renal disease</b>, or<b> large vessel disease</b>) is a condition where the artery to the kidney narrows and decreases the blood flow to the kidney.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">Similarly, the VA is making sure large vessel disease is properly rated under this code. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#u" target="_blank">7535</a></span><span lang="EN-GB"> for toxic nephropathy remains the same. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#u" target="_blank">7536</a></span><span lang="EN-GB"> for glomerulonephritis remains the same. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#m" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7537</span></b></a></span><span style="font-size: 10pt;">:<b> Interstitial nephritis</b> occurs when the spaces between <a name="o"></a>the tubules in the kidney swell. This reduces the ability of the kidneys to filter blood</span>.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><i style="background-color: white;"> </i></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i>-Final-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7537</span></b></span>:<b> Interstitial nephritis</b> occurs when the spaces between the tubules in the kidney swell. This reduces the ability of the kidneys to filter blood. This code also covers <b>gouty nephropathy</b>(the decrease of kidney function caused by high levels of uric acid due to gout) and <b>disorders of calcium metabolism </b>(the inability to properly metabolize calcium). <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">The VA feels that code 7537 is the best rating option for gouty nephropathy and disorders of calcium metabolism and so adds them here. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#w" target="_blank">7538</a></span><span lang="EN-GB"> for papillary necrosis remains the same. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#x" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7539</span></b></a></span><span style="font-size: 10pt;">: <b>Renal amyloid disease</b> is caused by the buildup <a name="z"></a>of protein in the kidney, which may result in the kidney not being able to filter blood.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white; font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code<a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#z" target="_blank"> </a></span></b><span lang="EN-GB"><b style="color: purple;"><span lang="EN-US" style="font-size: 10pt;"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#z" target="_blank">7541</a></span></b></span><span style="font-size: 10pt;">: <b>Renal Involvement</b> in other conditions. So, if the kidneys are affected<a name="aa"></a> by conditions like sickle cell anemia, lupus, or diabetes, it can be rated separately from those conditions.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white; font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i>-Final-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7539</span></b></span>: <b>Renal amyloid disease</b> is caused by the buildup of protein in the kidney, which may result in the kidney not being able to filter blood. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;">In addition, <b>renal involvement in other systemic conditions</b> is rated under this code. This includes renal involvement in conditions such as lupus, sickle cell disease, Henoch-Schonlein syndrome, and other systemic conditions. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i>-Final-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7541</span></b></span>: <b>Renal involvement</b> <b>in diabetes mellitus</b> is rated under this code. If a veteran is diagnosed with either type I or type II diabetes, and it causes a decrease in renal function, it is rated under this code. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;">For these two codes, the VA basically combined them all under code 7539. They only left diabetes mellitus separate under code 7541 because they wanted to be able to more accurately track the rate of this condition in the veteran population. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i><span lang="EN-GB">-NEW Code-</span></i><span lang="EN-GB"> <b>Code 7544:</b> <b>Renal disease caused by viral infections</b>, such as HIV and Hepatitis B or C, are rated under this code. This code includes renal disease caused by the treatment of such viral infections as well. <o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;">The VA is adding this new code to specifically cover diseases caused by viral infections. While this code is not limited to HIV and Hepatitis B or C, for other viral infections to qualify, there must be regular clinical proof that the infection itself or its treatment causes kidney disease. For this reason, Hepatitis A is not included as there is clinical proof that it does not cause kidney disease. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;">___________________________________________________<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#hydro" target="_blank">7509</a></span><span lang="EN-GB"> for hydronephrosis remains exactly the same.<o:p></o:p></span></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;">___________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#hydro" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7508</span></b></a></span><span style="font-size: 10pt;">: <b>Nephrolithiasis</b> (also known as <b>kidney stones</b>) is the presence of stones in the kidney or ureter. These stones block the flow of urine through the tubes. This condition is rated as hydronephrosis unless stones are <u>repeatedly</u> formed and it requires either drug therapy, diet therapy, or removal surgeries or procedures 3 or more times each year. If this is the case, it is rated 30%. Otherwise, rate as hydronephrosis.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white; font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#hydro" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7510</span></b></a></span><span style="font-size: 10pt;">: <b>Ureterolithiasis</b> is the presence of stones in the ureter. These stones can block the flow of urine through the tubes. This condition is rated as hydronephrosis unless stones are <u>repeatedly</u> formed and it requires either drug therapy, diet therapy, <u>or</u> removal surgeries or procedures 3 or more times each year. If this is the case, it is rated 30%. Otherwise, rate as hydronephrosis.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i>-Final-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7508</span></b></span>: <b>Nephrolithiasis</b> (also known as “<b>kidney stones</b>”), <b>Ureterolithiasis, </b>and <b>Nephrocalcinosis</b> are all rated under this code. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;">Nephrolithiasis is the presence of stones in the kidney, Ureterolithiasis is the presence of stones in the ureter, and Nephrocalcinosis is the buildup of calcium in the kidneys that can lead to stone formation. These stones block the flow of urine. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;">If stones are <u>repeatedly</u> formed and it requires removal surgeries or procedures 3 or more times each year, it is rated 30%. Otherwise, it is rated as hydronephrosis, code 7509.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;">The VA is combining codes 7508 and 7510 into a single code since both deal with the formation of stones that block the urinary tract. They are also adding nephrocalcinosis to this code to ensure it is properly rated. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;">The ratings for these conditions are mostly stay the same, but dietary and drug treatments have not proven ineffective, so the VA is removing them as rating options. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;">__________________________________________________<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#dd" target="_blank">7511</a></span><span lang="EN-GB"> for ureteral stricture remains exactly the same.<o:p></o:p></span></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;">__________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in; text-align: justify;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#ee" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7520</span></b></a></span><span style="font-size: 10pt;">: If half or more of the <b>penis is removed</b>, then it is rated 30%. This condition can also be rated under the urinary rating system if that can result in a higher rating than 30%.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in; text-align: justify;"><span style="background-color: white; font-size: 10pt;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in; text-align: justify;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#ee" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7521</span></b></a></span><span style="font-size: 10pt;">: If the glans is removed, it is rated 20%. This condition can also be rated under the urinary rating system if that can result in a higher rating than 20%.</span><span style="font-size: 10pt;"><span lang="EN-GB"><o:p></o:p></span></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-align: justify;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-align: justify;"><span style="background-color: white;"><i>-Final-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7520</span></b></span>: If half or more of the <b>penis is removed</b>, then it is rated 30%. This condition may qualify for <a href="https://militarydisabilitymadeeasy.com/special-monthly-compensation.html#k" target="_blank">SMC-K</a> as loss of use of a creative organ. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-align: justify;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-align: justify;"><span style="background-color: white;"><i>-Final-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7521</span></b></span>: If the glans is removed, it is rated 20%. This condition may qualify for <a href="https://militarydisabilitymadeeasy.com/special-monthly-compensation.html#k" target="_blank">SMC-K</a> as loss of use of a creative organ.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: justify;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: justify;"><span style="background-color: white;">For both of these codes, the VA is removing the option to rate these conditions as urinary dysfunction since most of the circumstances around urinary dysfunction (like leakage, use of a pad, etc.) don’t really apply. These both, however, might qualify for Special Monthly Compensation, Category K (SMC-K) since they may result in the loss of use of the creative organ, if the penis can no longer can function in that way. <o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;">___________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 1in;"><span style="background-color: white;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#gg" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7522</span></b></a></span><span style="font-size: 10pt;">: If the <b>penis is deformed</b> and cannot erect<a name="ii"></a>, then it is rated 20%.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><b style="background-color: white;"> </b></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;"><i>-Final-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7522</span></b></span>: Erectile dysfunction, for any reason, is rated 0%. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;">Any scarring or <b>deformity of the penis</b> as the result of an injury is also rated under this code as erectile dysfunction.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in;"><span style="background-color: white;">These conditions may qualify for <a href="https://militarydisabilitymadeeasy.com/special-monthly-compensation.html#k" target="_blank">SMC-K</a> as loss of use of a creative organ. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><o:p style="background-color: white;"> </o:p></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">The VA will no longer be rating erectile dysfunction more than 0%. They justify this change by claiming that the purpose of compensable ratings is to compensate for conditions that interfere with the veteran’s ability to work. Erectile dysfunction does not interfere with the veteran’s ability to work, and so should not be rated more than 0%. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">This condition may, however, still qualify for </span>Special Monthly Compensation, Category K (SMC-K) since it is considered loss of use of a reproductive organ.<span lang="EN-GB"><o:p></o:p></span></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;">__________________________________________________<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#ll" target="_blank">7505</a></span><span lang="EN-GB"> for tuberculosis of the kidney remains exactly the same.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#hh" target="_blank">7523</a></span><span lang="EN-GB"> for atrophy of the testicles remains exactly the same.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#hh" target="_blank">7524</a></span><span lang="EN-GB"> for removal of the testicles remains exactly the same.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#cancer" target="_blank">7528</a> </span><span lang="EN-GB">for malignant cancer remains exactly the same.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#cancer" target="_blank">7529</a></span><span lang="EN-GB"> for benign tumors remains exactly the same.<o:p></o:p></span></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;"> </span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;">__________________________________________________<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt; text-align: center;"><span lang="EN-GB" style="background-color: white;"> </span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt 0.5in; text-align: justify;"><span style="background-color: white;"><i><span lang="EN-GB">-NEW Code-</span></i><span lang="EN-GB"> <b>Code 7543:</b> <b>Varicocele</b> (enlarged veins in the scrotum) and <b>hydrocele</b> (the build-up of fluid around the testicles) are both rated 0% under this code.</span> These conditions may qualify for <a href="https://militarydisabilitymadeeasy.com/special-monthly-compensation.html#k" target="_blank">SMC-K</a> as loss of use of a creative organ if they result in infertility.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><br /></span></p><p class="MsoNormal" style="font-family: Cambria, serif; margin: 0in 0in 0.0001pt;"><span lang="EN-GB" style="background-color: white;">The VA is adding a new code to cover varicocele and hydrocele—both conditions that are not currently addressed in the VASRD. These conditions do not interfere with the ability of the veteran to work, and so the VA is giving only a 0% rating. However, if they lead to infertility, they would qualify for SMC-K.</span></p>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com0tag:blogger.com,1999:blog-4162041641030931379.post-85968256088444729042021-09-30T11:12:00.008-07:002021-11-10T09:05:31.361-08:00Changes coming November 2021 to the Ratings of the Cardiovascular System <p><span style="font-family: Cambria, serif;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: Cambria, serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEim8OZ_YJjsLGOed_y_vK_eLRKdxKk1gE3Ii7tZlOA6e1tu4-OyZ9GHOGQOlumD8B6oBoYlGozdvK1_O847j3OiETbaqCgthAzP3ol7I-DCZs8fl1mzHJ8N0I1omyKuT4HSTd0XKJyI_Ik/s2048/the+heart.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1260" data-original-width="2048" height="197" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEim8OZ_YJjsLGOed_y_vK_eLRKdxKk1gE3Ii7tZlOA6e1tu4-OyZ9GHOGQOlumD8B6oBoYlGozdvK1_O847j3OiETbaqCgthAzP3ol7I-DCZs8fl1mzHJ8N0I1omyKuT4HSTd0XKJyI_Ik/s320/the+heart.jpg" width="320" /></a></span></div><span style="font-family: Cambria, serif;">On September 30</span><sup style="font-family: Cambria, serif;">th</sup><span style="font-family: Cambria, serif;">, 2021, the VA published their final changes to the ratings of the Cardiovascular System and Genitourinary System (discussed in a separate <a href="https://blog.militarydisabilitymadeeasy.com/2021/10/changes-coming-november-2021-to-ratings.html" target="_blank">blog article</a>).</span><span style="font-family: Cambria, serif;"> </span><span style="font-family: Cambria, serif;"> </span><p></p><p><span style="font-family: Cambria, serif;"><br /></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The rewrite of the <a href="https://militarydisabilitymadeeasy.com/vasrd.html" target="_blank">VASRD</a> began in 2014 with the goal to be finished by the end of 2016. To date, these are the tenth and eleventh sections to be finalized, with a number still to go. </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"><br /></span></p><p class="MsoNormal" style="font-size: medium;">So far, finalized changes have also been made to the ratings of the <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theblood.html" target="_blank"><span lang="EN-US">Hematologic and Lymphatic Systems</span></a></span>, the <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theskin.html" target="_blank"><span lang="EN-US">Skin</span></a></span>, the <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/femalereproductive.html" target="_blank"><span lang="EN-US">Female Reproductive System</span></a></span>, the <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theeyes.html" target="_blank"><span lang="EN-US">Eyes</span></a></span>, <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/themouthandteeth.html" target="_blank"><span lang="EN-US">Dental and Oral Conditions</span></a></span>, the <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theendocrinesystem.html" target="_blank"><span lang="EN-US">Endocrine System</span></a></span>, <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/mentaldisorders.html" target="_blank"><span lang="EN-US">Mental Disorders</span></a>, <a href="https://blog.militarydisabilitymadeeasy.com/2020/11/changes-coming-february-2021-to-ratings.html" target="_blank">Musculoskeletal System</a>, and </span><span style="background-color: white;"><a href="https://militarydisabilitymadeeasy.com/infectiousratings.html" target="_blank">Infectious Diseases, Immune Disorders</a>, and <a href="https://militarydisabilitymadeeasy.com/nutritionaldeficiencyratings.html" target="_blank">Nutritional Deficiencies</a>.</span><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;">The following Cardiovascular changes will go into effect <b>November 14th, 2021</b>, and we’ll officially update all the information on our website at that time. These new ratings will automatically apply to any new claims for cardiovascular conditions submitted on or after November 14th.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"> <span lang="EN-GB"><o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The following are the VA’s final changes to the ratings for the Cardiovascular System. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The changes are fairly extensive, so I’ll walk through each, one at a time.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;">For each condition, the ones labeled <i>-Current-</i> are the codes as they are right now. Click on the links to be taken to the discussion of that code on our site. After the current code, I’ll discuss the final changes and then VA’s justification.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">__________________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p align="center" class="MsoNormal" style="font-size: medium; margin-left: 0.25in; text-align: center;"><i><span lang="EN-GB">-Final-</span></i><span lang="EN-GB"> <span style="background-color: white;"><a href="https://militarydisabilitymadeeasy.com/heartratings.html#system" target="_blank">General Rating Formula for Heart Conditions</a></span><o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-size: medium; margin-left: 0.25in; text-align: center;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;">All heart conditions are rated on this General Rating Formula unless otherwise noted. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;"><i> </i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;"><i>Note: It is very important that the physician performing your exam gets an MET (metabolic equivalent of task) test done for ANY heart condition. An MET test, more often known as an exercise test, checks for how much oxygen is being used by the body to perform increasingly strenuous tasks. 1 MET equals the amount of oxygen a person uses when at rest. The only time an MET test is not required is if it is medically contraindicated or if a 100% rating can be made without it. For all other cases, it is <u>essential</u> to getting a proper heart rating. Be proactive and make sure an MET test is done!</i><o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;"><i> </i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;"><i>It is also vital that the need for medication for the condition and whether or not there is hypertrophy or dilation is clearly recorded by the physician.<o:p></o:p></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in; text-align: center;">The General Rating Formula:<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;">A 100% rating is given if an MET test causes symptoms (like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting) at 3.0 METs or less.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;">A 60% rating is given if an MET test causes symptoms (like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting) at 3.1 to 5.0 METs.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;">A 30% rating is given if there is one or more of the following:<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">1) An MET test causes symptoms (like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting) at 5.1 to 7.0 METs.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">2) Evidence (echocardiogram, multigated acquisition scan, MRI, etc.) of hypertrophy or dilatation. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.25in;">A 10% rating is given if there is one or more of the following:<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">1) An MET test causes symptoms (like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting) at 7.1 to 10.0 METs.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">2) Continuous medication is required for control.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA is adjusting the heart’s General Rating Formula by focusing mostly on MET test results and removing congestive heart failure and ejection fractions as rating options. This is because both congestive heart failure and ejection fractions can be affected by things unrelated to the heart condition itself. Instead, an MET test gives a more accurate reflection of the heart condition itself.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Codes <a href="https://militarydisabilitymadeeasy.com/heartratings.html#a" target="_blank">7000</a> for valvular heart disease, <a href="https://militarydisabilitymadeeasy.com/heartratings.html#a" target="_blank">7001</a> for endocarditis, <a href="https://militarydisabilitymadeeasy.com/heartratings.html#a" target="_blank">7002</a> for pericarditis, <a href="https://militarydisabilitymadeeasy.com/heartratings.html#j" target="_blank">7003</a> for pericardial adhesions, <a href="https://militarydisabilitymadeeasy.com/heartratings.html#j" target="_blank">7004</a> for syphilitic heart disease, <a href="https://militarydisabilitymadeeasy.com/heartratings.html#j" target="_blank">7005</a> for coronary artery disease, code <a href="https://militarydisabilitymadeeasy.com/heartratings.html#d" target="_blank">7006</a> for myocardial infarction, code <a href="https://militarydisabilitymadeeasy.com/heartratings.html#j" target="_blank">7007</a> for hypertensive heart disease, code <a href="https://militarydisabilitymadeeasy.com/heartratings.html#q" target="_blank">7008</a> for hyperthyroid heart disease remain exactly the same.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">____________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Final NEW CODE-</i><b> Code 7009: Bradycardia </b>(i.e., <b>bradyarrhythmia</b>, including sinus bradycardia, sinoatrial block, atrioventricular junctional escape rhythm, AV heart block or dissociation, atrial fibrillation/flutter, and idioventricular escape rhythm)<b> </b>is an abnormally slow heart rate below 60 beats per minute (bpm). <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">If the condition requires the implantation of a permanent pacemaker, it is rated 100% for the first month after discharge from the hospital and then rated on the General Rating Formula. If there are no symptoms, it cannot be rated more than 0%.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA is adding this new code to cover all cases of bradycardia. This will be very beneficial as there is currently not a decent code to analogously rate these conditions, making rating choices difficult and inconsistent. Bradycardia isn’t always a problematic condition, however. Healthy, athletic adults and people sleeping often have low heart rates with no negative symptoms. Because of this, only cases of bradycardia that cause negative symptoms can be considered a compensable disability.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/heartratings.html#p" target="_blank">7010</a>: Supraventricular arrhythmias </span></b><span style="font-size: 10pt;">are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two upper chambers. If episodes of abnormal heart rhythms occur 5 or more times a year, then it is rated 30%. A 10% rating is given if episodes of abnormal rhythm occur 1 to 4 times a year or if there is permanent atrial fibrillation with no evidence of other heart diseases or conditions. All episodes must be properly documented by an ECG test.<b><o:p></o:p></b></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB">-Final-</span></i><span lang="EN-GB"> </span><b>Code 7010: </b>All types of <b>Supraventricular tachycardia </b>are rated under this code. These are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two upper chambers. The condition must be confirmed by an ECG test.<b><o:p></o:p></b></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">The condition is rated 30% if it requires intravenous pharmacologic adjustment, cardioversion, and/or ablation to relieve symptoms 5 or more times a year.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">The condition is rated 10% if it requires one or more of the following:<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 67.5pt; text-indent: -13.5pt;">1) intravenous pharmacologic adjustment, cardioversion, and/or ablation to relieve symptoms 1 to 4 times a year<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-indent: 0.25in;">2) continuous use of oral medication to control symptoms<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-indent: 0.25in;">3) vagal maneuvers (vagus nerve stimulation) to control symptoms<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA is changing the name of this code from arrhythmia, which could be any type of abnormal heart rhythm, to tachycardia, abnormally fast heart rhythms. In reality, this code has always been used just for tachycardias, so this change will help clarify that. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA is also changing the rating requirements from recorded episodes to required treatments. There can be episodes of tachycardia that do not cause any symptoms and so do not cause a measurable disability. By rating the condition based on needed treatments, the ratings will more properly reflect the disability caused by a symptomatic condition. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">_____________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/heartratings.html#f" target="_blank">7011</a>: Sustained ventricular arrhythmias </span></b><span style="font-size: 10pt;">are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two lower chambers. These rhythms can come and go and are usually treated with medication or electric therapy. This condition receives the 100% rating the entire time it is being treated in the hospital or the entire time an implantable defibrillator is in place. If a pacemaker is implanted, then it is rated under code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#h"><span lang="EN-US" style="font-size: 10pt;">7018</span></a></span><span style="font-size: 10pt;">.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB" style="font-family: "Times New Roman", serif;">-Final-</span></i><span lang="EN-GB" style="font-family: "Times New Roman", serif;"> </span><b><span style="font-family: "Times New Roman", serif;">Code 7011: Sustained ventricular arrhythmias</span></b><span style="font-family: "Times New Roman", serif;"> are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two lower chambers. These rhythms can come and go and are usually treated with medication or electric therapy. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;">This condition receives a 100% rating the entire time it is being treated in the hospital or the entire time an implantable defibrillator is in place. If a pacemaker is implanted, then it is rated under code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#h"><span lang="EN-US" style="font-family: "Times New Roman", serif;">7018</span></a></span><span style="font-family: "Times New Roman", serif;">. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;">Six months after discharge from the hospital, the condition will be re-evaluated and re-rated based on the </span>General Rating Formula.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The only change to this code is to establish a 6-month period after hospital discharge for a re-evaluation by the VA.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">_____________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/heartratings.html#n" target="_blank">7015</a>: Atrioventricular block </span></b><span style="font-size: 10pt;">occurs when the electrical impulses that allow the different parts of the heart to communicate and function are blocked. This must be associated with other evidence of heart disease to be considered unfitting. It is rated on the basic rating system with one addition: if a pacemaker is required, it is rated 10%. <b><o:p></o:p></b></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB" style="font-family: "Times New Roman", serif;">-Final-</span></i><span lang="EN-GB" style="font-family: "Times New Roman", serif;"> </span><b><span style="font-family: "Times New Roman", serif;">Code 7015: Atrioventricular block </span></b><span style="font-family: "Times New Roman", serif;">occurs when the electrical impulses that allow the different parts of the heart to communicate and function are blocked. There are two different types of atrioventricular block: benign and non-benign. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;">A benign condition is less severe and includes First-Degree and Second-Degree (Type I). It is rated on the </span>General Rating Formula<span style="font-family: "Times New Roman", serif;">. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;">A non-benign condition is much more severe and includes Second-Degree (Type II) and Third-Degree. It is rated under the General Rating Formula unless it requires a pacemaker, then it is rated under code 7018.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA is adjusting these ratings to ensure that the severity of the condition is properly rated. Most, if not all, non-benign conditions require a permanent pacemaker, so it makes sense to rate it directly under code 7018. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">______________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Codes <a href="https://militarydisabilitymadeeasy.com/heartratings.html#g" target="_blank">7016</a> for heart valve replacement, and code <a href="https://militarydisabilitymadeeasy.com/heartratings.html#e" target="_blank">7017 </a>for coronary bypass surgery remain exactly the same.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">______________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/heartratings.html#h" target="_blank">7018</a>: Cardiac pacemakers </span></b><span style="font-size: 10pt;">are implanted if the rhythm of the heart is too slow. This condition is rated 100% for the first 2 months following the surgery. After that, it is rated under the base condition that caused the irregular heart rhythm: </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#p"><span lang="EN-US" style="font-size: 10pt;">supraventricular arrhythmias</span></a></span><span style="font-size: 10pt;">, </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#f"><span lang="EN-US" style="font-size: 10pt;">ventricular arrhythmias</span></a></span><span style="font-size: 10pt;">, or an </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#n"><span lang="EN-US" style="font-size: 10pt;">atrioventricular block</span></a></span><span style="font-size: 10pt;">. The minimum rating for a condition requiring a pacemaker is 10%. If a defibrillator is implanted, then it is rated under code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#f"><span lang="EN-US" style="font-size: 10pt;">7011</span></a></span><span style="font-size: 10pt;">.<b><o:p></o:p></b></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB" style="font-family: "Times New Roman", serif;">-Final-</span></i><span lang="EN-GB" style="font-family: "Times New Roman", serif;"> </span><b><span style="font-family: "Times New Roman", serif;">Code 7018: Cardiac pacemakers </span></b><span style="font-family: "Times New Roman", serif;">are implanted if the rhythm of the heart is too slow. This condition is rated 100% for the first month following discharge from the hospital after the surgery. After that, it is rated under the underlying condition that caused the irregular heart rhythm: </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#p"><span lang="EN-US" style="font-family: "Times New Roman", serif;">supraventricular arrhythmias</span></a></span><span style="font-family: "Times New Roman", serif;">, </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#f"><span lang="EN-US" style="font-family: "Times New Roman", serif;">ventricular arrhythmias</span></a></span><span style="font-family: "Times New Roman", serif;">, or an </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#n"><span lang="EN-US" style="font-family: "Times New Roman", serif;">atrioventricular block</span></a></span><span style="font-family: "Times New Roman", serif;">. The minimum rating for a condition requiring a pacemaker is 10%. If a defibrillator is implanted, then it is rated under code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#f"><span lang="EN-US" style="font-family: "Times New Roman", serif;">7011</span></a></span><span style="font-family: "Times New Roman", serif;">.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The only change to this is to allow a 1-month 100% rating after hospital discharge following the surgery instead of 2 months after the surgery itself. The VA justifies this change by stating that new surgical techniques require a much shorter recovery period. Since less time is needed, a month should cover most recovery needs. For those with more serious cases that need longer hospital stays, they’ll still be covered by the<span style="background-color: white;"> <a href="https://militarydisabilitymadeeasy.com/vasrd-principles.html#hospital" target="_blank">Hospital Ratings Principle</a> t</span>hat rates long hospital stays (21 days+) 100% anyway. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">_______________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Codes <a href="https://militarydisabilitymadeeasy.com/heartratings.html#n" target="_blank">7019</a> for heart transplant, <a href="https://militarydisabilitymadeeasy.com/heartratings.html#o" target="_blank">7020</a> for cardiomyopathy, and <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#a" target="_blank">7101</a> for hypertension remain the same.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">_______________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code<a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#b" target="_blank"> 7110</a>: </span></b><span style="font-size: 10pt;">If an <b>aneurysm in the aortic artery</b> is corrected by surgery, then it is rated 100% from the day of admittance to the hospital. This rating continues for the first 6 months after discharge from the hospital. The condition is then reevaluated and rated accordingly. If the condition is active and causes <a name="c"></a>symptoms such as pain or hemorrhaging, or if it is 5 centimeters or larger in diameter, then it is rated 100%. If the condition is serious enough that you cannot perform moderately strenuous activities (lifting weights or running), then it is rated 60%. If the condition does not qualify for these ratings, then it is rated based on the existing symptoms in the affected organ (e.g. if it caused erratic heart beats, then it would be rated as arrhythmia).<b><o:p></o:p></b></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB" style="font-family: "Times New Roman", serif;">-Final-</span></i><span lang="EN-GB" style="font-family: "Times New Roman", serif;"> </span><b><span style="font-family: "Times New Roman", serif;">Code 7110: Aneurysms in the thoracic, abdominal, or ascending aortic artery </span></b><span style="font-family: "Times New Roman", serif;">are rated under this code. Aneurysms occur when the aorta significantly expands with the potential of bursting. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;">It is rated 100% if it meets one or more of the following:<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-indent: 0.25in;"><span style="font-family: "Times New Roman", serif;">1) the aneurysm is 5 cm or larger<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-indent: 0.25in;"><span style="font-family: "Times New Roman", serif;">2) the aneurysm causes symptoms (like the inability to perform moderately strenuous activities for fear of rupture) <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in; text-indent: 0.25in;"><span style="font-family: "Times New Roman", serif;">3) a physician recommends surgery<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;">If it does not meet any of these requirements, it is rated 0%. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;">In the case of a physician recommending surgery, the 100% rating starts from the date of the physician’s recommendation and will be re-evaluated 6 months after discharge from the hospital post-surgery. After that, any remaining heart symptoms are rated on the </span>General Rating Formula<span style="font-family: "Times New Roman", serif;">. All other symptoms can be rated separately on the body system affected. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA is eliminating the 60% rating, stating that any condition causing symptoms is serious enough to need surgery to avoid a medical emergency and so should be rated 100%. The addition of the 0% rating allows conditions without symptoms to be increased more quickly if they worsen and require surgery quickly. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">_________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#c" target="_blank">7111</a>: </span></b><span style="font-size: 10pt;">If an<b> aneurysm in any large artery </b>(except the aortic artery) is surgically corrected, then it is rated 100% from the date of admission to the hospital. This rating continues for the first 6 months after discharge from the hospital. The condition is then reevaluated and rated accordingly. A 100% rating is given if there is pain in the limbs (claudication) <u>and</u> tears in the skin of the limbs from lack of oxygen <u>or</u> if there is pain in the limbs <u>and</u> the ankle brachial index is 0.4 or less.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 60% rating is given if you cannot walk further than 25 yards without limping because of pain <u>and</u> one or more of the following: there is coldness in the limb that does not respond to warming methods, there are one or more tears in the skin of the limb, or the ankle brachial index is 0.5 or less.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 40% rating is given if you have limping because of pain when walking between 25 and 100 yards <u>and</u> one or more of the following: there are 1.) changes to the hair, skin, or nails of the affected limb, or 2.) the ankle brachial index is 0.7 or less.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 20% rating is given if you have limping because of pain when walking more than 100 yards and one or more of the following: the pulse in the limb is diminished, or the ankle brachial index is 0.9 or less.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">Note: These ratings are for a single limb only. If more than one limb has an aneurysm, then rate each separately.</span></i><span style="font-size: 10pt;"><o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i><span lang="EN-GB" style="font-family: "Times New Roman", serif;">-Final-</span></i><span lang="EN-GB" style="font-family: "Times New Roman", serif;"> </span><b><span style="font-family: "Times New Roman", serif;">Code 7111: </span></b><span style="font-family: "Times New Roman", serif;">If an<b> aneurysm in any large artery </b>(except the aortic artery, code 7110) causes symptoms (like the inability to perform moderately strenuous activities for fear of rupture), it is rated 100%. