## Section E. Coded Conclusion

#### Overview

+------------+---------------------------------------------------------+
| #          | > This chapter contains the following topics:           |
| #### In th |                                                         |
| is Chapter |                                                         |
+------------+---------------------------------------------------------+

  ------------ ---------------------------------------------- ------------
  Topic        Topic Name                                     See Page

  22           General Information on the Coded Conclusion    6-E-2

  23           Diagnostic Codes                               6-E-3

  24           Evaluations                                    6-E-5

  25           Combined Evaluation and Effective Date         6-E-7
               Determinations                                 

  26           Other Coding Issues                            6-E-9

  27           Listing Compensation Rating Codes              6-E-11

  28           Listing Pension Rating Codes                   6-E-13

  29           Listing Disabilities That Are                  6-E-14
               Nonservice-Connected (NSC)                     
  ------------ ---------------------------------------------- ------------

#### 22. General Information on the Coded Conclusion

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about the coded       |
| troduction | > conclusion, including                                 |
|            |                                                         |
|            | -   preparing a coded conclusion                        |
|            |                                                         |
|            | -   coding subsequent ratings, and                      |
|            |                                                         |
|            | -   requiring a coded conclusion.                       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a    | > A coded conclusion is generated by RBA 2000.          |
| . Preparin | >                                                       |
| g a Coded  | > ***Reference***: For more information on generating a |
| Conclusion | > coded conclusion, see the RBA 2000 User's Guide.      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > In RBA 2000, subsequent ratings bring forward the     |
| # b. Codin | > coding for all disabilities previously rated whenever |
| g Subseque | > coding directly affecting compensation or pension     |
| nt Ratings | > entitlement is added or changed.                      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c    | > Denial of Special Monthly Compensation (SMC) or a     |
| . Requirin | > finding of "not new and material evidence" as the     |
| g a Coded  | > sole issue requires no coded conclusion since there   |
| Conclusion | > are no codes applicable to the disposition of these   |
|            | > issues.                                               |
+------------+---------------------------------------------------------+

#### 23. Diagnostic Codes

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about diagnostic      |
| troduction | > codes (DCs), including                                |
|            |                                                         |
|            | -   creating analogous codes                            |
|            |                                                         |
|            | -   components of an analogous code                     |
|            |                                                         |
|            | -   rating residual conditions, and                     |
|            |                                                         |
|            | -   rating multiple disabilities.                       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Create a built-up diagnostic code (DC) consisting of  |
| ## a. Crea | > two DCs separated by a hyphen when evaluating, by     |
| ting Analo | > analogy, any disability not listed in the rating      |
| gous Codes | > schedule.                                             |
|            | >                                                       |
|            | > ***Reference***: For more information on analogous    |
|            | > ratings, see 38 CFR 4.20.                             |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b. C | > The *first* DC of an analogous code is composed of a  |
| omponents  | > four digit code as follows:                           |
| of an Anal |                                                         |
| ogous Code | -   the first two digits refer to the body system       |
|            |     involved in the rating, and                         |
|            |                                                         |
|            | -   the second two digits are 99.                       |
|            |                                                         |
|            | > The *second* DC of an analogous code is composed of a |
|            | > four digit code that                                  |
|            |                                                         |
|            | -   is taken from the rating schedule, and              |
|            |                                                         |
|            | -   identifies the diagnostic criteria used to evaluate |
|            |     the claimed disability.                             |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   Disabilities under code 8 (service connection       |
|            |     denied) only need to show the 99 code unless        |
|            |     evaluated for pension purposes.                     |
|            |                                                         |
|            | -   -99 endings are not acceptable in RBA 2000 except   |
|            |     where the disability is hyphenated as in 6699-6603. |
|            |                                                         |
|            | > ***Example***: Use 6599-6516 for postoperative        |
|            | > tonsillectomy if the condition was evaluated under    |
|            | > the criteria for chronic laryngitis.                  |
+------------+---------------------------------------------------------+

