ptsd Code Sheet

[Navy4life]

Hello and good afternoon my fellow Veterans;

After reviewing a lot of posts on here regarding "Code Sheet" I finally went and got mine at my local DAV office while at the VA Hospital today.  The DAV rep indicated that they aren't supposed to give them out but she printed it off and stated to me "you didn't get this from me".  So I reviewed it and I find it very informative.  I like that it gives the actual code for the disability I am rated, hence "Code Sheet" LOL 

I noticed all my disabilities have "static" except for my PTSD which has an out date of 2021 for Future Exam.  That makes me feel pretty good!

In case some are not aware, a static disability is a disability that is considered permanent by its nature, history and severity.  It is assigned a permanent evaluation without the need for future exams.  

Now I would assume if you go to file an increase for a "static" disability, then you are open to a reduction.  Not sure if that is correct or not???

Just wanted to share this with my fellow Veterans!

Edited May 3, 2016 by Navy4life

[Meddac]

You are correct, Navy. Applying for an Increase automatically triggers VA to order an exam which "could" lead to a process that includes a reduction in the percentage assigned. Shouldn't be that way, but I can solemnly swear that I have witnessed reductions based on one exam alone rather than two separate exams.

It's a slippery slope with VA. Depends a lot on the rater that decides your case.

[Buck52]

Filing a new claim secondary to a existing disability  is that consider a increase?

example

Veteran has a 70% PTSD and has a sleep study  done at VA because  he stops breathing at night since taking VA PTSD Medications and VA Orders the sleep study and the veteran is diagnose with S.A.

would the code sheets give out the code for what the veteran is diagnosed for S.A  For?

would it matter what the Veteran is currently rated at?

say he is rated at 100%and meets the SMC Criteria and is currentyl getting the SMC H.B. S 1...and files a new secondary claim for Sleep Apnea ?

.............Buck

[FormerMember]

A filing for a disease secondary to an existing one is not an increase. Each disease that evolvves as a secondary is a stand alone claim. If you win, the rating diagnostic code will be an amalgam of the primary rating such as DC 7354 for hepatitis C and the second disease such as Porphyria cutanea tarda. The rating sheet would read 7354-7815. I have two like that. the other one is 7354-7700 ( 60% anemia -old 1994 DC 7700). I appealed for 100% for it based on the similarity to 4.115a (dialysis) because there was no 100% rating for porphyria phlebotomies-just 40% under DC 7704. It's called rating by analogy when there is no specific code for a disease/injury. Look at 38 CFRs 4.20 and 4.27

  § 4.20 Analogous ratings.

When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin

§ 4.27

The diagnostic code numbers appearing opposite the listed ratable disabilities are 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. Great care will be exercised in the selection of the applicable code number and in its citation on the rating sheet. No other numbers than these listed or hereafter furnished are to be employed for rating purposes, with an exception as described in this section, as to unlisted conditions. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number will be “built-up” as follows: The first 2 digits will be selected from that part of the schedule most closely identifying the part, or system, of the body involved; the last 2 digits will be “99” for all unlisted conditions. This procedure will facilitate a close check of new and unlisted conditions, rated by analogy. In the selection of code numbers, injuries will generally be represented by the number assigned to the residual condition on the basis of which the rating is determined. With diseases, preference is to be given to the number assigned to the disease itself; if the rating is determined on the basis of residual conditions, the number appropriate to the residual condition will be added, preceded by a hyphen. Thus, rheumatoid (atrophic) arthritis rated as ankylosis of the lumbar spine should be coded “5002-5240.” In this way, the exact source of each rating can be easily identified. In the citation of disabilities on rating sheets, the diagnostic terminology will be that of the medical examiner, with no attempt to translate the terms into schedule nomenclature. Residuals of diseases or therapeutic procedures will not be cited without reference to the basic disease.

[Buck52]

Navy4life  thats good information

Thanks.

[Navy4life]

Buck;

i believe so. The fact that you file a secondary to an already s/c contention is new. 

May code sheet shows my secondary contention to my primary contention. 

Edited May 4, 2016 by Navy4life

[Navy4life]

2 hours ago, Meddac said:

You are correct, Navy. Applying for an Increase automatically triggers VA to order an exam which "could" lead to a process that includes a reduction in the percentage assigned. Shouldn't be that way, but I can solemnly swear that I have witnessed reductions based on one exam alone rather than two separate exams.

It's a slippery slope with VA. Depends a lot on the rater that decides your case.

Meddac thank you for your valuable input!