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;">If a physician recommends surgery, it is rated 100% from the date of the physician’s recommendation until 6 months after discharge following the surgery. After that, it is re-evaluated and rated under code <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#f" target="_blank">7114</a>. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">These changes clarify how the 100% rating should be applied. By eliminating the remaining rating options and instructing for further ratings to be done under code 7114, the VA is hoping to simplify the process. Code 7114, for peripheral artery disease, causes similar symptoms as post-surgical aneurysms. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#d" target="_blank">7112</a> for small artery aneurysms remains the same.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">__________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#e" target="_blank">7113</a></span></b><span style="font-size: 10pt;">: A <b>traumatic arteriovenous fistula</b> is an abnormal passageway between an artery and a vein. They are most often caused by penetrating wounds that affected nearby arteries or veins, thus causing the body to create a false passageway to continue blood flow. They can cause the heart to have to work harder to provide the necessary blood to all regions of the body, thus leading to various heart conditions. It can also cause loss of blood flow to the limbs resulting in pain, infection, swelling, skin changes, or amputation.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">If the condition causes heart failure, then it is rated 100%. If the heart has not failed, but is enlarged with a rapid pulse and a wide pulse pressure, then it is rated 60%. If the heart is not affected, but in an arm there is swelling, stasis dermatitis, <u>and</u> either tears in the skin or a cellulitis infection, then it is rated 40%. If a leg has swelling, stasis dermatitis, <u>and</u> either tears in the skin or a cellulitis infection, it is rated 50%. If there is only swelling <u>or</u> stasis dermatitis in a leg, then it is rated 30%. If the swelling <u>or</u> stasis dermatitis is in an arm, it is rated 20%.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Final-</i><b> Code 7113: </b>A <b>traumatic arteriovenous fistula</b> is an abnormal passageway between an artery and a vein. They are most often caused by penetrating wounds that affected nearby arteries or veins, thus causing the body to create a false passageway to continue blood flow. They can cause the heart to have to work harder to provide the necessary blood to all regions of the body, thus leading to various heart conditions. It can also cause loss of blood flow to the limbs resulting in pain, infection, swelling, skin changes, or amputation.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">If the condition causes heart failure, then it is rated 100%. If the heart has not failed, but is enlarged with a rapid pulse and a wide pulse pressure, then it is rated 60%. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">If the heart is not affected, but there is constant swelling, stasis dermatitis, <u>and</u> either tears in the skin or a cellulitis infection in a leg, then it is rated 50%. If the same symptoms are in an arm, it is rated 40%. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">If there is only constant swelling <u>or</u> stasis dermatitis in a leg, then it is rated 30%. If the same symptoms are in an arm, it is rated 20%.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The only real change to this code is to specify that the swelling must be chronic, or constant. </span><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#f" target="_blank">7114</a>: Arteriosclerosis obliterans </span></b><span style="font-size: 10pt;">(a.k.a. <b>peripheral vascular disease</b>) is the thickening and hardening of the tissues of a vessel that causes the vessel to narrow and develop blood clots. This condition most often affects the aortic artery in the abdomen and the small or medium vessels in the legs.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 100% rating is given if there is pain in the limbs <u>and</u> tears in the skin of the limbs from lack of oxygen <u>or</u> if there is pain in the limbs <u>and</u> the ankle brachial index is 0.4 or less.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 60% rating is given if you cannot walk further than 25 yards without limping because of leg pain (claudication) <u>and</u> one or more of the following: there is coldness in the limb that does not respond to warming methods, there are one or more tears in the skin of the limb, or the ankle brachial index is 0.5 or less.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 40% rating is given if there is limping because of leg pain when walking between 25 and 100 yards <u>and</u> one or more of the following: there are 1.) changes to the hair, skin, or nails of the affected limb, or 2.) the ankle brachial index is 0.7 or less.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 20% rating is given if there is limping because of leg pain when walking more than 100 yards and one or more of the following: the pulse in the limb is diminished, or the ankle brachial index is 0.9 or less.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">Note: The above ratings are for a single limb only. If more than one limb is affected, then rate each separately.</span></i><span style="font-size: 10pt;"><o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><i> </i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Final-</i><b> Code 7114: Peripheral arterial disease</b> is the thickening and hardening of the tissues of a vessel that causes the vessel to narrow and develop blood clots. This condition most often affects the aortic artery in the abdomen and the small or medium vessels in the legs. All symptoms remaining after an <b>aortic bypass surgery</b> or a <b>large arterial bypass surgery</b> are rated under this code.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">For a 100% rating, there must be at least one of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->ankle pressure less than 50mm Hg<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->toe pressure less than 30mm Hg<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->transcutaneous oxygen tension less than 30 mm Hg<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->ankle brachial index 0.39 or less<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">For a 60% rating, there must be at least one of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->ankle pressure 50–65 mm Hg<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->toe pressure 30–39 mm Hg<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->transcutaneous oxygen tension 30–39 mm Hg<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->ankle brachial index is 0.40–0.53<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.75in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">For a 40% rating, there must be at least one of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->ankle pressure 66–83 mm Hg<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->toe pressure 40–49 mm Hg<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->transcutaneous oxygen tension 40–49 mm Hg<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->ankle brachial index is 0.54–0.66<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="font-size: medium; margin-left: 1in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">For a 20% rating, there must be at least one of the following: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->ankle pressure 84–99 mm Hg<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->toe pressure 50–59 mm Hg<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->transcutaneous oxygen tension 50–59 mm Hg<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 1in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->ankle brachial index is 0.67–0.79<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">Whichever test result allows for the higher rating is the test that should be used for rating purposes. Not all tests must be performed in order to rate the condition. Additional tests are only required if the Ankle Brachial Index does not properly reflect the severity of the condition.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>Note: The above ratings are for a single limb only. If more than one limb is affected, then rate each separately.</i><o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA is updating the name of this condition to the one more commonly used today. They also are expanding the rating options to include more wide-spread measurements that better reflect the overall disability of a condition. The <a>ankle pressure </a></span><span lang="EN-GB">is the systolic blood pressure measured at the ankle. The toe pressure is the systolic blood pressure measured in the big toe. The transcutaneous oxygen tension is a test that measures the amount of oxygen in the blood at the intercostal space on the foot.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA also makes it clear that symptoms remaining after large artery bypass surgery should be rated under this code. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">_______________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#f" target="_blank">7115</a>: Thrombo-angiitis obliterans </span></b><span style="font-size: 10pt;">(or<b> “Buerger’s Disease”</b>) is a disease where the blood vessels of the hands or feet become blocked due to the build up of plaque. It is mostly associated with the use of tobacco products. It causes pain and swelling in the hands and feet and could result in necessary amputation.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><b><span style="font-size: 10pt;"> </span></b></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 100% rating is given if there is pain in the limbs <u>and</u> tears in the skin of the limbs from lack of oxygen <u>or</u> if there is pain in the limbs <u>and</u> the ankle brachial index is 0.4 or less.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 60% rating is given if you cannot walk further than 25 yards without limping because of leg pain (claudication) <u>and</u> one or more of the following: there is coldness in the limb that does not respond to warming methods, there are one or more tears in the skin of the limb, or the ankle brachial index is 0.5 or less.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 40% rating is given if there is limping because of leg pain when walking between 25 and 100 yards <u>and</u> one or more of the following: there are 1.) changes to the hair, skin, or nails of the affected limb, or 2.) the ankle brachial index is 0.7 or less.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 20% rating is given if there is limping because of leg pain when walking more than 100 yards and one or more of the following: the pulse in the limb is diminished, or the ankle brachial index is 0.9 or less.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">Note: The above ratings are for a single limb only. If more than one limb is affected, then rate each separately.</span></i><span style="font-size: 10pt;"><o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><b><span style="font-size: 10pt;"> </span></b></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Final-</i><b> Code 7115: Thrombo-angiitis obliterans </b>(or<b> “Buerger’s Disease”</b>) is a disease where the blood vessels of the hands or feet become blocked due to the build-up of plaque. It is mostly associated with the use of tobacco products. It causes pain and swelling in the hands and feet and could result in necessary amputation.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">If the condition affects the legs, it is rated under code 7114. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">If the condition affects the arms, it is rated under the following system:<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 100% rating is given if there are tears in the skin, death of the tissues from lack of oxygen, continual coldness in the limb, trophic changes, pain with use, and a weak pulse in the arm. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 60% rating is given if there is continual coldness in the limb, trophic changes, pain with use, and a weak pulse in the arm.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 40% rating is given if there are trophic changes, numbness in the fingertips, and a weak pulse in the arm.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 20% rating is given if there is a weak pulse in the arm.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><a><i>Trophic changes </i></a><i>include thinning of the skin, skin atrophy, hair loss, tears in the skin, fingernail deformities, etc. <o:p></o:p></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i> </i></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>Note: The above ratings are for a single arm only. If more than one arm is affected, then rate each separately.<o:p></o:p></i></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The VA is changing this code to better reflect the unique affect it has on the arms. The legs would still be rated under the same rating system as code 7114, but the arms will now have have their own rating system. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">______________________________________________________<o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span lang="EN-GB"> </span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#g" target="_blank">7117</a> for Raynaud’s Syndrome (a.k.a. “Raynaud’s phenomenon” or “secondary Raynaud’s”) remains exactly the same except to specify that only Raynaud’s syndrome can be rated under this code. Raynaud’s <u>disease</u> would be rated under the new code 7124, below.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">_______________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Codes <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#i" target="_blank">7118</a> for angioneurotic edema, <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#h" target="_blank">7119</a> for erythromelalgia,<span style="background-color: white;"> <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#j" target="_blank">7120</a> </span>for varicose veins, and <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#j" target="_blank">7121</a> for post-phlebitic syndrome remain the same.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">________________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;"> </span></i></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#k" target="_blank">7122</a>: Frostbite and other conditions caused by overexposure to the cold </span></b><span style="font-size: 10pt;">can cause permanent damage to the arteries, nerves, and veins and are rated on the persistent symptoms of the condition.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 30% rating is given if there is joint pain, numbness <u>or</u> sensitivity to the cold in the area affected <u>and</u> two or more of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, or other abnormalities proven by x-ray.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 20% rating is given if there is joint pain, numbness <u>or</u> sensitivity to the cold in the area affected <u>and</u> one of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, or other abnormalities proven by x-ray.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">A 10% rating is given if there is only pain, numbness <u>or</u> sensitivity to the cold in the affected area.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">These ratings are for individual parts affected. So if a foot and a hand are both affected, then they each receive a separate rating. This does not include individual toes or fingers—if one or more fingers or toes are affected, then it is just rated once on the hand or foot.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><span style="font-size: 10pt;">Any other conditions resulting from overexposure to the cold not listed under this code are to be rated separately, including amputations, carcinomas and neuropathies.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 1in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Final-</i><b> Code 7122: Frostbite and other conditions caused by overexposure to the cold </b>can cause permanent damage to the arteries, nerves, and veins and are rated on the persistent symptoms of the condition.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 30% rating is given if there is joint pain, numbness <u>or</u> sensitivity to the cold in the area affected <u>and</u> two or more of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, inability to sweat, muscle atrophy, fibrosis, deformation of the toe or finger joints, loss of the pads in the toes or fingers, bone tissue death (necrosis), constant tears in the skin, carpal tunnel, tarsal tunnel, or other abnormalities proven by x-ray.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 20% rating is given if there is joint pain, numbness <u>or</u> sensitivity to the cold in the area affected <u>and</u> one of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, inability to sweat, muscle atrophy, fibrosis, deformation of the toe or finger joints, loss of the pads in the toes or fingers, bone tissue death (necrosis), constant tears in the skin, carpal tunnel, tarsal tunnel, or other abnormalities proven by x-ray.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 10% rating is given if there is only pain, numbness <u>or</u> sensitivity to the cold in the affected area.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">These ratings are for individual parts affected. So if a foot and a hand are both affected, then they each receive a separate rating. This does not include individual toes or fingers—if one or more fingers or toes are affected, then the entire hand or foot is just rated once.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">Any other conditions resulting from overexposure to the cold not listed under this code are to be rated separately, including amputations, carcinomas, and neuropathies.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">The only change to this code is to expand the list of symptoms that cold exposure can cause. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">_______________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Code <a href="https://militarydisabilitymadeeasy.com/arteryandveinratings.html#l" target="_blank">7123</a> for soft tissue sarcoma will remain the same.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">_______________________________________________________<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB"><br /></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><i>-Final NEW CODE-</i><b> Code 7124: Raynaud’s Disease </b>(a.k.a. “<b>primary Raynaud’s</b>”)<b> </b>is a condition that causes the blood vessels in the fingers and toes, and sometimes the nose and ears, to narrow and restrict blood flow when the person is stressed, emotionally upset, or cold.<o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">Only one rating can be given under this code, regardless of the number of body parts affected. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;">“Characteristic attacks” describes a period of time, at least a few minutes long, in which the color of the fingers or toes change in at least one limb, occasionally with pain and numbness.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><span style="font-family: "Times New Roman", serif;"> </span></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><a>Trophic changes </a>include thinning of the skin, skin atrophy, hair loss, tears in the skin, fingernail deformities, etc. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium; margin-left: 0.5in;">A 10% rating is given if there are characteristic attacks <u>and</u> trophic changes. If there are characteristic attacks, but no trophic changes, it is rated 0%. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="font-size: medium;"><span lang="EN-GB">Raynaud’s disease is a less severe condition than Raynaud’s syndrome. Currently, Raynaud’s disease can only be rated under Raynaud’s syndrome, but the rating requirements under that code do not really reflect Raynaud’s disease symptoms. To fix this and avoid rating confusion, the VA is creating a new code for Raynaud’s disease.</span></p><style class="WebKit-mso-list-quirks-style">
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</style>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com0tag:blogger.com,1999:blog-4162041641030931379.post-68150740897350560462021-08-02T13:39:00.004-07:002021-08-06T07:11:06.535-07:00New Burn Pit Exposure Presumptive List<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFcrdiK8Ea2nCDiNc7QRInvdyzfuXl61PtGgPJ_y9XQEoAhAtGIuPsN_U4W-KDywrFB9kVmPCV-cNrxuJPt45cBipxpNN0w16ai7SvfoU0DfD0dBHWeuOghaHtO4pAH3ShC2q-CXLyQZY/s269/Burn+Pits.jpeg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="269" data-original-width="268" height="269" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFcrdiK8Ea2nCDiNc7QRInvdyzfuXl61PtGgPJ_y9XQEoAhAtGIuPsN_U4W-KDywrFB9kVmPCV-cNrxuJPt45cBipxpNN0w16ai7SvfoU0DfD0dBHWeuOghaHtO4pAH3ShC2q-CXLyQZY/s0/Burn+Pits.jpeg" width="268" /></a></div>As of August 5, 2021, the VA has created the <a href="https://militarydisabilitymadeeasy.com/vapresumptivelist.html#burnpit" target="_blank">Burn Pit Presumptive List </a>with 3 presumptive conditions for veterans exposed to particulate matter from burn pits and other sources. <div><br /></div><div>In addition to burn pits, other sources of particulate matter include:</div><div><ul style="text-align: left;"><li>sand/dust</li><li>general air pollution</li><li>exhaust/mechanical fumes</li><li>Oil well fire smoke</li></ul><p></p><p>The three presumptive conditions are asthma, rhinitis, and sinusitis. </p><p>To qualify, a veteran must have served in Southwest Asia on or after August 2, 1990 or in Afghanistan, Syria, Uzbekistan, or Djibouti on or after September 19, 2001 and later developed one of these conditions within 10 years of their date of discharge. </p><p>The final rule was officially published in the federal register on August 5th, however, according to the VA's <a href="https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5699" target="_blank">official press release</a>, they will begin applying the new rules to claims starting August 2nd. </p><p>If you have a claim currently pending for these conditions, the new rules will be automatically applied, and nothing further is needed. </p><p>If you have not yet submitted a claim for these conditions, then you can get these benefits by submitting a new <a href="https://militarydisabilitymadeeasy.com/va-disability-claim.html" target="_blank">VA Disability Claim.</a></p><p>If you have claimed these conditions before, but they were denied, then you can reapply by submitting VA <a href="https://militarydisabilitymadeeasy.com/wp-content/uploads/2021/05/VBA-20-0995-ARE.pdf" target="_blank">Form 20-0995</a>, a supplemental claim. </p><p>Along with your claim, make sure to include full evidence of your service in these locations during these dates, along with evidence that your condition developed within 10 years of your discharge date.</p></div>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com5tag:blogger.com,1999:blog-4162041641030931379.post-1424067620404521502021-07-06T09:36:00.002-07:002021-07-06T09:36:36.397-07:00What Evidence is Most Important? -- The Hierarchy of Evidence for Supporting Your Ratings<p><span style="font-family: Calibri, sans-serif;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAivb96D_nPASekDw1e-cybt1nvKCcKLwo5ET9SjVwTL3mU5r3eItNKcqnHjAUSbmF9vvuIFEcZDskZiGRnd76E0Z5VCPcvQp2MwxbPsA-V3WuQbLCDsUYaYF43dDw6wvaVAo5GniuZsU/s2048/evidence.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1365" data-original-width="2048" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAivb96D_nPASekDw1e-cybt1nvKCcKLwo5ET9SjVwTL3mU5r3eItNKcqnHjAUSbmF9vvuIFEcZDskZiGRnd76E0Z5VCPcvQp2MwxbPsA-V3WuQbLCDsUYaYF43dDw6wvaVAo5GniuZsU/s320/evidence.jpg" width="320" /></a></div><br />While it is the VA’s job to decide the ratings for your conditions, it is YOUR job to provide the evidence necessary to support the correct ratings.<span style="font-family: Calibri, sans-serif;"> </span><p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Evidence is essential to your military disability. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p align="center" class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><b>No evidence = no benefits. No question.<o:p></o:p></b></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">But not all evidence is created equal. The VA will give more “probative value” to some evidence over others. The basic idea is that if the evidence comes from a more official source or from someone with more authority to speak on the topic, then that evidence is more likely to be true and accurate. Thus, evidence from a neurosurgeon will have more probative value than from a chiropractor, an official exposure document will have more probative value than a <a href="https://blog.militarydisabilitymadeeasy.com/2019/06/the-4-parts-of-buddy-letter.html" target="_blank">Buddy Letter</a>, etc. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">So when it comes to supporting your ratings, what evidence is the best evidence? <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Here’s a list of evidence ranked from the most important to the least important for supporting your ratings.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">As you go down this list, if your ratings are firmly established with the evidence you have from #1 through #4 (the essentials), you don’t really need to proceed further. If it isn’t, though, or it could be stronger, then add something from the next number, then the next, etc., until your evidence for your ratings is as solid as you can make it.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Before compiling your evidence, make sure you <a href="https://militarydisabilitymadeeasy.com/search.html" target="_blank">find your condition</a> on our site so you know what evidence is necessary to properly rate your condition.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;">1. <b>Official diagnostic medical records</b>. </p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><br /></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">For each and every condition on your claim, there needs to be a clear diagnosis. No diagnosis means that there isn’t a condition to rate. If you claim ischemic heart disease, but only heart murmurs are officially diagnosed, your claim will be denied. So the first thing your evidence must do is show proof that the condition exists and has been diagnosed officially.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;">2. <b>Current medical evidence from specialists</b>. </p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><br /></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">The VA rates all conditions on their severity at the time you submit the claim, so there must be sufficient current legitimate medical evidence that supports your rating. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Evidence from specialists will always have the highest probative value, so it’s important before submitting your claim to ensure that you have current evidence from a specialist for your condition (cardiologist for heart disease, psychologist for mental disorders, etc.). <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">If this means making a new appointment to have your conditions re-examined, do it. The specialist can be a civilian physician or a VA physician. It doesn’t matter. However, the VA’s C&P Exam does NOT count as evidence under this section (see number 3 below), so do not think that a C&P exam is all you need here. It’s not.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">The VA has <a href="https://militarydisabilitymadeeasy.com/dbq.html" target="_blank">DBQs </a>that you can have your specialist fill out to help support your claim. DBQs are helpful but not essential. As long as you know what evidence (measurements, tests, etc.) is needed to rate your condition, you can have your specialist simply record that information in your medical records. A DBQ is not needed as long as the correct information needed to rate your conditions is recorded. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><i>A Quick Note: Not all conditions need to be treated by a specialist, so if your general practitioner (GP) has been the one to manage your condition, then your GP is considered the one with the most knowledge of your condition, and so qualifies as the best one to give evidence here.<o:p></o:p></i></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;">3. <b>C&P Exam(s)</b>. </p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><br /></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">After you submit your claim, the VA will schedule you to see one of their VA physicians for a <a href="https://militarydisabilitymadeeasy.com/c-and-p-exam.html" target="_blank">C&P Exam</a>. You may only have a single C&P Exam by a general practitioner, or you could have multiple with various specialists. The VA will decide based on the amount of evidence you have and the complexity of your conditions.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">At the C&P Exam, the VA physician will review your conditions and perform tests. It is essential that<i> you</i> make sure all the correct tests are performed and necessary evidence recorded to rate your conditions during this exam. Do not assume the VA physician knows what information is needed to rate your conditions. The majority of the time, they don’t. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Also do not suppose that the information gathered during the C&P exam will be enough so you don’t have to get this information from specialists in #2 above. WRONG. The evidence from #2 is vital, and here’s why:<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">The VA will put a lot of probative value on the C&P exam since its entire purpose is to evaluate conditions for VA Disability. However, in order to ensure that you get the correct rating, it is more important for you to focus on outside evidence from specialists for two reasons. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">First, if the evidence gathered during the C&P exam agrees with the evidence from your specialists, your case will be solid. Second, if the C&P exam evidence doesn’t agree, you’ll have submitted strong evidence to throw doubt on the C&P exam. If there is enough of this strong evidence, the VA could still decide in your favor, despite the C&P exam.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">So even though the VA does give significant weight to the C&P exam and it is important for you to make sure the correct info is recorded then, your outside medical evidence is even more important. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;">4. <b>All other recent medical evidence.</b> </p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><br /></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Since the VA rates conditions on their current severity, all of the medical evidence you have regarding your condition from the past 12 months is very important. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Many ratings look closely at the 12 months prior to submitting your claim, so don’t just submit the most current records from your specialist. Submit everything from lab tests, radiology, physical therapy, etc. Everything from the past 12 months that has anything to do with your condition can be valuable to your rating. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">For example, migraine headaches are rated on how often they occur and their severity. On average, one prostrating migraine each month rates 30%, so in order to properly assign a 30% rating, the VA will need to see evidence of migraines occurring at least once each month on average for the past 12 months. </p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><i>A note as we move on: We are now getting into things that don’t apply to every condition, so if your evidence is already solid by this point, you may not need to add anything further from this list. Regardless, additional supporting evidence never hurt a claim...<o:p></o:p></i></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;">5. <b>Medical evidence connecting the current condition to the original diagnosis.</b><o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">As we discussed in our previous blog, <a href="https://blog.militarydisabilitymadeeasy.com/2021/06/whats-most-important-hierarchy-of.html" target="_blank">The Hierarchy of Evidence for Proving Service-Connection</a>, if your condition was diagnosed a while back, then it is vital to be able to show proof that your current condition is the same as the original condition for <a href="https://militarydisabilitymadeeasy.com/service-connection.html" target="_blank">service-connection</a> purposes. However, this evidence can also be valuable for rating purposes as it shows the development of the condition over time. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Since the VA only rates conditions on their current severity, this evidence won’t affect the ratings for the majority of conditions. But some ratings, especially for conditions like mental disorders, look at the entire condition and how it affects all aspects of your life over time, so this history can add helpful evidence in these cases.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><div style="text-align: center;">6. <b>Commander/Employer letters</b>. </div><div style="text-align: center;"><br /></div><p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Some ratings, like the ratings for <a href="https://militarydisabilitymadeeasy.com/mentaldisorders.html" target="_blank">mental disorders</a>, look at how the condition affects your ability to do your job. For these ratings, it can be very helpful to get a letter from your boss that addresses how your condition affects your work performance.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;">7. <b>Buddy/Family letters</b>. </p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><br /></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Like Commander/Employer letters, letters from friends and family that testify to how your condition affects your daily life can strengthen your claim for conditions, like mental disorders, that look at your daily functioning when determining a rating.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;">8. <b>Personal Statements</b>. </p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: center;"><br /></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">You are always welcome to write a personal statement, but this is always lowest in the hierarchy of evidence simply because if there is no other evidence to support the things stated in your personal statement, it will be ignored. There must be outside evidence to corroborate your statement in order for it to have any value.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Because of this, personal statements are not needed in the majority of claims. They really are only helpful in providing one more point of support, and so come in handy for conditions, like mental disorders, that are rated based on things that cannot be tested and officially proven. The idea is that if you, your boss, and your wife all testify of a symptom that affects your daily life, then it is more likely to be true than if it is only mentioned in one place.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p><br /></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p>As you compile your evidence, remember to focus on gathering evidence with the highest probative value, and your claim will be solid.</o:p></p>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com2tag:blogger.com,1999:blog-4162041641030931379.post-68671388653436227202021-06-08T08:22:00.009-07:002021-08-11T10:14:34.773-07:00What Evidence is Most Important? -- The Hierarchy of Evidence for Proving Service-Connection<p><span face="Calibri, sans-serif"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfmqyJJl5fmkT7s-ZnDkLxD_PDu9UXj_mZjwXw6WKrMf9BVgbn1atz8EJvAAt8kj2U-uLfN6Sb_tSFwC2ySn54pppBBu4ZK49VhHJe0OpUWcEInYkeeWIkublcAWyWDj1j9RzO48xWH1s/s450/649-08118192en_Masterfile.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="299" data-original-width="450" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfmqyJJl5fmkT7s-ZnDkLxD_PDu9UXj_mZjwXw6WKrMf9BVgbn1atz8EJvAAt8kj2U-uLfN6Sb_tSFwC2ySn54pppBBu4ZK49VhHJe0OpUWcEInYkeeWIkublcAWyWDj1j9RzO48xWH1s/s320/649-08118192en_Masterfile.jpg" width="320" /></a></div><br /><span style="font-family: georgia;">In order for the VA (and DoD) to rate a condition, it MUST be <a href="https://militarydisabilitymadeeasy.com/service-connection.html" target="_blank">Service-Connected</a>. And it is ultimately your responsibility to submit the evidence necessary to prove service-connection.</span><p></p><span style="font-family: georgia;"><style class="WebKit-mso-list-quirks-style">
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</style></span><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;"><o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">Evidence is essential to your military disability. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><b><span style="font-family: georgia;">No evidence = No benefits. No question.<o:p></o:p></span></b></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">But not all evidence is created equal. The VA will give more “probative value” to some evidence over others. The basic idea is that if the evidence comes from a more official source or from someone with more authority to speak on the topic, then that evidence is more likely to be true and accurate. Thus, evidence from a neurosurgeon will have more probative value than from a chiropractor, an official exposure document will have more probative value than a Buddy Letter, etc. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">So when it comes to proving service-connection, what evidence is the best evidence? <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">Here’s a list of evidence ranked from the most important to the least important for each type of service-connection. Click on the type of service-connection to be taken to the discussion of it on our site so you can know which applies to your conditions.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">As you go down this list, if your service-connection is firmly established with evidence you have from #1 and #2, you don’t really need to proceed further. If it isn’t, though, or it could be stronger, then add something from the next number, then the next, etc., until your evidence for service-connection is as solid as you can make it.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span style="font-family: georgia;"><a href="https://militarydisabilitymadeeasy.com/service-connection.html#military" target="_blank">Conditions Diagnosed While in the Military</a><o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">1. <b>Service-Treatment Records (STRs).</b> STRs are your medical records from your time on active duty, so these alone can establish service-connection as long as there is clear record of the diagnosis and subsequent treatments (up to the current condition). <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">2. <b>Military Personnel Records</b>. As long as the diagnosis and treatments are clear in your STRs, then you only need the following personnel records: <o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]-->1.<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><b>DD214 </b>is essential in every case to establish your service dates. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]-->2.<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><b>Deployment records</b> are necessary if your condition occurred while deployed. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]-->3.<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><b>Official Exposure records</b> are necessary if your condition was caused by an officially recorded exposure.<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]-->4.<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><b>Line of Duty determinations</b> are necessary for Reservists. Reservists must be able to prove that the condition occurred in the <a href="https://militarydisabilitymadeeasy.com/service-connection.html#reservists" target="_blank">Line of Duty</a> in order to be service-connected. If an official LOD is made, then that’s all you need to prove LOD. If you don’t have an official LOD, that’s okay as long as your medical records clearly record how the condition developed in relation to your service. <b>Incident reports</b> or <b>Buddy Letters</b> from those witnessing the event can also be helpful here. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">3. <b>Veteran Medical Records.</b> If you are claiming your conditions once you are a veteran, then you need to show that your current condition is the same as the one diagnosed during service. Medical records from your date of separation up to the present (from civilian and/or VA physicians) are essential to show that the condition is not two separate conditions. So if you hurt your back in service, but it healed and there’s no evidence of any other issues for the next 20 years, then you hurt your back again, those are going to be considered two separate conditions and not related.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span style="font-family: georgia;"><a href="https://militarydisabilitymadeeasy.com/service-connection.html#aggravated" target="_blank">Conditions Aggravated by Military Service</a><o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">1. <b>Service-Treatment Records (STRs).</b> STRs are your medical records from your time on active duty, so these alone can establish service-connection as long as there is clear record of how your condition was aggravated by your military service. Your entry examination should thoroughly record the severity of the condition upon entry (if nothing is recorded, it is assumed asymptomatic) and then your STRs over time need to show the abnormal development of the condition caused by service in relation to the standard development of the condition in most cases.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><span style="font-family: georgia;">2. <b>Military Personnel Records</b>. As long as the diagnosis and treatments are clear in your STRs, then you only need the following personnel records: <o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 0.75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><b>DD214 </b>is essential in every case to establish your service dates. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><b>Deployment records</b> are necessary if your condition was aggravated by or during your deployment. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; font: 7.0pt "Times New Roman"; line-height: normal;"> </span></span></span><!--[endif]--><b>Official Exposure records</b> are necessary if your condition was aggravated by an officially recorded exposure.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;"><style class="WebKit-mso-list-quirks-style">
