Overview
In This Section |
This section contains the following topics:
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1. General Information on the Coded Conclusion
Introduction |
This topic contains general information on the coded conclusion, including
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Change Date |
December 19, 2014 |
III.iv.6.E.1.a. Definition: Coded Conclusion |
A coded conclusion is the section of the Codesheet of a rating decision which contains
Reference: For more information on generating a coded conclusion in Veterans Benefits Management System – Rating (VBMS – R), see the VBMS-R User Guide.
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2. DCs
Introduction |
This topic contains information about DCs, including
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Change Date |
August 28, 2017 |
III.iv.6.E.2.a. Using Analogous Codes |
Use analogous codes to evaluate disabilities not listed in 38 CFR Part 4, VA Schedule for Rating Disabilities (the rating schedule) based on
Reference: For more information on analogous ratings, see 38 CFR 4.20.
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III.iv.6.E.2.b. Components of an Analogous Code |
An analogous code consists of two diagnostic codes (DCs) separated by a hyphen. The first DC of an analogous code is a four-digit code as follows:
The second DC of an analogous code is composed of a four-digit code that
Example: Use 6599-6516 for postoperative tonsillectomy if the condition is evaluated under the criteria for chronic laryngitis.
Note: A DC may not end in 99 unless
Example: The image below demonstrates the use of the 99 modifier on a rating decision Codesheet when SC only was considered and denied for a nonspecific arm condition.
![]() Reference: For more information on listing pension rating codes, see M21-1, Part III, Subpart iv, 6.E.7.
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III.iv.6.E.2.d. Rating Multiple Disabling Manifestations From the Same Disease |
When rating multiple disabling manifestations resulting from the same disease, such as arthritis, multiple sclerosis, or cerebrovascular accident, code each disability separately as follows:
Example: Multiple disabling manifestations of Parkinson’s disease (DC 8004) would result in the following hyphenated codes:
Reference: For more information on rating multiple disabling manifestations from the same disease, see the VBMS-R User Guide.
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3. Evaluations and Effective Dates
Introduction |
This topic contains information about evaluations and effective dates, including
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Change Date |
August 23, 2018 |
III.iv.6.E.3.a. Required Evaluations and Effective Dates for SC Disabilities |
The coded conclusion on the Codesheet must contain the following information for all service-connected (SC) disabilities, both individually and as combined totals:
Important: The rating activity should carefully review the coded conclusion and backfill all historical disability information in the master record as necessary.
Note: An effective date of pension entitlement is required only next to rating code 2.
Reference: For more information on backfilling the master record, see the VBMS-R User Guide.
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III.iv.6.E.3.c. Recording Evaluations |
For each SC disability, record
Note: Show only one line of entitlement after the SC condition whenever there is a retroactive increase or reduction.
Example: A Veteran has been entitled to 30 percent from 01/01/1993 and 50 percent from 01/01/1994. A retroactive increase of 70 percent from 01/01/1994 has been awarded. The coded conclusion should only show the 30-percent evaluation from 01/01/1993 and the 70-percent evaluation from 01/01/1994.
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III.iv.6.E.3.d. Showing Evaluations in Ratings That Apply 38 CFR 3.105(e) |
When applying the provisions of 38 CFR 3.105(e) in a final reduction rating, the coded conclusion should show the
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4. Combined Evaluations
Introduction |
This topic contains information about combined evaluations, including
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Change Date |
August 23, 2018 |
III.iv.6.E.4.a. Combined Evaluations Contained on the Coded Conclusion |
The coded conclusion contains the
The COMBINED EVALUATION FOR COMPENSATION field is populated whenever there is at least one SC or 38 U.S.C. 1151-awarded disability.
The COMBINED EVALUATION FOR PENSION field is populated with the combined evaluations of both the NSC and SC disabilities whenever a claim for pension has been decided.
Exception: Proposed evaluations, such as under the Integrated Disability Evaluation System program or proposed reductions, are not reflected in the combined evaluation.
