M21-1, Part III, Subpart iv, Chapter 6, Section E – Coded Conclusion

In This Section

Introduction

• definition of coded conclusion
• coding subsequent ratings, and
• decisions not requiring a coded conclusion.

Change Date

III.iv.6.E.1.a.  Definition:  Coded Conclusion

• a summary of information on the status of benefits, and
• all decided issues.

III.iv.6.E.1.b.  Coding Subsequent Ratings

III.iv.6.E.1.c.  Decisions Not Requiring a Coded Conclusion

• denial of special monthly compensation, or
• a finding of not new and material evidence.

Introduction

• using analogous codes
• components of an analogous code
• using hyphenated codes to rate residual conditions, and
• rating multiple disabling manifestations from the same disease.

Change Date

III.iv.6.E.2.a.  Using Analogous Codes

• function(s) affected
• anatomical location, and
• symptomatology.

III.iv.6.E.2.b. Components of an Analogous Code

• the first two digits refer to the body system involved in the rating, and
• the second two digits are always 99.

• is taken from the rating schedule, and
• identifies the criteria used to evaluate the claimed disability.

• it is the first four digit code in an analogous code, or
• service connection (SC) for the disability has been denied and it has not been evaluated for pension.

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.

III.iv.6.E.2.c.  Using Hyphenated Codes to Rate Residual Conditions

III.iv.6.E.2.d.  Rating Multiple Disabling Manifestations From the Same Disease

• show the DC of the disease as the lead DC of the hyphenated codes
• follow the lead code with a code for the body system of the most severely affected disorder
• code the involvement of the other body systems under the DC for the disability on which the evaluation is determined, and
• identify the basic disease entity in the diagnoses of the disabilities involved.

• 8004-8520 sciatic nerve condition due to Parkinson’s disease as the most severely affected residual, followed by less disabling residuals of
• 8515 median nerve condition due to Parkinson’s disease
• 9434 major depressive disorder due to Parkinson’s disease, and
• 7203 esophageal stricture due to Parkinson’s disease.

Introduction

• required evaluations and effective dates for service-connected (SC) disabilities
• evaluations and effective dates for NSC disabilities
• recording evaluations, and
• showing evaluations in ratings that apply 38 CFR 3.105(e).

Change Date

III.iv.6.E.3.a.  Required Evaluations and Effective Dates for SC Disabilities

• current percentage evaluation
• current effective date
• future percentage evaluation, if applicable, and
• future effective date, if applicable.

III.iv.6.E.3.b.  Evaluations and Effective Dates for NSC Disabilities

III.iv.6.E.3.c.  Recording Evaluations

• the evaluation in effect
• the new evaluation assigned, if indicated, and
• future evaluation(s), if indicated.

III.iv.6.E.3.d.  Showing Evaluations in Ratings That Apply 38 CFR 3.105(e)

• current evaluation in effect, and
• future reduced evaluation.

Introduction

• combined evaluations contained on the coded conclusion
• applying the bilateral factor, and
• rounding combined evaluations.

Change Date

III.iv.6.E.4.a. Combined Evaluations Contained on the Coded Conclusion

• current combined evaluation
• historical combined evaluation(s), and
• the effective date(s) for each combined evaluation.

III.iv.6.E.4.b. Applying the Bilateral Factor

• both arms
• both legs, or
• paired skeletal muscles.

• The bilateral factor only applies when there are qualifying disabilities of the left and right sides.
• When a specific DC provides one evaluation for a bilateral condition, only apply the bilateral factor if there is an independently ratable condition in one of the involved extremities such as in the case of a 20-percent evaluation for left leg muscle damage under DC 5311 in addition to 30-percent evaluation for bilateral flat feet under DC 5276.

III.iv.6.E.4.c.  Rounding Combined Evaluations

Introduction

Change Date

III.iv.6.E.5.a.  General Information on VBMS-R’s Withholding Functionality

• of disability severance pay
• under the Radiation Exposure Compensation Act (RECA)
• in connection with tort awards, or
• of Office of Workers’ Compensation Programs (OWCP) benefits.

• type of concurrent payment for which VA benefit withholding is necessary and,
• if applicable, the percentage of VA benefit withholding needed.