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</style></span></p><p class="MsoListParagraphCxSpLast" style="margin-left: 0.75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]-->4.<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><b>Line of Duty determinations</b> are necessary for Reservists. Reservists must be able to prove that the condition was aggravated in the <a href="https://militarydisabilitymadeeasy.com/service-connection.html#reservists" target="_blank">Line of Duty</a>. If an official LOD is made, then that’s all you need to prove LOD. If you don’t have an official LOD, that’s okay as long as your medical records clearly record how the condition was aggravated because of your service. <b>Incident reports</b> or <b>Buddy Letters</b> from those witnessing the event can also be helpful here. <o:p></o:p></span></p><p></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]--><o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]--><o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]--><o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo1; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]--><o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span style="font-family: georgia;"><a href="https://militarydisabilitymadeeasy.com/service-connection.html#otherconditions" target="_blank">Conditions Caused by Service-Connected Conditions (“Secondary”)</a><o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">1. <b>Service-Treatment Records (STRs)/Military Personnel Records.</b> These are listed first because they are essential in establishing service-connection for the original condition. Once the original condition is firmly service-connected, then you can move on to #2 to connect the secondary condition to it. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">2. <b>Veteran Medical Records.</b> All secondary conditions diagnosed after service need clear medical records that show the development of the condition with as much connection to the original condition as possible. If these records don’t connect it firmly to the original condition, then #3 is a MUST.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">3. <b>Nexus Letter</b>. A Nexus Letter from the physician that knows your condition the best is VITAL for most secondary conditions. This firmly connects the secondary condition to the original condition.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">4. <b>Other Medical Evidence</b>. With the Nexus and the rest of your evidence, your case should be fairly solid. But if it’s not as firm as you like, it could help to submit additional evidence that supports the relationship between your secondary and original conditions. This could be things like legitimate published research studies, medical articles, etc. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span style="font-family: georgia;"><a href="https://militarydisabilitymadeeasy.com/service-connection.html#exposure" target="_blank">Conditions Caused by Exposure</a><o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">If your exposure condition was diagnosed in service, use the first section above to prove it. This section is for exposure conditions diagnosed after service.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">1. <b>Military Personnel Records</b>. It is not easy to prove exposure unless there are official exposure records or the condition is on the <a href="https://militarydisabilitymadeeasy.com/vapresumptivelist.html" target="_blank">Presumptive List</a>. Here are the prioritized personnel records that can help establish the exposure: <o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo2; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]-->1.<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><b>Official Exposure records</b> (including <b>Incident Reports</b>) with exact locations, dates, severities, lengths, etc., are very important if you have them. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo2; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]-->2.<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><b>DD214 </b>is essential to establish your service dates. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo2; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]-->3.<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><b>Deployment records</b> are necessary if the exposure happened during your deployment. <o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo2; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]-->4.<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><b>Duty Assignments</b> can add valuable evidence if you were exposed because of the duty you were performing.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">2. <b>Service-Treatment Records (STRs).</b> Since your condition wasn’t diagnosed until after service, there won’t be much evidence of it in here. However, these can provide clues that could support the exposure itself. Maybe you were examined after the incident that caused the exposure? Maybe symptoms appeared soon after the exposure? If you have anything like this in your STRs, it could be additional evidence of the exposure even if they were not attributed to it at the time. The symptoms, of course, would have to be known common symptoms of that type of exposure. <o:p></o:p></span></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">3. <b>Veteran Medical Records.</b> It is essential to show the development and diagnosis of the condition. Any records that include information about the condition’s relation to the exposure are even better.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">4. <b>Commander or Buddy Letters</b>. If with the evidence above you have not yet created a strong enough case that the exposure did indeed occur, then Commander and/or Buddy Letters could save the day. A letter from your Commander or any of the people you served with at the time of the exposure can provide valuable testimony to the exposure. Each letter should include as much detail as possible, including dates, locations, type, length, and severity of exposure, etc. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">5. <b>Nexus Letter</b>. A Nexus Letter from the physician that knows your condition the best can provide essential testimony that they believe the condition “more likely than not” was caused by the exposure.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">6. <b>Personal Statement</b>. If there are no official records of the exposure, then you will need to write a personal statement detailing everything you can about the exposure itself, including dates, locations, type, length, severity of exposure, etc. This information will be strongest when matching the other evidence noted above. <o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p align="center" class="MsoNormal" style="font-size: medium; text-align: center;"><span style="font-family: georgia;"><a href="https://militarydisabilitymadeeasy.com/service-connection.html#presumptive" target="_blank">Conditions on the VA Presumptive List</a><o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">1. <b>Military Personnel Records</b>. For conditions on the <a href="https://militarydisabilitymadeeasy.com/vapresumptivelist.html" target="_blank">VA Presumptive List</a>, it is essential to prove the service requirements of the appropriate category. <o:p></o:p></span></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo3; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]-->1.<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><b>DD214 </b>is essential to establish your service dates and length. <o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo3; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]-->2.<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><b>Deployment records</b> and <b>Duty Assignments</b> are necessary to prove that you served in a certain place at a certain time. Make sure these records also show how long you were in that location.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo3; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]-->3.<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><b>Prisoner of War records</b> are needed if you are applying for a condition on the POW list.<o:p></o:p></span></p><p class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo3; text-indent: -0.25in;"><span style="font-family: georgia;"><!--[if !supportLists]-->4.<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]--><b>Any other personnel records </b>that support the requirements on the appropriate Presumptive List.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">2. <b>Veteran Medical Records.</b> It is essential to show the development and diagnosis of the condition. Most of the Presumptive List categories require the condition to have developed to a certain severity by a certain time, so this proof must be found in the veteran medical records in order for the conditions to qualify.<o:p></o:p></span></p><p class="MsoNormal" style="font-size: medium;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">3. <b>Commander Letters/Buddy Letters/Personal Statements/Service Treatment Records</b>. These are really only useful for the Mustard Gas or Lewisite Presumptive List since there are few official records of exposure that were kept at this time. Because of this, as much evidence surrounding the exposure as possible, the stronger your claim will be. A personal testimony also providing as many details as possible will be essential. Testimonies from your commander or others present that corroborate the personal statement are valuable evidence of exposure. Service treatment records detailing anything from the exposure event or the immediate effects of the exposure can also help. The more you can provide, the better.</span></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;"><br /></span></p><p class="MsoNormal" style="font-size: medium;"><span style="font-family: georgia;">That's all the evidence needed for each type of Service-Connection. Remember that the evidence with the highest probative value will hold the most weight and influence, but it's always better to be safe than sorry, so including as much other evidence as possible as well definitely won't hurt.</span></p>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com0tag:blogger.com,1999:blog-4162041641030931379.post-28760378482376299422021-03-03T08:42:00.036-08:002021-05-17T10:26:21.784-07:00Understanding the Slight to Severe Scale for Rating Muscles<p><span face="Calibri, sans-serif"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9bndx4G6jZyzRyL3A24Tr7W6GW1DM_eK4LY68VgVLMu3Y_8wuJ3aYirmwgU7KKPpokELGa5d1Z_ToAdYsn_kPIO86D2fTHwqE5zLQEIAVlMgDnOXPB2SHRvz5SzzaFAtqZNakuKmKx6I/s2048/slight+to+severe+scale+for+rating+muscle+injuries.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1067" data-original-width="2048" height="209" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9bndx4G6jZyzRyL3A24Tr7W6GW1DM_eK4LY68VgVLMu3Y_8wuJ3aYirmwgU7KKPpokELGa5d1Z_ToAdYsn_kPIO86D2fTHwqE5zLQEIAVlMgDnOXPB2SHRvz5SzzaFAtqZNakuKmKx6I/w400-h209/slight+to+severe+scale+for+rating+muscle+injuries.jpg" width="400" /></a></div><p style="text-align: left;"><span style="font-family: times;">The majority of muscle conditions are rated on either limited motion or the <a href="https://militarydisabilitymadeeasy.com/musculoskeletalprinciples.html#eval" target="_blank">Slight to Severe Scale</a>, whichever gives the higher rating.<span face="Calibri, sans-serif"> </span><span face="Calibri, sans-serif"> </span></span></p><p style="text-align: left;"></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt; text-align: left;"><span style="font-family: times;">The Slight to Severe Scale offers four different levels (Slight, Moderate, Moderately Severe, and Severe) that are associated with different ratings for each muscle group, depending on the functional impact of the damage to that muscle group.</span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt; text-align: left;"><span style="font-family: times;"><br /></span></p><span style="font-family: times;"><style class="WebKit-mso-list-quirks-style">
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</style></span><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">For example, <a href="https://militarydisabilitymadeeasy.com/shoulderandarmmuscleratings.html#iii" target="_blank">Group III</a> for the muscles that control raising the arm out to the side is rated 40% for the dominant hand’s Severe level, while <a href="https://militarydisabilitymadeeasy.com/shoulderandarmmuscleratings.html#iv" target="_blank">Group IV</a> for the muscles that control the rotation of the arm is rated 30% for the dominant hand’s Severe level. Basically, the inability to raise the arm out to the side is considered a more serious disability than being unable to rotate the arm and so is given higher ratings for the Slight to Severe Scale levels.</span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"> </span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">But how does the Slight to Severe Scale work? Let’s start by talking about the Cardinal Signs and Symptoms.</span></p><p class="MsoNormal" style="text-align: center;"><span style="font-family: times;"><o:p><span> </span></o:p><b style="text-align: center;">The Cardinal Signs and Symptoms</b></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">One of the criterion looked at when determining the Slight to Severe Scale level is the Cardinal Signs and Symptoms. </span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">The Cardinal Signs and Symptoms include:</span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"></p><ul style="text-align: left;"><li><span style="font-family: times;"><b style="text-indent: -0.25in;">Loss of power</b><span style="text-indent: -0.25in;">. This is the inability to actively use the muscle in a proactive task, like pushing or lifting in the shortest amount of time possible.</span></span></li><li><span style="font-family: times;"><b style="text-indent: -0.25in;">Weakness</b><span style="text-indent: -0.25in;">. This is different than the loss of power in that weakness isn’t just active, but passive. There is an overall lack of strength in the muscles. </span></span></li><li><span style="font-family: times;"><b style="text-indent: -0.25in;">Easily fatigued</b><span style="text-indent: -0.25in;">. The muscle has no endurance, but gets tired much faster than it should. </span></span></li><li><span style="font-family: times;"><b style="text-indent: 0.5in;">Pain with fatigue</b><span style="text-indent: 0.5in;">. The muscle hurts when it gets tired. </span></span></li><li><span style="font-family: times;"><b style="text-indent: -0.25in;">Lack of coordination</b><span style="text-indent: -0.25in;">. This means that the muscle isn’t able to perform movements with as much precision of time, effort, and direction as it should. </span></span></li><li><span style="font-family: times;"><b style="text-indent: -0.25in;">Decreased movement control</b><span style="text-indent: -0.25in;">. This is similar to lack of coordination, but is more about the communication between the brain and the muscle. The nervous system is telling the muscle to move (either directly or as a reflex), but the muscle is unable to follow the instructions like it should.</span></span></li></ul><p></p><p align="center" class="MsoNormal" style="text-align: center;"><span style="font-family: times;"><b><br /></b></span></p><p align="center" class="MsoNormal" style="text-align: center;"><span style="font-family: times;"><b>The Criteria</b></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">Each level on the Slight to Severe Scale has a variety of criteria that cover things like the type of wound, the Cardinal Signs and Symptoms, scarring, limitation of function, the ability to work, etc. </span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">Since muscles can be damaged in many different ways and result in many different symptoms and limitations, it’s important to remember that the criteria used for each level are meant to give an overall idea of the functional disability for that level.</span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">A condition does <b>not</b> have to match each of the criterion perfectly, but generally reflect the same overall disability. <o:p></o:p></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">For example, each level has a criterion that defines the type of external wound that would qualify for that level, but many muscle conditions are not caused by external forces and so won’t have an external wound at all. In those cases, this criterion simply does not apply. </span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">When assigning a level, the VA will focus only on the criteria that applies to the type of injury and the symptoms present. </span></p><p align="center" class="MsoNormal" style="text-align: center;"><span style="font-family: times;"><b><br /></b></span></p><p align="center" class="MsoNormal" style="text-align: center;"><span style="font-family: times;"><b>The Slight to Severe Scale Levels</b></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">We aren’t going to go criterion by criterion through each level, since you can find the entire <a href="https://militarydisabilitymadeeasy.com/musculoskeletalprinciples.html#eval" target="_blank">Slight to Severe Scale</a> on our site, but let’s discuss how to choose the right level. </span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">There are four levels:</span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"></p><p style="text-align: left;"></p><ul style="text-align: left;"><li><span style="font-family: times;"><b style="text-indent: -0.25in;">Slight</b><span style="text-indent: -0.25in;">. This disability will have little to no functional limitations.</span></span></li></ul><ul style="text-align: left;"><li><span style="font-family: times;"><b style="text-indent: -0.25in;">Moderate</b><span style="text-indent: -0.25in;">. This disability will have symptoms and some limitations. </span></span></li></ul><ul style="text-align: left;"><li><span style="font-family: times;"><b style="text-indent: -0.25in;">Moderately Severe</b><span style="text-indent: -0.25in;">. This disability will have significant limitations and the constant presence of serious symptoms. </span></span></li></ul><ul style="text-align: left;"><li><span style="font-family: times;"><b style="text-indent: -0.25in;">Severe</b><span style="text-indent: -0.25in;">. This disability will have constant severe limitations and symptoms. Basically, these muscles no longer function in any helpful or meaningful way. </span></span></li></ul><p></p><p></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">In order to choose the right level, the symptoms and circumstances of the muscle damage needs to be compared to the criteria for each level. </span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">Remember, ignore the criteria that does not apply. Instead, focus on the described severity of the criteria that does apply. </span><span style="font-family: times;"> </span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">Start at the Severe level. If any of the applicable criteria does not match the level described here, then move down to Moderately Severe, etc., until you find the level that best covers the overall severity of the condition. </span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">Once the Slight to Severe Scale level is identified, the rating associated with that level for the muscle group is assigned. </span></p><p align="center" class="MsoNormal" style="text-align: center;"><span style="font-family: times;"><b><br /></b></span></p><p align="center" class="MsoNormal" style="text-align: center;"><span style="font-family: times;"><b>Special Circumstances</b></span><span style="font-family: times;"> </span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">There are a couple rules that cover two special circumstances. </span><span style="font-family: times;"> </span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">The first states that any muscle damage that is the result of an open comminuted fracture (in the initial injury, the bone is crushed or splintered and there is an open wound above it) will be rated at the Severe level. </span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;">The only time this rule doesn’t apply is when the open comminuted fracture is in a purely boney spot, like the wrist, where there isn’t much muscle. No muscle damage, no muscle rating. But as long as a muscle is clearly involved, then the damage to it will always be considered Severe. </span></p><p class="MsoNormal" style="text-align: left;"><span style="font-family: times;"><o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt; text-align: left;"><span style="font-family: times;"><span><br /></span></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt; text-align: left;"><span style="font-family: times;"><span>The second states that a through-and-through muscle injury (in the initial injury, a bullet or projectile went in one side and straight out the other) will be rated no less than Moderate, but can be rated more if the symptoms qualify.</span><span> </span> <o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt; text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt; text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt; text-align: center;"><b><span style="font-family: times;">Want more? </span></b></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt; text-align: center;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt; text-align: left;"><span style="font-family: times;"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt; text-align: left;"><span style="font-family: times;">Become an <a href="https://militarydisabilitymadeeasy.com/get-all-access-membership.html" target="_blank">All-Access Member</a> and get free access to instructional videos that delve deep into topics like rating muscle disabilities, the VA Presumptive List, the Top 10 Things to Do to Maximize your Disability, and more!</span></p>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com0tag:blogger.com,1999:blog-4162041641030931379.post-19256545930233591512020-11-28T12:23:00.008-08:002021-02-04T07:53:27.574-08:00Changes coming February 2021 to the Ratings of the Musculoskeletal System On November 30th, 2020, the VA published their final changes to the ratings of the Musculoskeletal System.<div><br /> <div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhw3CBdwQdBbpwwWj_yS_h__DL4MPi7zsggfgIntl5SlvWQeQuYiyDrWgd4nC-Gi7tAIDeHqykZsDBH0soFcLaKnC37yMOhyphenhyphenqfxMZsbUUtFR_DwNhJc-Zrdp8mOwT4BLLR1UAPsZd-FXAs/s320/knee.jpg" style="clear: right; display: block; float: right; padding: 1em 0px; text-align: center;"><img alt="" border="0" data-original-height="320" data-original-width="249" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhw3CBdwQdBbpwwWj_yS_h__DL4MPi7zsggfgIntl5SlvWQeQuYiyDrWgd4nC-Gi7tAIDeHqykZsDBH0soFcLaKnC37yMOhyphenhyphenqfxMZsbUUtFR_DwNhJc-Zrdp8mOwT4BLLR1UAPsZd-FXAs/s320/knee.jpg" /></a></div>
The rewrite of the VASRD began in 2014 with the goal to be finished by the end of 2016. To date, this is the ninth section to be finalized, with many still to go. </div><div><br /></div><div>So far, finalized changes have also been made to the ratings of the <a href="https://militarydisabilitymadeeasy.com/thebloodratings.html" target="_blank">Hematologic and Lymphatic Systems</a>, the <a href="https://militarydisabilitymadeeasy.com/skinratings.html" target="_blank">Skin</a>, the <a href="https://militarydisabilitymadeeasy.com/femalereproductiveratings.html" target="_blank">Female Reproductive System</a>, the <a href="https://militarydisabilitymadeeasy.com/eyeratings.html" target="_blank">Eyes</a>, <a href="https://militarydisabilitymadeeasy.com/mouthandteethratings.html" target="_blank">Dental and Oral Conditions</a>, the <a href="https://militarydisabilitymadeeasy.com/endocrinesystemratings.html" target="_blank">Endocrine System</a>, <a href="https://militarydisabilitymadeeasy.com/mentaldisorderratings.html" target="_blank">Mental Disorders</a>, and <a href="https://militarydisabilitymadeeasy.com/infectiousratings.html" target="_blank">Infectious Diseases and Immune Disorders</a>, and <a href="https://militarydisabilitymadeeasy.com/nutritionaldeficiencyratings.html" target="_blank">Nutritional Deficiencies</a>. </div><div><br /></div><div>Proposed changes have been published for the Genitourinary and Cardiovascular Systems, but they have not yet been finalized.
</div><div><br /></div><div>The following changes will go into effect <b>February 7th, 2021</b>, and we’ll officially update all the information on our website at that time. These new ratings will automatically apply to any new claims for musculoskeletal conditions submitted on or after February 7th. </div><div><br /></div><div>The following are the VA's final changes to the ratings for the Musculoskeletal System. The changes are fairly extensive, so I’ll walk through each, one at a time. If you don’t want to have to plod through them all, it might be most effective to just search for keywords (command-F works great!). </div><div><br /></div><div>For each condition, the ones labeled -<i>Current-</i> are the codes as they are right now. Click on the links to be taken to the discussion of that code on our site. After the current code, I’ll discuss the final changes and then VA’s justification.
__________________________________________________________________</div><div><br /></div><div> <a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#h" target="_blank">Code 5000</a> for osteomyelitis remains exactly the same.
__________________________________________________________________</div><div><br /></div><div> <a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#g" target="_blank">Code 5001</a> for tuberculosis of the musculoskeletal system remains exactly the same.
__________________________________________________________________</div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div> </div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div>-<i>Current-</i> <a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#d" target="_blank">Code 5002</a>: Rheumatoid arthritis is the destruction of the soft tissues in a joint because of swelling. </div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><br /></div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div>Regardless of how many joints are affected, if the arthritis is severe enough that you cannot function, but are completely incapacitated and bedridden, then it is rated 100%. </div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><br /></div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div>If there is significant weight loss, anemia, and overall severe decrease in health but not complete incapacitation, or if severe incapacitating episodes happen 4 or more times a year, then it is rated 60%.</div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><br /></div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div>If there is a definite decline in overall health, or if incapacitating episodes happen 3 or more times a year, then it is rated 40%. </div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div> </div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div>One or two episodes a year rates 20%. </div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div> </div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div>These ratings cannot be used in addition to ratings for limited motion. One or the other. Any rheumatoid arthritis less severe than noted above is just rated upon its symptoms, such as limited motion. In these cases individual joints can be rated. So, if three joints are involved, but there are no incapacitating episodes, all three can be rated separately on limited motion. A minimum of 10% is given for every joint that at least has pain with motion. </div></blockquote></blockquote><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><i>-Final-</i> <b>Code 5002: Multi-joint systemic arthritis</b> includes any arthritis diseases (including <b>rheumatoid arthritis, psoriatic arthritis, spondyloarthropathies</b>, etc.) that affect multiple joints in the body and could affect other body systems as well. To be rated under this code, there must be a definite diagnosis, the arthritis must be active, and at least 2 joints must be affected. This code does not cover post-traumatic arthritis or gout. </div><div><br /></div><div>If the arthritis is severe enough that you cannot function, but are completely incapacitated and bedridden, then it is rated 100%. </div><div><br /></div><div>If there is significant weight loss, anemia, and overall severe decrease in health but not complete incapacitation, or if severe incapacitating episodes happen 4 or more times a year, then it is rated 60%.
</div><div><br /></div><div>If there is a definite decline in overall health, or if incapacitating episodes happen 3 or more times a year, then it is rated 40%. </div><div> </div><div>One or two episodes a year rates 20%. </div><div> </div><div>Any arthritis no longer active or less severe than noted above is rated under code 5003 as degenerative arthritis. Multiple ratings, however, cannot be given. Any rating under this code cannot be combined with ratings for degenerative arthritis or limited motion in the same joints. Instead, the code that can offer the higher rating is used. </div></blockquote><div><br /></div><div>Although the ratings themselves did not change, the VA wanted to expand this code to cover all systemic arthritis, not just rheumatoid arthritis. The only other significant change was to rate lesser conditions as degenerative arthritis instead of just on limited motion.
________________________________________________________________</div><div><br /></div><div>The only change for <a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#a" target="_blank">Code 5003</a> for <b>degenerative arthritis</b> is to adjust the name of the code to specify that this is for all degenerative arthritis except post-traumatic degenerative arthritis. The ratings remain exactly the same. </div><div> ________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#j" target="_blank">Codes 5004-5008</a> for <b>gonorrheal arthritis, pneumococcic arthritis, typhoid arthritis, syphilitic arthritis</b>, and <b>streptococcic arthritis</b>, continue to be rated under code 5002 for any active disease and code 5003 for anything that doesn’t qualify for those ratings.
__________________________________________________________________</div><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#j" target="_blank">Code 5009</a>: All <b>other arthritis</b> is rated under this code. </div></blockquote></blockquote><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Final-</i> <b>Code 5009: All other diseases of the joints </b>(except gout) are rated under this code. All active diseases are rated under code 5002, systemic arthritis. Anything that doesn’t qualify for a rating under that code is rated under code 5003, for degenerative arthritis. </div></blockquote><div> </div><div>The VA adjusted this code to include any other disease that would affect the joints, not just arthritis.
__________________________________________________________________</div><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"> <i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#b" target="_blank">Code 5010</a>: <b>Post-traumatic arthritis</b> is arthritis that is due to an accident or injury. This code doesn’t have its own ratings, but is rated as degenerative arthritis. The final code for this condition will look like this: 5010-5003. The first four-digit code defines the condition as traumatic arthritis, and the second four-digit code tells how it is rated. </div></blockquote></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Final-</i> <b>Code 5010: Post-traumatic arthritis</b> is arthritis caused by an accident or injury. This condition is rated as limited motion, dislocation, or instability of the joint affected, whichever one is ratable for that joint and gives the higher rating. Multiple ratings for a single joint cannot be combined unless the codes specifically state that they can (as is the case for instability of the knee). Each joint receives its own rating. </div></blockquote><div> </div><div>Degenerative arthritis is just rated on limited motion of the joint, so the changes to this code allow instability and dislocation to be considered as a legitimate rating option instead of just limited motion for post-traumatic arthritis.
___________________________________________________________________</div><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#f" target="_blank">Code 5011</a>: <b>Caisson disease</b> is the premature death of bone and marrow cells, often caused by compressed air most often seen in divers. It is rated based on its most prevalent symptom. For example, if it affects the spinal cord and causes limited motion in the hip, it would be rated under that symptom. Common symptoms include deafness, arthritis in the joints, loss of motion, etc. Only the symptom that can give the highest rating can be rated for this condition. The final code for this condition would look like this: 5011-5261. The first four-digit code identifies the condition as caisson disease, and the second four-digit code tells what symptom the condition is rated under. </div></blockquote></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Final-</i> <b>Code 5011: Decompression sickness</b> (a.k.a. <b>caisson disease, divers’ disease</b>, or <b>the bends</b>) occurs when gas bubbles form in the body because of decompression. The most common symptom is joint pain, however, since the bubbles can form in any part of the body, a variety of symptoms can occur, including arthritis, <a href="https://militarydisabilitymadeeasy.com/centralnervoussystemratings.html" target="_blank">nerve and/or brain damage</a>, <a href="https://militarydisabilitymadeeasy.com/earratings.html" target="_blank">hearing loss</a>, <a href="https://militarydisabilitymadeeasy.com/skinratings.html" target="_blank">skin damage</a>, <a href="https://militarydisabilitymadeeasy.com/respiratorysystemratings.html" target="_blank">lung damage</a>, and more. This condition is rated on its symptoms. So if it causes a rash on the skin and joint pain, it would be rated under arthritis and dermatitis. Each symptom receives its own rating as long as a single symptom is not rated twice (see the <a href="https://militarydisabilitymadeeasy.com/vasrdprinciples.html#pyram" target="_blank">Pyramiding Principle</a>). </div></blockquote><div> </div><div>The VA is expanding this code to include any symptom caused by decompression sickness, not just ones related to the musculoskeletal system.</div><div> __________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/musculoskeletalcancerratings.html#c" target="_blank">Code 5012</a> for <b>malignant bone cancer</b> essentially remains the same. They updated some wording to modern medical jargon, but it has no effect on interpretation or rating.</div><div> __________________________________________________________________</div><div><br /></div><div>Both <a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#c" target="_blank">code 5013</a>, for <b>osteoporosis</b>, and <a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#c" target="_blank">code 5014</a>, for <b>osteomalacia</b>, are essentially remaining the same. The VA added “residuals of” to the requirements to show that the conditions themselves aren’t ratable—it’s the symptoms that they cause in the joints that are ratable. Ultimately, nothing really changes. This principle was already applied in rating practice, but now it will be extra clear.</div><div> __________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#c" target="_blank">Code 5015</a> for <b>non-cancerous bone growth</b> (“neoplasms”) remains the same.</div><div> __________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#c" target="_blank">Codes 5016, 5017, 5019, and 5021</a> for <b>osteitis deformans, gout, bursitis</b>, and <b>myositis</b> remain the same.</div><div> __________________________________________________________________</div><div> </div><div>The VA is removing the following codes: </div><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#c" target="_blank">Code 5018</a>: <b>Intermittent hydrarthrosis</b> is the periodic swelling most commonly of major joints, although other joints could also be affected, on a regular and predictable schedule. </div><div><br /></div><div><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#k" target="_blank">Code 5020</a>: <b>Synovitis</b> is the swelling of a membrane that lines synovial joints. </div><div> </div><div><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#k" target="_blank">Code 5022</a>: <b>Periostitis</b> is the swelling of the tissue that surrounds the bones. </div></blockquote><div> </div><div>Based on modern medical practices, these conditions are actually symptoms of larger conditions, like rheumatoid arthritis, and so should not be treated as stand-alone conditions. Instead, any disability they cause is already covered by the rating of the main condition.
___________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#k" target="_blank">Code 5023</a> for <b>myositis ossificans</b> remains the same, but the name is changing to <b>heterotopic ossification</b>. This is the accepted modern terminology for this condition. </div><div>___________________________________________________________________</div><div><br /></div><div>The name for <a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#k" target="_blank">code 5024</a> is changing to include not only <b>tenosynovitis</b>, but also <b>tendinitis, tendinosis</b>, and <b>tendinopathy</b>. All of these conditions should already be rated under this code, but this change makes it clearer exactly where these conditions are intended to be rated. </div><div>___________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/musculoskeletaldiseasesratings.html#i" target="_blank">Code 5025</a> for <b>fibromyalgia</b> remains the same.</div><div> __________________________________________________________________</div><div><br /></div><div style="text-align: center;">Prosthetic Implants and Resurfacing </div><div> </div><div>For all codes 5051-5056 for the prosthetic replacement of joints and resurfacing, six notes have been added. </div><div> </div><div><ul style="text-align: left;"><li>Note 1 specifies that no other musculoskeletal rating can be given in addition to this code. Separate ratings can be given for nerve conditions or scars caused by these procedures, but not for arthritis, limited motion, etc. Only one musculoskeletal rating per condition. </li><li>Note 2 clarifies that revision procedures (procedures meant to fix things from previous procedures) are to be rated the same as original procedures only if as the original components are completely replaced (the entire original knee replacement is completely replaced again, etc.).
</li><li>Note 3 specifies that a “replacement” includes a total replacement of the entire joint. For code 5054 for a hip replacement, however, it means a total replacement of the head of the femur <u>and/or</u> of the acetabulum. This is how the ratings have always been applied, so no real change here.