Note: VBMS-R automatically calculates each combined evaluation effective date based on the issues established and effective dates entered.
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III.iv.6.E.4.b. Applying the Bilateral Factor |
38 CFR 4.26 provides for a bilateral factor whenever there are compensable disabilities affecting the use of
The ratings for the disabilities of the right and left sides will be combined as usual, and 10 percent of this value will be added (i.e., not combined) before proceeding with further combinations of non-bilateral disabilities, or converting to degree of disability. This is known as the bilateral factor.
Important:
Reference: For more information on when the bilateral factor may not be applied to skin conditions, see M21-1, Part III, Subpart iv, 4.L.1.g.
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III.iv.6.E.4.c. Rounding Combined Evaluations |
Rounding combined evaluations is the last step in determining the combined degree of disability under 38 CFR 4.25, and is to be done only once per rating.
Use the table below to determine how to round actual combined evaluations.
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5. Benefit Withholdings
Introduction |
This topic contains information about coding and codesheet entries needed to identify benefits subject to withholding, including
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Change Date |
August 23, 2018
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III.iv.6.E.5.a. General Information on VBMS-R’s Withholding Functionality |
VBMS-R includes functionality that facilitates offsets to Department of Veterans Affairs (VA) benefit awards when beneficiaries have received certain concurrent payments
When review of the evidentiary record reveals that a beneficiary received one of the above-referenced payment types for an SC disability, use the WITHHOLDING INFORMATION field in VBMS-R’s DISABILITY DECISION INFORMATION (DDI) screens in order to identify the
Exception: Do not enter the withholding information attributes described in this block if a Veteran received disability severance pay for one or more SC disabilities incurred in a combat zone or during the performance of duty in combat-related operations, as discussed in M21-1, Part III, Subpart v, 4.B.3.e and f. Instead, identify such disability(ies) by following the procedures in M21-1, Part III, Subpart iv, 6.E.5.b.
References: For more information on
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III.iv.6.E.5.b. Identifying Disabilities for Which Combat-Related Disability Severance Pay Was Awarded |
When awarding SC for disabilities that were incurred in a combat zone, or during the performance of duty in combat-related operations, and resulted in an award of disability severance pay, as discussed in M21-1, Part III, Subpart v, 4.B.3.e and f, identify each such disability by selecting Enhanced Disability Severance Pay from the SPECIAL ISSUE INFORMATION drop-down menu in VBMS-R.
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III.iv.6.E.5.c. Identifying Periods of Service for Which Separation Benefits Were Awarded |
As is discussed in M21-1, Part III, Subpart v, 4.B.2.i, identification of the period(s) of service during which SC disabilities had their onset can often materially influence award actions to recoup separation benefits (other than disability severance pay) awarded by the Department of Defense at the time of discharge.
When awarding SC to a Veteran who received a separation benefit other thandisability severance pay, follow the steps in the table below to properly identify the periods of service during which all SC disabilities were incurred, as necessary.
Exception: If the authorization activity is able to confirm that separation benefits have already been recouped in full, inclusion of the annotations and service-period differentiation discussed in this block is not required.
References: For more information on
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III.iv.6.E.5.d. Examples: Separation Benefit Codesheet Annotations |
Scenario 1: A Veteran served from February 13, 1985, to September 26, 1991, and again from October 28, 1992, to December 4, 1996. He received separation benefits at the end of the first period of service. SC is established for right shoulder impingement syndrome, left hip bursitis, bronchial asthma, gastric ulcer, and bilateral testicular atrophy. Analysis of service treatment records (STRs) shows that the shoulder, hip, and gastric ulcer were incurred during the first period of service. The testicular atrophy and asthma had their onset during the second period of service.
Outcome: A sufficient Codesheet annotation is shown below.