Continued on next page

23\. Diagnostic Codes, Continued

+------------+---------------------------------------------------------+
| #####      | > Hyphenated codes do *not* necessarily denote          |
|  c. Rating | > analogous ratings. Two DCs may be used to identify    |
|  Residual  | > the proper evaluation of a disability or a residual   |
| Conditions | > from disease.                                         |
|            | >                                                       |
|            | > ***Example***: Ankylosis of the wrist from rheumatoid |
|            | > arthritis would be rated as 5002-5214.                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d    | > When rating multiple disabilities resulting from the  |
| . Rating M | > same disease entity, such as arthritis, multiple      |
| ultiple Di | > sclerosis, or cerebrovascular accident, code each     |
| sabilities | > disability separately as follows:                     |
|            |                                                         |
|            | -   show the DC of the disease entity only once 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 diagnostic code for the disability on     |
|            |     which the evaluation is determined, and             |
|            |                                                         |
|            | -   identify the basic disease entity in the diagnoses  |
|            |     of the disabilities involved.                       |
+------------+---------------------------------------------------------+

#### 24. Evaluations

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about disability      |
| troduction | > evaluations, including                                |
|            |                                                         |
|            | -   when evaluations and effective dates are required   |
|            |                                                         |
|            | -   when evaluations and effective dates are not        |
|            |     required                                            |
|            |                                                         |
|            | -   showing historical evaluations                      |
|            |                                                         |
|            | -   recording evaluations, and                          |
|            |                                                         |
|            | -   showing evaluations in ratings that apply 38 CFR    |
|            |     3.105(e).                                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > Current and, if applicable, future percentage         |
|  When Eval | > evaluations and effective dates are required both     |
| uations an | > individually and as combined totals, for all          |
| d Effectiv | > service-connected (SC) disabilities.                  |
| e Dates Ar | >                                                       |
| e Required | > An effective date of pension entitlement is required  |
|            | > only next to rating code 2.                           |
|            | >                                                       |
|            | > ***Reference***: For more information on listing      |
|            | > individual percentages, see M21-1, Part I, Appendix   |
|            | > A.                                                    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > When rating a claim for compensation only,            |
| #### b. Wh | > evaluations of NSC disabilities are *not* required.   |
| en Evaluat | > Evaluations are required for *all* disabilities when  |
| ions or Ef | > rating a claim for both compensation and pension or   |
| fective Da | > pension only.                                         |
| tes Are No | >                                                       |
| t Required | > Effective dates are *not* required for NSC            |
|            | > disabilities.                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > Show historical evaluations for SC disabilities under |
| Showing Hi | > the 1925 schedule, protected under 38 CFR 3.951 and   |
| storical E | > 38 CFR 3.952, when the rating grants pension as the   |
| valuations | > greater entitlement. This ensures that the protected  |
|            | > evaluations will not be overlooked in the event       |
|            | > pension is subsequently terminated.                   |
|            | >                                                       |
|            | > ***Note***: Furnish an historical evaluation only to  |
|            | > the extent necessary.                                 |
+------------+---------------------------------------------------------+

Continued on next page

24\. Evaluations, Continued

+------------+---------------------------------------------------------+
| ##### d. R | > Record the evaluation in effect for each              |
| ecording E | > service-connected disability, as well as the new      |
| valuations | > evaluation assigned, with future evaluation(s), if    |
|            | > indicated.                                            |
|            | >                                                       |
|            | > ***Note***: Show only one line of entitlement after   |
|            | > the SC condition whenever there is a retroactive      |
|            | > increase or reduction.                                |
|            | >                                                       |
|            | > ***Example***: If the 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 need only show that one line of            |
|            | > entitlement.                                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Show the current evaluation in effect followed by the |
| e. Showing | > future reduced evaluation in ratings that apply the   |
|  Evaluatio | > provisions of 38 CFR 3.105(e).                        |
| ns in Rati |                                                         |
| ngs that A |                                                         |
| pply 38 CF |                                                         |
| R 3.105(e) |                                                         |
+------------+---------------------------------------------------------+

