The terminology and jargon used in VA documents can often be confusing for those applying for VA disabilities. In fact, we often have clients call in and ask us specific questions about “what this means” or “how do I respond” in relation to their rating decision. One particular question we have received in the past has been, “What are these numbers next to my disability?” In reviewing your rating decision, you may have noticed a four- or eight-digit code next to the name of your disability. This code is called a “diagnostic code.” The VA diagnostic code clarifies details about your claim and how your claim is being processed.
A diagnostic code is defined by the VA as “arbitrary numbers for the purpose of showing the basis of the evaluation assigned and for statistical analysis in the Department of Veterans Affairs, and as will be observed, extend from 5000 to a possible 9999.” 38 C.F.R. § 4.27. While the VA diagnostic codes listed in the regulations cover a wide range of disabilities, there are times when the four-digit system doesn’t quite fit. For instance, if your disability is based on residual conditions, you will see an eight-digit VA diagnostic code, with the first four digits representing the initial condition and the last four digits representing the residual condition (e.g, 5678-9012).
If you happen to have a condition that is new or unlisted, or should your condition require a rating by analogy, the diagnostic code assigned will use the first two numbers based on where the problem is (respiratory system, skin, etc.), and the last two numbers will be “99”.
Each diagnostic code has an associated schedule of disability ratings and criteria that is used to determine what disability rating is assigned to you. Generally, the VA will use the criteria listed in the diagnostic code when determining your initial rating, as well as any increases (or decreases) as time goes on.
In cases where a rating is assigned by analogy, ensuring a correct VA diagnostic code is key, as the rating criteria in the assigned diagnostic code will be used as a basis for deciding any rating increases. A condition may be rated by analogy when a condition is unlisted and there is a listed disease or injury which is closely related “in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous.” 38 C.F.R. § 4.20. While an assigned VA diagnostic code may be closely related, the assigned code’s rating criteria may not be an exact match for the aggravation of your symptoms, which may lead to an erroneous decision.
Understanding VA diagnostic codes may seem insignificant at first glance, but they carry a heavy impact in your rating and disability compensation. If you or somebody you know has been denied disability benefits or rated to low, you may need legal assistance. Our team of skilled VA disability lawyers can assist in appealing your rating decision and helping you get the benefits you deserve. Contact our team at (888) 883-2483 to schedule a free, confidential consultation today.
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