-Right shoulder impingement syndrome, left hip bursitis, and gastric ulcer
were incurred during period of service spanning 02/13/85-09/26/91. -Testicular atrophy and bronchial asthma were incurred during period of
service spanning 10/28/92 – 12/04/96. Scenario 2: A Veteran served from March 18, 2001, to November 9, 2009, and again from May 30, 2011, to April 18, 2016. She received separation benefits at the end of the second period of service. SC is established for status-post total abdominal hysterectomy, scarring alopecia, and bilateral plantar fasciitis. Analysis of STRs shows that the hysterectomy was performed during the first period of service, while the alopecia and plantar fasciitis manifested during the second.
Outcome: A sufficient Codesheet annotation is shown below.
–All SC disabilities subject to recoupment.
Scenario 3: A Veteran served from September 22, 2003, to December 15, 2007; from April 17, 2009, to September 18, 2014; and from January 7, 2016, to May 2, 2018. He received separation benefits at the end of the second period of service. SC is established for migraine headaches, thoracolumbar strain, and temporomandibular joint dysfunction (TMD). Analysis of STRs shows that the thoracolumbar strain and TMD were incurred during the first period of service, while the migraine headaches manifested during the third.
Outcome: A sufficient Codesheet annotation is shown below.
-Back strain and TMD were incurred during the period of service
spanning 9/22/03 – 12/15/07. -Headaches were incurred during the period of service spanning 1/7/16 –
5/2/18. |
6. Other Coding Issues
Introduction |
This topic contains information about other coding issues, including
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Change Date |
August 23, 2018 |
III.iv.6.E.6.a. Denying IU |
When the issue of entitlement to individual unemployability (IU) is denied for the first time, a formal, coded rating is required.
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III.iv.6.E.6.b. Denying SMP |
A summary of past coding pertaining to compensation or pension entitlement is not required when there is no entitlement to special monthly pension (SMP), unless the decision has changed.
Include the denial of SMP in any future ratings that bring forward compensation or pension coding.
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III.iv.6.E.6.c. Coding Competency |
The coded conclusion should show all determinations of incompetency and restored competency. Include competency determinations in any future ratings that bring forward compensation or pension coding.
If a previously incompetent Veteran has regained competency
Important: Do not furnish a copy of the rating to the fiduciary activity in the case of a VA institutionalized Veteran without a spouse, child, or fiduciary if VA Form 21-592, Request for Appointment of a Fiduciary, Custodian, or Guardian, was not furnished earlier under the provisions of M21-1, Part III, Subpart v, 6.E.2.
Reference: For more information on the process for making competency determinations, see M21-1, Part III, Subpart iv, 8.A.3.
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III.iv.6.E.6.d. Removing Active Duty Discontinuance Coding |
As is discussed in M21-1, Part III, Subpart v, 4.C.7.c, preparation of a rating decision that reflects loss of entitlement to benefits based on a Veteran’s return to active duty is not necessary.
Similarly, as discussed in M21-1, Part III, Subpart v, 4.C.7.g, rating action to reinstate benefits following a Veteran’s release from active duty is not necessaryunless the Veteran’s award was originally discontinued by rating decision.
When deciding the claim of a Veteran whose prior Codesheet(s) reflect the loss of SC during a period of active duty, use the MASTER RECORD tab and/or DDI screens to remove all previous Active Duty – Discontinue selections and corresponding discontinuance dates from all affected SC disabilities. The authorization activity will recreate all necessary adjustments by award action.
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7. Listing Compensation Rating Codes
Introduction |
This topic contains information about listing compensation rating codes, including
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Change Date |
August 23, 2018 |
III.iv.6.E.7.a. Grouping SC Disabilities |
Group all disabilities subject to compensation under code 1, showing the
Note: In VBMS-R, disabilities are grouped automatically and carried forward from rating to rating.
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III.iv.6.E.7.b. Using Diagnostic Terminology |
Use the diagnostic terminology provided by the medical examiner (or other alternative medical evidence) in the rating decision.
Notes:
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III.iv.6.E.7.c. Coding Compensation Awards |
When first establishing SC for a particular disability, include the following under each diagnosis:
Note: Some decision basis selections will require additional information. For example, if the selected decision basis is SECONDARY, an associated disability must be selected from the ASSOCIATED DISABILITY drop-down menu.
