DIAGNOSTIC CODES IN RATINGS GRANTS


haditlogo2007I frequently see claimants on Hadit.com’s forum mention they cannot decipher their grants and that the decision doesn’t specifically identify the rating by Diagnostic Code or DC. Duh. VA really would prefer to keep you in the dark on that one. We don’t need a bunch of VSO lawyer wannabe’s dissecting the grant and trying to find out why you only got 10% when you should rightfully have been awarded 20 or 40%. This requires some sleuthing on your part. 

The trick to this is to look in the diagnostic codes pertinent to your rating. Find the phrase they copied and pasted into your decision and the assigned rating. From there, you can easily see the rating requirements for the degrees of disability higher and determine if yours merit an increase. Most times they do because VA is fond of using information from 20 years ago to rate on. They myopically try to ignore that C&P several months ago unless and until you point out the more recent findings. This gives them a 16-25 month breather to work on another Veteran’s stuff and then get back to you with a favorable DRO decision you should have gotten at the outset.

On the other hand, an SOC will go into great detail as to why you are not going to get the higher rating. They will parse every ‘if…then’, ‘and’ and ‘or’ in a convoluted argument that stands reason on its head. At this time, you will discover the DC that you were rated under.

Allow me to use some of my own more recent decisions to illustrate this point. First, a rating decision granting fibromyalgia/cryoglobulinemia (below). I filed for these in 2008 after I won the big one for Hep C. The Seattle rater, Victor Morales, either purposefully or in ignorance of SMC S, informed me there was no higher rating than 100% and that any claims above that were pointless. I withdrew them to allow other Vets a stab at justice. About six months later  I discovered the world of Special Monthly Compensation (SMC) and had a few unkind words to say about Victor. Live and learn. The decision below doesn’t contain one diagnostic code and is ambiguous as to what is for application other than what the rater deigns to inform you of.

4-6-2015 rating 40% for cryo-fibro Redacted

Note the language.

“Widespread musculoskeletal pain and tender points with symptoms of headache, paresthesias, sleep disturbance, Raynaud’s -like symptoms, stiffness and irritable bowel symptoms that are constant, near constant and refractory to therapy.”

Turn to 38 CFR  https://www.law.cornell.edu/cfr/text/38/4.71a and look up  Diagnostic code 5025 (fibromyalgia) and lo and behold there it is in VA English. They do not make it easy to find but then it can’t be said they are obscuring it.

5025———Fibromyalgia (fibrositis, primary fibromyalgia syndrome)

Widespread musculoskeletal pain and tender points with symptoms of headache, paresthesias, sleep disturbance, Raynaud’s -like symptoms, stiffness and irritable bowel symptoms that are constant, near constant and refractory to therapy—————- 40%

Whereas when you are denied and have filed a long-winded Notice of Disagreement objecting strenuously to your injustice, the VA is required to inform you in no uncertain terms as to why you lost.  They will send you a Statement of the Case (SOC) that goes into great detail about why and gives you sixty (60) days in which to complain and complete your appeal with a Form 9. 38 CFR 19.29 states:

§ 19.29 Statement of the Case.

The Statement of the Case must be complete enough to allow the appellant to present written and/or oral arguments before the Board of Veterans’ Appeals. It must contain:

a) A summary of the evidence in the case relating to the issue or issues with which the appellant or representative has expressed disagreement;

(b) A summary of the applicable laws and regulations, with appropriate citations, and a discussion of how such laws and regulations affect the determination; and

(c) The determination of the agency of original jurisdiction on each issue and the reasons for each such determination with respect to which disagreement has been expressed.

Here’s a classic SOC  I received that was a Clear and Unmistakable Error (CUE) filing.

10-6-2014 PCT CUE SOC Redacted

After I filed my Extraordinary Writ at the Court of Appeals for Veterans Claims (CAVC) several months later in January 2015, the Seattle VA surreptitiously “reaccomplished” that horrible DRO review with a SSOC that “corrected” their defective logic.

SSOC PCT 2-17-2015 Redacted

Unfortunately, it still did not grant the 100% for Porphyria I sought . I was forced to go to the BVA on appeal and win it there this September 4th.