</li><li>Notes 4 and 5 changes the start date of the 100% recovery ratings for all replacements to after the 1-month 100% rating given after a hospital discharge. So instead of the 100% rating period starting right after the procedure, it will begin 1-month after discharge from the hospital. That first month will also rate at 100% because of the hospital ratings allowed under § 4.30. </li><li>Note 6 specifies that a joint replacement condition can qualify for Special Monthly Compensation starting from the date it is decided that the permanent use of crutches is required. </li></ul>Besides the above notes, codes 5051-5053 and 5056 for <a href="https://militarydisabilitymadeeasy.com/shoulderandarmratings.html#d" target="_blank">shoulder</a>, <a href="https://militarydisabilitymadeeasy.com/elbowandforearmratings.html#f" target="_blank">elbow</a>, <a href="https://militarydisabilitymadeeasy.com/wristratings.html#c" target="_blank">wrist</a>, and <a href="https://militarydisabilitymadeeasy.com/ankleratings.html#c" target="_blank">ankle</a> replacements remain the same. </div><div><br /></div><div>The codes that are changing: </div><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/hipandthighratings.html#f" target="_blank">Code 5054</a>: If either the <b>entire head of the femur</b> or <b>entire head of the acetabulum has been replaced</b> by a false joint prosthesis, then the condition is rated 100% for the first year after the surgery. (This period is mainly for the VA, but the DoD will also use it if the veteran is placed on TDRL before being permanently separated). After the 1-year period, the condition is given a permanent rating. If there is weakness and severe pain with motion that requires the use of crutches, then it is rated 90%. If there is weakness and severe pain, but it does not require crutches, then it is rated 70%. If the pain is not severe, but does limit the range of motion, then it is rated 50%. The minimum rating for a hip replacement is 30%. </div></blockquote></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>If your condition rates 90% under this code, you may also qualify for additional compensation by the VA. Please see the <a href="https://militarydisabilitymadeeasy.com/special-monthly-compensation.html" target="_blank">Special Monthly Compensation</a> page for more information. </i></div></blockquote></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Final-</i> <b>Code 5054</b>: If the <b>hip has been resurfaced</b> <u>or</u> if either the entire <b>head of the femur</b> or entire <b>head of the acetabulum</b> <b>has been replaced</b> by a false joint prosthesis, then the condition is rated 100% for the first 4 months after the surgery. (This period is mainly for the VA, but the DoD will also use it if the veteran is placed on <a href="https://militarydisabilitymadeeasy.com/temporary-disability-retired-list-tdrl.html" target="_blank">TDRL</a> before being permanently separated). After the 4-month period, the condition is given a permanent rating. </div></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><b>For joint replacements</b>: If there is weakness and severe pain with motion that requires the use of crutches, then it is rated 90%. If there is weakness and severe pain, but it does not require crutches, then it is rated 70%. If the pain is not severe, but does limit the range of motion, then it is rated 50%. The minimum rating for a hip replacement is 30%. </div></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>If your condition rates 90% under this code, you may also qualify for additional compensation by the VA. Please see the <a href="https://militarydisabilitymadeeasy.com/special-monthly-compensation.html" target="_blank">Special Monthly Compensation</a> page for more information. </i></div></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><b>For resurfacing</b>: All remaining symptoms are rated as <a href="https://militarydisabilitymadeeasy.com/hipandthighratings.html#lim" target="_blank">limited motion of the hip</a>, <a href="https://militarydisabilitymadeeasy.com/hipandthighratings.html#too" target="_blank">too much motion or dislocation </a>of the hip, <a href="https://militarydisabilitymadeeasy.com/hipandthighratings.html#a" target="_blank">no motion</a> (frozen joint) of the hip, or <a href="https://militarydisabilitymadeeasy.com/hipandthighratings.html#pelvic" target="_blank">malunion</a> of the hip. The code that best describes the overall symptoms and provides the highest rating is assigned. </div></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#e" target="_blank">Code 5055</a>: If the <b>entire knee joint has been replaced</b> by a prosthesis, then the condition is rated 100% for the first year after the surgery. (This period is mainly for the VA, but the DoD will also use it if the veteran is placed on TDRL before being permanently separated). After the 1-year period, the condition is given a permanent rating. If there is weakness and severe pain with motion, then it is rated 60%. If the pain is not severe, but does limit the range of motion, then it is rated under code 5256 if it is frozen, or under codes 5261 or 5262, discussed below, if it is not frozen. The minimum rating for a total knee replacement, however, is 30% regardless of how much motion it has. </div></blockquote></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>Note: This code is only for total knee replacements. Partial replacements are rated on any symptoms that they cause, like limited motion. </i></div></blockquote></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Final-</i> <b>Code 5055</b>: If the <b>knee has been resurfaced</b> <u>or</u> If the <b>entire knee joint has been replaced</b> by a prosthesis, then the condition is rated 100% for the first 4 months after the surgery. (This period is mainly for the VA, but the DoD will also use it if the veteran is placed on <a href="https://militarydisabilitymadeeasy.com/temporary-disability-retired-list-tdrl.html" target="_blank">TDRL</a> before being permanently separated). After the 4-month period, the condition is given a permanent rating. </div></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><b>For replacements</b>: If there is weakness and severe pain with motion, then it is rated 60%. If the pain is not severe, but does limit the range of motion, then it is rated under code 5256 if it is frozen, or under codes 5261 or 5262, discussed below, if it is not frozen. The minimum rating for a total knee replacement, however, is 30% regardless of how much motion it has. </div></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>Note: This code is only for total knee replacements. Partial replacements are rated on any symptoms that they cause, like limited motion. </i></div></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><b>For resurfacing</b>: All remaining symptoms are rated as <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#limo" target="_blank">limited motion</a> of the knee, <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#too" target="_blank">too much motion or instability</a> of the knee, <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#loss" target="_blank">no motion</a> (frozen joint) of the knee, <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#meniscus" target="_blank">cartilage removal or dislocation</a>, or <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#lower" target="_blank">malunion</a> of the knee. The code that best describes the overall symptoms and provides the highest rating is assigned. </div></blockquote><div> </div><div>Joint resurfacing is now a common alternative for joint replacements for the hip and the knee. While they provide similar disability as a joint replacement, they do not qualify under the current rating requirements. Thus the VA is adjusting codes 5054 and 5055 to include resurfacing. Resurfacing, however, creates a shorter convalescent period and fewer long-term disabilities. Thus, they are giving only a 4 month 100% rating period and then alternative rating options for remaining symptoms after the resurfacing.</div><div> ___________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/amputationratings.html#z" target="_blank">Codes 5104, 5105, and 5108</a> for <b>hand and foot combination amputation/loss of use</b> remains the same.</div><div> ___________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/amputationratings.html#g" target="_blank">Code 5106</a> for <b>both hand amputation</b> remains the same.</div><div> ___________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/amputationratings.html#t" target="_blank">Code 5107</a> for <b>both foot amputation</b> remains the same. ____________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/handratings.html#c" target="_blank">Code 5109</a> for <b>loss of use of both hands</b> remains the same.</div><div> __________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/footratings.html#c" target="_blank">Code 5110</a> for <b>loss of use of both feet</b> remains the same.</div><div>___________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/handratings.html#c" target="_blank">Code 5111</a> for <b>loss of use of one hand and one foot</b> remains the same. </div><div>___________________________________________________________________</div><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/amputationratings.html#a" target="_blank">Code 5120</a>: If the <b>entire arm is amputated </b>from the shoulder joint down, it is rated 90% for either arm. </div></blockquote></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Final-</i> <b>Code 5120</b>: If the <b>entire arm is amputated</b> from the top of the humerus down, it is rated 90% for either arm. If the amputation includes the shoulder, including the scapula, clavicle, and/or ribs, it is rated 100% for either arm. </div></blockquote><div> </div><div>The VA is adding a 100% rating option for amputees with more than the shoulder joint and arm removed. The further removal of ribs and the shoulder results in a higher level of disability as prosthetics are much more difficult, if not impossible, to use.</div><div>___________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/amputationratings.html#b" target="_blank">Codes 5121-5156</a> for various <b>amputations of the arms, hands, and fingers</b> remain the same.</div><div> ___________________________________________________________________</div><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/amputationratings.html#m" target="_blank">Code 5160</a>: If the entire leg is <b>amputated at the hip joint</b>, it is rated 90%. </div></blockquote></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Final-</i> <b>Code 5160</b>: If the <b>entire hip is amputated</b> from the top of the femur down, it is rated 90%. If the amputation includes any part of the pelvic bones as well, it is rated 100%. </div></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;">If the amputation causes any bladder or bowel problems, they can be rated separately. </div></blockquote><div> </div><div>The VA is adding a 100% rating option for amputees with more than the hip joint and leg removed. The further removal of the pelvis results in a higher level of disability as prosthetics are much more difficult, if not impossible, to use.</div><div> ___________________________________________________________________</div><div><br /></div><div>Codes <a href="https://militarydisabilitymadeeasy.com/amputationratings.html#n" target="_blank">5161-5167</a> and <a href="https://militarydisabilitymadeeasy.com/amputationratings.html#w" target="_blank">5171-5173</a> for various <b>amputations of the legs, feet, and toes</b> remain the same.</div><div>____________________________________________________________________</div><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/amputationratings.html#v" target="_blank">Code 5170</a>: If <b>all of the toes are amputated</b>, not including the ball of the foot, it is rated 30%. </div></blockquote></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Final-</i> <b>Code 5170</b>: If <b>all of the toes are amputated</b>, not including the ball of the foot, it is rated 30%. This can include up to half of the metatarsals, but less than the entire ball of the foot. </div></blockquote><div> </div><div>The VA is clarifying that anything more than all of the toes but less than the ball of the foot should be rated under this code.</div><div> ___________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/shoulderandarmratings.html#a" target="_blank">Code 5200</a> for a <b>frozen shoulder joint </b>remains the same.</div><div> ___________________________________________________________________</div><div><br /></div><div>The VA changed some of the phrasing in <a href="https://militarydisabilitymadeeasy.com/shoulderandarmratings.html#e" target="_blank">code 5201</a> for <b>limitation of motion of the shoulder</b>, but it effectively remains exactly the same.</div><div> __________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/shoulderandarmratings.html#f" target="_blank">Code 5202</a> for <b>dislocation of the humerus</b> and other <b>humerus bone conditions </b>effectively remains the same.</div><div> ___________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/shoulderandarmratings.html#i" target="_blank">Codes 5203-5213</a> for all <b>other conditions of the shoulder and arm</b> remain the same.</div><div> ___________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/wristratings.html#a" target="_blank">Codes 5214-5215</a> for <b>conditions of the wrist </b>remain the same.</div><div> __________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/handratings.html#h" target="_blank">Codes 5216-5230</a> for <b>conditions of the hand</b> remain the same.</div><div> __________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/spineratings.html#a" target="_blank">Codes 5235-5241</a> for <b>conditions of the spine</b> remain the same.</div><div> ___________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/spineratings.html#b" target="_blank">Code 5242</a> for <b>degenerative arthritis of the spine</b> is further expanded to include degenerative disc disease and all other disc conditions (except intervertebral disc syndrome). The ratings remain the same with alternative rating options under code 5003 or 5010.</div><div> __________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/spineratings.html#e" target="_blank">Code 5243</a> for<b> intervertebral disc syndrome</b> remains the same, but the VA is adding a note to specify that this code can only be used when there is disc herniation with compression or with irritation of the nerve root. All other disc conditions are meant to be rated under code 5242. </div><div>__________________________________________________________________</div><div><br /></div><div><i>-NEW Final-</i> <b>Code 5244</b>: Both <b>paraplegia</b> and <b>quadriplegia</b> are rated under this code. In order to be rated under this code the paralysis must be complete, meaning no ability to use the hands/feet at all. Incomplete paralysis is rated under the affected nerves. </div><div> </div><div>Paraplegia is the complete paralysis of the legs and lower body. It is rated 100% under <a href="https://militarydisabilitymadeeasy.com/footratings.html#c" target="_blank">code 5110</a>, complete loss of use of the feet. This condition is also entitled to <a href="https://militarydisabilitymadeeasy.com/special-monthly-compensation.html" target="_blank">Special Monthly Compensation</a>.
</div><div><br /></div><div>Quadriplegia is the complete paralysis of both the arms and the legs. It is given two ratings: 100% under <a href="https://militarydisabilitymadeeasy.com/footratings.html#c" target="_blank">code 5110</a> for complete loss of use of the feet, and 100% under <a href="https://militarydisabilitymadeeasy.com/handratings.html#c" target="_blank">code 5109</a> for complete loss of use of the hands. Having two 100% ratings qualifies the veteran for a higher level of <a href="https://militarydisabilitymadeeasy.com/special-monthly-compensation.html" target="_blank">Special Monthly Compensation</a>. </div><div>__________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/hipandthighratings.html#a" target="_blank">Codes 5250-5254</a> for <b>limited motion of the hip, no motion</b> of the hip, and <b>too much motion</b> of the hip remain the same.</div><div> __________________________________________________________________</div><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/hipandthighratings.html#k" target="_blank">Code 5255</a>: Any problems with the <b>femur or femoral neck bones</b> are rated under this code. If either is completely broken through and it causes loose or erratic leg motion, then it is rated 80%. If it is broken through but the leg motion is not loose and the leg can support weight with the help of a brace, then it is rated 60%. If it is fractured and has a false joint, it is rated 60%. </div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div> </div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div>All other femur bone conditions are rated by how they affect the hip or knee joint. If they cause serious problems (can barely use the joint at all), then it is a 30% rating. If the joints can be used, but the condition significantly limits the amount of activity, then it is rated 20%. If the hip or knee joint is affected only slightly, then it is rated 10%. </div></blockquote></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Final-</i> <b>Code 5255</b>: Any problems with the <b>femur or femoral neck bones</b> are rated under this code. If either is completely broken through and it causes loose or erratic leg motion, then it is rated 80%. If it is broken through but the leg motion is not loose and the leg can support weight with the help of a brace, then it is rated 60%. If it is fractured and has a false joint, it is rated 60%. </div></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;">All other femur bone conditions are rated by how they affect the hip or knee joint, whichever results in a higher rating. Rating options for the knee include code <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#a" target="_blank">5256</a>, code <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#i" target="_blank">5257</a>, code <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#g" target="_blank">5260</a>, or code <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#f" target="_blank">5261</a>. Rating options for the hip include, codes <a href="https://militarydisabilitymadeeasy.com/hipandthighratings.html#a" target="_blank">5250-5254</a>. Only one code can be assigned for this condition.
</div></blockquote><div><br /></div><div>The VA recognizes that the current language for these ratings is rather vague. It’s hard for “marked” to be regularly defined by every rating authority, etc. Because of this, ratings for femur bone conditions aren’t standard across the board. To fix this, the VA is changing it to be rated instead on exactly how the knee or hip are affected, thus eliminating guesswork.</div><div> ___________________________________________________________________</div><div><br /></div><div><a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#a" target="_blank">Code 5256</a> for <b>no motion of the knee</b> remains the same.</div><div> ____________________________________________________________________</div><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#i" target="_blank">Code 5257</a>: The knee can have<b> too much motion</b> (<b>instability</b>) from side to side or <b>dislocate</b> regularly. This can happen when the tendons and cartilage are damaged and can no longer support the knee joint properly. If there is only slight instability, then it is rated 10%. If there is more instability that might cause the knee to buckle or dislocate every now and then, then it is rated 20%. If, however, it is so unstable that it gives out or dislocates regularly, it is rated 30%. </div></blockquote></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><i>-Final-</i> <b>Code 5257</b>: The knee can have <b>too much motion</b> (<b>instability</b>) from side to side or <b>dislocate</b> (subluxation) regularly. This can happen when the tendons and cartilage are damaged and can no longer support the knee joint properly. Similarly injuries can cause the kneecap instability, causing it to shift out of position. </div></blockquote><div> </div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><b>For general instability and subluxation</b>: </div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"> Complete ligament tear: </div></blockquote><p></p><ul style="text-align: left;"><ul><li>A 30% rating is given if surgery could not be performed or if it was performed, but failed to repair the tear, <u>and</u> a physician prescribed both a brace and a device to help with walking (crutch, walker, cane, etc.). </li><li>If a physician prescribes only a brace <u>or</u> a device to help with walking, it is rated 20%. </li><li>If successful surgery was performed, but it still requires a physician-prescribed brace <u>and/or</u> a device to help with walking, it is rated 20%. </li><li>If it does not require a physician-prescribed brace or a device to help with walking, it is rated 10%. </li></ul></ul><p></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;"> Sprain or partial ligament tear: </p></blockquote><p style="text-align: left;"></p><ul style="text-align: left;"><ul><li>If the condition causes persistent instability and a physician prescribes a brace <u>and/or</u> a device to help with walking, it is rated 20%. </li><li>If the condition causes persistent instability but does not require a physician-prescribed brace or a device to help with walking, it is rated 10%. </li></ul></ul><p></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;"><b>For kneecap instability:</b> </p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;">To be rated below, the diagnosed condition must involve at least one or more of the patellofemoral complex parts: the quadriceps tendon, the patella, and the patellar tendon. No other knee surgeries can be rated here. </p></blockquote><p></p><ul style="text-align: left;"><ul><li>If the kneecap continues to be unstable after surgery is performed and it requires a physician-prescribed brace <u>and</u> a cane or walker, it is rated 30%. </li><li>If the kneecap continues to be unstable after surgery is performed and it requires a physician-prescribed brace, cane, <u>or</u> walker, it is rated 20%. </li><li>If the kneecap is unstable without surgery or continues to be unstable after surgery is performed but does not require a physician-prescribed brace, cane, or walker, it is rated 10%.</li></ul></ul>The VA is changing this code to offer more measure-able rating requirements for instability of the knee. Since “mild,” “moderate,” and “severe” are difficult to uniformly define, more specific criteria is needed to eliminate inconsistent ratings. They are also adding ratings specific to kneecap instability. The kneecap is not addressed at all under the current ratings.<br />____________________________________________________________________<p></p><p><a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#j" target="_blank">Codes 5258-5261</a> for conditions of the <b>meniscus</b> and <b>limited motion of the knee</b> remains the same. ____________________________________________________________________</p><p><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#k" target="_blank">Code 5262</a>: Any problems with the <b>tibia or fibula bones</b> in the lower leg are rated under this code. If there is a complete break in either bone that cannot heal and requires a brace, then it is rated 40%. All other conditions are rated by how they affect the knee or ankle joint. If they cause serious problems (can barely use the joint at all), then it is a 30% rating. If the joints can be used, but the condition significantly limits the amount of activity, then it is rated 20%. If the knee or ankle joint is affected only slightly, then it is rated 10%. </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;"> -<i>Final-</i> <b>Code 5262</b>: Any problems with the <b>tibia or fibula bones</b> in the lower leg are rated under this code. </p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;">If there is a <b>complete break</b> in either bone that cannot heal and requires a brace to stabilize, then it is rated 40%. </p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;"><b>Medial tibial stress syndrome</b> (a.k.a. “<b>MTSS</b>” or “<b>shin splints</b>”) is rated on the following criteria: </p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;"></p><ul style="text-align: left;"><li>
If both legs are affected, it has been treated consistently for 12 months or more, <u>and</u> it is not responsive to any form of treatment (including surgery), it is rated 30%. </li><li>
If only one leg is affected, it has been treated consistently for 12 months or more, <u>and</u> it is not responsive to any form of treatment (including surgery), it is rated 20%.</li><li>
If one or both legs are affected, it has been treated consistently for 12 months or more, and it is only unresponsive to conservative treatments (like orthotics), it is rated 10%. </li><li>
If the condition has been treated for less than 12 months, it is rated 0%. </li></ul><p></p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;"><b>
All other conditions</b> (including breaks that haven’t healed correctly) are rated by how they affect the knee or ankle joint, whichever results in a higher rating. Rating options for the knee include code <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#a" target="_blank">5256</a>, code <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#i" target="_blank">5257</a>, code <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#g" target="_blank">5260</a>, or code <a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#f" target="_blank">5261</a>. Rating options for the ankle include, codes <a href="https://militarydisabilitymadeeasy.com/ankleratings.html#a" target="_blank">5270-5271</a>. Only one code can be assigned for this condition. </p></blockquote><p style="text-align: left;">
Again, the VA is getting rid of vague language that leaves too much up to interpretation. Thus instead of rating other conditions on “moderate,” etc., they are changing this code to rate them on the actual impairment of the joints affected. The new ratings also add separate rating criteria for shin splints, a condition previously ignored in the ratings. __________________________________________________________________</p><p style="text-align: left;"><a href="https://militarydisabilitymadeeasy.com/kneeandlegratings.html#h" target="_blank">Code 5263</a> for <b>genu recurvatum</b> remains the same.
__________________________________________________________________</p><p style="text-align: left;">All <a href="https://militarydisabilitymadeeasy.com/ankleratings.html#a" target="_blank"><b>ankle ratings</b></a>, except code 5271 (below), remain the same.
___________________________________________________________________</p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;"><i>-Current-</i> <a href="https://militarydisabilitymadeeasy.com/ankleratings.html#b" target="_blank">Code 5271</a>: If the ankle is not frozen, but <b>limited in motion</b>, then it is rated under this code. Normal range of motion for the ankle is 0° to 20° dorsiflexion and 0° to 45° plantar flexion. A 20% rating is given for a markedly limited range of motion and a 10% is given for a moderately limited range of motion. </p></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;"><i>-Final-</i> <b>Code 5271</b>: If the <b>ankle</b> is not frozen, but <b>limited in motion</b>, then it is rated under this code. Normal range of motion for the ankle is 0° to 20° dorsiflexion and 0° to 45° plantar flexion. </p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;">If dorsiflexion is less than 5° or plantar flexion is less than 10°, it is rated 20%. If dorsiflexion is between 5° and 14° or plantar flexion is between 10° and 29°, it is rated 10%. </p></blockquote><p style="text-align: left;">
The VA is better defining the vague “marked” and “moderate” requirements to include the exact range of motions necessary for the ratings.
_________________________________________________________________</p><p style="text-align: left;"><a href="https://militarydisabilitymadeeasy.com/hipandthighratings.html#l" target="_blank">Code 5275</a> for <b>shortening of the bones</b> remains the same.
__________________________________________________________________</p><p style="text-align: left;">All current <a href="https://militarydisabilitymadeeasy.com/footratings.html#f" target="_blank">foot codes</a> remain the same.
__________________________________________________________________</p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;"><i>-NEW Final-</i> <b>Code 5269</b>: <b>Plantar fasciitis</b> is a condition where the skin and tissues on the bottom of the foot swell and cause pain. If both feet are affected, and the symptoms are not responsive to any kind of treatment, including surgery (or if the veteran is not a surgical candidate), it is rated 30%. If only one foot is affected, and the symptoms are not responsive to any kind of treatment, including surgery (or if the veteran is not a surgical candidate, it is rated 20%. If the symptoms are treatable, it is rated 10%. </p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;">If the condition is not responsive to treatment and is so severe that the foot cannot be used at all, it is rated 40% under code <a href="https://militarydisabilitymadeeasy.com/amputationratings.html#s" target="_blank">5167</a> for loss of use of the foot. </p></blockquote><p style="text-align: left;">The VA is adding this code because plantar fasciitis is a common enough condition that it should be given its own rating system.
________________________________________________________________<br /><br /></p><p style="text-align: left;">Codes 5296-5298 for s<a href="https://militarydisabilitymadeeasy.com/skullratings.html#a" target="_blank">kull conditions</a>, <a href="https://militarydisabilitymadeeasy.com/ribratings.html#a" target="_blank">rib conditions</a>, and <a href="https://militarydisabilitymadeeasy.com/spineratings.html#d" target="_blank">conditions of the coccyx</a> remain the same.
__________________________________________________________________</p><p style="text-align: left;">All codes for Muscle Ratings remain the same except for the addition of the following two new codes: </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p style="text-align: left;"> <i>-NEW Final-</i> <b>Code 5330</b>: <b>Rhabdomyolysis</b> is a condition where the muscles break down rapidly, usually due to trauma or overuse. Each muscle group affected is rated separately. So if a crush injury causes rhabdomyolysis in the <a href="https://militarydisabilitymadeeasy.com/forearmandhandmuscles.html" target="_blank">forearm and hand</a>, affecting all three of the muscle groups in that area, it will be given three separate ratings. </p><p style="text-align: left;">Additionally, as the muscles break down and are absorbed into the blood, the kidneys can be damaged. Because of this, any <a href="https://militarydisabilitymadeeasy.com/genitourinaryratings.html#recon" target="_blank">kidney damage</a> caused by rhabdomyolysis can be rated separately. </p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;"><i>-NEW Final-</i> <b>Code 5331: Compartment Syndrome</b> is a condition where pressure builds up rapidly in the tissues, usually due to a trauma or overuse, and cuts off the blood supply to an area of muscle. Each muscle group affected is rated separately. So if a crush injury causes compartment syndrome in the <a href="https://militarydisabilitymadeeasy.com/forearmandhandmuscles.html" target="_blank">forearm and hand</a>, affecting all three of the muscle groups in that area, it will be given three separate ratings. </p></blockquote><p style="text-align: left;">The VA is adding these two new codes to help the rating authorities know how best to rate these conditions. Currently they are rated analogously on any muscle groups that are damaged, but these codes make the requirements more clear. Hopefully it will avoid improper ratings.
____________________________________________________________________</p>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com0tag:blogger.com,1999:blog-4162041641030931379.post-63460678548514085902020-09-17T09:53:00.012-07:002020-09-17T10:03:27.055-07:00Service-Aggravation Specifically Defined in Proposed Regulation Change<p style="text-align: center;"><b><span style="font-size: medium;"></span></b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivERkp45X2bMXJu9F5TbvEtPSC-Jq-zQJQEmdjEDNOhDNc-8AhTzzxo9Ii5ugHdGWVpkPliu3Ea0ac8FAcg5sluVSqWebqF5ljkUBioiw2DVVkfLSWqtncZxaZPSbtiNM5Jvt3ECef0dU/s2048/service-aggravation.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="2048" data-original-width="1536" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivERkp45X2bMXJu9F5TbvEtPSC-Jq-zQJQEmdjEDNOhDNc-8AhTzzxo9Ii5ugHdGWVpkPliu3Ea0ac8FAcg5sluVSqWebqF5ljkUBioiw2DVVkfLSWqtncZxaZPSbtiNM5Jvt3ECef0dU/s320/service-aggravation.jpg" /></a></div><p class="MsoNormal" style="text-align: center;"><b><span style="font-size: medium;">What is Service-Aggravation?</span></b></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><br /></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><a href="https://militarydisabilitymadeeasy.com/service-connection.html#aggravated" target="_blank">Service-aggravation</a> refers to conditions that are made worse by (but are not caused by) military service and/or <a href="https://militarydisabilitymadeeasy.com/service-connection.html" target="_blank">service-connected</a> conditions (see <a href="https://militarydisabilitymadeeasy.com/service-connection.html#otherconditions" target="_blank">Secondary Conditions</a>). <o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Service-aggravated conditions are entitled to receive some disability compensation. <o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Service-aggravation can apply to two types of conditions: <o:p></o:p></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->conditions that Existed Prior To Service (<a href="https://militarydisabilitymadeeasy.com/epts.html" target="_blank">EPTS</a>), including <a href="https://militarydisabilitymadeeasy.com/epts.html#genetic" target="_blank">genetic and hereditary</a> conditions<o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->conditions that are unrelated to service and do not meet the requirements for any other type of service-connection<o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: Calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">In order to be considered service-aggravated, these conditions must either be made measurably worse 1.) directly by military service, or 2.) by another condition that qualifies as service-connected.<o:p></o:p></p><p class="MsoNormal" style="text-align: center;"><style class="WebKit-mso-list-quirks-style">
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</style></p><p class="MsoNormal" style="font-size: medium;"><o:p> </o:p></p><p class="MsoNormal" style="text-align: center;"><b><span style="font-size: medium;">The Issue</span></b></p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="font-size: medium;">In the current regulations that lay out the rules governing service-aggravation, the VA uses two different wordings when referring to the concept of making the condition worse ("aggravation"). </p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="font-size: medium;">When discussing conditions made worse by military service (<a href="https://www.law.cornell.edu/cfr/text/38/3.306" target="_blank">38 CFR 3.306</a>), service-aggravation is defined as any “increase in disability.” When discussing conditions made worse by service-connected conditions (<a href="https://www.law.cornell.edu/cfr/text/38/3.310" target="_blank">38 CFR 3.310</a>), however, it is defined as “any increase in severity.” <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="font-size: medium;">While this does not seem like a huge difference, the small variation in wording has led to significant debates in recent years in various veterans courts. </p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="font-size: medium;">In the majority of these court cases, the courts have interpreted the regulations to define service-aggravation as any significant and permanent increase in the severity of the disability. However, in the 2019 <i><a href="https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000121972/Ward,-Neal-v.-Wilkie,-Jun-14,-2019,-31-Vet.App.-233-(2019)" rel="nofollow" target="_blank">Ward v. Wilkie</a></i> case, the United States Court of Appeals for Veterans Claims determined that service-aggravation could include even temporary or occasional flare-ups of the condition. <o:p></o:p></p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="text-align: center;"><b><span style="font-size: medium;">VA's Proposal</span></b></p><p class="MsoNormal" style="text-align: center;"><b><span style="font-size: medium;"><br /></span></b></p><p class="MsoNormal" style="font-size: medium;">In order to eliminate the confusion surrounding service-aggravation, the VA now proposes to change the wording of the regulations to a single, clear definition. </p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="font-size: medium;">Under these proposed changes, in order for a condition to be considered service-aggravated, “the increase in disability must be permanent, not merely temporary or intermittent” (<a href="https://www.federalregister.gov/documents/2020/09/11/2020-17672/aggravation-definition?utm_medium=email&utm_campaign=subscription+mailing+list&utm_source=federalregister.gov" rel="nofollow" target="_blank">FR 85, 177</a>). </p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="font-size: medium;">Once officially published, this change will effectively undermine the decision in <i>Ward v. Wilkie</i>, and ensure that all future cases are determined using this single definition. </p><p class="MsoNormal" style="font-size: medium;"><br /></p><p class="MsoNormal" style="font-size: medium;">Before publishing the final change, the VA will accept and consider comments on this proposed change until November 10<sup>th</sup>, 2020. You can submit your comments at <a href="http://www.regulations.gov/">www.Regulations.gov</a> by searching for "AQ80-Proposed Rule-Aggravation Definition."</p><style class="WebKit-mso-list-quirks-style">
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</style>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com0tag:blogger.com,1999:blog-4162041641030931379.post-67995803512695427182020-08-25T08:07:00.003-07:002020-08-25T08:08:54.776-07:00The NEW Military Disability Made Easy—A Letter from our COO <p><span face=""></span></p><div class="separator" style="clear: both; text-align: center;"><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeHn5XGjbXQJ7u3cE6Oz5RqwHySZvsO-r0TBNIgSiWncIOp1PEVgAIwVDvafOR2WrZ9DQ_vfzHdX2vKEJzMtwr47XuCbgtUsUmWaruNWkwZF-0UzGNYQSf0vcP0yPMwDI2XfbBaPENsTc/s2048/MDMESocialPost.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1739" data-original-width="2048" height="222" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeHn5XGjbXQJ7u3cE6Oz5RqwHySZvsO-r0TBNIgSiWncIOp1PEVgAIwVDvafOR2WrZ9DQ_vfzHdX2vKEJzMtwr47XuCbgtUsUmWaruNWkwZF-0UzGNYQSf0vcP0yPMwDI2XfbBaPENsTc/w262-h222/MDMESocialPost.png" width="262" /></a></div><div style="text-align: left;">Thank you to each of the veterans, service members, professionals, and supporters who have helped Military Disability Made Easy blossom since our launch in 2013! It is because of you that we have become the #1 military disability website in the world. </div><o:p></o:p><p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">As such, YOU have been our motivation over the past months as we’ve worked hard to develop a new Military Disability Made Easy designed to give you even more assistance in obtaining the benefits you deserve. <o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Better service from us = better benefits for you!<o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">With the launch of the new Military Disability Made Easy, we are proud to be able to continue offering our in-depth coverage of both the DoD and VA Disability processes for free to ensure that you know what to expect at every turn, the steps you need to take, and how to best prepare yourself for success. Thank you for your service.<o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">But we can now offer you even more! <o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">With the launch of the new Military Disability Made Easy, I am excited to announce two new features designed to help you maximize your disability.<o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.25in; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>All-Access Membership. </b>For only $19.95/month ($14.95 during the month of August!), you can unlock these powerful perks:<o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.25in; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoListParagraphCxSpFirst" style="margin-left: 0.75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: left; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]-->Have a question about your claim, ratings, or benefits? <b>As an All-Access member, you can now submit specific questions about your disability to our team of Military Disability Experts! </b>While this does not include a full case review, document review, or claim/appeal preparation, if you encounter any bumps on your DIY disability journey, we are here to answer any question you may have.<o:p></o:p></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: left; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]-->Want to know exactly how your conditions are rated? <b>All-Access members can explore the most in-depth coverage of the VASRD in existence.</b> Knowing exactly how your conditions are rated will allow you to take your claim and appeal preparation to the next level. Maximize your disability by expertly tailoring your case and evidence with this valuable information. <o:p></o:p></p><p class="MsoListParagraphCxSpLast" style="margin-left: 0.75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: left; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]-->Want even more? No problem. <b>All-Access members will also receive Exclusive Monthly Content delivered to their inbox each month AND a 75% discount on all of our Academy courses!</b><o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.25in; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.25in; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><b>The Academy</b>. Discover what you need to stay firmly on the path to maximizing your benefits! Military disability expertise and life coaching come together in our new motivating courses. <o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.25in; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.25in; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">While our website has all the information you need for disability success, the disability system is still unavoidably vast and complex. <o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.25in; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.25in; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Through The Academy, we offer specialized courses that present everything you need to know about specific topics in an easy-to-follow streamlined course structure. Each course digs deep into the topics, helping you turn the information into clear action points and empowering you with a solid, manageable game plan. <o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 0.25in; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">As we strive to better meet your needs through the All-Access Membership and The Academy, I thank you for your continued support.<span> </span><o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">The many success stories you have shared inspire us to continue to improve our services in order to better meet your needs. <o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Our job is not done until every veteran is receiving the benefits they deserve. <o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt 3in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Thanks for using Military Disability Made Easy!<o:p></o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0in 0.0001pt; orphans: auto; text-align: start; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;"><o:p> </o:p></p><p class="MsoNormal" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; caret-color: rgb(0, 0, 0); color: black; font-family: calibri, sans-serif; font-size: medium; font-style: normal; font-variant-caps: normal; font-weight: normal; letter-spacing: normal; margin: 0in 0.5in 0.0001pt 2.5in; orphans: auto; text-align: start; text-decoration: none; text-indent: 0.5in; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px;">Rebecca Sara,<o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt; text-align: start;"><style class="WebKit-mso-list-quirks-style">
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</style></p><p class="MsoNormal" style="font-size: medium; margin-left: 2.5in; text-align: start; text-indent: 0.5in;">COO and Co-Founder<o:p></o:p></p></div><p class="MsoNormal" style="font-size: medium;"> <o:p></o:p></p>Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com7tag:blogger.com,1999:blog-4162041641030931379.post-70622967919908761332019-12-04T07:25:00.001-08:002019-12-04T07:25:25.311-08:00Comments Submitted on the Genitourinary Changes<div class="MsoNormal">
<span style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">The following are the comments we
submitted on your behalf to the VA in regards to the <a href="http://blog.militarydisabilitymadeeasy.com/2019/10/new-proposed-changes-to-ratings-of.html" target="_blank">new proposed changes to the ratings of the Genitourinary System</a>. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Every time the VA publishes their proposed changes for a section
of the <a href="http://www.militarydisabilitymadeeasy.com/vasrd.html" target="_blank">VASRD</a>, they include a comment period in which veterans and
organizations can provide feedback on the coming changes. Thank you for
submitting your comments to us regarding the Genitourinary System so that we
could submit them in a unified front to the VA. Hopefully, we will be able to
effect change and make the rating system fairer for all veterans. </span><span style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Here are the comments we submitted for the Genitourinary System: </span><span style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">We at <a href="http://www.militarydisabilitymadeeasy.com/">www.MilitaryDisabilityMadeEasy.com</a> would
like to submit the following comments on behalf of our staff and veterans in
response to the proposed changes to the ratings for the Genitourinary
System. </span><span style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Item #1</span><span style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">In the proposed changes released in July 2017, a note was proposed
to clarify that Peyronie’s disease is not ratable. That note is not in the
recent proposal. What, then, is the intention of the VA regarding the rating of
Peyronie’s disease? </span><span style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Item #2</span><span style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">One veteran submits his situation regarding
code 7543 for varicoceles and hydroceles. In his case, they cause acute pain
that inhibits walking and keeps him from working for more than 4 hours. Driving
also aggravates his condition. Offering a single rating option of only 0%
eliminates the ability for veterans like him whose conditions definitely interfere
with their earning capacity to be properly compensated. He suggests adding a
10% (max) rating for severe cases like this. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Item #3<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">In the withdrawal of the original proposed
changes, it was mentioned that the error needing correction was in the ACR
values. However, in the new proposed changes, the GFR values have been
significantly altered as well. A comment from one veteran notes how these GFR
changes will affect their ratings:<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">“I believe the July 2017 renal disease
recommendations for ratings are more in line with the Kidney Foundation than
those that are being considered in the October 2019 version. I have a
consistent GFR in the 40's. I do not have albumin in the urine. I am tired all
the time. I definitely have less energy. By 2pm I am exhausted beyond belief.
