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8 Other Diagnostic Classification Systems and Rating Schedules
Pages 252-271

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From page 252...
... instead of the Department of Veterans Affairs' (VA's) Schedule for Rating Disabilities (Rating Schedule)
From page 253...
... 253 OTHER DIAGNOSTIC CLASSIFICATION SYSTEMS AND RATING SCHEDULES committee.1 The 10th and most recent revision of the ICD was published in 1992 and is used by the United States to report mortality statistics. The 9th revision (published in 1977)
From page 254...
... 254 EVALUATING VETERANS FOR DISABILITY BENEFITS TABLE 8-1 Examples of ICD Classifications 250 Diabetes mellitus 250.0 Diabetes mellitus without mention of complication 250.1 Diabetes with ketoacidosis 250.2 Diabetes with hyperosmolarity 250.3 Diabetes with other coma 250.4 Diabetes with renal manifestations 250.5 Diabetes with ophthalmic manifestations 250.6 Diabetes with neurological manifestations 250.7 Diabetes with peripheral circulatory disorders 250.8 Diabetes with other specified manifestations 250.9 Diabetes with unspecified complications 491 Chronic bronchitis 491.0 Simple chronic bronchitis 491.1 Mucopurulent bronchitis 491.2 Obstructive chronic bronchitis 491.20 Without mention of acute exacerbation 491.21 With acute exacerbation 491.8 Other chronic bronchitis 491.9 Unspecified chronic bronchitis 717 Internal derangement of knee 717.0 Old bucket handle tear of medial meniscus 717.1 Derangement of anterior horn of medial meniscus 717.2 Derangement of posterior horn of medial meniscus 717.3 Other and unspecified derangement of medial meniscus 717.4 Derangement of lateral meniscus 717.40 Derangement of lateral meniscus, unspecified 717.41 Bucket handle tear of lateral meniscus 717.42 Derangement of anterior horn of lateral meniscus 717.43 Derangement of posterior horn of lateral meniscus 717.49 Other 717.5 Derangement of meniscus, not elsewhere classified 717.6 Loose body in knee 717.7 Chondromalacia of patella 717.8 Other internal derangement of knee 717.81 Old disruption of lateral collateral ligament 717.82 Old disruption of medial collateral ligament 717.83 Old disruption of anterior cruciate ligament 717.84 Old disruption of posterior cruciate ligament 717.85 Old disruption of other ligaments of knee 717.89 Other 717.9 Unspecified internal derangement of knee SOURCE: St. Anthony's Publishing (2003)
From page 255...
... 255 OTHER DIAGNOSTIC CLASSIFICATION SYSTEMS AND RATING SCHEDULES can be classified at the five-digit level as "without mention of acute exacerbation" (491.20) or "with acute exacerbation" (491.21)
From page 256...
... To receive disability benefits from SSA, a person must be unable to engage in any substantial gainful activity for at least a year because of a physical or mental impairment. The substantial gainful activity concept, currently defined as earning no more than $900 a month, originally derived from the War Risk Insurance Act of 1914, which defined total disability as mental or physical impairment making it impossible for the individual "to follow any substantial gainful occupations" (Berkowitz, 1987:44)
From page 257...
... • Axis II includes mental retardation and personality disorders, such as antisocial, avoidant, borderline, dependent, histrionic, narcissistic, obsessivecompulsive, paranoid, schizoid, and schizotypal personality disorders. • Axis III consists of medical conditions that may be relevant to the understanding and treatment of the mental disorder.
From page 258...
... 258 EVALUATING VETERANS FOR DISABILITY BENEFITS 4. irritability, 5.
From page 259...
... Individuals with disabling childhood disorders presumably are not accepted for military service. For policy reasons, substance abuse and personality disorders are expressly barred from being the basis for disability compensation.
From page 260...
... . The role of the physician, the Guides makes clear, is limited only to determining degree of medical impairment and individual-level functional limitations on activities, and to providing supporting medical information to those making disability determinations, not deciding if someone is disabled for purposes of disability benefits.
From page 261...
... It includes almost 800 unique diagnostic codes categorized by body system. Raters match the medical conditions of veterans applying for disability compensation with one or more of the codes and then use the criteria associated with each code to assign a percentage rating.
From page 262...
... Raters use these records, whether from private providers or the VHA health-care system, as part of establishing the diagnosis or diagnoses pertinent to a veteran's claim. C&P examinations, whether by VHA clinicians or contract clinicians, play a prominent role in the disability compensation system, probably in part because the examiner provides the service of interpreting the medical information and translating it into Rating Schedule terms for raters to use.
From page 263...
... . The rater is directed to evaluate the condition according to its various neurological consequences, "such as hemiplegia, epileptiform seizures, facial nerve paralysis, etc." There is no other guidance in the Rating Schedule on the likely sequelae of brain injury for the rater to consider.
From page 264...
... No classification system can identify every possible diagnosis ahead of time, not even one with 800 codes such as those found in the VA Rating Schedule. VA provides flexibility by allowing the rater to use an analogous condition as a guide for determining the rating percentage.
From page 265...
... The short-term direct costs would be significant in terms of changing computer systems and retraining raters. These costs would already be incurred, however, if the Rating Schedule undergoes a comprehensive revision in which most of the codes would be changed anyway.
From page 266...
... VA should use the most recent versions of the ICD and the DSM in the disability determination process. When the Rating Schedule is revised, it should include the conditions most prevalent in the veteran population, classified according to current medical concepts and terminology.
From page 267...
... 267 OTHER DIAGNOSTIC CLASSIFICATION SYSTEMS AND RATING SCHEDULES rating of total impairment. The Guides leaves it to the adjudicator in the workers' compensation program or other disability program to determine degree of disability, which involves considerations of functioning that the Guides does not address.
From page 268...
... , tends to have lower ratings than the Rating Schedule. An example in the Guides is upper extremity amputation (Table 8-2)
From page 269...
... Wrist 70 60 All digits 70 60 90 54 NOTE: The insertion points for the pronator teres and bicipital muscles are at slightly different points on the upper forearm, so it is possible for someone to have an amputation above the pronator teres and below the bicipital insertion, which is just below the elbow. SOURCES: VA Schedule for Rating Disabilities (diagnostic codes 5120−5125)
From page 270...
... Presentation to the IOM Committee on Medical Evaluation of Veterans for Disability Compensation, Washington, DC, Septem ber 21. NCHS (National Center for Health Statistics)
From page 271...
... Presentation to the IOM Committee on Medical Evaluation of Veterans for Disability Compensation, Washington, DC, Septem ber 21.


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