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  • 14 Questions about VA Disability Compensation Benefits Claims

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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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*Bergie*

Wrong Diagnostic Code

Question

Listen to this,

Earlier I got a phone call from the VARO. I filed a NOD regarding a denial for "swelling in my lower legs" that was eventually diagnosed as chronic venous insufficiency. It would seem that acording to them my condition matches "sciatic nerve paralysis". They claim that when they put it into the computer that is what it closely matched up to. I don't for the life of me see how they got that but they said that is what they are rating it under. I was unable to really talk so unfortunately I couldn't ask them about matching the symptoms up with a vascular condition such as vericose veins. Which it actually matches up with. I'm now going to have to request a DRO hearing to try to get my point accross to them. This really sucks

Bergie

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Listen to this,

Earlier I got a phone call from the VARO. I filed a NOD regarding a denial for "swelling in my lower legs" that was eventually diagnosed as chronic venous insufficiency. It would seem that acording to them my condition matches "sciatic nerve paralysis". They claim that when they put it into the computer that is what it closely matched up to. I don't for the life of me see how they got that but they said that is what they are rating it under. I was unable to really talk so unfortunately I couldn't ask them about matching the symptoms up with a vascular condition such as vericose veins. Which it actually matches up with. I'm now going to have to request a DRO hearing to try to get my point accross to them. This really sucks

Bergie

I would write them a letter and explain it than its really up to them until you get a final word.

Good Luck

Pete

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Bergie,

You might be able to straighten out a request for a change in Diagnostic Code

by using Iris.

jmho,

carlie

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Out of 623,522 cases at the BVA web site ,this term "chronic venous insufficiency" only appears in 2 cases that won't help you.

The diagnostic code problem seems to be a lack of a specific code for this condition.This is actually a symptom that has disabling affects. Chronic Venous insufficiency is so braod of a term that VA wont know what it really means.

What other names is it called in your medical records? Possible PAD? Peripheral arterial disease?

Is this directly due to an established SC condition?

One case was a widow's claim but the insufficiency was due to heart disease and she did not prove a nexus.

In the other case thrombophlebitis was also used to characterize the venous insufficiency in the veteran's feet.

He was claiming this due to cold weather exposure and frostbite in 1947 but could not succeed in proving any chronicity after service,or any other nexus.

Edited by Berta

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Berta is certainly correct on that in questioning "other names is it called in your medical records?"

Here are a couple of 38 CFR regs that would apply and help with your research.

Hope this helps a vet/vba claimant.

carlie

§4.2 Interpretation of examination re- ports.

Different examiners, at different times, will not describe the same dis- ability in the same language. Features of the disability which must have per- sisted unchanged may be overlooked or a change for the better or worse may not be accurately appreciated or de- scribed. It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the var- ious reports into a consistent picture so that the current rating may accu- rately reflect the elements of disability present. Each disability must be con- sidered from the point of view of the veteran working or seeking work. If a diagnosis is not supported by the find- ings on the examination report or if the report does not contain sufficient detail, it is incumbent upon the rating board to return the report as inad- equate for evaluation purposes.

[41 FR 11292, Mar. 18, 1976]

§ 4.3 Resolution of reasonable doubt.

It is the defined and consistently ap- plied policy of the Department of Vet- erans Affairs to administer the law under a broad interpretation, con- sistent, however, with the facts shown in every case. When after careful con- sideration of all procurable and assem- bled data, a reasonable doubt arises re- garding the degree of disability such doubt will be resolved in favor of the claimant. See § 3.102 of this chapter.

[40 FR 42535, Sept. 15, 1975]

§ 4.6 Evaluation of evidence.

The element of the weight to be ac- corded the character of the veteran’s service is but one factor entering into the considerations of the rating boards in arriving at determinations of the evaluation of disability. Every element in any way affecting the probative value to be assigned to the evidence in each individual claim must be thor- oughly and conscientiously studied by each member of the rating board in the light of the established policies of the Department of Veterans Affairs to the end that decisions will be equitable and just as contemplated by the require- ments of the law.