My appetite stinks, I sleep like crap, and I have to go to the bathroom often. It
is tiring and hard to stay focused when working. I highly recommend that the VA
stays with their July 2017 proposed changes for renal disease. July 2017
recommendations more accurately reflect disease progression when considering
disability.”<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB" style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Thanks for considering these comments.</span><span style="color: black; font-family: "Verdana",sans-serif; font-size: 9.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of figures"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="envelope address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="envelope return"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="line number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="page number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of authorities"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="macro"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="toa heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 5"/>
<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Closing"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Signature"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
UnhideWhenUsed="true" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
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Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com2tag:blogger.com,1999:blog-4162041641030931379.post-5926267823203443462019-10-15T08:19:00.000-07:002019-10-15T08:19:02.410-07:00-NEW- Proposed Changes to the Ratings of the Genitourinary System <div class="separator" style="clear: both; text-align: center;">
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On<a href="http://blog.militarydisabilitymadeeasy.com/2017/08/proposed-changes-to-ratings-of.html" target="_blank"> July 28th, 2017</a>, the VA published proposed changes to the ratings of the Genitourinary System, but they withdrew those proposed changes in March of this year because there were errors in the rating criteria.</div>
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<span lang="EN-GB">Today, October 15<sup>th</sup>, 2019, the VA published their revised proposal for changes to the ratings of the Genitourinary System. Since it will be too confusing to discuss the differences between the original proposal as well as the differences between the current system, I am only going to focus on the changes that will occur if these new proposed changes go into effect. If curious, you can find the original proposal<a href="http://blog.militarydisabilitymadeeasy.com/2017/08/proposed-changes-to-ratings-of.html" target="_blank"> here</a>. <o:p></o:p></span></div>
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<span lang="EN-GB">With each set of proposed changes, the VA allows a period in which comments can be submitted. The VA then takes each comment into consideration and makes any additional changes that are warranted before publishing the final ruling. <o:p></o:p></span></div>
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<span lang="EN-GB">We encourage you to submit any comments you might have on these proposed changes to us either by commenting on this post or by <a href="http://www.militarydisabilitymadeeasy.com/contactus.html" target="_blank">contacting us </a>through our website. All comments must be received by December 1st, 2019. We will then compile all of your comments into a single report and submit it on your behalf to the VA, just as we did for the other sections (see the <a href="http://blog.militarydisabilitymadeeasy.com/2015/04/you-spoke-we-listenedthe-comments.html" target="_blank">Female Reproductive System Comments</a>). This is a great opportunity to really make a difference, so please let us know your thoughts. <o:p></o:p></span></div>
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<span lang="EN-GB">The following are the VA’s new proposed changes to the ratings for the Genitourinary System. The changes to the current system are fairly extensive, so I’ll walk through them, one at a time.<o:p></o:p></span></div>
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<span lang="EN-GB">For each condition, the small, indented parts are the codes as they are right now. Click on the links to be taken to the discussion of that code on our site. After the current code, I’ll discuss the proposed changes and the VA’s justification. <o:p></o:p></span></div>
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<span lang="EN-GB">The <b><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#urinary" target="_blank">Urinary Rating Systems</a> </b>remain exactly the same. No changes proposed. <o:p></o:p></span></div>
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<span lang="EN-GB">All <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#urcon" target="_blank">Urinary Conditions</a> (codes 7512, 7515, 7516, 7517, 7518, and 7519) are staying the same, except: <o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#g" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7542</span></b></a></span><span style="font-size: 10pt;">: A <b>Neurogenic Bladder </b>occurs when a person looses control over urination because of damage to the nerves or the brain. This condition is rated on the Urinary Rating System. <o:p></o:p></span></div>
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<i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> </span><b>Code </b><span lang="EN-GB"><b><span lang="EN-US">7542</span></b></span>: A <b>Neurogenic Bladder </b>occurs when a person looses control over urination because of damage to the nerves or the brain. This condition is rated on either the Urinary Rating System or as a Urinary Tract Infection, whichever gives the higher rating. <o:p></o:p></div>
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<span lang="EN-GB">The only change to this code is allowing it to be alternatively rated as a urinary tract infection. This is because neurogenic bladders have a high rate of urinary tract infections, so if that is the predominant disability and would offer a higher rating, that should be an alternative rating option. <o:p></o:p></span></div>
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<i><span lang="EN-GB" style="font-family: "times new roman" , serif;">-NEW Proposed Code-</span></i><span lang="EN-GB" style="font-family: "times new roman" , serif;"> <b>Code 7545: Diverticulum of the bladder</b> occurs when the wall of the bladder weakens and a portion protrudes, creating a pouch. This causes urine to get trapped in the pouch, leading to voiding dysfunction and/or infection. It can be rated either on the Urinary Rating Systems or as a Urinary Tract Infection, whichever is the main disability.<o:p></o:p></span></div>
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<span lang="EN-GB">The VA proposes to add this new code to cover diverticulum of the bladder. Currently, there aren’t any codes that truly reflect the disability of this condition. Thus it needs its own code. <o:p></o:p></span></div>
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<a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#tract" target="_blank">Urinary Tract Infection</a><o:p></o:p></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><span style="font-size: 10pt;"> The ratings: <o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 30% rating is given if the condition causes regular infections that require hospitalization 3 or more times a year, <u>or</u> if it requires serious continuous treatment. <o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 10% rating is given if the condition requires regular drug therapy, 1 or 2 hospitalizations a year, or if it requires serious continuous treatment.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">If any of these conditions that are rated as urinary tract infections also cause renal p<a href="https://www.blogger.com/null" name="i"></a>roblems, then only one or the other can be rated. If the renal problems are more severe, then the condition should be rated under the </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#renal" style="color: purple;"><span lang="EN-US" style="font-size: 10pt;">renal rating system</span></a></span><span style="font-size: 10pt;">.</span></div>
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<i>-Proposed-</i> The ratings: <o:p></o:p></div>
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A 30% rating is given if the condition causes regular infections that require a stent or nephrostomy tube to be implanted for drainage, if the condition requires hospitalization 3 or more times a year, <u>or</u> if it requires serious continuous treatment. <o:p></o:p></div>
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A 10% rating is given if the condition requires suppressive drug therapy for 6 months or more, <u>or</u> 1 or 2 hospitalizations a year.<o:p></o:p></div>
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A 0% rating is given if the condition is recurrent and requires treatment of suppressive drug therapy for less than 6 months or antiobotic therapy, and does not require hospitalizations. <o:p></o:p></div>
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If any condition rated as a urinary tract infection also causes renal problems, then only one or the other can be rated unless they are diagnosably separate with clearly separate symptoms. If the renal problems are more severe, then the condition should be rated under the <span lang="EN-GB"><span lang="EN-US">renal rating system (see new one below)</span></span>.<o:p></o:p></div>
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The changes to the 30% simply specify that the infection must require drainage by more than a catheter in order to be rated at this level. Catheter drainage does not require surgery and rarely requires significant hospitalization. <o:p></o:p></div>
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The changes to the 10% more clearly define the required treatment. The VA argues that suppressive drug therapy for at least 6 months suggests a significant chronic condition appropriate for this rating level. <o:p></o:p></div>
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A 0% rating was added to enforce that anything less than the requirements for the 10% should be given a 0%. <o:p></o:p></div>
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<span lang="EN-GB">Conditions Rated As Urinary Tract Infections<o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#h" target="_blank">7501</a> for abscess of the kidney remains the same. <o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#j" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7525</span></b></a></span><span style="font-size: 10pt;">: <b>Chronic Epididymo-orchitis</b> is pain in the epididymis. If the pain is caused by tuberculosis, it is rated as </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/tuberculosis.html" style="color: purple;"><span lang="EN-US" style="font-size: 10pt;">nonpulmonary tuberculosis</span></a></span><span style="font-size: 10pt;">.<o:p></o:p></span></div>
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<i>-Proposed-</i><b> Code 7525</b>: The following chronic infections are all rated under this code: <b>epididymitis </b>(infection/inflammation of the epididymis), <b>prostatitis</b> (infection/inflammation of the prostate gland, <b>urethritis</b> (infection/inflammation of the urethra), and <b>orchitis</b> (infection/inflammation of the testicles—one or both). If the condition is caused by tuberculosis, it is rated as nonpulmonary tuberculosis.<o:p></o:p></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#j" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7527</span></b></a></span><span style="font-size: 10pt;">: <b>Prostate Gland</b> conditions (any) are either rated as urinary tract infections or by the urinary rating system, whichever better defines the symptoms of the condition.<o:p></o:p></span></div>
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<i>-Proposed-</i><b> Code 7527</b>: <b>Prostate Gland</b> conditions (all except prostatitis) and <b>bladder outlet obstruction</b> are rated under this code either as urinary tract infections or under the urinary rating system, whichever better defines the symptoms of the condition.<o:p></o:p></div>
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<span lang="EN-GB">The VA recognized that there were quite a few infections that were not technically covered under the current codes, and so decided to add them in order to avoid improper analogous ratings. Thus, now code 7525 covers four conditions instead of just epididymitis. All of these conditions should have been rated under this code anyway, since they cause similar symptoms, but now it is official. No change in how they are rated. <o:p></o:p></span></div>
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<span lang="EN-GB">For code 7527, they decided to move prostatitis to 7525 because it is closer to the other infections covered by that code. All other prostate conditions are still covered under this code. The VA also decided to add bladder outlet obstruction because it is often caused by a prostate condition and can produce similar symptoms. Thus, it needs the option to be rated as a urinary tract infection as well. <o:p></o:p></span></div>
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<span lang="EN-GB">______________________________________________________________________<o:p></o:p></span></div>
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<span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#renal" target="_blank">The Renal Rating System</a><o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><span style="font-size: 10pt;"> A 100% rating is given if at least one of the following is present:<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– The condition requires regular dialysis.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– The body cannot perform any physical activity because of persistent edema or because of albuminuria.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– A BUN of more than 80 mg/dL.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– A creatinine level of 9 mg/dL or more in the blood.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– A severely decreased functioning of the kidneys or other organs due to kidney dysfunction.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">An 80% rating is given if one or more of the following is present:<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– Persistent edema <u>and</u> albuminuria with a BUN of 40 to 80 mg/dL.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– A creatinine level of 4 to 8 mg/dL in the blood.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– Overall poor health with symptoms like lethargy, weakness, anorexia, weight loss, or the inability to exert much energy.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 60% rating is given if one or more of the following is present:<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– Constant albuminuria with some edema.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– A definite decrease in kidney function.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– Hypertension with the average diastolic pressure (the smaller number on the bottom in the blood pressure reading) of 120 or more.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 30% rating is given if one or more of the following is present:<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– Hypertension with the average diastolic pressure (the smaller number on the bottom) of 100 or more, <u>or</u> with the average systolic pressure (the larger number on top) of 160 or more.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– Albumin is present in the urine with either hyaline and granular casts or red blood cells.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 0% rating is given if:<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– Hypertension with the average diastolic pressure of less than 100, or with the average systolic pressure of less than 160.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">– Albumin and casts are present in the urine with a history of nephritis.<o:p></o:p></span></div>
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<i><span lang="EN-GB">-Proposed-</span></i><span lang="EN-GB"> In order to qualify for ratings 30%-100%, a chronic kidney disease must be diagnosed. <o:p></o:p></span></div>
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<span lang="EN-GB"> </span>A 100% rating is given if at least one of the following is present:<span lang="EN-GB"><o:p></o:p></span></div>
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– A GFR (glomerular filtration rate) less than 15mL/min/1.73 m<sup>2 </sup>for a minimum of 3 consecutive months<o:p></o:p></div>
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– The condition requires regular dialysis.<o:p></o:p></div>
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– A kidney transplant has been performed<o:p></o:p></div>
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An 80% rating is given if the GFR is between 15 and 29 mL/min/1.73 m<sup>2 </sup>for a minimum of 3 consecutive months<o:p></o:p></div>
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A 60% rating is given if the GFR is between 30 and 44 mL/min/1.73 m<sup>2 </sup>for a minimum of 3 consecutive months.<o:p></o:p></div>
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A 30% rating is given if the GFR is between 45 and 59 mL/min/1.73 m<sup>2 </sup>for a minimum of 3 consecutive months<o:p></o:p></div>
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A 0% rating is given in the following symptoms are present for at least 3 consecutive months, even if a chronic kidney disease has not yet been diagnosed:<o:p></o:p></div>
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– The GFR is between 60 and 89 mL/min/1.73 m<sup>2</sup> <u>and</u><sup> </sup>there are recurrent red blood cell casts, white blood cell casts, <u>or</u> granular casts<o:p></o:p></div>
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– The GFR is between 60 and 89 mL/min/1.73 m<sup>2</sup> <u>and</u> there are abnormalities in the kidneys structure (cysts, obstruction, etc.)<o:p></o:p></div>
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– The GFR is between 60 and 89 mL/min/1.73 m<sup>2</sup> <u>and</u> the albumin/creatinine ratio (ACR) is 30 mg/g or more <o:p></o:p></div>
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<span lang="EN-GB">Note: Both estimated GFR (eGFR) and creatinine based approximations of GFR will be accepted for GFR ratings as long as they are calculated by a qualified physician. <o:p></o:p></span></div>
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<span lang="EN-GB">These are by far the biggest changes proposed. The VA feels that the current renal ratings are based on out-dated medical tests and other vague standards. The glomerular filtration rate is now the medical standard used to measure how well kidneys are filtering the blood. As it is a more accurate test of kidney health, the VA proposes to use it as the standard for rating criteria. <o:p></o:p></span></div>
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<span lang="EN-GB">The VA recognizes that the additional rating criteria is necessary to ensure that the full picture of the disease is taken into account for rating purposes. This is especially important for the 0% ratings, as a high GFR may not mean that the kidney isn’t impaired and causing symptoms. Thus additional symptoms are taken into account to reflect the increased risk for the development of chronic kidney disease. <o:p></o:p></span></div>
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<span lang="EN-GB">The 100% rating for individuals post-kidney transplant is another important addition. <o:p></o:p></span></div>
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<span lang="EN-GB">_______________________________________________________________________<o:p></o:p></span></div>
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<span lang="EN-GB">Renal (Kidney) Conditions<o:p></o:p></span></div>
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<span lang="EN-GB">The following conditions will still be rated on the renal rating system, but the new one proposed above. <o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#k" target="_blank">7500</a> for nephrectomy remains the same.<o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#k" target="_blank">7502</a> for nephritis remains the same, except that the note stating that only nephritis or a heart disease caused by the same condition (note both) could be rated is now extended to ALL renal conditions. So…<o:p></o:p></span></div>
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<span lang="EN-GB">NEW NOTE FOR ALL RENAL CONDITIONS:<o:p></o:p></span></div>
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Renal disease is often closely related to <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html" style="color: purple;"><span lang="EN-US">heart diseases</span></a></span>. If renal disease is present <u>and</u> a heart disease is present and both are caused by the same general condition, then only one rating can be given even though there are <a href="https://www.blogger.com/null" name="m"></a>two organs affected by the condition. Only the condition that rates the highest is used. The heart disease can, however, be rated separately if one kidney was removed because of renal disease but the remaining kidney is healthy. Then the heart disease warrants its own rating and the removed kidney can receive its own rating under code <span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#k" style="color: purple;"><span lang="EN-US">7500</span></a></span>. The heart disease could also be rated <a href="https://www.blogger.com/null" name="n"></a>separately if the renal disease is severe enough to need regular dialysis.<o:p></o:p></div>
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<span lang="EN-GB">All renal conditions are often closely related to heart conditions, so to limit this rule to just cases of nephritis doesn’t make sense. If the heart condition is caused by the same thing as the renal condition, then it applies. <o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#n" target="_blank">7504</a> for pyelonephritis remains the same. <o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#n" target="_blank">7507</a> for nephrosclerosis remains the same. <o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#p" target="_blank">7530</a> for any kidney disease that requires regular dialysis remains the same. <o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#p" target="_blank">7531</a> for a kidney transplant remains the same. <o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#r" target="_blank">7532</a> for renal tubular conditions remains the same. <o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#r" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7533</span></b></a></span><span style="font-size: 10pt;">: Any <b>cystic disease of the kidney</b> is rated under this code. <a href="https://www.blogger.com/null" name="u"></a>A cyst is a sac most often containing fluid that can grow anywhere in the body. Many do not cause problems, but some can seriously affect the functioning of the organs.<o:p></o:p></span></div>
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<i>-Proposed-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7533</span></b></span>: Any <b>cystic disease of the kidney</b> is rated under this code. A cyst is a sac most often containing fluid that can grow anywhere in the body. Many do not cause problems, but some can seriously affect the functioning of the organs. Some conditions rated under this code include <b>poycystic diseases, uremic medullary cystic disease, medullary sponge kidney, Alport’s syndrome, cystinosis, primary oxalosis, Fabry’s disease</b>, and more.<o:p></o:p></div>
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Again, the VA is just adding more conditions to this code to make sure that they are rated under the most appropriate code.<o:p></o:p></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#t" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7534</span></b></a></span><span style="font-size: 10pt;">: <b>Atherosclerotic renal disease</b> (also known as <b>renal artery stenosis</b> or <a href="https://www.blogger.com/null" name="v"></a><b>atheroembolic renal disease</b>) is a condition where the artery to the kidney narrows and decreases the blood flow to the kidney.<o:p></o:p></span></div>
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<i>-Proposed-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7534</span></b></span>: <b>Atherosclerotic renal disease</b> (also known as <b>renal artery stenosis</b>, <b>atheroembolic renal disease</b>, or<b> large vessel disease</b>) is a condition where the artery to the kidney narrows and decreases the blood flow to the kidney.<o:p></o:p></div>
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<span lang="EN-GB">Similarly, the VA just wants to make sure that large vessel disease is properly rated under this code. <o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#u" target="_blank">7535</a> for toxic nephropathy remains the same. <o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#u" target="_blank">7536</a> for glomerulonephritis remains the same. <o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#m" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7537</span></b></a></span><span style="font-size: 10pt;">:<b> Interstitial nephritis</b> occurs when the spaces between <a href="https://www.blogger.com/null" name="o"></a>the tubules in the kidney swell. This reduces the ability of the kidneys to filter blood</span>.<o:p></o:p></div>
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<i>-Proposed-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7537</span></b></span>:<b> Interstitial nephritis</b> occurs when the spaces between the tubules in the kidney swell. This reduces the ability of the kidneys to filter blood. This code also covers <b>gouty nephropathy</b>(the decrease of kidney function caused by high levels of uric acid due to gout) and <b>disorders of calcium metabolism </b>(the inability to properly metabolize calcium). <o:p></o:p></div>
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<span lang="EN-GB">The VA feels that code 7537 is the best rating option for gouty nephropathy and disorders of calcium metabolism and so adds them here. <o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#w" target="_blank">7538 </a>for papillary necrosis remains the same. <o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#w" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7539</span></b></a></span><span style="font-size: 10pt;">: <b>Renal amyloid disease</b> is caused by the buildup <a href="https://www.blogger.com/null" name="z"></a>of protein in the kidney, which may result in the kidney not being able to filter blood.<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#z" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7541</span></b></a></span><span style="font-size: 10pt;">: <b>Renal Involvement</b> in other conditions. So, if the kidneys are affected<a href="https://www.blogger.com/null" name="aa"></a> by conditions like sickle cell anemia, lupus, or diabetes, it can be rated separately from those conditions.<o:p></o:p></span></div>
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<i>-Proposed-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7539</span></b></span>: <b>Renal amyloid disease</b> is caused by the buildup of protein in the kidney, which may result in the kidney not being able to filter blood. <o:p></o:p></div>
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In addition, <b>renal involvement in other systemic conditions</b> is rated under this code. This includes renal involvement in conditions such as lupus, sickle cell disease, Henoch-Schonlein syndrome, and other systemic conditions. <o:p></o:p></div>
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<i>-Proposed-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7541</span></b></span>: <b>Renal involvement</b> in diabetes mellitus is rated under this code. So if a veteran is diagnosed with either type I or type II diabetes, and it causes a decrease in renal function, it would be rated under this code. <o:p></o:p></div>
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For these two codes, the VA basically combined them all under code 7539. They only left diabetes mellitus separate because they wanted to be able to more accurately track the rate of this condition in the veteran population. Thus code 7541 is now just for renal involvement in diabetes. <o:p></o:p></div>
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<i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 7544:</b> <b>Renal disease caused by viral infections</b>, such as HIV and Hepatitis B or C, are rated under this code. This code includes renal disease caused by the treatment of such viral infections as well. <o:p></o:p></span></div>
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The VA proposes to add a new code to specifically cover diseases caused by viral infections. While this code is not limited to HIV and Hepatitis B or C, for other viral infections to qualify, there must be regular clinical proof that the infection itself or its treatment causes kidney disease. For this reason, Hepatitis A is not included as there is clinical proof that it does not cause kidney disease. <o:p></o:p></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#aa" target="_blank">7509</a> for hydronephrosis remains exactly the same.<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#bb" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7508</span></b></a></span><span style="font-size: 10pt;">: <b>Nephrolithiasis</b> (also known as <b>kidney stones</b>) is the presence of stones in the kidney or ureter. These stones block the flow of urine through the tubes. This condition is rated as hydronephrosis unless stones are <u>repeatedly</u> formed and it requires either drug therapy, diet therapy, or removal surgeries or procedures 3 or more times each year. If this is the case, it is rated 30%. Otherwise, rate as hydronephrosis.<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#cc" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7510</span></b></a></span><span style="font-size: 10pt;">: <b>Ureterolithiasis</b> is the presence of stones in the ureter. These stones can block the flow of urine through the tubes. This condition is rated as hydronephrosis unless stones are <u>repeatedly</u> formed and it requires either drug therapy, diet therapy, <u>or</u> removal surgeries or procedures 3 or more times each year. If this is the case, it is rated 30%. Otherwise, rate as hydronephrosis.<o:p></o:p></span></div>
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<i>-Proposed-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7508</span></b></span>: <b>Nephrolithiasis</b> (also known as <b>kidney stones</b>) is the presence of stones in the kidney. <b>Ureterolithiasis</b> is the presence of stones in the ureter. <b>Nephrocalcinosis</b> is the buildup of calcium in the kidneys that can lead to stone formation. These stones block the flow of urine through the tubes. <o:p></o:p></div>
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If stones are <u>repeatedly</u> formed and it requires removal surgeries or procedures 3 or more times each year, it is rated 30%. Otherwise, rate as hydronephrosis.<o:p></o:p></div>
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The VA proposes combining codes 7508 and 7510 into a single code since both deal with the formation of stones that block the urinary tract. They also suggest adding nephrocalcinosis to this code to ensure its proper rating. The ratings for this would mostly stay the same, but dietary and drug treatments for stone have not proven pertinent to this condition, so they suggest removing them. <o:p></o:p></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#dd" target="_blank">7511</a> for ureteral stricture remains exactly the same.<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#ee" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7520</span></b></a></span><span style="font-size: 10pt;">: If half or more of the <b>penis is removed</b>, then it is rated 30%. This condition can also be rated under the urinary rating system if that can result in a higher rating than 30%.<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#ee" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7521</span></b></a></span><span style="font-size: 10pt;">: If the glans is removed, it is rated 20%. This condition can also be rated under the urinary rating system if that can result in a higher rating than 20%.</span><span style="font-size: 10pt;"><span lang="EN-GB"><o:p></o:p></span></span></div>
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<i>-Proposed-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7520</span></b></span>: If half or more of the <b>penis is removed</b>, then it is rated 30%. This condition may qualify for SMC-K as loss of use of a creative organ. <o:p></o:p></div>
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<i>-Proposed-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7521</span></b></span>: If the glans is removed, it is rated 20%. This condition may qualify for SMC-K as loss of use of a creative organ.<o:p></o:p></div>
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The VA proposes to remove the option to rate these conditions as urinary dysfunction since most of the circumstances around urinary dysfunction (like leakage, use of a pad, etc.) don’t really apply. These both, however, might qualify for Special Monthly Compensation, Category K (<a href="http://www.militarydisabilitymadeeasy.com/specialmonthlycompensation.html#k" target="_blank">SMC-K</a>) since they may result in the loss of use of the creative organ, if it no longer can function in that way. <o:p></o:p></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#gg" style="color: purple;" target="_blank"><b><span lang="EN-US" style="font-size: 10pt;">7522</span></b></a></span><span style="font-size: 10pt;">: If the <b>penis is deformed</b> and cannot erect<a href="https://www.blogger.com/null" name="ii"></a>, then it is rated 20%.<o:p></o:p></span></div>
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<i>-Proposed-</i><b> Code </b><span lang="EN-GB"><b><span lang="EN-US">7522</span></b></span>: Erectile dysfunction, for any reason, is rated 0%. This condition may qualify for SMC-K as loss of use of a creative organ. <o:p></o:p></div>
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<span lang="EN-GB">This is the change that is going to cause the most waves. The VA proposes to no longer rate erectile dysfunction at all. They justify this change by claiming that they offer compensable ratings for conditions that interfere with the veteran’s ability to work. Erectile dysfunction does not interfere with the veteran’s ability to work, and so should not be rated more than 0%. <o:p></o:p></span></div>
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<span lang="EN-GB">This condition may, however, still qualify for </span>Special Monthly Compensation, Category K (<a href="http://www.militarydisabilitymadeeasy.com/specialmonthlycompensation.html#k" target="_blank">SMC-K</a>) since it is considered loss of use of a reproductive organ.<span lang="EN-GB"><o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#ll" target="_blank">7505</a> for tuberculosis of the kidney remains exactly the same.<o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#hh" target="_blank">7523</a> for atrophy of the testicles remains exactly the same.<o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#hh" target="_blank">7524</a> for removal of the testicles remains exactly the same.<o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#jj" target="_blank">7528</a> for malignant cancer remains exactly the same.<o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#jj" target="_blank">7529</a> for benign tumors remains exactly the same.<o:p></o:p></span></div>
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<span lang="EN-GB">__________________________________________________________________________<o:p></o:p></span></div>
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<i><span lang="EN-GB">-NEW Proposed Code-</span></i><span lang="EN-GB"> <b>Code 7543:</b> <b>Varicocele</b> (enlarged veins in the scrotum) and <b>hydrocele</b> (the build-up of fluid around the testicles) are both rated 0% under this code.</span> These conditions may qualify for SMC-K as loss of use of a creative organ if they result in infertility.<o:p></o:p></div>
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<span lang="EN-GB">The VA proposes adding a new code to cover varicocele and hydrocele—both conditions that are not currently addressed in the VASRD. These conditions do not interfere with the ability of the veteran to work, and so the VA proposes only a 0% rating. However, if they lead to infertility, they would qualify for <a href="http://www.militarydisabilitymadeeasy.com/specialmonthlycompensation.html#k" target="_blank">SMC-K</a>. <o:p></o:p></span></div>
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Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com30tag:blogger.com,1999:blog-4162041641030931379.post-87924184557923604832019-09-18T09:02:00.001-07:002019-09-18T09:02:37.723-07:00Cardiovascular System Changes Comments<div class="MsoNormal" style="font-family: Cambria; margin: 0in 0in 0.0001pt;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPDpFrY8tZ2DYEfeRkQIukUigA1dyLyHQ9AXWevMuI-uFExWrTbAd_23XJFuab9B_7Dm8UabdqfA_IU-reQWofcKC1ZRriNAl0dtW4yhP-OmMlZGgrf21EulMVHJNyoSQOVMMlrCLz8so/s1600/cardiovascular+changes.jpeg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="251" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPDpFrY8tZ2DYEfeRkQIukUigA1dyLyHQ9AXWevMuI-uFExWrTbAd_23XJFuab9B_7Dm8UabdqfA_IU-reQWofcKC1ZRriNAl0dtW4yhP-OmMlZGgrf21EulMVHJNyoSQOVMMlrCLz8so/s400/cardiovascular+changes.jpeg" width="400" /></a>The following are the comments we submitted on your behalf to the VA in regards to the <a href="http://blog.militarydisabilitymadeeasy.com/2019/08/proposed-changes-to-ratings-of.html" target="_blank">proposed changes to the ratings of the Cardiovascular System</a>. </div>
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<span lang="EN-GB">Every time the VA publishes their proposed changes for a section of the <a href="http://www.militarydisabilitymadeeasy.com/vasrd.html" target="_blank">VASRD</a>, they include a comment period in which veterans and organizations can provide feedback on the coming changes. Thank you for submitting your comments to us regarding the Cardiovascular System so that we could submit them in a unified front to the VA. Hopefully, we will be able to effect change and make the rating system fairer for all veterans. <o:p></o:p></span></div>
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<span lang="EN-GB">Here are the comments we submitted for the Cardiovascular System: <o:p></o:p></span></div>
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<span lang="EN-GB">We at <a href="http://www.militarydisabilitymadeeasy.com/" style="color: purple;">www.MilitaryDisabilityMadeEasy.com</a> would like to submit the following comments on behalf of our staff and veterans in response to the proposed changes to the ratings for the Cardiovascular System. <o:p></o:p></span></div>
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<span lang="EN-GB">Item #1<o:p></o:p></span></div>
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<span lang="EN-GB">For Code 7019, please clarify the one-year time periods required for the rating and the mandatory evaluation. It doesn’t make sense to have two different one-year time periods for this code. The 100% rating starts on the date of admission to the hospital while the mandatory examination is 1-year from the date of discharge. If the 100% rating can only be for a year, then immediately upon its end, a re-evaluation must take place in order to provide a new rating. If this is to account for the amount of time the person is hospitalized, it might be better to have the 100% start upon admission saying nothing about the 1-year limit. Then specify that the 100% rating will only continue for 1-year following discharge whereupon there must be a mandatory evaluation in order to award the new rating. <o:p></o:p></span></div>
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<span lang="EN-GB">For Code 7110, there is a bit of confusion regarding that “ands” and “ors” in this code. The first part separates the size of the aneurysm from the need for symptoms or surgery, suggesting that the size itself rates 100%. If it is smaller, but causes symptoms and requires surgery, then it is also rated 100%. The 0% code, however, also includes an “or” that would make rating confusing. The wording suggests that any aneurysm less than 5 cm is rated here regardless of the severity of symptoms. Does that mean that a small aneurysm requiring surgery is only rated 0%? Clearly not, so an adjustment in the language would help clarify how these ratings should be applied to ensure proper rating. Potentially, “If less than 5 cm and surgical correction not recommended.”<o:p></o:p></span></div>
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<span lang="EN-GB">Thanks for considering these comments.<o:p></o:p></span></div>
Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com2tag:blogger.com,1999:blog-4162041641030931379.post-25239818769218048652019-08-03T13:54:00.002-07:002019-08-03T13:54:22.606-07:00Proposed Changes to the Ratings of the Cardiovascular System <style class="WebKit-mso-list-quirks-style">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEix4jkO5x5g9M6bI588fPQ8vuJGz7OQx1F-ht9_Lrd_WcDpHpaVqdI5h9JZn9m93qzZejOgpUoBie0_4QTWBQfeiuDhxOHlURILd26zX3Mr3bduWziWfanW4g0rIClyMnObSjco5Yh73rU/s1600/cardiovascular+changes.jpeg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="985" data-original-width="1600" height="198" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEix4jkO5x5g9M6bI588fPQ8vuJGz7OQx1F-ht9_Lrd_WcDpHpaVqdI5h9JZn9m93qzZejOgpUoBie0_4QTWBQfeiuDhxOHlURILd26zX3Mr3bduWziWfanW4g0rIClyMnObSjco5Yh73rU/s320/cardiovascular+changes.jpeg" width="320" /></a></div>
On August 1st, 2019, the VA published a new section of proposed VASRD changes, this time to the ratings of The Cardiovascular System (<a href="http://www.militarydisabilitymadeeasy.com/theheart.html" target="_blank">The Heart</a> and <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html" target="_blank">The Arteries and Veins</a>).</div>
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<span lang="EN-GB">The rewrite of the <a href="http://www.militarydisabilitymadeeasy.com/vasrd.html" target="_blank">VASRD</a> began in 2014 with the goal to be finished by the end of 2016. While they clearly haven’t met their goal, the VA continues to slowly release proposed and finalized changes. <o:p></o:p></span></div>
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<span lang="EN-GB">So far, finalized changes have been made to the ratings of <a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html" target="_blank">Infectious Diseases, Immune Disorders</a>, and <a href="http://www.militarydisabilitymadeeasy.com/nutritionaldeficiencies.html" target="_blank">Nutritional Deficiencies</a>, the <a href="http://www.militarydisabilitymadeeasy.com/theskin.html" target="_blank">Skin</a>, the <a href="http://www.militarydisabilitymadeeasy.com/femalereproductive.html" target="_blank">Female Reproductive System</a>, the <a href="http://www.militarydisabilitymadeeasy.com/theeyes.html" target="_blank">Eyes</a>, the <a href="http://www.militarydisabilitymadeeasy.com/themouthandteeth.html" target="_blank">Dental and Oral Conditions</a>, the <a href="http://www.militarydisabilitymadeeasy.com/theendocrinesystem.html#adrenal" target="_blank">Endocrine System</a>, and <a href="http://www.militarydisabilitymadeeasy.com/mentaldisorders.html" target="_blank">Mental Disorders</a>.<o:p></o:p></span></div>
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<span lang="EN-GB">Other proposed changes that have not yet been finalized include the <a href="http://blog.militarydisabilitymadeeasy.com/2017/08/proposed-changes-to-ratings-of_7.html" target="_blank">Musculoskeletal System</a>.<o:p></o:p></span></div>
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<span lang="EN-GB">With each set of proposed changes, the VA allows a period in which comments can be submitted. The VA then takes each comment into consideration and makes any additional changes that are warranted before publishing the final ruling. <o:p></o:p></span></div>
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<span lang="EN-GB">We encourage you to submit any comments you might have on these proposed changes to us either by commenting on this post or by <a href="http://www.militarydisabilitymadeeasy.com/contactus.html" target="_blank">contacting us</a> through our website. All comments must be received by September 30th, 2019. We will then compile all of your comments into a single report and submit it on your behalf to the VA, just as we did for the other sections (see the <a href="http://blog.militarydisabilitymadeeasy.com/2015/04/you-spoke-we-listenedthe-comments.html" target="_blank">Female Reproductive System Comments</a>). This is a great opportunity to really make a difference, so please let us know your thoughts. <o:p></o:p></span></div>
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<span lang="EN-GB">The following are the VA’s proposed changes to the ratings for the Cardiovascular System. The changes are fairly extensive, so I’ll walk through each, one at a time.<o:p></o:p></span></div>
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<span lang="EN-GB">For each condition, the small, indented parts are the codes as they are right now. Click on the links to be taken to the discussion of that code on our site. After the current code, I’ll discuss the proposed changes and the VA’s justification. <o:p></o:p></span></div>
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<span lang="EN-GB">-Proposed Changes- <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#system" target="_blank">Basic Rating System for Heart Conditions</a><o:p></o:p></span></div>
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The majority of heart conditions are rated based on a set rating system.<o:p></o:p></div>
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<i>Note: It is very important that the physician performing your exam gets an MET (metabolic equivalent of task) test done for ANY heart condition. An MET test, more often known as an exercise test, checks for how much oxygen is being used by the body to perform increasingly strenuous tasks. 1 MET equals the amount of oxygen a person uses when at rest. An MET test is only not required if it is medically contraindicated or if a 100% rating can be made without it. For all other cases, it is <u>essential</u>to getting a proper heart rating. Be proactive and make sure an MET test is done!</i><o:p></o:p></div>
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<i>It is also vital that the need for medication for the condition and whether or not there is hypertrophy or dilation is clearly recorded by the physician.<o:p></o:p></i></div>
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The basic rating system:<o:p></o:p></div>
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A 100% rating is given if an MET test results in 3.0 METs or less and causes symptoms like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting.<o:p></o:p></div>
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A 60% rating is given if an MET test results in 3.1 to 5.0 METs and causes symptoms like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting.<o:p></o:p></div>
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A 30% rating is given if there is one or more of the following:<o:p></o:p></div>
