Tacoma Disability

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How VA Diagnostic Codes are Used in VA Disability Ratings

One of the best ways to get a handle on your VA disability claim is to become familiar with the VA diagnostic codes relevant to your conditions.

Knowing the VA diagnostic codes that apply to your disabling conditions will help you in having a more prepared and thorough claim. Moreover, if your VA claim is or has been denied, knowing the specific rating criteria (via diagnostic codes) that your claim is measured by will help you in breaking down how to overcome the denial and win your case.

Here are a couple of examples of how and why using VA diagnostic codes can help in understanding your VA disability claim and appeal.

We will be using the rating criteria defined, here.

VA Diagnostic Codes Example: PTSD

Johnny was in Afghanistan for fifteen months. He lost five of his friends during that time due to an IED hitting their convoy. When Johnny got back to the states, his wife noticed that he was acting differently but decided it was just him trying to acclimate to being home.

At night, Johnny suffered from insomnia. He was having nightmares so vividly about what he saw while in Afghanistan that he was afraid to close his eyes. During the day, any loud sounds resembling a boom startle him. Being in large crowds also overwhelms him.

Johnny feels as though he is not safe and has panic attacks if someone gets too close. Johnny’s wife has also noticed that he has become more irritable and has irrational moments of anger. He has also become withdrawn and does not participate in family outings or social gatherings with their friends.

At the suggestion of his wife, Johnny goes to see a VA psychiatrist who diagnoses him with Posttraumatic Stress Disorder (PTSD).

When the VA sees that Johnny has filed a claim for PTSD, they apply the criteria defined in the schedule of ratings VA diagnostic code most appropriate for his diagnosis. The diagnostic code for PTSD is 9411, and because of his levels of impairment, the criteria most closely resembles a VA disability rating of 50%.

VA Diagnostic Codes Example: Skin

Lisa was in Johnny’s unit (see above) when the IED hit their convoy. Fortunately, she survived but suffered severe facial, head, and neck burns from the blast. She spent two months in the hospital recovering and now has significant scarring on the right side of her face. There is visible tissue loss, her nose and her right eye are disfigured, and she lost her right ear.

After reading this article, Lisa fills out her claim for VA benefits; she looks up the VA diagnostic codes on the VA benefits website.  She finds that the diagnostic code for Skin Disorders is 7800. And she also looks at the descriptions for the general rating formula for skin disorders and sees that because of the scarring, disfigurement, and general disability presented by her skin conditions she is most likely to rate a VA disability of 80%

If she is denied her VA disability or provided a rating of less than 80%, she would have reasonable cause to appeal the VA rating decision.  

She could/should also reach out to an experienced VA disability advocate or attorney for help.

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