§ 4.7 Higher of two evaluations.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly ap- proximates the criteria required for that rating. Otherwise, the lower rat- ing will be assigned.

§ 4.13 Effect of change of diagnosis.

The repercussion upon a current rat- ing of service connection when change is made of a previously assigned diag- nosis or etiology must be kept in mind. The aim should be the reconciliation and continuance of the diagnosis or eti- ology upon which service connection for the disability had been granted. The relevant principle enunciated in §4.125, entitled ‘‘Diagnosis of mental disorders,’’ should have careful atten- tion in this connection. When any change in evaluation is to be made, the rating agency should assure itself that there has been an actual change in the conditions, for better or worse, and not

merely a difference in thoroughness of the examination or in use of descrip- tive terms. This will not, of course, preclude the correction of erroneous ratings, nor will it preclude assignment of a rating in conformity with § 4.7.

[29 FR 6718, May 22, 1964, as amended at 61 FR 52700, Oct. 8, 1996]

§ 4.20 Analogous ratings.

When an unlisted condition is en- countered it will be permissible to rate under a closely related disease or in- jury in which not only the functions af- fected, but the anatomical localization and symptomatology are closely analo- gous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diag- nosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic dis- eases and injuries be assigned by anal- ogy to conditions of functional origin.

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Out of 623,522 cases at the BVA web site ,this term "chronic venous insufficiency" only appears in 2 cases that won't help you.

The diagnostic code problem seems to be a lack of a specific code for this condition.This is actually a symptom that has disabling affects. Chronic Venous insufficiency is so braod of a term that VA wont know what it really means.

What other names is it called in your medical records? Possible PAD? Peripheral arterial disease?

Is this directly due to an established SC condition?

One case was a widow's claim but the insufficiency was due to heart disease and she did not prove a nexus.

In the other case thrombophlebitis was also used to characterize the venous insufficiency in the veteran's feet.

He was claiming this due to cold weather exposure and frostbite in 1947 but could not succeed in proving any chronicity after service,or any other nexus.

Berta,

Thank you for your response. I developed the swelling around the top of my boots while serving in Iraq. When I left country I reported this on my post deployment health screening. In my medical records they did not give it a name until late last year they only made reference to the 1+, or 2+ edema. However, I pretty much ignored it until a couple years back when it began to get worse. At first the doctors thought it was related to my chronic kidney disease, they only function at 50% and I will need dialysis in the next 10 years. However, after they ruled that out they sent me for an echocardiogram. This was my second one, I had one in 2006 for the swelling and it was normal. This one though was abnormal and they refered me to cardiology. Cardiology ordered a stress test which was normal so then the cardiologist went and viewed the abnormal echo. He came back 1-1/2 hours later and said the echo was normal. I went ballistic and began to use profanity because I wanted to know what was causing this and what was going on. I went to my Kaiser doctor and was refered to their cardiologist. Another echo was done and this was normal. The Kaiser cardiologist as well as the VAMC staff cardiologist both felt the condition was Chronic venous insufficiency. Also, along the way I had vascular studies done which were fairly normal. When I filed my original claim I had no diagnosis and the claim was denied for not having a diagnosis and for a false statement made by a resident doctor. I got the false statement changed by going through the patient advocate and as I said I got the diagnosis of chronic venous insufficiency. This is when I filed the NOD, and with it I cited each doctors note from both Kaiser, the VAMC i also listed the number of pages of each doctors note. I then made copies of each note and submitted the packet all together. After finding out that they were using diagnostic code 8520, I contacted the DAV who want me to write a letter, which I had done after reading Pete's post. I also contacted the 1-800# and they made an entry stating the veteran requests this claim be rated using diagnostic code 7120-varicose veins. I will submit this letter next week when I can travel to the VARO.

Thank you again,

Bergie

Edited by *Bergie*

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