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1) An MET test results in 5.1 to 7.0 METs and causes symptoms like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting.<o:p></o:p></div>
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2) Evidence (echocardiogram, multigated acquisition scan, MRI, etc.) of hypertrophy or dilatation. <o:p></o:p></div>
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A 10% rating is given if there is one or more of the following:<o:p></o:p></div>
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1) An MET test results in 7.1 to 10.0 METs and causes symptoms like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting.<o:p></o:p></div>
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2) Continuous medication is required.<o:p></o:p></div>
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<span lang="EN-GB">The VA is proposing to adjust the Basic Heart Rating System by focusing mostly on MET test results and removing congestive heart failure and ejection fractions as rating options. This is because both congestive heart failure and ejection fractions can be affected by things unrelated to the heart condition itself. Instead, an MET test gives a more accurate reflection of the heart condition itself.<o:p></o:p></span></div>
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<span lang="EN-GB">Codes <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#a" target="_blank">7000</a> for valvular heart disease, <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#a" target="_blank">7001</a> for endocarditis, <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#a" target="_blank">7002</a> for pericarditis, <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#j" target="_blank">7003</a> for pericardial adhesions, <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#j" target="_blank">7004</a> for syphilitic heart disease, <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#j" target="_blank">7005</a> for coronary artery disease, code <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#a" target="_blank">7006</a> for myocardial infarction, code <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#j" target="_blank">7007</a> for hypertensive heart disease, code <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#q" target="_blank">7008</a> for hyperthyroid heart disease remain exactly the same.<o:p></o:p></span></div>
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<i>-Proposed NEW CODE- </i><b>Code 7009: Bradycardia </b>(i.e., <b>bradyarrhythmia</b>, including sinus bradycardia, sinoatrial block, atrioventricular junctional escape rhythm, AV heart block or dissociation, atrial fibrillation/flutter, and idioventricular escape rhythm) <b></b>is an abnormally slow heart rate below 60 beats per minute (bpm). <o:p></o:p></div>
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If the condition requires the implantation of a permanent pacemaker, it is rated 100% for the first month after discharge from the hospital and then rated on the Basic Rating System.<o:p></o:p></div>
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As long as the condition causes clear symptoms, it is rated on the Basic Rating System. If there are no symptoms, then the condition cannot be considered <a href="http://www.militarydisabilitymadeeasy.com/service-connected.html" target="_blank">service-connected</a>.<o:p></o:p></div>
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<span lang="EN-GB">The VA proposes to add this new code to cover all cases of bradycardia. This will be very beneficial as there is currently not a decent code to analogously rate these conditions, making rating choices difficult and inconsistent. Bradycardia isn’t always a problematic condition, however. Healthy, athletic adults and people sleeping often have low heart rates with no negative symptoms. Because of this, only cases of bradycardia that cause negative symptoms can be considered a service-connected disability.<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current- </span></i><b><span style="font-size: 10pt;">Code <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#p" target="_blank">7010</a>: Supraventricular arrhythmias </span></b><span style="font-size: 10pt;">are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two upper chambers. If episodes of abnormal heart rhythms occur 5 or more times a year, then it is rated 30%. A 10% rating is given if episodes of abnormal rhythm occur 1 to 4 times a year or if there is permanent atrial fibrillation with no evidence of other heart diseases or conditions. All episodes must be properly documented by an ECG test.<b><o:p></o:p></b></span></div>
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<i><span lang="EN-GB">-Proposed- </span></i><span lang="EN-GB"></span><b>Code 7010: </b>All types of <b>Supraventricular tachycardia </b>are rated under this code. These are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two upper chambers. The condition must be confirmed by an ECG test.<b><o:p></o:p></b></div>
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If the condition requires intravenous pharmacologic adjustment, cardioversion, and/or ablation to relieve symptoms 5 or more times a year, then it is rated 30%. If the condition requires intravenous pharmacologic adjustment, cardioversion, and/or ablation to relieve symptoms 1 to 4 times a year, then it is rated 10%.<o:p></o:p></div>
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<span lang="EN-GB">The VA is proposing to change the name from arrhythmia, which could be any type of abnormal heart rhythm, to tachycardia, abnormally fast heart rhythms. This code has always been intended to be used just for tachycardias, and this change will help clarify that. The VA is also proposing to change the rating requirements from recorded episodes to required treatments. There can be episodes of tachycardia that do not cause any symptoms and so do not cause a measureable disability. By rating the condition based on needed treatments, the ratings will more properly reflect the disability caused by a symptomatic condition. <o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#f" target="_blank">7011</a>: Sustained ventricular arrhythmias </span></b><span style="font-size: 10pt;">are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two lower chambers. These rhythms can come and go and are usually treated with medication or electric therapy. This condition receives the 100% rating the entire time it is being treated in the hospital or the entire time an implantable defibrillator is in place. If a pacemaker is implanted, then it is rated under code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#h"><span lang="EN-US" style="font-size: 10pt;">7018</span></a></span><span style="font-size: 10pt;">.<o:p></o:p></span></div>
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<i><span lang="EN-GB" style="font-family: "times new roman";">-Proposed- </span></i><span lang="EN-GB" style="font-family: "times new roman";"></span><b><span style="font-family: "times new roman";">Code 7011: Sustained ventricular arrhythmias</span></b><span style="font-family: "times new roman";"> are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two lower chambers. These rhythms can come and go and are usually treated with medication or electric therapy. This condition receives the 100% rating the entire time it is being treated in the hospital or the entire time an implantable defibrillator is in place. If a pacemaker is implanted, then it is rated under code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#h"><span lang="EN-US" style="font-family: "times new roman";">7018</span></a></span><span style="font-family: "times new roman";">. Six months after discharge from the hospital, the condition will be re-evaluated and re-rated based on the Basic Rating System. <o:p></o:p></span></div>
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<span lang="EN-GB">The only change to this code is to establish a 6-month period after hospital discharge for a re-evaluation. <o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current-</span></i><b><span style="font-size: 10pt;"> Code <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#n" target="_blank">7015</a>: Atrioventricular block </span></b><span style="font-size: 10pt;">occurs when the electrical impulses that allow the different parts of the heart to communicate and function are blocked. This must be associated with other evidence of heart disease to be considered unfitting. It is rated on the basic rating system with one addition: if a pacemaker is required, it is rated 10%. <b><o:p></o:p></b></span></div>
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<i><span lang="EN-GB" style="font-family: "times new roman";">-Proposed- </span></i><span lang="EN-GB" style="font-family: "times new roman";"></span><b><span style="font-family: "times new roman";">Code 7015: Atrioventricular block </span></b><span style="font-family: "times new roman";">occurs when the electrical impulses that allow the different parts of the heart to communicate and function are blocked. There are two different types of atrioventricular block: benign and non-benign. A benign condition is less severe and includes First-Degree and Second-Degree (Type I). It is rated on the Basic Rating System. A non-benign condition is much more severe and includes Second-Degree (Type II) and Third-Degree. If it requires a pacemaker, it is rated under code 7018.<o:p></o:p></span></div>
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<span lang="EN-GB">The VA proposes to adjust these ratings to ensure that the severity of the condition is properly rated. Most, if not all, non-benign conditions require a permanent pacemaker, so it makes sense to rate it directly under code 7018. <o:p></o:p></span></div>
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<span lang="EN-GB">Codes <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#g" target="_blank">7016</a> for heart valve replacement, and code <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#e" target="_blank">7017</a> for coronary bypass surgery remain exactly the same.<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current- </span></i><b><span style="font-size: 10pt;">Code <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#h" target="_blank">7018</a>: Cardiac pacemakers </span></b><span style="font-size: 10pt;">are implanted if the rhythm of the heart is too slow. This condition is rated 100% for the first 2 months following the surgery. After that, it is rated under the base condition that caused the irregular heart rhythm: </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#p"><span lang="EN-US" style="font-size: 10pt;">supraventricular arrhythmias</span></a></span><span style="font-size: 10pt;">, </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#f"><span lang="EN-US" style="font-size: 10pt;">ventricular arrhythmias</span></a></span><span style="font-size: 10pt;">, or an </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#n"><span lang="EN-US" style="font-size: 10pt;">atrioventricular block</span></a></span><span style="font-size: 10pt;">. The minimum rating for a condition requiring a pacemaker is 10%. If a defibrillator is implanted, then it is rated under code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#f"><span lang="EN-US" style="font-size: 10pt;">7011</span></a></span><span style="font-size: 10pt;">.<b><o:p></o:p></b></span></div>
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<i><span lang="EN-GB" style="font-family: "times new roman";">-Proposed- </span></i><b><span style="font-family: "times new roman";">Code 7018: Cardiac pacemakers </span></b><span style="font-family: "times new roman";">are implanted if the rhythm of the heart is too slow. This condition is rated 100% for the first month following discharge from the hospital after the surgery. After that, it is rated under the base condition that caused the irregular heart rhythm: </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#p"><span lang="EN-US" style="font-family: "times new roman";">supraventricular arrhythmias</span></a></span><span style="font-family: "times new roman";">, </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#f"><span lang="EN-US" style="font-family: "times new roman";">ventricular arrhythmias</span></a></span><span style="font-family: "times new roman";">, or an </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#n"><span lang="EN-US" style="font-family: "times new roman";">atrioventricular block</span></a></span><span style="font-family: "times new roman";">. The minimum rating for a condition requiring a pacemaker is 10%. If a defibrillator is implanted, then it is rated under code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#f"><span lang="EN-US" style="font-family: "times new roman";">7011</span></a></span><span style="font-family: "times new roman";">.<o:p></o:p></span></div>
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<span lang="EN-GB">The only change to this is to allow a 1 month 100% rating after hospital discharge following the surgery instead of 2 months after the surgery itself. The VA justifies this change by stating that new surgical techniques require a much shorter recovery period. Since less time is needed a month should cover most recovery needs. For those with more serious cases that need longer hospital stays, they’ll still be covered by the <a href="http://www.militarydisabilitymadeeasy.com/vasrdprinciples.html#hospital" target="_blank">Hospital Ratings Principle</a> that rates long hospital stays (21 days+) 100% anyway. <o:p></o:p></span></div>
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<span lang="EN-GB">Codes <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#i" target="_blank">7019</a> for heart transplant, <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#o" target="_blank">7020</a> for cardiomyopathy, and <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#a" target="_blank">7101</a> for hypertension remain the same.<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current- </span></i><b><span style="font-size: 10pt;">Code <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#b" target="_blank">7110</a>: </span></b><span style="font-size: 10pt;">If an <b>aneurysm in the aortic artery</b> is corrected by surgery, then it is rated 100% from the day of admittance to the hospital. This rating continues for the first 6 months after discharge from the hospital. The condition is then reevaluated and rated accordingly. If the condition is active and causes <a href="https://www.blogger.com/null" name="c"></a>symptoms such as pain or hemorrhaging, or if it is 5 centimeters or larger in diameter, then it is rated 100%. If the condition is serious enough that you cannot perform moderately strenuous activities (lifting weights or running), then it is rated 60%. If the condition does not qualify for these ratings, then it is rated based on the existing symptoms in the affected organ (e.g. if it caused erratic heart beats, then it would be rated as arrhythmia).<b><o:p></o:p></b></span></div>
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<i><span lang="EN-GB" style="font-family: "times new roman";">-Proposed- </span></i><span lang="EN-GB" style="font-family: "times new roman";"></span><span style="font-family: "times new roman";"><b>Code 7110: Aneurysms in the thoracic, abdominal, </b>or <b>ascending aortic artery </b></span><span style="font-family: "times new roman";">are rated under this code. Aneurysms occur when the aorta significantly expands with the potential of bursting. <o:p></o:p></span></div>
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<span style="font-family: "times new roman";">If the aneurysm is 5 cm or larger, it is rated 100%. If it causes symptoms (like the inability to perform moderately strenuous activities for fear of rupture) and a physician recommends surgery, it is rated 100% from the date of the physician’s recommendation until 6 months after discharge following the surgery. After that, any remaining heart symptoms are rated on the Basic Rating System. All other symptoms can be rated separately on the body system affected. <o:p></o:p></span></div>
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<span style="font-family: "times new roman";">If the aneurysm is less than 5 cm and surgery is not recommended, it is rated 0%. <o:p></o:p></span></div>
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<span lang="EN-GB">The VA proposes to eliminate a 60% rating, stating that any condition causing symptoms is serious enough to need surgery to avoid a medical emergency and so should be rated 100%. The addition of the 0% rating allows conditions without symptoms to be increased more quickly if they worsen and require surgery quickly. <o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current- </span></i><b><span style="font-size: 10pt;">Code <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#b" target="_blank">7111</a>: </span></b><span style="font-size: 10pt;">If an <b>aneurysm in any large artery </b>(except the aortic artery) is surgically corrected, then it is rated 100% from the date of admission to the hospital. This rating continues for the first 6 months after discharge from the hospital. The condition is then reevaluated and rated accordingly. A 100% rating is given if there is pain in the limbs (claudication) <u>and </u>tears in the skin of the limbs from lack of oxygen <u>or</u>if there is pain in the limbs <u>and </u>the ankle brachial index is 0.4 or less.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 60% rating is given if you cannot walk further than 25 yards without limping because of pain <u>and </u>one or more of the following: there is coldness in the limb that does not respond to warming methods, there are one or more tears in the skin of the limb, or the ankle brachial index is 0.5 or less.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 40% rating is given if you have limping because of pain when walking between 25 and 100 yards <u>and </u>one or more of the following: there are 1.) changes to the hair, skin, or nails of the affected limb, or 2.) the ankle brachial index is 0.7 or less.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 20% rating is given if you have limping because of pain when walking more than 100 yards and one or more of the following: the pulse in the limb is diminished, or the ankle brachial index is 0.9 or less.<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">Note: These ratings are for a single limb only. If more than one limb has an aneurysm, then rate each separately.</span></i><span style="font-size: 10pt;"><o:p></o:p></span></div>
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<i><span lang="EN-GB" style="font-family: "times new roman";">-Proposed- </span></i><span lang="EN-GB" style="font-family: "times new roman";"></span><b><span style="font-family: "times new roman";">Code 7111: </span></b><span style="font-family: "times new roman";">If an <b>aneurysm in any large artery </b>(except the aortic artery, above) causes symptoms (like the inability to perform moderately strenuous activities for fear of rupture), it is rated 100%. If a physician recommends surgery, it is rated 100% from the date of the physician’s recommendation until 6 months after discharge following the surgery. After that, it is rated under code 7114. <o:p></o:p></span></div>
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<span lang="EN-GB">These changes clarify how the 100% rating should be applied. By eliminating the remaining rating options and instructing for further ratings to be done under code 7114, the VA is hoping to simplify the process. Code 7114, for peripheral artery disease, causes similar symptoms as post-surgical aneurysms. <o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#d" target="_blank">7112</a> for small artery aneurysms remains the same.<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current- </span></i><b><span style="font-size: 10pt;">Code <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#d" target="_blank">7113</a></span></b><span style="font-size: 10pt;">: A <b>traumatic arteriovenous fistula </b>is an abnormal passageway between an artery and a vein. They are most often caused by penetrating wounds that affected nearby arteries or veins, thus causing the body to create a false passageway to continue blood flow. They can cause the heart to have to work harder to provide the necessary blood to all regions of the body, thus leading to various heart conditions. It can also cause loss of blood flow to the limbs resulting in pain, infection, swelling, skin changes, or amputation.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">If the condition causes heart failure, then it is rated 100%. If the heart has not failed, but is enlarged with a rapid pulse and a wide pulse pressure, then it is rated 60%. If the heart is not affected, but in an arm there is swelling, stasis dermatitis, <u>and </u>either tears in the skin or a cellulitis infection, then it is rated 40%. If a leg has swelling, stasis dermatitis, <u>and </u>either tears in the skin or a cellulitis infection, it is rated 50%. If there is only swelling <u>or </u>stasis dermatitis in a leg, then it is rated 30%. If the swelling <u>or </u>stasis dermatitis is in an arm, it is rated 20%.<o:p></o:p></span></div>
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<i>-Proposed- </i><b>Code 7113: </b>A <b>traumatic arteriovenous fistula </b>is an abnormal passageway between an artery and a vein. They are most often caused by penetrating wounds that affected nearby arteries or veins, thus causing the body to create a false passageway to continue blood flow. They can cause the heart to have to work harder to provide the necessary blood to all regions of the body, thus leading to various heart conditions. It can also cause loss of blood flow to the limbs resulting in pain, infection, swelling, skin changes, or amputation.<o:p></o:p></div>
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If the condition causes heart failure, then it is rated 100%. If the heart has not failed, but is enlarged with a rapid pulse and a wide pulse pressure, then it is rated 60%. <o:p></o:p></div>
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If the heart is not affected, there is constant swelling, stasis dermatitis, <u>and </u>either tears in the skin or a cellulitis infection in a leg then it is rated 50%. If the same symptoms are in an arm, it is rated 40%. <o:p></o:p></div>
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If there is only constant swelling <u>or</u>stasis dermatitis in a leg, then it is rated 30%. If the same symptoms are in an arm, it is rated 20%.<o:p></o:p></div>
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<span lang="EN-GB">The only real change to this code is to specify that the swelling must be chronic, or constant. </span><o:p></o:p></div>
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<i><span style="font-size: 10pt;">-Current- </span></i><b><span style="font-size: 10pt;">Code <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#f" target="_blank">7114</a>: Arteriosclerosis obliterans </span></b><span style="font-size: 10pt;">(a.k.a. <b>peripheral vascular disease</b>) is the thickening and hardening of the tissues of a vessel that causes the vessel to narrow and develop blood clots. This condition most often affects the aortic artery in the abdomen and the small or medium vessels in the legs.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 100% rating is given if there is pain in the limbs <u>and </u>tears in the skin of the limbs from lack of oxygen <u>or </u>if there is pain in the limbs <u>and </u>the ankle brachial index is 0.4 or less.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 60% rating is given if you cannot walk further than 25 yards without limping because of leg pain (claudication) <u>and </u>one or more of the following: there is coldness in the limb that does not respond to warming methods, there are one or more tears in the skin of the limb, or the ankle brachial index is 0.5 or less.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 40% rating is given if there is limping because of leg pain when walking between 25 and 100 yards <u>and </u>one or more of the following: there are 1.) changes to the hair, skin, or nails of the affected limb, or 2.) the ankle brachial index is 0.7 or less.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 20% rating is given if there is limping because of leg pain when walking more than 100 yards and one or more of the following: the pulse in the limb is diminished, or the ankle brachial index is 0.9 or less.<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">Note: The above ratings are for a single limb only. If more than one limb is affected, then rate each separately.</span></i><span style="font-size: 10pt;"><o:p></o:p></span></div>
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<i>-Proposed- </i><b>Code 7114: Peripheral arterial disease </b>is the thickening and hardening of the tissues of a vessel that causes the vessel to narrow and develop blood clots. This condition most often affects the aortic artery in the abdomen and the small or medium vessels in the legs. All symptoms remaining after an <b>aortic bypass surgery </b>or a <b>large arterial bypass surgery </b>are rated under this code.<o:p></o:p></div>
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For a 100% rating, there must be at least one of the following: <o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->ankle pressure less than 50mm Hg<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->toe pressure less than 30mm Hg<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->transcutaneous oxygen tension less than 30 mm Hg<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--> ankle brachial index 0.39 or less<o:p></o:p></div>
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For a 60% rating, there must be at least one of the following: <o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->ankle pressure 50–65 mm Hg<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->toe pressure 30–39 mm Hg<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->transcutaneous oxygen tension 30–39 mm Hg<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--> ankle brachial index is 0.40–0.53<o:p></o:p></div>
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For a 40% rating, there must be at least one of the following: <o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->ankle pressure 66–83 mm Hg<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->toe pressure 40–49 mm Hg<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->transcutaneous oxygen tension 40–49 mm Hg<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--> ankle brachial index is 0.54–0.66<o:p></o:p></div>
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For a 20% rating, there must be at least one of the following: <o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->ankle pressure 84–99 mm Hg<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->toe pressure 50–59 mm Hg<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->transcutaneous oxygen tension 50–59 mm Hg<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--> ankle brachial index is 0.67–0.79<o:p></o:p></div>
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Whichever test result allows for the higher rating is the test that should be used for rating purposes. <o:p></o:p></div>
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<i>Note: The above ratings are for a single limb only. If more than one limb is affected, then rate each separately.</i><o:p></o:p></div>
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<span lang="EN-GB">The VA proposes to update the name of the condition to the one more commonly used today. They also propose to expand the rating options to include more wide-spread measurements that better reflect the overall disability of a condition. The ankle pressure is the systolic blood pressure measured at the ankle. The toe pressure is the systolic blood pressure measured in the big toe. The transcutaneous oxygen tension is a test that measures the amount of oxygen in the blood at the intercostal space on the foot.<o:p></o:p></span></div>
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<span lang="EN-GB">The VA also makes it clear that symptoms remaining after large artery bypass surgery should be rated under this code. <o:p></o:p></span></div>
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<span lang="EN-GB">__________________________________________________________________<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current- </span></i><b><span style="font-size: 10pt;">Code <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#f" target="_blank">7115</a>: Thrombo-angiitis obliterans </span></b><span style="font-size: 10pt;">(or <b>“Buerger’s Disease”</b>) is a disease where the blood vessels of the hands or feet become blocked due to the build up of plaque. It is mostly associated with the use of tobacco products. It causes pain and swelling in the hands and feet and could result in necessary amputation.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 100% rating is given if there is pain in the limbs <u>and </u>tears in the skin of the limbs from lack of oxygen <u>or </u>if there is pain in the limbs <u>and </u>the ankle brachial index is 0.4 or less.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 60% rating is given if you cannot walk further than 25 yards without limping because of leg pain (claudication) <u>and </u>one or more of the following: there is coldness in the limb that does not respond to warming methods, there are one or more tears in the skin of the limb, or the ankle brachial index is 0.5 or less.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 40% rating is given if there is limping because of leg pain when walking between 25 and 100 yards <u>and </u>one or more of the following: there are 1.) changes to the hair, skin, or nails of the affected limb, or 2.) the ankle brachial index is 0.7 or less.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 20% rating is given if there is limping because of leg pain when walking more than 100 yards and one or more of the following: the pulse in the limb is diminished, or the ankle brachial index is 0.9 or less.<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">Note: The above ratings are for a single limb only. If more than one limb is affected, then rate each separately.</span></i></div>
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<i>-Proposed- </i><b>Code 7115: Thrombo-angiitis obliterans </b>(or <b>“Buerger’s Disease”</b>) is a disease where the blood vessels of the hands or feet become blocked due to the build up of plaque. It is mostly associated with the use of tobacco products. It causes pain and swelling in the hands and feet and could result in necessary amputation.<o:p></o:p></div>
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If the condition affects the legs, it is rated under code 7114. If the condition affects the arms, it is rated under the following system:<o:p></o:p></div>
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A 100% rating is given if there are tears in the skin, death of the tissues from lack of oxygen, continual coldness in the limb, trophic changes, pain with use, and a weak pulse in the arm. <o:p></o:p></div>
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A 60% rating is given if there is continual coldness in the limb, trophic changes, pain with use, and a weak pulse in the arm.<o:p></o:p></div>
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A 40% rating is given if there are trophic changes, numbness in the fingertips, and a weak pulse in the arm.<o:p></o:p></div>
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A 20% rating is given if there is a weak pulse in the arm.<o:p></o:p></div>
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<i>Trophic changes include thinning of the skin, skin atrophy, hair loss, tears in the skin, fingernail deformities, etc. <o:p></o:p></i></div>
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<i>Note: The above ratings are for a single arm only. If more than one arm is affected, then rate each separately.<o:p></o:p></i></div>
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<span lang="EN-GB">The VA proposes to change this code to better reflect the unique affect it has on the arms. The legs would still be rated under the same rating system as code 7114, but the arms would get their own rating system. <o:p></o:p></span></div>
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<span lang="EN-GB">___________________________________________________________________<o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#g" target="_blank">7117</a> for Raynaud’s Syndrome (a.k.a. “Raynaud’s phenomenon” or “secondary Raynaud’s”) remains exactly the same except to specify that only Raynaud’s syndrome can be rated under this code. Raynaud’s <u>disease </u>would be rated under the new code 7124, below.<o:p></o:p></span></div>
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<span lang="EN-GB">____________________________________________________________________<o:p></o:p></span></div>
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<span lang="EN-GB">Codes <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#i" target="_blank">7118</a> for angioneurotic edema, <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#h" target="_blank">7119</a> for erythromelalgia, <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#j" target="_blank">7120</a> for varicose veins, and <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#j" target="_blank">7121</a> for post-phlebitic syndrome remain the same.<o:p></o:p></span></div>
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<span lang="EN-GB">_____________________________________________________________________<o:p></o:p></span></div>
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<i><span style="font-size: 10pt;">-Current- </span></i><b><span style="font-size: 10pt;">Code <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#k" target="_blank">7122</a>: Frostbite and other conditions caused by overexposure to the cold </span></b><span style="font-size: 10pt;">can cause permanent damage to the arteries, nerves, and veins and are rated on the persistent symptoms of the condition.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 30% rating is given if there is joint pain, numbness <u>or </u>sensitivity to the cold in the area affected <u>and </u>two or more of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, or other abnormalities proven by x-ray.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 20% rating is given if there is joint pain, numbness <u>or </u>sensitivity to the cold in the area affected <u>and </u>one of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, or other abnormalities proven by x-ray.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">A 10% rating is given if there is only pain, numbness <u>or </u>sensitivity to the cold in the affected area.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">These ratings are for individual parts affected. So if a foot and a hand are both affected, then they each receive a separate rating. This does not include individual toes or fingers—if one or more fingers or toes are affected, then it is just rated once on the hand or foot.<o:p></o:p></span></div>
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<span style="font-size: 10pt;">Any other conditions resulting from overexposure to the cold not listed under this code are to be rated separately, including amputations, carcinomas and neuropathies.<o:p></o:p></span></div>
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<i>-Proposed- </i><b>Code 7122: Frostbite and other conditions caused by overexposure to the cold </b>can cause permanent damage to the arteries, nerves, and veins and are rated on the persistent symptoms of the condition.<o:p></o:p></div>
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A 30% rating is given if there is joint pain, numbness <u>or </u>sensitivity to the cold in the area affected <u>and </u>two or more of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, inability to sweat, muscle atrophy, fibrosis, deformation of the toe or finger joints, loss of the pads in the toes or fingers, bone tissue death (necrosis), constant tears in the skin, carpal tunnel, tarsal tunnel, or other abnormalities proven by x-ray.<o:p></o:p></div>
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A 20% rating is given if there is joint pain, numbness <u>or </u>sensitivity to the cold in the area affected <u>and </u>one of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, inability to sweat, muscle atrophy, fibrosis, deformation of the toe or finger joints, loss of the pads in the toes or fingers, bone tissue death (necrosis), constant tears in the skin, carpal tunnel, tarsal tunnel, or other abnormalities proven by x-ray.<o:p></o:p></div>
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A 10% rating is given if there is only pain, numbness <u>or</u>sensitivity to the cold in the affected area.<o:p></o:p></div>
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These ratings are for individual parts affected. So if a foot and a hand are both affected, then they each receive a separate rating. This does not include individual toes or fingers—if one or more fingers or toes are affected, then it is just rated once on the hand or foot.<o:p></o:p></div>
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Any other conditions resulting from overexposure to the cold not listed under this code are to be rated separately, including amputations, carcinomas and neuropathies.<o:p></o:p></div>
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<span lang="EN-GB">The VA proposes to expand the list of symptoms that cold exposure can cause. <o:p></o:p></span></div>
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<span lang="EN-GB">____________________________________________________________________<o:p></o:p></span></div>
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<span lang="EN-GB">Code <a href="http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#l" target="_blank">7123</a> for soft tissue sarcoma will remain the same.<o:p></o:p></span></div>
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<i>-Proposed NEW CODE- </i><b>Code 7124: Raynaud’s Disease </b>(a.k.a. “<b>primary R</b><b>aynaud’s phenomenon</b>” or “<b>primary Raynaud’s</b>”) <b></b>is a condition that causes the blood vessels in the fingers and toes, and sometimes the nose and ears, to narrow and restrict blood flow when the person is stressed, emotionally upset, or cold.</div>
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<o:p></o:p></div>
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Only one rating can be given under this code, regardless of the number of body parts affected. <o:p></o:p></div>
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<span style="font-family: "times new roman";">“Characteristic attacks” describes a period of time, at least a few minutes long, in which the color of the fingers or toes change in at least one limb, occasionally with pain and numbness.<o:p></o:p></span></div>
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Trophic changes include thinning of the skin, skin atrophy, hair loss, tears in the skin, fingernail deformities, etc. <o:p></o:p></div>
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A 10% rating is given if there are characteristic attacks <u>and </u>trophic changes. If there are characteristic attacks, but no trophic changes, it is rated 0%. <o:p></o:p></div>
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<span lang="EN-GB">Raynaud’s disease is a less severe condition than Raynaud’s syndrome. Currently, Raynaud’s disease can only be rated under Raynaud’s syndrome, but the rating requirements under that code do not really reflect Raynaud’s disease symptoms. To fix this and avoid rating confusion, the VA proposes to create a new code for Raynaud’s disease.<o:p></o:p></span></div>
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Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com4tag:blogger.com,1999:blog-4162041641030931379.post-62067650617164143692019-06-20T14:35:00.001-07:002019-06-20T14:35:24.041-07:00Official Changes to the Ratings of Infectious Diseases, Immune Disorders, and Nutritional Deficiencies <div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsAlkeK8BEG2knQb2uKIrXW6ygaDmrbrtaB6udqtp3AJWPKP-sJ5UHUWpWVsRfmMNQHSrI1l2So3aOD44XGryo0xJFsFXWmp3Ew2uX407aLrsId5E3hjZUcf13iM9XgXFoJr6f56_x9IU/s1600/infectious+diseases.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsAlkeK8BEG2knQb2uKIrXW6ygaDmrbrtaB6udqtp3AJWPKP-sJ5UHUWpWVsRfmMNQHSrI1l2So3aOD44XGryo0xJFsFXWmp3Ew2uX407aLrsId5E3hjZUcf13iM9XgXFoJr6f56_x9IU/s320/infectious+diseases.jpg" width="320" /></a>On June 18th, 2019, the VA published their
final changes to the ratings of <a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#">Infectious Diseases, Immune Disorders</a>, and
<a href="http://www.militarydisabilitymadeeasy.com/nutritionaldeficiencies.html">Nutritional Deficiencies</a>.</div>
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<span lang="EN-GB">The rewrite of the <a href="http://www.militarydisabilitymadeeasy.com/vasrd.html">VASRD</a> began in 2014 with
the goal to be finished by the end of 2016. While they clearly haven’t met
their goal, the VA continues to slowly release proposed and finalized changes. <o:p></o:p></span></div>
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<span lang="EN-GB">So far, finalized changes have also been made to
the ratings of the <a href="http://www.militarydisabilitymadeeasy.com/theblood.html">Hematologic and Lymphatic Systems</a>, the <a href="http://www.militarydisabilitymadeeasy.com/theskin.html">Skin</a>, the <a href="http://www.militarydisabilitymadeeasy.com/femalereproductive.html">Female Reproductive System</a>, the <a href="http://www.militarydisabilitymadeeasy.com/theeyes.html">Eyes</a>, <a href="http://www.militarydisabilitymadeeasy.com/themouthandteeth.html">Dental and Oral Conditions</a>, the <a href="http://www.militarydisabilitymadeeasy.com/theendocrinesystem.html">EndocrineSystem</a>, and <a href="http://www.militarydisabilitymadeeasy.com/mentaldisorders.html">Mental Disorders</a>.<o:p></o:p></span></div>
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<span lang="EN-GB">Other proposed changes that have not yet
been finalized include the <a href="http://blog.militarydisabilitymadeeasy.com/2017/08/proposed-changes-to-ratings-of.html" target="_blank">Genitourinary System</a> and the <a href="http://blog.militarydisabilitymadeeasy.com/2017/08/proposed-changes-to-ratings-of_7.html" target="_blank">Musculoskeletal System</a>.<o:p></o:p></span></div>
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<span lang="EN-GB">The following changes will go into effect
<b>August 11th, 2019</b>, and we’ll officially update all the information on our
website at that time. These new ratings will automatically apply to any new
claims for Infectious Diseases, Immune Disorders, and Nutritional Deficiencies submitted
on or after August 11<sup>th</sup>.<o:p></o:p></span></div>
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<span lang="EN-GB">The following are the VA’s final changes to
the ratings for Infectious Diseases, Immune Disorders, and Nutritional
Deficiencies. The changes are fairly extensive, so I’ll walk through each, one
at a time.<o:p></o:p></span></div>
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<span lang="EN-GB">For each condition, the ones labeled -Current- are the codes as they are right now. Click on the links to be taken to
the discussion of that code on our site. After the current code, I’ll discuss
the final changes and then VA’s justification. <o:p></o:p></span></div>
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<span lang="EN-GB">__________________________________________________________________<o:p></o:p></span></div>
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<span lang="EN-GB">-NEW-
General Rating System for Infectious Diseases<o:p></o:p></span></div>
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<span lang="EN-GB">A 100% rating is
given for all active diseases. Once the infection is eliminated or completely suppressed,
the condition must be re-evaluated and rated 0%. Any lasting side effects
caused by the infection are then rated separately.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span lang="EN-GB">The VA is creating a General Rating System
for Infectious Diseases. This doesn’t have a huge effect on the ratings as
currently all infectious diseases are rated 100% while active, then on residual
symptoms/conditions. Regardless, creating a central rating system like this
will more greatly ensure consistency in applying the ratings to infectious
diseases. <o:p></o:p></span></div>
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<span lang="EN-GB">The addition of a 0% rating for an inactive
disease also doesn’t have any direct impact on the ratings themselves, but will
allow for an easier adjustment to the ratings if the disease relapses. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span lang="EN-GB">__________________________________________________________________<o:p></o:p></span></div>
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<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#infect" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6300</span></b></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">: <b>Asiatic
cholera</b> is an infection in the small intestine that causes severe diarrhea
and vomiting. The 100% rating for this condition continues for 3 months after
the active infection. If there are symptoms left over after the 3-month period,
then they are rated separately. These symptoms could include papillary
necrosis, which is rated under code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#w"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7538</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.<b><o:p></o:p></b></span></div>
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<i style="mso-bidi-font-style: normal;"><span lang="EN-GB">-Final-</span></i><span lang="EN-GB"> </span><b><span style="mso-ansi-language: EN-US;">Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="mso-ansi-language: EN-US;">6300</span></b></span><b><span style="mso-ansi-language: EN-US;">: <span style="mso-spacerun: yes;"> </span>Vibriosis </span></b>(<b>cholera </b>and <b>non-cholera</b>) is an
infection in the small intestine caused by <i style="mso-bidi-font-style: normal;">Vibrio</i>
bacteria. It is rated on the General Rating System. Lasting side effects could
include <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#recon" target="_blank">renal failure</a>, <a href="http://www.militarydisabilitymadeeasy.com/theskin.html" target="_blank">skin conditions</a>, and musculoskeletal conditions (like <a href="http://www.militarydisabilitymadeeasy.com/analogous.html#anal" target="_blank">necrotizing fasciitis</a>). <span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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<span lang="EN-GB">Currently, this code only covers Asiatic
cholera, which is caused by the <i style="mso-bidi-font-style: normal;">Vibrio</i>
bacteria. This bacteria, however, can cause many other types of infections as
well. To ensure that those infections are properly recognized and rated, the VA
is changing this code to include all <i style="mso-bidi-font-style: normal;">Vibrio</i>
infections. The other change to this code is to eliminate the 100% rating for
the 3 months after the active infection since modern treatments allow full
recovery in a fairly short time period. <o:p></o:p></span></div>
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<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#b" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6301</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: Visceral
leishmaniasis </span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is a disease of parasites in<a href="https://www.blogger.com/null" name="c"></a> the
internal organs that can cause symptoms like weight loss, fever, and anemia.