#### 25. Combined Evaluation and Effective Date Determinations

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about combined        |
| troduction | > evaluations and effective dates, including            |
|            |                                                         |
|            | -   when to show combined evaluations and effective     |
|            |     dates                                               |
|            |                                                         |
|            | -   how to show SC and NSC combined evaluations         |
|            |                                                         |
|            | -   applying the bilateral factor, and                  |
|            |                                                         |
|            | -   rounding combined evaluations.                      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a. W | > Show the combined evaluation and effective date for   |
| hen to Sho | > disabilities that carry historical and/or future      |
| w Combined | > evaluations.                                          |
|  Evaluatio | >                                                       |
| n and Effe | > Do *not* show                                         |
| ctive Date |                                                         |
|            | -   an effective date when denying a claim for pension  |
|            |     only, and                                           |
|            |                                                         |
|            | -   a combined evaluation and effective date when there |
|            |     is only a single evaluation.                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > Where both compensation and pension entitlement are   |
| ### b. How | > at issue                                              |
|  to Show S |                                                         |
| C and NSC  | -   separately show the SC combined degree, "*COMB SC   |
| Combined E |     %*," immediately under the ratings code 2 or 9      |
| valuations |     citation, and                                       |
|            |                                                         |
|            | -   then show the NSC combined evaluation, "*COMB NSC   |
|            |     %*."                                                |
|            |                                                         |
|            | > ***Note***: RBA 2000 automatically performs these     |
|            | > functions if all the issues are considered and input  |
|            | > correctly.                                            |
+------------+---------------------------------------------------------+

Continued on next page

25\. Combined Evaluation and Effective Date Determinations, Continued

+------------+---------------------------------------------------------+
| ##### c.   | > Whenever there are compensable disabilities affecting |
|  Applying  | > the use of paired extremities, apply the bilateral    |
| the Bilate | > factor specified in 38 CFR 4.26 before other          |
| ral Factor | > combinations are carried out, regardless of location  |
|            | > or specified type of impairment.                      |
|            | >                                                       |
|            | > When a specific DC provides an evaluation for a       |
|            | > bilateral condition (for example, 30 percent for      |
|            | > bilateral flat feet under DC 5276), apply the         |
|            | > bilateral factor if there is an independently ratable |
|            | > condition in one of the involved extremities (for     |
|            | > example, 20 percent for left leg muscle damage under  |
|            | > DC 5311).                                             |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d.   | > If an actual combined evaluation ends with a fraction |
|  Rounding  | > which equals or exceeds 0.5, round up to the nearest  |
| Combined E | > degree. If a whole number ends with a digit that      |
| valuations | > equals or exceeds five, then round up to the nearest  |
|            | > number divisible by 10. Otherwise, round the combined |
|            | > evaluation down to the nearest number divisible by    |
|            | > 10.                                                   |
|            | >                                                       |
|            | > ***Note***: This 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.                   |
|            | >                                                       |
|            | > ***Example***: A combined evaluation of 54.5 percent  |
|            | > should be raised to 55 percent and then adjusted      |
|            | > upward to 60 percent.                                 |
+------------+---------------------------------------------------------+

#### 26. Other Coding Issues

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about other coding    |
| troduction | > issues, including                                     |
|            |                                                         |
|            | -   denying individual unemployability                  |
|            |                                                         |
|            | -   denying Special Monthly Pension (SMP), and          |
|            |                                                         |
|            | -   coding competency.                                  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > When the issue of entitlement to individual           |
| ## a. Deny | > unemployability is being denied for the first time, a |
| ing Indivi | > formal coded rating is required.                      |
| dual Unemp |                                                         |
| loyability |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b. D | > A summary of past coding pertaining to compensation   |
| enying SMP | > 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.         |
+------------+---------------------------------------------------------+

Continued on next page

26\. Other Coding Issues, Continued

+------------+---------------------------------------------------------+
| #####      | > After proper input into RBA 2000, the coded           |
| c. Coding  | > conclusion will show a determination of incompetency. |
| Competency | > Include it in any future ratings that bring forward   |
|            | > compensation or pension coding.                       |
|            | >                                                       |
|            | > If a previously incompetent veteran has regained      |
|            | > competency                                            |
|            |                                                         |
|            | -   prepare a rating to show                            |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   that the veteran is competent, and                  |
|            |                                                         |
|            | -   the effective date of the determination, and        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   furnish a copy of the rating to the fiduciary       |
|            |     activity.                                           |
|            |                                                         |
|            | > ***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     |
|            | > M21-1MR, Part III, Subpart v, 6.E.22 (TBD) or M21-1,  |
|            | > Part IV, 18.31.                                       |
+------------+---------------------------------------------------------+

