How To Read A Rating Criteria Table

Start With The Code And The Question

A diagnosis, a diagnostic code and a percentage do different jobs. The diagnosis describes a medical condition. The code identifies the schedule provision used to evaluate it. The percentage reflects the applicable evaluation criteria, which are designed around average impairment in earning capacity.

Use the decision and its explanation to identify the code actually applied. Then check the official section, including whether the code remains active. Do not assume an older internet chart contains the rules relevant to a current decision or to an earlier period under review.

Sources: [1] [2].

Read The Columns Before The Numbers

Not every value in a table is a percentage. Some upper-extremity tables distinguish major and minor sides. Eye provisions may direct an equivalent visual-acuity evaluation. A blank cell can carry a heading or instruction rather than a missing award.

Read across the complete row, including each alternative and qualification. For example, a joint table can distinguish direction of movement, affected side and the particular joint. A number copied without those labels loses the rule that makes it meaningful.

Sources: [1] [2].

Follow Shared Formulas And Notes

Several codes can point to one formula. Conversely, a nearby code may use different instructions. In the spine schedule, codes 5235 through 5243 use the general spine formula, with the stated IVDS alternative. Code 5244 has separate complete-paralysis instructions. The IVDS episode formula should not be attached to 5244 merely because it follows it on the page.

Notes can define an episode, require an examination, describe separate neurologic evaluation, or set a treatment-related period. Keep those instructions with the table. Cross-references are part of the reading, not optional fine print.

Sources: [1].

Do Not Treat Every List The Same Way

Sections 4.7 and 4.21 explain general principles for comparing evaluations and recognizing atypical disability pictures. They do not make every criterion optional. In Johnson v. Wilkie, the Veterans Court held that migraine code 8100 has successive criteria and that those two provisions do not override its required elements.

Identify whether the language describes alternatives, cumulative requirements or examples before drawing a conclusion. The meaning depends on the particular code and applicable legal interpretation, not a universal checklist rule.

Sources: [1] [2] [3].

Separate Evaluation From Combined Rating Math

Once individual evaluations are established, VA generally combines them under section 4.25 rather than simply adding them. Reading one condition table cannot tell you the combined percentage for several conditions. Keep the code-specific evaluation, combined-rating calculation and payment questions separate when reviewing a decision.

Sources: [1].