The 100% rating for this condition continues for the first 6 months after
treatment for this disease ends. It is then reevaluated, and any remaining
symptoms or side effects are rated separately. These symptoms could include
liver damage, which is rated under code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html#s"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7312</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.<b><o:p></o:p></b></span></div>
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<i style="mso-bidi-font-style: normal;"><span lang="EN-GB" style="font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">-Final -</span></i><span lang="EN-GB" style="font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"> </span><b><span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">6301</span></b></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">: <span style="mso-bidi-font-weight: bold;">Visceral
leishmaniasis</span> </span></b><span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">is a disease of parasites in the internal organs
that can cause symptoms like weight loss, fever, and anemia. It is rated 100%
while it is active. The 100% rating for this condition continues for the first
6 months after the final treatment once the disease is no longer active. It is
then reevaluated, and any remaining side effects are rated separately. These </span>side effects<span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"> could include <a href="http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html#liver" target="_blank">liver damage</a>, <a href="http://www.militarydisabilitymadeeasy.com/theblood.html" target="_blank">bone marrow diseases</a>, or <a href="http://www.militarydisabilitymadeeasy.com/theskin.html#f" target="_blank">leishmaniasis</a></span><span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"><a href="http://www.militarydisabilitymadeeasy.com/theskin.html#f" target="_blank"> of the skin</a>. <o:p></o:p></span></div>
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<span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">If the infection recurs, it must be officially
confirmed by culture, histopathology, or other lab test. <o:p></o:p></span></div>
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<span lang="EN-GB">The only changes to this code are to
include bone marrow diseases and dermal leishmaniasis in the list of potential
residuals and to specify that any recurrence must be properly confirmed by lab
test. <o:p></o:p></span></div>
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<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#c" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6302</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: Leprosy (</span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">or<b>
“Hansen’s Disease”) </b>is a bacterial disease that attacks the skin, nerves,
and airways. It causes severe skin damage and can lead to many other conditions
if left untreated. The 100% rating for this condition continues for the first 6
months after treatment for this disease ends. It is then reevaluated,<a href="https://www.blogger.com/null" name="d"></a> and
any remaining symptoms or side effects are rated separately. These symptoms
could include skin damage, codes </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/scars.html#a"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7800–7805</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">, or
nerve damage. Nerve damage is a bit complicated to rate, and the code depends
on which nerves are damaged. Thorough information on rating nerve damage can be
found on </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html" target="_blank"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">The Central Nervous System</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> page.<b><o:p></o:p></b></span></div>
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<i style="mso-bidi-font-style: normal;"><span lang="EN-GB" style="font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">-Final-</span></i><span lang="EN-GB" style="font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"> </span><b><span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">6302</span></b></span><b><span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">: Leprosy (</span></b><span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi;">or<b> “Hansen’s Disease”) </b>is a bacterial disease that attacks the
skin, nerves, and airways. It causes severe skin damage and can lead to many
other conditions if left untreated. The 100% rating for this condition
continues for the first 6 months after treatment for this disease ends. It is
then re-evaluated, and any remaining side effects are rated separately.
These </span>side
effects<span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi;"> could include <a href="http://www.militarydisabilitymadeeasy.com/theskin.html" target="_blank">skin damage</a>, <a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html" target="_blank">nerve damage</a>, or <a href="http://www.militarydisabilitymadeeasy.com/amputations.html" target="_blank">amputation</a>.
<b><o:p></o:p></b></span></div>
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<span lang="EN-GB">The VA is adding amputations to the list of
possible residuals since leprosy can lead to auto-amputation. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#d" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6304</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: Malaria </span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is a
disease of parasites that infect red blood cells and cause severe fevers and
other symptoms. For malaria to be properly diagnosed, it must be confirmed by
blood smear <a href="https://www.blogger.com/null" name="e"></a>tests unless it is clear that the veteran was in
an area where contamination could be very likely. The 100% rating for this
condition continues only while the condition is active. Afterwards, any
remaining side effects are rated separately. These symptoms could include liver
damage, which is rated under code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html#s"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7312</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.<b><o:p></o:p></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span lang="EN-GB" style="font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">-Final-</span></i><span lang="EN-GB" style="font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"> </span><b><span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">6304</span></b></span><b><span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">: Malaria </span></b><span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi;">is a disease of parasites that infect red blood cells and cause severe
fevers and other symptoms. </span>It is rated on the General Rating System. <span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi;">For malaria to be properly diagnosed (initially and for any recurrence),
it must be confirmed by blood smear tests or lab tests, like antigen
detection, immunologic tests, and molecular tests. </span>Side effects<span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi;"> could include <a href="http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html#liver" target="_blank">liver damage</a>, <a href="http://www.militarydisabilitymadeeasy.com/theblood.html#spleen" target="_blank">spleen damage</a>, <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#recon" target="_blank">renal disease</a>, and <a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html" target="_blank">central nervous system</a> conditions.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB">The VA is now requiring proper tests to
diagnose all cases of malaria before they can be rated. They are also adding a
few potential symptoms to the list, though these lists are never exhaustive. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">___________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#e" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6305</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: Lymphatic filariasis </span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is a
disease of parasites that infect the lymphatic system, including the lymph
nodes. The 100% rating for this condition continues only while the condition is
active. Afterwards, any remaining symptoms or side effects are rated
separately. These symptoms could include epididymitis, which is rated under
code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#i" target="_blank"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7525</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.<b><o:p></o:p></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span lang="EN-GB" style="font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">-Final-</span></i><span lang="EN-GB" style="font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"> </span><b><span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">6305</span></b></span><b><span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">: Lymphatic filariasis </span></b><span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi;">(“<b>elephantiasis</b>”)<b> </b>is a disease of parasites that infect the
lymphatic system, including the lymph nodes. </span>It is rated on the General Rating System.<span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi;"> </span>Side
effects<span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi;"> could include <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#i" target="_blank">epididymitis</a> and various <a href="http://www.militarydisabilitymadeeasy.com/theblood.html" target="_blank">lymphatic conditions</a>.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB">The only change here is to include the name
“elephantiasis” that is commonly used to refer to this condition and to include
various lymphatic conditions in the list of side effects. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">__________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#f" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6306</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: Bartonellosis </span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is a
bacterial infection which can cause many other diseases including trench fever,
chronic bacteremia, endocarditis, neurological conditions, Carrion’s
disease, <a href="https://www.blogger.com/null" name="g"></a>cat-scratch disease, bacillary angiomatosis,
peliosis hepatis, and chronic lymphadenopathy. All of these conditions are
rated under this code. The 100% rating for this condition continues for three
months after the condition is active. Afterwards, any remaining symptoms or
side effects are rated separately. These symptoms could include skin damage,
which is rated under codes </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/scars.html#a"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7800–7805</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.<b><o:p></o:p></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Final-</span></i><b><span style="mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="mso-ansi-language: EN-US;">6306</span></b></span><b><span style="mso-ansi-language: EN-US;">: Bartonellosis </span></b><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is a bacterial
infection which can cause many other diseases including trench fever, chronic
bacteremia, neurological conditions, Carrion’s disease, cat-scratch
disease, bacillary angiomatosis, peliosis hepatis, and chronic lymphadenopathy.
All of these conditions are rated under this code. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
It is rated on the General Rating System.<span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi;"> </span>Side
effects could include <a href="http://www.militarydisabilitymadeeasy.com/theskin.html" target="_blank">skin damage</a> and <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#b" target="_blank">endocarditis</a>.<b><o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-ansi-language: EN-US;">Again, not a huge
change. The VA is removing the three-month rating since this condition is
usually easily treated and is including endocarditis as a potential side
effect. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">___________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#g" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6307</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: Plague </span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">(any
kind) is a bacterial infection that can attack different parts of the body. It
can be treated if caught early. The 100% rating for this condition continues
only while the condition is active. After that, any remaining side effects or
symptoms are rated separately. These symptoms could include gangrene that could
lead to amputation. It would then be rated on the amputation of the particular
body part. See the </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/amputations.html"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Amputations</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> page for a complete list of amputation
ratings. In addition to gangrene, this condition could also cause nerve or
brain damage. The code depends on the extent of the nerve or brain damage. All
nerve and brain conditions are discussed on </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">The Central Nervous System</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> page.<b><o:p></o:p></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Final-</span></i><b><span style="mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="mso-ansi-language: EN-US;">6307</span></b></span><b><span style="mso-ansi-language: EN-US;">: Plague</span></b><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> (any kind) is a bacterial infection that can
attack different parts of the body. It is rated on the General Rating System.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB">Treatments for the plague are advanced to
the point that residuals or side effects are very rare. They can absolutely be
rated if they occur, but the VA feels that they no longer need to be directly
discussed. </span><span style="mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">___________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#h" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6308</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: Relapsing fever </span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is a
bacterial infection that causes fevers, chills, aches, and nausea that can last
between 2 and 9 days. Every couple of weeks, these symptoms return if not
treated with antibiotics. The 100% rating for this condition continues only
while the condition is active. After that, any remaining<a href="https://www.blogger.com/null" name="i"></a> side
effects or symptoms are rated separately. These symptoms could include liver
damage, code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html#s"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7312</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">, spleen damage, codes </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theblood.html#g"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7706-7707</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">, or nerve damage. The code for nerve damage
depends on which nerve is affected and the severity of the damage. Thorough
information on rating nerve damage can be found on </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">The Central Nervous System</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> page.<b><o:p></o:p></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Final-</span></i><b><span style="mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="mso-ansi-language: EN-US;">6308</span></b></span><b><span style="mso-ansi-language: EN-US;">: Relapsing fever </span></b>is a bacterial
infection that causes fevers, chills, aches, and nausea that can last between 2
and 9 days. Every couple of weeks, these symptoms return if not treated with
antibiotics. It is rated on the General Rating System. Side effects could
include <a href="http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html#liver" target="_blank">liver damage</a>, <a href="http://www.militarydisabilitymadeeasy.com/theblood.html#spleen" target="_blank">spleen damage</a>, <a href="http://www.militarydisabilitymadeeasy.com/theeyes.html#i" target="_blank">choroidopathy</a>, or <a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html" target="_blank">central nerve damage</a>. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB">The VA is adding choroidopathy (like
iritis, uveitis, etc.) as a potential side effect.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">___________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#i" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6309</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: Rheumatic fever </span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is a
disease that affects the tissues of the body, causing them to swell. It can
damage the valves of the heart, which can cause congestive heart failure.
Symptoms<a href="https://www.blogger.com/null" name="j"></a> also include rashes, twitching in the face and
arms, and fevers. The 100% rating for this condition continues only while the
condition is active. After that, any remaining side effects or symptoms are
rated separately. These symptoms could include heart damage, code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#o"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7020</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.<b><o:p></o:p></b></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Final-</span></i><b><span style="mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="mso-ansi-language: EN-US;">6309</span></b></span><b><span style="mso-ansi-language: EN-US;">: Rheumatic fever </span></b><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is a disease that
affects the tissues of the body, causing them to swell. It can damage the
valves of the heart, which can cause congestive heart failure.
Symptoms also include rashes, twitching in the face and arms, and fevers. It
is rated on the General Rating System. Side effects could include heart damage,
code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#o"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7020</span></a></span><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB">The only change to this code is for it to
be rated on the General Rating System. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">___________________________________________________________________<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#n" target="_blank">Code 6310</a> for syphilis remains exactly the
same.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">___________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/tuberculosis.html#g" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6311</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: Miliary
tuberculosis </span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is tuberculosis that began in the lungs
but then traveled to other parts of the body. This condition would be rated for
both </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/tuberculosis.html#pulm"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">pulmonary</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> and </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/tuberculosis.html#non"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">nonpulmonary tuberculosis</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">. (Their 100% ratings,
however, cannot be combined during the 1-year period after inactivity. Their
symptoms or complications, however, can be rated during that period instead of
waiting for reevaluation at the 1-year mark).<b><o:p></o:p></b></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Final-</span></i><b><span style="mso-ansi-language: EN-US;"> Code </span></b><a href="https://www.blogger.com/null" style="mso-comment-date: 20190620T0901; mso-comment-reference: rj_2;"></a><span style="mso-comment-continuation: 2;"><b><span style="mso-ansi-language: EN-US;">6311</span></b></span><b><span style="mso-ansi-language: EN-US;">: Miliary tuberculosis </span></b><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is tuberculosis that
began in the lungs but then traveled to other parts of the body. This
condition would be rated for both </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/tuberculosis.html#pulm"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">pulmonary</span></a></span><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> </span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">and </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/tuberculosis.html#non"><span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">nonpulmonary
tuberculosis</span></a></span><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> if both are still present. (Their 100% ratings, however, cannot be
combined during the 1-year period after inactivity. Their symptoms or
complications, however, can be rated during that period instead of waiting for
reevaluation at the 1-year mark).<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">If the infection recurs, it must be officially
confirmed by culture, histopathology, or other lab test. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB">The VA effectually only added a note to
require the proper testing to confirm any recurrence. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">___________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- NEW CODE-</span></i><b><span style="mso-ansi-language: EN-US;"> Code 6312: Non-tuberculosis
mycobacterial infection </span></b>(“<b>NTM</b>”)<b> </b>is a lung infection, that
isn’t tuberculosis, which occurs when bacteria is inhaled. This can cover a
wide-range of infections caused by different types of inhaled bacteria. This
condition is rated 100% while active. Once inactive, the condition is
re-evaluated, and any side effects, like <a href="http://www.militarydisabilitymadeeasy.com/theskin.html" target="_blank">skin conditions</a>, <a href="http://www.militarydisabilitymadeeasy.com/therespiratorysystem.html" target="_blank">respiratory conditions</a>, <a href="http://www.militarydisabilitymadeeasy.com/theeyes.html" target="_blank">eye conditions</a>, <a href="http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html" target="_blank">digestive conditions</a>, etc., can be rated
separately. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "Times New Roman"; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">If the infection recurs, it must be officially
confirmed by culture, histopathology, or other lab test. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB">The VA is adding this new code to cover all
inhaled bacterial infections. Currently, tuberculosis is the only code similar
enough to cover these infections, but tuberculosis presents differently and has
more severe long-term implications than many of these other infections. As
such, this code will allow a clearly distinct rating option for these
conditions. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">___________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/nutritionaldeficiencies.html#avit" target="_blank">Code 6313</a> for Avitaminosis, <a href="http://www.militarydisabilitymadeeasy.com/nutritionaldeficiencies.html#beri" target="_blank">code 6314</a> for
Beriberi, and <a href="http://www.militarydisabilitymadeeasy.com/nutritionaldeficiencies.html#pella" target="_blank">code 6315</a> for Pellagra will remain the same.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">____________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#j" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6316</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: Brucellosis </span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is a
bacterial infection that causes fevers, headaches, depression, and weakness.
The symptoms can come and go throughout the rest of your life if the disease<a href="https://www.blogger.com/null" name="k"></a> is not properly treated with antibiotics. The 100% rating for
this condition continues only while the condition is active. After that, any
remaining side effects or symptoms are rated separately. These symptoms could
include liver damage, code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html#s"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7312</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">, or meningitis, code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html#s"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">8019</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.<b><o:p></o:p></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Final-</span></i><b><span style="mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="mso-ansi-language: EN-US;">6316</span></b></span><b><span style="mso-ansi-language: EN-US;">: Brucellosis </span></b>is a bacterial
infection that causes fevers, headaches, depression, and weakness. Diagnosis
and any recurrence must be confirmed by culture and/or serologic testing. It is
rated on the General Rating System. Side effects could include <a href="http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html#liver" target="_blank">liver damage</a>, <a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html" target="_blank">nervoussystem infections</a>, <a href="http://www.militarydisabilitymadeeasy.com/theblood.html#spleen" target="_blank">spleen damage</a>, <a href="http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#arthritis" target="_blank">arthritis</a>, <a href="http://www.militarydisabilitymadeeasy.com/theears.html" target="_blank">hearing loss</a>, <a href="http://www.militarydisabilitymadeeasy.com/therespiratorysystem.html" target="_blank">respiratoryinfections</a>, and much more. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal">
<span style="mso-ansi-language: EN-US;">The VA is requiring
the appropriate tests to diagnose the condition in order to ensure both proper
rating and proper treatment, and is expanding the list of potential side
effects. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">____________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal" style="tab-stops: 67.5pt right dotted 423.0pt 459.0pt; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in; tab-stops: 67.5pt right dotted 423.0pt 459.0pt; text-align: justify; text-justify: inter-ideograph;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#k" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6317</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: Scrub typhus</span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> is
an infection caused by parasites that can be treated with antibiotics, although
many strains are not responsive to treatments. The 100% rating for this
condition <a href="https://www.blogger.com/null" name="r"></a>continues while the condition is active and for
the first 3 months following. After that, any remaining side effects or
symptoms are rated separately. These symptoms could include skin damage,
codes </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/scars.html#a"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7800–7805</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">,
and spleen damage, codes </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theblood.html#g"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7706-7707</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.<b><o:p></o:p></b></span></div>
<div class="MsoNormal" style="margin-left: .5in; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-justify: inter-ideograph;">
<i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Final-</span></i><b><span style="mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="mso-ansi-language: EN-US;">6317</span></b></span><b><span style="mso-ansi-language: EN-US;">: Rickettsial infections </span></b>(including<b> scrub
typhus</b>, <b>erlichiosis</b>,<b> anaplasmosis, etc.</b>)<b> </b>are rated
under this code<b>. </b>These diseases are all commonly passed from ticks,
fleas, or other parasites. It is rated on the General Rating System. Side
effects could include <a href="http://www.militarydisabilitymadeeasy.com/theblood.html" target="_blank">bone marrow conditions</a>, <a href="http://www.militarydisabilitymadeeasy.com/theskin.html" target="_blank">skin conditions,</a> <a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html" target="_blank">central nervous conditions</a>, and <a href="http://www.militarydisabilitymadeeasy.com/theblood.html#spleen" target="_blank">spleen damage</a>.<o:p></o:p></div>
<div class="MsoNormal" style="tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="tab-stops: -4.5pt 0in 45.0pt .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-justify: inter-ideograph;">
<span style="mso-ansi-language: EN-US;">The VA is broadening the name of this code to
include all conditions caused by rickettsial infections, not just scrub typhus.
These conditions are already rated analogously under this code, but this change
will make it easier to rate them. They are also removing the 3-month rating
after the active infection since these infections are easily controlled by
modern medicines. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">____________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#l" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6318</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: Melioidosis </span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is a
bacterial infection that causes pain, <a href="https://www.blogger.com/null" name="l"></a>coughing, pneumonia
and skin infections. The 100% rating for this condition continues only while
the condition is active. After that, any remaining side effects or symptoms are
rated separately. These symptoms could include arthritis, code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#a"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">5003</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">, lung tissue damage, code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/therespiratorysystem.html#x"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">6825</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">, or meningitis, code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html#s"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">8019</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.<b><o:p></o:p></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Final-</span></i><b><span style="mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="mso-ansi-language: EN-US;">6318</span></b></span><b><span style="mso-ansi-language: EN-US;">: Melioidosis </span></b>is a bacterial
infection that causes pain, coughing, pneumonia, and skin infections. Diagnosis
and any recurrence must be confirmed by culture or appropriate lab testing. It
is rated on the General Rating System. Side effects could include <a href="http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#arthritis" target="_blank">arthritis</a>, <a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html#s" target="_blank">meningitis</a>,
and <a href="http://www.militarydisabilitymadeeasy.com/therespiratorysystem.html#x" target="_blank">lung lesions</a>.<b><o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-ansi-language: EN-US;">The VA is requiring the
appropriate tests to diagnose the condition in order to ensure both proper
rating and proper treatment. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">____________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#l" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6319</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: Lyme disease </span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is a
bacterial disease common in the US and spread by ticks. Symptoms include fever,
skin rash, fatigue, and depression and can affect the joints, heart and nerves<a href="https://www.blogger.com/null" name="m"></a> if it is not treated properly. The 100% rating for this
condition continues only while the condition is active. After that, any
remaining side effects or symptoms are rated separately. These symptoms could
include arthritis, codes </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#d"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">5002</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-</span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#a"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">5003</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">, heart damage, code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/theheart.html#o"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">7020</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">, chronic fatigue, code </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#q"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">6354</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">, and </span><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html"><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">nerve damage</span></a></span><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">.<b><o:p></o:p></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Final-</span></i><b><span style="mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="mso-ansi-language: EN-US;">6319</span></b></span><b><span style="mso-ansi-language: EN-US;">: Lyme disease</span></b> is a bacterial
disease common in the US and spread by ticks. Symptoms include fever, skin
rash, fatigue, and depression and can affect the joints, heart, and
nerves if it is not treated properly. It is rated on the General Rating
System. Side effects could include <a href="http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#arthritis" target="_blank">arthritis</a>, <a href="http://www.militarydisabilitymadeeasy.com/thecranialnerves.html#facial" target="_blank">Bell’s palsy</a>, <a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html" target="_blank">nerve damage</a>,<a href="http://www.militarydisabilitymadeeasy.com/theeyes.html" target="_blank"> eye conditions</a>, and <a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html#brain" target="_blank">mental dysfunction</a>.<b><o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-ansi-language: EN-US;">The only change is to
adjust the side effects list to include the most common side effects for this
condition. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">____________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#m" target="_blank">Code 6320</a> for <b style="mso-bidi-font-weight: normal;">other parasitic diseases</b> will remain the same.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">_____________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-justify: inter-ideograph;">
<i style="mso-bidi-font-style: normal;"><span lang="EN-GB">-NEW Code-</span></i><span lang="EN-GB"> <b style="mso-bidi-font-weight: normal;">Code 6325:</b> <span style="mso-spacerun: yes;"> </span></span><b><span style="mso-ansi-language: EN-US;">Hyperinfection
syndrome </span></b><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">(“<b>disseminated strongyloidiasis</b>”)<b> </b>is a parasitic disease caused
by roundworms. Symptoms include severe infections, diarrhea, skin rash, and
weight loss. It is rated 100% while active. Once it is inactive, it is
re-evaluated and rated on any remaining side effects. </span><span style="mso-ansi-language: EN-US;"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<span lang="EN-GB">The VA is adding a new code for hyperinfection syndrome, a condition
that presents unique symptoms and causes an incredibly severe infection with a
high mortality rate and vast, significant side effects. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">____________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB"><br /></span></div>
<div class="MsoNormal" style="margin-left: .5in; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-justify: inter-ideograph;">
<i style="mso-bidi-font-style: normal;"><span lang="EN-GB">-NEW Code-</span></i><span lang="EN-GB"> <b style="mso-bidi-font-weight: normal;">Code 6326:</b> <span style="mso-spacerun: yes;"> </span></span><b><span style="mso-ansi-language: EN-US;">Shistosomiasis
</span></b>(“<b>Katayama
syndrome</b>”) is an extremely common parasitic disease outside of the US.