Reference: For more information on coding compensation awards, see theVBMS-R User Guide.
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III.iv.6.E.7.d. Coding New Awards of Previously-Considered Issues |
Use the table below when awarding SC for an issue that was previously
Reference: For more information on editing and deleting existing disability decisions, see the VBMS-R User Guide.
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8. Listing Pension Rating Codes
Change Date |
December 13, 2005 |
III.iv.6.E.8.a. Handling Disabilities That Result From Willful Misconduct |
Code all claimed and noted disabilities, and show the evaluation of each disability, as appropriate, unless the disabilities have been held to be due to the claimant’s own willful misconduct by rating or by an administrative decision.
When intoxication from alcohol or drugs results proximately and immediately in disability or death, it is due to willful misconduct. However, organic diseases which are caused by the chronic use of alcohol are not considered of willful misconduct origin under 38 CFR 3.301(c)(2), and should be provided an evaluation if pension is claimed.
Example: Cirrhosis of the liver due to chronic alcohol abuse may form the basis for an award of NSC pension.
Note: Disabilities that result from the use of alcohol or drugs may not be SC because they cannot be deemed to have been incurred in the line of duty.
References: For more information on
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9. Coding Denials of NSC Conditions
Introduction |
This topic contains information about coding denials of NSC conditions, including |
Change Date |
December 16, 2016 |
III.iv.6.E.9.a. Showing Reasons for Denial of NSC Conditions |
When a claim is initially disposed of, the reasons for denial are shown after the diagnosis on the rating Codesheet. For example
These denial reasons will remain on the Codesheet for subsequent ratings unless
Note: VBMS-R automatically performs these functions if all the issues are correctly entered into the program.
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III.iv.6.E.9.b. Reflecting the Date of Original Denial |
If a disability was previously denied SC, VBMS-R will reflect the date of the prior decision in the ORIGINAL DATE OF DENIAL field in all subsequent rating decisions. This date is listed in the coded conclusion after the diagnosis on the rating Codesheet.
Note: This date is not populated on the Codesheet if the current decision is the initial denial.
When deciding a claim for a previously denied disability, decision makers must ensure the correct date of the initial denial of the claim is reflected in the ORIGINAL DATE OF DENIAL field. Follow the steps in the table below to update the ORIGINAL DATE OF DENIAL field in VBMS-R.
Reference: For more information on backfilling the master record, see
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8-23-18_Key-Changes_M21-1III_iv_6_SecE.docx | May 15, 2019 | 89 KB |
9-15-2015_Key-Changes_M21-1III_iv_6_SecE.docx | May 15, 2019 | 66 KB |
Historical_M21-1III_iv_6_SecE_12-16-16.doc | May 15, 2019 | 144 KB |
Historical_M21-1III_iv_6_SecE_8-28-17.docx | May 15, 2019 | 88 KB |
Historical_M21-1III_iv_6_SecE_6-1-15.doc | May 15, 2019 | 122 KB |
8-28-17_Key-Changes_M21-1III_iv_6_SecE.docx | May 15, 2019 | 90 KB |
Change-May-1-2015-Transmittal-Sheet-M21-1III_iv_6_SecE_TS.docx | May 15, 2019 | 39 KB |
Change-June-1-2015-Transmittal-Sheet-M21-1III_iv_6_SecE_TS.docx | May 15, 2019 | 38 KB |
Transmittal-12_13_05.doc | May 15, 2019 | 52 KB |
Transmittal-12_13_05.doc | May 15, 2019 | 52 KB |
Transmittal-12_13_05.doc | May 12, 2019 | 54 KB |
Transmittal-12_13_05.doc | May 12, 2019 | 54 KB |
Change-December-19-2014-Transmittal-Sheet-M21-1MRIII_iv_6_SecE_TS.docx | May 15, 2019 | 39 KB |
in Chapter 6 The Rating Decision, Part III General Claims Process, Subpart iv General Rating Process
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