VA is fond of camouflaging their artwork to make it difficult to follow. That’s why they invented VSOs to mislead you into thinking it’s way over your head and requires a Sherpa to decipher it. Nothing could be farther from the truth. Any Veteran with half a brain could excavate this information. Even if you didn’t know the Diagnostic Code (DC) for Fibromyalgia, or Cryoglobulinemia for that matter,   a simple Google™ search would turn it up in a second.

Enter “How does Vet Admin rate Fibromyalgia” and you get this:

Capture

Open the Hadit article and scroll down to the fourth comment by Pete 992 and there it is. DC 5025. Pretty cool beans, huh?

Capture 22

For hundreds of years, VA has made this anathema to Vets such that they felt it necessary to seek professional help. Unfortunately, VSOs are anything but that. That isn’t a blanket rule but it’s substantially the case for the most part. With Al Gore’s handy new invention called the Internet, we can find all these things out without resorting to legal channels…or VSOs.

Do not expect VA to “give” you anything. Most often, when you win, it is just the beginning of a long struggle to obtain the ultimate rating you set out for. The more clear and concise you make your claim, the sooner you will realize it.

 

 

About asknod

VA claims blogger
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9 Responses to DIAGNOSTIC CODES IN RATINGS GRANTS

  1. Gary Butler says:

    In the Hotlanta area the DC code sheet is sent along with the Decision itself. It lists the code, the disability name, and the disability percentage and the dates that the ratings were active for that code at what rate. Very helpful with research.

  2. John King says:

    I recently filed for “unauthorized expenses” with the VA. I filed two dental claims for reimbursement at different times. One claim I won (the cheap one) and lost the other (the expensive one). I cannot really make heads or tails of the VA’s logic except they did give me appeal rights to file with VARO over a medical expense. I am fully entitled to complete dental care, and yet the VA denied me. I got the work done on my own out of my pocket. I am filing my NOD, but who with? The VAMC is the one who denied me care. This is not about a disability rating denial. I filed the NOD with the people who denied me. I wonder if I should also file at the VARO. Even the claims I have won over the years neither me or my doctors understand why or why not.

    • Kiedove says:

      I’ve been wondering about this denial of dental care issue too–with whom to file with. My husband’s PCP in MN refused to give him a referral to get classified with the VA dental service. Do you know what your classification is? Since we were about to move, we let it go for the time being.

  3. jsprague says:

    Thanks Asknod.
    I have the same fight on my hands. M21-1 III iv 4 Sec 6 is on my side I think. It details the rating for my peripheral neuropathy very well. I have to use their words against them.

    • js03 says:

      so let me toss in a question here…

      “Service connection for left lower extremity radiculopathy (claimed as partial paralysis
      sciatic nerve left leg and left foot drop) as secondary to the service-connected disability of
      lumbosacral strain with intervertebral disc syndrome and degenerative disc disease (also
      claimed as spinal stenosis, low back strain, lumbar strain (chronic), mild thoracolumbar
      scoliosis, spinal instability)….”

      Is this statement providing inclusion of “claimed as” conditions, or would it not?

      • asknod says:

        It’s a partial statement from VA. If you take it out of context from the rating or the SOC, it is akin to an incomplete sentence. First, we have no idea what you have claimed versus how they interpreted what you claimed. The whole thing is too speculative to venture a guess as to what it is you want based on what you offer. Write me a email and scan the document. If you are worried, redact it but I have tons of social security numbers already and time shares everywhere on five continents.

  4. doubleo1951@yahoo.com says:

    AMAN, THE TRUTH SPEAKS

  5. Larry Gwinn says:

    I still can not get my appeal sent out of Houston to the BVA for HCV after 6 years and now I have liver cancer since I cured the HCV. I feel like that motto about the VA is TRUE.

    • Kiedove says:

      Everyone reading this will be sorry to hear about the progression to cancer. I would contact in writing the veteran staffer of one or both of your senators and let them know what you are dealing with. Our taxes pay for these services and we should all use them.
      Best wishes.

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