Symptoms include skin rash, fever, and headaches. This condition is usually
mild in most people, but some can have negative reactions to the parasite eggs
that can cause long-term side effects. Since the active infection itself is
mild, it is rated 0%. However, in cases that cause side effects, like <a href="http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html#liver" target="_blank">liver damage</a>, <a href="http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html" target="_blank">digestive conditions</a>, <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html" target="_blank">genitourinary conditions</a>, f<a href="http://www.militarydisabilitymadeeasy.com/femalereproductive.html" target="_blank">emale reproductive conditions</a>, or <a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html" target="_blank">central nervous conditions</a>, they can be rated separately. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<span lang="EN-GB">The VA is adding a new code for shistosomiasis, a unique condition that
is usually mild but can have significant disabling effects in some veterans.
This code will allow those veterans affected to be properly rated. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">____________________________________________________________________<o:p></o:p></span></div>
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<br /></div>
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<i style="mso-bidi-font-style: normal;"><span lang="EN-GB">-NEW Code-</span></i><span lang="EN-GB"> <b style="mso-bidi-font-weight: normal;">Code 6329:</b> <span style="mso-spacerun: yes;"> </span></span><b><span style="mso-ansi-language: EN-US;">Hemorrhagic
fevers </span></b>(including <b>dengue fever</b>, <b>yellow fever</b>, etc.)<b> </b>are
fevers caused by a viral infection. It is rated on the General Rating System. Side
effects could include <a href="http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html#liver" target="_blank">liver damage</a>, <a href="http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#recon" target="_blank">kidney damage</a>, and <a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html" target="_blank">central nervous conditions</a>. <span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<span lang="EN-GB">The VA is adding this new code to avoid having to rate these fevers
analogously. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">____________________________________________________________________<o:p></o:p></span></div>
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<br /></div>
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<i style="mso-bidi-font-style: normal;"><span lang="EN-GB">-NEW Code-</span></i><span lang="EN-GB"> <b style="mso-bidi-font-weight: normal;">Code 6330:</b> <span style="mso-spacerun: yes;"> </span></span><b><span style="mso-ansi-language: EN-US;">Campylobacter
jejuni </span></b>is a common type of food poisoning. Symptoms include diarrhea, nausea,
and fever. It is rated on the General Rating System. Side effects could include
<a href="http://www.militarydisabilitymadeeasy.com/theeyes.html#i" target="_blank">uveitis</a>, <a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html#l" target="_blank">Guillain-Barre syndrome</a>, and <a href="http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#rheum" target="_blank">reactive arthritis</a>.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<span lang="EN-GB">The VA is adding this new code to avoid having to rate it
analogously.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">_____________________________________________________________________<o:p></o:p></span></div>
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<br /></div>
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<i style="mso-bidi-font-style: normal;"><span lang="EN-GB">-NEW Code-</span></i><span lang="EN-GB"> <b style="mso-bidi-font-weight: normal;">Code 6331:</b> <span style="mso-spacerun: yes;"> </span></span><b><span style="mso-ansi-language: EN-US;">Coxiella
burnetii infection </span></b>(“<b>Q fever</b>”)<b> </b>is a bacterial infection spread by animals which
causes flu-like symptoms. It is rated on the General Rating System. Side
effects could include <a href="http://www.militarydisabilitymadeeasy.com/thedigestivesystem.html#liver" target="_blank">chronic hepatitis</a>, <a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#q" target="_blank">chronic fatigue syndrome</a>, <a href="http://www.militarydisabilitymadeeasy.com/theheart.html#b" target="_blank">endocarditis</a>,
<a href="http://www.militarydisabilitymadeeasy.com/theheart.html" target="_blank">vascular infection</a>, and <a href="http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#osteo" target="_blank">osteomyelitis</a>.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<span lang="EN-GB">The VA is adding this new code to avoid having to rate it
analogously.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">______________________________________________________________________<o:p></o:p></span></div>
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<br /></div>
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<i style="mso-bidi-font-style: normal;"><span lang="EN-GB">-NEW Code-</span></i><span lang="EN-GB"> <b style="mso-bidi-font-weight: normal;">Code 6333:</b> <span style="mso-spacerun: yes;"> </span></span><b><span style="mso-ansi-language: EN-US;">Salmonella</span></b><b><span style="mso-ansi-language: EN-US;"> infections </span></b>(non-typhoid)<b> </b>is a common type of food
poisoning. Symptoms include diarrhea, nausea, and fever. It is rated on the
General Rating System. Side effects could include <a href="http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#rheum" target="_blank">reactive arthritis</a> and more.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<span lang="EN-GB">The VA is adding this new code to avoid having to rate it
analogously.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">_______________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; tab-stops: .5in .75in 67.0pt right dotted 423.0pt 459.0pt; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
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<i style="mso-bidi-font-style: normal;"><span lang="EN-GB">-NEW Code-</span></i><span lang="EN-GB"> <b style="mso-bidi-font-weight: normal;">Code 6334:</b> <span style="mso-spacerun: yes;"> </span></span><b><span style="mso-ansi-language: EN-US;">Shigella
infections </span></b>(including <b>dysentery</b>)<b> </b>are the most common cause of diarrhea.
It is rated on the General Rating System. Side effects could include <a href="http://www.militarydisabilitymadeeasy.com/theblood.html#platelets" target="_blank">hemolytic-uremic syndrome</a> and <a href="http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#rheum" target="_blank">reactive arthritis</a>.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<span lang="EN-GB">The VA is adding this new code to avoid having to rate it
analogously.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">________________________________________________________________________<o:p></o:p></span></div>
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<br /></div>
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<i style="mso-bidi-font-style: normal;"><span lang="EN-GB">-NEW Code-</span></i><span lang="EN-GB"> <b style="mso-bidi-font-weight: normal;">Code 6335:</b> <span style="mso-spacerun: yes;"> </span></span><b><span style="mso-ansi-language: EN-US;">West
Nile virus</span></b><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> infections are spread by mosquitoes. Symptoms include headache,
vomiting, and fever. It is rated on the General Rating System. Side effects can
include physical, functional, and cognitive conditions.</span><span style="mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 0in .75in 67.0pt right dotted 423.0pt 459.0pt;">
<span lang="EN-GB">The VA is adding this new code to avoid having to rate it
analogously.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">________________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#p" target="_blank">Code 6350</a> for <b style="mso-bidi-font-weight: normal;">lupus erythematosus</b> will remain the same.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">_________________________________________________________________________<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Current-</span></i><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#o" target="_blank"><b><span lang="EN-US" style="font-size: 10.0pt; mso-ansi-language: EN-US;">6351</span></b></a></span><b><span style="font-size: 10.0pt; mso-ansi-language: EN-US;">: HIV (human immunodeficiency
virus) </span></b><span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is a virus mostly spread by sexual contact with an
infected person, although it can also be spread from mother to child or by
contact with infected blood. The virus attacks “T4” cells that support the
immune system of the body, thus causing the body to be very vulnerable to
infections, other diseases (“secondary diseases”), and cancers. The HIV virus
can cause the disease AIDS (acquired immunodeficiency syndrome). It takes many
years for an HIV infection to develop into AIDS. The presence of AIDS is
confirmed if the T4 cell count is less than 200.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">If a higher rating can be
received by rating a secondary disease or infection than can be received by
rating HIV or AIDS, then it can be rated under that secondary condition. A
rating for both, however, is not allowed—only a rating for HIV or a rating for
ONE of the secondary conditions, whichever can provide the higher rating. If it
is rated on one of the secondary conditions, then the final code will look like
this: 6351-4901. The first four-digit code defines the condition as HIV, and
the second four-digit code tells how the condition is rated.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">The ratings:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">If there is an active AIDS
disease with either regularly occurring infections/diseases or
infections/diseases in numerous areas of the body, it is rated 100%. A 100%
rating is also given for HIV if there is a secondary disease that is present
the majority of the time and causes continual weight loss.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">If there is a secondary
disease, infection, or neoplasm as a result of AIDS, then the minimum rating is
60%. This rating is also given if there are significant symptoms throughout the
body that cannot be controlled, diarrhea, and weight loss.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">If the HIV is being treated
by “approved” medication (medications that are prescribed for research by a
qualified medical institution), but there are still regularly occurring
symptoms throughout the body and intermittent diarrhea, then it is rated 30%. This
rating is also the minimum rating given if the T4 cell count is less than 200,
there is hairy cell leukoplakis, or oral candidiasis.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">If the HIV is being treated
by “approved” medication, there are at least definite symptoms present, and the
T4 cell count is between 200 and 500, then it is rated 10%. If there are clear
signs of depression or memory loss that interfere with the ability to work, a
rating of 10% may also be given.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">If there are no symptoms
that affect the ability of the individual to function, then it is rated 0%,
even if there is a decreased T4 cell count, disease in the lymph nodes, or
diagnosed AIDS.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">-Final-</span></i><b><span style="mso-ansi-language: EN-US;"> Code </span></b><span lang="EN-GB"><b><span lang="EN-US" style="mso-ansi-language: EN-US;">6351</span></b></span><b><span style="mso-ansi-language: EN-US;">: HIV (human immunodeficiency virus) </span></b><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">is a virus mostly
spread by sexual contact with an infected person, although it can also be
spread from mother to child or by contact with infected blood. The virus
attacks “T4” cells that support the immune system of the body, thus causing the
body to be very vulnerable to infections, other diseases (“secondary
diseases”), and cancers. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">The HIV virus can cause the disease <b>AIDS</b>
(acquired immunodeficiency syndrome). It takes many years for an HIV infection
to develop into AIDS. The diagnosis of AIDS is confirmed if the T4 cell count
is less than 200 <u>or</u> if there is the presence of one of the following opportunistic
infections in addition to HIV.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<u><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Opportunistic Infections<o:p></o:p></span></u></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Candidiasis of the bronchi, trachea,
esophagus, or lungs<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Invasive cervical cancer<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Coccidioidomycosis<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Cryptococcosis<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Cryptosporidiosis<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Cytomegalovirus (including CMV retinitis)<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Encephalopathy<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Herpes simplex-chronic ulcers (must be
present more than 1 month)<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Bronchitis<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Pneumonia<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Esophagitis<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Histoplasmosis<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Chronic intestinal isosporiasis<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Kaposi’s sarcoma<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Lymphoma<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Mycobacterium avium complex<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Tuberculosis<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Pneumocystis jirovecii pneumonia<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Recurrent pneumonia<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Progressive multifocal leukoencephalopathy<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Recurrent Salmonella septicemia<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Toxoplasmosis of the brain<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">- Wasting syndrome<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
Secondary diseases or infections, like
diagnosed <a href="http://www.militarydisabilitymadeeasy.com/mentaldisorders.html" target="_blank">mental disorders</a>, opportunistic infections, neoplasms, and <a href="http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html" target="_blank">central nervous system conditions</a>, may be rated separately <u>in addition</u> to a
rating under this code as long as symptoms do not overlap (<a href="http://www.militarydisabilitymadeeasy.com/vasrdprinciples.html#pyram" target="_blank">Pyramiding Principle</a>).
For example, chronic bronchitis can be rated in addition to a rating under this
code as the ratings cover different symptoms. However, a rating for Major
Depressive Disorder cannot be given in addition for a 10% rating based on
depression under this code as they both are rating the symptom of depression.
In these cases, only one rating can be given. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">The ratings:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">If there is AIDS <u>and</u> an opportunistic
infection <u>or</u> a disease that affects numerous areas of the body, it is
rated 100%. A 100% rating is also given for HIV if there is a secondary disease
that is present the majority of the time and causes continual weight loss.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">If there is an opportunistic infection or
neoplasm, then the minimum rating is 60%. This rating is also given if there
are diarrhea, weight loss, and other significant symptoms throughout the body
that cannot be controlled.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">If the HIV is being treated by “approved”
medication (medications and treatment regimens that are prescribed for research
by a qualified medical institution), but there are still regularly occurring
symptoms throughout the body and intermittent diarrhea, then it is rated 30%.
This rating is also the minimum rating given if the T4 cell count is less than
200.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">If the HIV is being treated by “approved”
medication, there are definite symptoms present, the T4 cell count is between
200 and 500, <u>or</u> there are clear signs of depression or memory loss that
interfere with the ability to work, a rating of 10% is given.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">If there are no symptoms that affect the
ability of the individual to function, then it is rated 0%, even if there is a
decreased T4 cell count and lymph node disease.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-ansi-language: EN-US;">The VA is making a
number of changes to this code to better rate HIV based on current medical
understandings and treatments. The VA is adding a list of opportunistic
infections to help diagnose the presence of AIDS and allow for more clarity
when rating secondary conditions. They are further clarifying that secondary
conditions can be rated in addition to a rating under this code as long as
there is no pyramiding. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-GB">__________________________________________________________________________</span></div>
<div class="MsoNormal" style="margin-left: 1.0in;">
<br /></div>
<div class="MsoNormal">
<span lang="EN-GB"><a href="http://www.militarydisabilitymadeeasy.com/infectiousdiseasesandimmunedisorders.html#q" target="_blank">Code 6354</a> for <b style="mso-bidi-font-weight: normal;">chronic fatigue syndrome </b>will remain the same. </span>The VA <a href="http://blog.militarydisabilitymadeeasy.com/2019/02/proposed-changes-to-ratings-of.html" target="_blank">originally proposed</a> making significant
changes to this code and the diagnosis criteria for CFS back in February.
However, they received enough comments refuting the lack of evidence supporting
the proposed changes that the VA decided to not making any adjustments to this
code until additional research can be performed to best know how to update
these ratings.</div>
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Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com10tag:blogger.com,1999:blog-4162041641030931379.post-13852919810330138542019-06-14T07:21:00.002-07:002019-06-14T07:21:45.955-07:00The 4 Parts of a Buddy Letter<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiVW17xznvqdmUvok1rkkZU8OVzu4wpUa64M79Gn56hQDy3p9TF08efO3yZ_KR5eUoC4OKW5NO7RRahMBWgp39eb7JEdjCcR6XNykZG0vi1osaGjXCLdK8l32ec0cf8OodmZ3yDrwZqQs/s1600/buddy+statement.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiVW17xznvqdmUvok1rkkZU8OVzu4wpUa64M79Gn56hQDy3p9TF08efO3yZ_KR5eUoC4OKW5NO7RRahMBWgp39eb7JEdjCcR6XNykZG0vi1osaGjXCLdK8l32ec0cf8OodmZ3yDrwZqQs/s320/buddy+statement.jpg" width="320" /></a>A buddy letter is a statement in support of a <a href="http://www.militarydisabilitymadeeasy.com/vadisabilityclaim.html">VA Disability Claim</a>, written
by someone 18 years of age or older, who has direct, first-hand knowledge of an
event or injury, and offers an account of what they witnessed in support of a
veteran's claim.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
These personal statements can be from your spouse, friend,
pastor, co-worker, boss, adult child, a fellow service member, or any other
credible witness (18 years of age or older). <o:p></o:p></div>
<div class="MsoNormal">
A credible and supportive statement from a competent
individual can be the linchpin to winning your VA disability claim.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A buddy statement constitutes “lay evidence” under the law,
which simply means “after the fact” evidence. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In this post, we will be exploring the 4 essential elements
of a buddy letter, followed by VA buddy letter examples.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-align: center;">
<b>How to write a VA buddy letter<o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
When writing or obtaining a buddy letter in support of a
veteran's VA disability claim, use <a href="https://www.vba.va.gov/pubs/forms/VBA-21-4138-ARE.pdf">VA Form 21-4138</a>, Statement
in Support of a Claim.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I've heard gossip that the VA Form 21-4138 might
be hurting your claim…<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Guess what?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
They are wrong.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
VA Form 21-4138 is still the
PREFERRED method for personal statements according to VA Rating Officials. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When filling out the form, remember: A great VA buddy letter is short and sweet (3-4 paragraphs max). Think less is more. We’re not writing a novel here, friends.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
VA Raters are very busy people, so you want to give them the
exact information they need, at the moment they need it, to support a veteran's VA disability claim.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
All buddy letters must include:</div>
<div class="MsoNormal">
</div>
<ol>
<li>Your name, personal identifying information, and how you know the veteran</li>
<li>What you witnessed or are
witnessing</li>
<li>The veteran's current symptoms and level of disability</li>
<li>A signature testifying that the information stated is to the best of your knowledge and belief</li>
</ol>
<div>
Let's look at some examples.<br /><br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-align: center;">
<b>Part 1: How do you know the veteran?<o:p></o:p></b></div>
<div class="MsoNormal" style="text-align: center;">
<b><br /></b></div>
<div class="MsoNormal">
In part 1, you need to explain how you know the veteran. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Here is an example of how to write this section:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“My name is John Doe, and I'm the husband of veteran [INSERT
VETERAN'S NAME]. <o:p></o:p></div>
<div class="MsoNormal">
I'm writing this statement on behalf of veteran [INSERT
VETERAN'S NAME]. <o:p></o:p></div>
<div class="MsoNormal">
I have known [VETERAN] since 1989. We met in high school and became high school
sweethearts. <o:p></o:p></div>
<div class="MsoNormal">
Over the past 30 years, we have interacted daily.”<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-align: center;">
<b>Part 2: What you witnessed or are witnessing. <o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
In part 2, you need to explain in detail what you witnessed
or are witnessing in regards to the incident that caused the condition or how the condition developed over time. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
You do NOT need to explain every detail, just establish the condition's beginning in relation to the veteran's military service. Basically, help define how the condition is <a href="http://www.militarydisabilitymadeeasy.com/service-connected.html">service-connected</a>. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Here is an example of how to write this section:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“When I first met [VETERAN] before she entered active duty
military service, she was happy, fun loving, and had no mental health issues
whatsoever. All of that changed in July 2004 when she was raped by
another service member while TDY to Lackland Air Force Base, San Antonio,
Texas. It became very evident to me that she suffered and still suffers from severe
PTSD, depression, and anxiety following this event. I encouraged her to get help and seek treatment many times
over the years, but because she was an officer and worked with senior military
leaders, she was afraid of retaliation and reprisal.”</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-align: center;">
<b>Part 3: The veteran's current symptoms.<o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
In part 3, you need to explain how the veteran currently suffers from the condition, including symptoms and limitations caused by the disability. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Again, you do NOT need to explain every detail or reproduce the doctor's notes. Just include the
things you know about and have personally witnessed. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Here is an example of how to write this section:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“Ever since the incident, I witnessed her suffer from severe
depression, anxiety, insomnia, nightmares, relationship problems, trust issues,
anger issues, panic attacks 3-5x per week, memory problems, and sexual
dysfunction, among many others. The rape mentioned above by a fellow service member has
affected her so much that it is my belief she cannot have a normal relationship
with anyone anymore, which has caused numerous marital
challenges over the years. I am 100% certain that her PTSD, depression, and anxiety is
due to the rape.”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal" style="text-align: center;">
<b>Part 4: Signature.<o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
In part 4, you need to sign and date your name to testify that the information stated is to the best of your knowledge and belief.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Here is an example of how to write this section:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>“I CERTIFY THAT the statements on this form are true and
correct to the best of my knowledge and belief.”<o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
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Signed, John Doe, January 23, 2019.</div>
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<br /></div>
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<b>Conclusion</b></div>
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<b><br /></b></div>
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Ultimately, buddy letters can be a great help to a veteran's claim if they are simple, straightforward, and clearly communicate how the condition caused by military service has affected the veteran's life. </div>
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Military Disability Made Easyhttp://www.blogger.com/profile/10320151544107767655noreply@blogger.com39tag:blogger.com,1999:blog-4162041641030931379.post-10855156174213354472019-04-08T12:27:00.000-07:002019-04-08T12:30:06.376-07:00Secondary Disability Claims? It’s time to start thinking outside the box…<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-CJbtWNaK7z7nnswxAXxK2b6hnUREscXG9razPCKucLsTV7fabrX1K6jIx8OxXLSoyGsEFwz8r7IDhcfnNczkTmfxrAffiY7MPTb3CiX0_3GvzeI_FiWBPK_i-qjJxxF6eABG4b0IkRrZ/s1600/Think+Outside+the+Box.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-CJbtWNaK7z7nnswxAXxK2b6hnUREscXG9razPCKucLsTV7fabrX1K6jIx8OxXLSoyGsEFwz8r7IDhcfnNczkTmfxrAffiY7MPTb3CiX0_3GvzeI_FiWBPK_i-qjJxxF6eABG4b0IkRrZ/s400/Think+Outside+the+Box.jpg" width="400" /></a></div>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">It’s important to remember that in order to be eligible for VA disability compensation and benefits under the law, a disability or condition you suffer from today, must have been caused or made worse by your active duty military service, OR by another service-connected disability rated at 0% or higher.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">In this post, I’m going to focus on the latter part of the law: How to prove service-connection using secondary disability claims, specifically, the side effects of any medications you’re taking for other service-connected conditions.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Secondary disability claims are by far the most overlooked part of a veterans VA disability claim strategy, mainly because VSOs and Attorneys lack the medical experience and expertise needed to provide a clear and cohesive strategy.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Now that Military Disability Made Easy is a part of VA Claims Insider, one of the ways we can help you “prove” secondary service-connection is by looking for possible medical “Nexus” links, utilizing our team of medical professionals.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">One very clear and well medically documented secondary “Nexus” involves side effects of any medications you’re taking.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">For instance, many veterans attempt to connect their Obstructive Sleep Apnea (OSA) secondary to Post Traumatic Stress Disorder (PTSD).</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmcysgdq2SvxtZrJhFnLnvib9W8c4JN12FCSkqAVm7dlpSpDLe9r03Jq5edpZVgIbrZd7pMNEbcegckoI3iaATW-3_NbRhLlZ4V6Hxmgev3yk2aCVxuFB-TSgE3DTesPRJ9W5zEY_JXK9R/s1600/Sleep+Apnea+picture+.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1267" data-original-width="1600" height="253" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmcysgdq2SvxtZrJhFnLnvib9W8c4JN12FCSkqAVm7dlpSpDLe9r03Jq5edpZVgIbrZd7pMNEbcegckoI3iaATW-3_NbRhLlZ4V6Hxmgev3yk2aCVxuFB-TSgE3DTesPRJ9W5zEY_JXK9R/s320/Sleep+Apnea+picture+.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Obstructive Sleep Apnea occurs when your throat muscles intermittently relax and block your airway during sleep.</td></tr>
</tbody></table>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">While this strategy does work on occasion, the problem with this secondary linkage between OSA and PTSD is that the medical research is questionable at best, and thus, I fully expect more VA denials than approvals.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">BUT…maybe there’s a better way?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Well, there is, and it requires you to think outside the box.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">For example, did you know a veteran recently got secondary service-connected for Obstructive Sleep Apnea (OSA) based upon his current service-connected Plantar Fasciitis?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">At first, you might be thinking, “Brian, that doesn’t even make sense. How can OSA be caused or made worse by severe heal pain?”</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Well, let’s first take a deep-dive into the law and explore how we got here.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Service-Connection (SC) on a secondary basis requires a showing of causation.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">A showing of causation requires that the secondary disability be shown to be proximately due to, or the result of, a primary SC condition.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">And by the way, to establish causation, the primary disability need NOT already be SC, or even diagnosed, at the time the secondary condition is incurred. <a href="https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000077271/Frost-v.-Shulkin,-29-Vet.App.-131-(2017)" target="_blank">Read Frost v. Shulkin (2017) U.S. Court of Appeals for Veterans Claims (Court) HERE.</a></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b><u>Example:</u></b> SC was granted for a back disability with radiculopathy effective in 2015. Credible evidence showed that the Veteran had a 20-year history of back pain and progressively worsening radiculopathy dating back to roughly 2001. The formal diagnosis of radiculopathy was not made until 2010. The Veteran claimed SC for a shoulder disability in 2016, stating that his early symptoms of radiculopathy caused him to lose his balance, fall, and tear his rotator cuff in 2008. He provided a medical opinion linking his rotator cuff tear to a fall, and the fall to sensory impairment and difficulty with proprioception due to early symptoms of radiculopathy. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b><u>Result:</u></b> As the medical opinion establishes causation for the rotator cuff tear in the shoulder due to the radiculopathy, the requirements for SC on a secondary basis are satisfied. Although the radiculopathy was not formally diagnosed until after the fall, the credible evidence adequately establishes a history of back problems and gradual onset of radiculopathy dating back to 2001. A finding of causation does not require that the primary disability be formally diagnosed at the time the secondary condition is incurred. Additionally, although SC had not been established for the back condition and radiculopathy at the time of the fall and subsequent rotator cuff tear, a finding of causation does not require that the primary disability be SC at the time the secondary condition was incurred. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">A baseline level of disability, as shown by medical evidence, must be present for an examiner to opine whether aggravation has occurred, and the Veteran’s statement alone, without medical evidence of record showing the baseline level of the claimed disability, is not sufficient to order an examination.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Medical examinations are not to be automatically provided in all cases. Some degree of judgement must be used in determining whether the threshold has been met to schedule an examination.Consider whether satisfactory evidence exists that shows the presence of the claimed disability and its association with the existing SC disability. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">A medical diagnosis up front is not always required to show the presence of the claimed disability, or its link to an SC disability, but it is HIGHLY RECOMMENDED…</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">A generalized statement merely asserting a conclusion that a condition is secondary to an SC disability is not enough to satisfy the Element 3 standard for requesting an examination.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Assess the credibility and merit of the claim prior to ordering an examination. </span><span style="font-family: "arial" , "helvetica" , sans-serif;">Medical evidence showing a relationship between the primary SC disability and the claimed secondary disability. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">The Veteran’s lay statement (personal statement in support of a claim) describing the symptoms present and how they are related to the claimed primary disability.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Medical treatise establishing a known relationship between the primary SC disability and the claimed secondary disability, or a VA regulation or procedure exists that defines a relationship between the primary SC disability and the claimed secondary disability.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Now that we’ve explored a few examples, I’d like to dive into the three evidentiary elements that must be satisfied to prove secondary service connection under the law:</span><br />
<br />
<ol>
<li><b style="font-family: arial, helvetica, sans-serif;">Lay or medical evidence of a current disability or symptoms</b></li>
<li><b style="font-family: arial, helvetica, sans-serif;">Evidence of a SC primary disability (which substitutes for the in-service event, injury, or disease), AND</b></li>
<li><b style="font-family: arial, helvetica, sans-serif;">Indication that the claimed secondary condition may be associated with the primary disability. </b></li>
</ol>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">The first part (#1) can be satisfied with a veteran’s personal statement, a buddy letter, or any existing medical evidence in service treatment records, VA medical records, or any private medical records.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">The second part (#2) can be satisfied with a veteran’s existing service-connected disability rated at 0% or higher.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">The third part (#3) can be satisfied with a credible medical “Nexus” opinion from a qualified medical professional.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">SC on the basis of aggravation of a non-service-connected disability (NSC) may be specifically claimed or may be considered as a part of the claim for secondary SC as directed at M21-1, Part III, Subpart iv, 6.B.5.a. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">BUT, pursuant to 38 CFR 3.310(b) and M21-1, Part IV, Subpart ii, 2.B.5.c, the following additional factors apply when determining whether examination is warranted:</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Medical expertise is ultimately required to establish SC on a secondary basis, but the threshold for ordering an examination (aka a C&P exam) is low. However, there is still a threshold that must be met before an examination is provided.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><u>The following types of evidence “may” give credibility to the claim:</u></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b><u>Example:</u></b> Veteran claims stomach problems secondary to his SC heart condition. He indicates that since he began taking prescribed medications two years ago for his heart condition, he has experienced stomach problems to include constipation, pain, and indigestion. There are no specific diagnoses relating to his stomach symptoms noted in the evidence of record. </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b><u>Analysis:</u></b> While the Veteran’s lay statement is not sufficient to ultimately prove the claim, it is sufficient in this instance to warrant an examination. The Veteran is competent to describe his symptoms and the possible association of symptoms to his SC condition. Furthermore, his statement appears credible when considering the evidence at hand. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b><u>Example:</u></b> A Veteran submits a statement indicating that he has hypertension secondary to his SC low back condition. Medical evidence of record shows no treatment for hypertension and normal blood pressure readings over the last three years.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b><u>Analysis:</u></b> Although the claimant is competent to describe symptoms of a disability, his statement that he has hypertension secondary to the low back condition is not credible as competent medical evidence in this case is required to show elevated blood pressure readings or establish a diagnosis of hypertension. Although Veterans are competent to attest to their symptoms, they are not generally competent to make their own medical diagnoses. The Veteran could attest to symptoms he experiences associated with hypertension, such as dizziness or headaches, but he is not competent to make medical diagnoses. The reason the medical evidence would be required in this case is because the medical evidence of record shows normal blood pressure readings over the last three years and no diagnosis of hypertension. Consequently, the Element 1 standard requiring medical or lay evidence of a current disability has not been met. The substitute evidence from the Element 2 standard is met on the basis that there is an SC disability, a low back condition, present and the claim is being made on a secondary basis. However, the Element 3 standard is not met because the Veteran has submitted a generalized statement suggesting the conclusion that the hypertension is secondary to the back condition, but there is no specific discussion or evidence correlating the hypertension to the back condition. Additionally, there is no VA regulation, procedure, or medical treatise establishing an association. Because the three evidentiary elements are not satisfied, no examination is warranted.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Okay, enough legal jargon, now back to my earlier example of Obstructive Sleep Apnea (OSA) secondary to Plantar Fasciitis. Let’s explore the facts a bit.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The Veteran provided a personal statement, a “lay statement” under the law, as well as a credible medical “Nexus” letter that cited relevant medical research and literature regarding side-effects of the medications he was prescribed for his severe heal pain, the Plantar Fasciitis.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Weight gain was one of the side effects of the pain management medication he was taking. Medical research studies from the Mayo Clinic were cited in the medical “Nexus” opinion, which clearly met the “showing of causation,” standard BECAUSE the Obstructive Sleep Apnea on a secondary basis was shown to be proximately due to, or the result of, the Plantar Fasciitis.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Obstructive Sleep Apnea has been medically linked to weight gain, which shows causation. Thus, as a result of the veteran’s weight gain, the medical “Nexus” letter stated that the Obstructive Sleep Apnea was “at least as likely as not” to have been proximately due to or the result of the medication side effects, which were taken to manage the pain of his Plantar Fasciitis. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">So now I’ve probably got you thinking, what can you possibly connect on a secondary basis due to side effects of any medications you’re taking for your current disabilities?</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">If you need some help, please send us a note through our “Contact Us” page here on Military Disability Made Easy.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Want to listen to the new VA Claims Insider Podcast? <a href="https://anchor.fm/vaclaimsinsider" target="_blank">Click HERE now.</a></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">*****</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Brian Reese is an Air Force service-disabled veteran, and his personal frustration with the VA disability process led him to found VA Claims Insider in 2016, which provides veterans with expert resources for successfully submitting winning VA disability claims. He is also the CEO of Military Disability Made Easy. His eBook, "The 9 Secret Strategies for Winning Your VA Disability Claim,” has been downloaded more than 250,000 times in the past three years and is the #1 rated free VA disability claims guide for veterans. Brian is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011. Brian is a Distinguished Graduate of Management from the United States Air Force Academy and holds an MBA from Oklahoma State University’s Spears School of Business, where he was a National Honor Scholar (Top 1% of Graduate School class).</span>Unknownnoreply@blogger.com16