After you have applied for disability benefits and the Department of Veterans Affairs (VA) has determined that your disability is service-connected, the next step is for the VA to assign a rating to your disability. The rating reflects the severity of your disability and is intended to reflect how much the impairment impacts your ability to work. Your rating is used to set the amount of your disability compensation, so that you are compensated for your loss in earning capacity as a result of your service to the country.
Generally, less severe disabilities receive lower ratings and more severe disabilities receive higher ratings. The VA has developed a Schedule of Rating Disabilities (VARSD). The ratings in the schedule are based on the average impact on earning capacity that each disability has in civilian occupations. Ratings range from 0% to 100% in 10% increments.
The VA Schedule of Rating Disabilities breaks down disabilities into different categories based on the part of the body impacted. Each category contains groups of medical issues. Each group of issues then contains a list of diagnoses, and each diagnosis has its own diagnostic code. Each diagnostic code specifies symptoms that are required for various ratings of disability.
For example, under the Digestive System category, there are four groups:
Under ulcers, there are three diagnoses, one of which is "Ulcer, duodenal", diagnostic code 7305. Under diagnostic code 7305, four different ratings are described:
Each level of severity then lists the symptoms you must suffer to qualify for the associated rating. For example, for a severe rating of 60% for an ulcer, you must have symptoms including periodic vomiting and only partial relief from ulcer therapy.
To rate your disability, the VA will start at the body system category, locate your diagnosis, and then find the diagnostic code which best matches with your symptoms. The VA is required to carefully review the medical evidence in your file when assigning a rating.
Even if one disability could satisfy more than one diagnostic code, you can only get rated (and paid) under one code. Where two or more codes apply, the VA must choose the diagnostic code that will give the highest rating.
Sometimes the VA does not apply the rating criteria correctly. Other times, you may feel your disability is more severe than the VA says it is, but it actually has been correctly rated under the criteria in the Schedule of Rating Disabilities.
If your disability is not listed in the Schedule of Rating Disabilities, the VA will look for a disability that is close to the one you have and then evaluate your disability based on the diagnostic code for the related disability.
A 0% rating doesn't pay any disability compensation but is important because it may qualify you for priority health care and other VA benefits.
The monthly payment for ratings of 10% or higher will vary based on whether the veteran has any dependents, and if so, how many.
If you are a single veteran with no dependents, in 2017 you'll receive a monthly benefit of:
If you are married with one dependent child, in 2017 your monthly payment rate will be:
If you have multiple ratings (because you have multiple disaiblities), the VA does not simply add them together to create your final rating. What the VA does is combine your ratings according to a formula. To apply this formula, the VA uses a Combined Ratings Table. The combined rating is then rounded up or down to the nearest whole number. In no case can you receive a rating that is higher than 100%.
For example, say you have one disability rated at 40% and another rated at 60%. Again, you might think this entitles you to a 100% rating, but it does not. You can use the Combined Ratings Table to see what your combined rating will be. Go across the table to where you find the 40, then scroll down until you see the number 60 in the left hand column. There you will find the number 76, which will be rounded up to the nearest increment of 10, which is 80. Your combined disability rating will be 80%.
The VA is required to evaluate each of your service-connected disabilities independently and assign a rating to each. However, if you have both service-connected and non-service connected disabilities and it is very difficult to determine which condition is causing your symptoms, the VA is required to apply the "benefit of the doubt" rule. The benefit of the doubt rule means that when the VA can't tell which disability is causing your symptoms, they have to assume that your service-connected disability is causing them (not your non-service connected disability). This can help you to get a higher rating.
You can ask the VA to assign you different ratings for different periods of time while your application was pending. This is called "staged ratings." You can ask the VA to look at the medical evidence and assign you a higher rating for the period during which your symptoms worsened and met the criteria for a diagnostic code with a higher rating. (If your disability improved, then the VA will also assign a lower rating for the period when your symptoms were lighter.) Staged ratings can help you get a higher retroactive benefit payment when it has taken years for your claim to get awarded.
Continue reading to find out about advanced ratings, such as special monthly compensation, 100% TDIU ratings, and 100% disability ratings, and special rules for TBIs and muscle injuries.
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