#### 27. Listing Compensation Rating Codes

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about coding          |
| troduction | > compensation decisions, including                     |
|            |                                                         |
|            | -   grouping SC disabilities                            |
|            |                                                         |
|            | -   using diagnostic terminology, and                   |
|            |                                                         |
|            | -   coding compensation awards.                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Group all disabilities subject to compensation under  |
| ## a. Grou | > code 1. SC and show the                               |
| ping SC Di |                                                         |
| sabilities | -   disabilities by current evaluation in descending    |
|            |     order, and                                          |
|            |                                                         |
|            | -   diagnostic code followed by the diagnosis.          |
|            |                                                         |
|            | > ***Note***: In RBA 2000, disabilities are             |
|            | > appropriately grouped automatically and carried       |
|            | > forward from rating to rating.                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b    | > Use the diagnostic terminology of the medical         |
| . Using Di | > examiner in the compensation rating.                  |
| agnostic T | >                                                       |
| erminology | > ***Notes***:                                          |
|            |                                                         |
|            | -   Do not attempt to translate the examiner's terms    |
|            |     into schedular terminology unless citation is       |
|            |     required by way of explanation, as for an 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 basic disease.  |
|            |                                                         |
|            | -   Do not include unnecessary descriptive words in the |
|            |     diagnosis. For example, state the diagnosis as      |
|            |     "hypertension," and not "severe hypertension."      |
+------------+---------------------------------------------------------+

Continued on next page

27\. Listing Compensation Rating Codes, Continued

+------------+---------------------------------------------------------+
| #####      | > When first establishing compensation entitlement for  |
|  c. Coding | > a particular disability, include the following under  |
|  Compensat | > each diagnosis:                                       |
| ion Awards |                                                         |
|            | -   percentage evaluation                               |
|            |                                                         |
|            | -   effective date                                      |
|            |                                                         |
|            | -   period of service, and                              |
|            |                                                         |
|            | -   appropriate basis for each grant                    |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   incurred (INC)                                      |
|            |                                                         |
|            | -   aggravated (AGG), or                                |
|            |                                                         |
|            | -   presumptive (PRES).                                 |
+------------+---------------------------------------------------------+

#### 28. Listing Pension Rating Codes

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Code all claimed and noted disabilities, and show the |
| a. Handlin | > evaluation of each disability, as appropriate,        |
| g Disabili | > *unless* the disabilities have been held to be due to |
| ties That  | > the claimant's own willful misconduct by rating or by |
| Result fro | > an administrative decision.                           |
| m Willful  | >                                                       |
| Misconduct | > 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 under code 8 if pension is     |
|            | > claimed.                                              |
|            | >                                                       |
|            | > ***Example***: Cirrhosis of the liver due to chronic  |
|            | > alcohol abuse may form the basis for a grant of NSC   |
|            | > pension.                                              |
|            | >                                                       |
|            | > ***Note***: Disabilities that result from the use of  |
|            | > alcohol or drugs may not be service-connected because |
|            | > they cannot be deemed to have been incurred in the    |
|            | > line of duty.                                         |
|            | >                                                       |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   willful misconduct determinations, see M21-1MR,     |
|            |     Part III, Subpart v, 1.D.15 (TBD) or M21-1, Part    |
|            |     IV, 11.04                                           |
|            |                                                         |
|            | -   line-of-duty determinations, see M21-1MR, Part III, |
|            |     Subpart v, 1.D.19 (TBD) or M21-1, Part IV, 11.03,   |
|            |     and                                                 |
|            |                                                         |
|            | -   the prohibition of payment of compensation for      |
|            |     disability resulting from use of alcohol and drugs, |
|            |     see M21MR, Part III, Subpart v, 1.D.18 (TBD) or     |
|            |     M21-1, Part IV, 11.04e.                             |
+------------+---------------------------------------------------------+

#### 29. Listing Disabilities That Are Nonservice-Connected (NSC)

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > When a claim is initially disposed of, the reasons    |
|  a. Showin | > for denial are shown after the diagnosis on the       |
| g Reasons  | > rating codesheet. For example:                        |
| for Denial |                                                         |
|            | -   "not incurred/caused by service"                    |
|            |                                                         |
|            | -   "constitutional/developmental abnormality"          |
|            |                                                         |
|            | -   "willful misconduct, injury," or                    |
|            |                                                         |
|            | -   "not in line of duty."                              |
|            |                                                         |
|            | > These denial reasons will remain on the codesheet for |
|            | > subsequent ratings unless the situation changes.      |
|            | >                                                       |
|            | > ***Note***: RBA 2000 automatically performs these     |
|            | > functions if all the issues are considered and input  |
|            | > correctly.                                            |
+------------+---------------------------------------------------------+