How Does Va Determine Diagnostic Code To Use?

[Angela]

Does anyone know of a law or reg that says that the ROs have to rate conditions using the rating code that grants the Veteran the maximum according to their symptoms?

[Jay Johnson]

That's a very broad question...there are regs and tables for just about every disability that can be SC (and if there isn't one they are supposed to approximate it to an existing condition/table), but even those tables are at the discretion of the rater. If you could be more specific about the disability in question I'm sure someone here can find the appropriate table.

[Angela]

I apologize for being unclear. I read many BVA decisison that discuss the ratings possible under one diagnostic code (considering the disability picture under consideration) and then going on to discuss how under another diagnostic code, the disability percentage would be higher. They choose the diagnostic code that allows for the higher rating when the condition is just as well described by one as the other. My question is, is there a law, reg, or rule that requires this?

I found 38 cfr 4.27 Use of diagnostic code numbers and

4.21 Application of rating schedule but it neither reference address this practice. I know that some of the body systems have specific instructions for how to rate using their codes. I'm asking a more general question though.

If the residual of whatever injury or surgery is just as well described under two different diagnostic code, but one allows for a greater disability percentage, what rule covers this?

[wallyg]

The rule that says the veteran should ALWAYS get the benefit of the doubt. ;)

[Angela]

I FOUND IT!

in a CVA decision and provide it here in case anyone else needs it.

http://www.hadit.com/library/law/89114scha...hvderwinski.htm

"VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions raised in the record, and to explain the reasons and bases for its conclusions (Schafrath v. Derwinski, 1 Vet. App. 589). "

It's use in relation to diagnostic codes was found in a BVA decision

http://www.va.gov/vetapp05/files1/0504840.txt

that says:

"VA has a duty to acknowledge and consider all regulations

that are potentially applicable through the assertions raised

in the record, and to explain the reasons and bases for its

conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991).

However, there are no other diagnostic code provisions that

would provide a basis for a higher evaluation for the

veteran's service-connected disability in this case. The

Board has considered other diagnostic codes pertaining to the

feet. However, aside from the other codes being inapplicable

from a medically diagnostic point of view, none of the other

foot-relevant diagnostic codes provide a disability

evaluation higher than 50 percent, the veteran's current

assignment. 38 C.F.R. § 4.71a, Diagnostic Codes 5277-84

(2004)."