• concurrent benefits and elections, see 38 CFR 3.700
• prohibition against duplication of benefits in claims involving
  • disability severance pay, see M21-1, Part III, Subpart v, 4.B
  • RECA, see M21-1, Part III, Subpart v, 4.F.4
  • tort awards, see
    • M21-1, Part IV, Subpart ii, 3.D, and
    • M21-1, Part IV, Subpart iii, 3.E, and
• OWCP benefits, see M21-1, Part III, Subpart v, 4.D.

III.iv.6.E.5.b. Identifying Disabilities for Which Combat-Related Disability Severance Pay Was Awarded

III.iv.6.E.5.c. Identifying Periods of Service for Which Separation Benefits Were Awarded

• Compensation payable for SC disabilities incurred during any period of service that preceded the discharge for which separation benefits were paid is subject to recoupment.
• Compensation payable for SC disabilities incurred during a period of service that followed the discharge for which separation benefits were paid is not subject to recoupment.

• determining whether a Veteran received separation benefits, see M21-1, Part III, Subpart v, 4.B.1.b, and
• special notations and notification templates, see M21-1, Part III, Subpart iv, 6.D.6.

III.iv.6.E.5.d. Examples:  Separation Benefit Codesheet Annotations

Introduction

• denying individual unemployability (IU)
• denying special monthly pension (SMP)
• coding competency, and
• removing active duty discontinuance coding.

Change Date

III.iv.6.E.6.a.  Denying IU

III.iv.6.E.6.b.  Denying SMP

III.iv.6.E.6.c.  Coding Competency

• prepare a rating to show
  • that the Veteran is competent, and
  • the effective date of the determination, and
• furnish a copy of the rating to the fiduciary activity.

III.iv.6.E.6.d. Removing Active Duty Discontinuance Coding

Introduction

• grouping SC disabilities
• using diagnostic terminology
• coding compensation awards, and
• coding new awards of previously-considered issues.

Change Date

III.iv.6.E.7.a.  Grouping SC Disabilities

• disabilities by current evaluation in descending order, and
• DC followed by the diagnosis.

III.iv.6.E.7.b.  Using Diagnostic Terminology

• Do not attempt to translate the examiner’s terms into schedular terminology unless citation is required by way of explanation, such as when rating by analogy.
• Do not cite a lengthy diagnosis in full.  Instead, retain its essential elements in the decision.
• Do not cite residuals of diseases or therapeutic procedures without reference to the underlying disease.
• Do not include unnecessary descriptive words in the diagnosis.  For example, state the diagnosis as hypertension, and not severe hypertension.
• Do not follow the diagnosis with parenthetical annotations that include the terminology used by the claimant to describe his/her condition on his/her application (e.g. tinnitus (claimed as ringing in the ears)) on theCodesheet.  Instead, as instructed in M21-1, Part III, Subpart iv, 6.C.3.d, limit use of such annotations to the rating decision Narrative alone.

III.iv.6.E.7.c.  Coding Compensation Awards

• percentage evaluation
• effective date
• period of service, and
• appropriate basis for each award
  • INCURRED
  • AGGRAVATED
  • PRESUMPTIVE
  • SECONDARY
  • 38 CFR 3.383 (PAIRED EXTREMITY), or
  • AGGRAVATED NSC.

III.iv.6.E.7.d.  Coding New Awards of Previously-Considered Issues

Change Date

III.iv.6.E.8.a. Handling Disabilities That Result From Willful Misconduct

• willful misconduct, see M21-1, Part III, Subpart v, 1.D
• line-of-duty determinations, see M21-1, Part III, Subpart v, 1.D.6, and
• the prohibition of payment of compensation for disability resulting from use of alcohol and drugs, see M21-1, Part III, Subpart v, 1.D.4.

Introduction

Change Date

III.iv.6.E.9.a.  Showing Reasons for Denial of NSC Conditions

• not incurred/caused by service
• constitutional/developmental abnormality
• willful misconduct, injury, or
• not in line of duty.

• a new reason for denial is required, or
• SC is awarded.

III.iv.6.E.9.b.  Reflecting the Date of Original Denial

• the VBMS-R User Guide, and
• M21-1, Part III, Subpart iv, 6.E.3.a.