Our Disclaimer
This Knol is provided to you to describe general processes and procedures that occur during the application for disability compensation and pension and other benefits within the Department of Veterans Affairs System. Any author you find here is not providing you with legal advice. Any information provided by this Knol or any contributor to this Knol is not intended as and should not be construed as legal advice. You should always consult an attorney to help answer specific questions regarding how VA laws apply to you and/or your situation. The summaries provided here are incomplete, and the DVA laws and regulations are subject to change. We do not guarantee and we are not liable for the accuracy or completeness of any of the information provided, or any results or outcome as a result of the use of this information.The Ratings
Your application for veterans disability compensation benefits completes a lengthy and complex process before you learn of the outcome or decision. You must apply, your eligibility must be verified, the diagnosis of your claimed condition is confirmed with evidence gathered by or for you and at the end of all those steps, the accumulated data is placed in front of a Ratings Veterans Service Representative.
The RSVR then considers applicable law, rules and regulations together with the data in your file and determines a rating for your condition. This rating is multi-faceted and will be comprised of the degree of the disability stated as a percentage, whether the condition is anticipated to be permanent or temporary and whether the condition(s) are thought to be totally disabling.
The Percentage of Disability
In the VA system, ratings are assigned in degrees of 10% to signify the severity of the condition and what it may represent in lost income to you.
The RSVR uses his or her education, experience, training and multiple reference sources to determine the rating. An often referred to guide for the RSVR is the M21-1MR.
While that may sound reasonable on the surface, it quickly becomes very complex. To fully understand the ratings one must look at not only the M21-1MR but also The Schedule For Rating Disabilities and The Index of Disability Examination Worksheets.
If a single condition has been the focus of the claim, the process is relatively easy to understand. For example, a knee joint that was injured in a fall while in training may have limited motion. The RSVR will look at how limited the motion is and assign a percentage of disability that will probably fall within the 10% to 40% range.
If there are multiple conditions involved, VA does not total those up by adding one percentage to the next and so on. If you have applied for and been awarded a service connection for 3 conditions that are rated as 20% and 20% and 40% disabling, it's not very likely that your final rating will be a total of 80%.
Your VBA uses the Combined Ratings Table to total the accumulated ratings.
It is explained that; "Table I, Combined Ratings Table, results from the consideration of the efficiency of the individual as affected first by the most disabling condition, then by the less disabling condition, then by other less
disabling conditions, if any, in the order of severity. Thus, a person having a 60 percent disability is considered 40 percent efficient. Proceeding from this 40 percent efficiency, the effect of a further 30 percent disability is to leave only 70 percent of the efficiency remaining after consideration of the first disability, or 28 percent efficiency altogether. The individual is thus 72 percent disabled, as shown in table I opposite 60 percent and under 30 percent."
I've not found a simple way to explain the CRT. It's best that you open the link above and follow the examples presented and then set up a few exercises of your own.
The RSVR uses his or her education, experience, training and multiple reference sources to determine the rating. An often referred to guide for the RSVR is the M21-1MR.
While that may sound reasonable on the surface, it quickly becomes very complex. To fully understand the ratings one must look at not only the M21-1MR but also The Schedule For Rating Disabilities and The Index of Disability Examination Worksheets.
If a single condition has been the focus of the claim, the process is relatively easy to understand. For example, a knee joint that was injured in a fall while in training may have limited motion. The RSVR will look at how limited the motion is and assign a percentage of disability that will probably fall within the 10% to 40% range.
If there are multiple conditions involved, VA does not total those up by adding one percentage to the next and so on. If you have applied for and been awarded a service connection for 3 conditions that are rated as 20% and 20% and 40% disabling, it's not very likely that your final rating will be a total of 80%.
Your VBA uses the Combined Ratings Table to total the accumulated ratings.
It is explained that; "Table I, Combined Ratings Table, results from the consideration of the efficiency of the individual as affected first by the most disabling condition, then by the less disabling condition, then by other less
disabling conditions, if any, in the order of severity. Thus, a person having a 60 percent disability is considered 40 percent efficient. Proceeding from this 40 percent efficiency, the effect of a further 30 percent disability is to leave only 70 percent of the efficiency remaining after consideration of the first disability, or 28 percent efficiency altogether. The individual is thus 72 percent disabled, as shown in table I opposite 60 percent and under 30 percent."
I've not found a simple way to explain the CRT. It's best that you open the link above and follow the examples presented and then set up a few exercises of your own.
100% Disabled
Ratings of 100% are unique. You may be rated at 100% disabled after having a condition or multiple conditions that equal 100% on the Schedule For Rating Disabilities (A 'schedular' rating) or you may be assigned a 100% rating due to Individual Unemployability (IU).
The payment to you is the same no matter which category you are assigned. Either of the 100% categories may be rated as temporary or permanent. There is no rationale to believe that one 100% rating is "better than" the other. There are differences between the 2 ratings but to most veterans, that you are schedular rated or IU isn't a point that matters much.
The single most important difference between a 100% schedular rating and an IU designation is that the veteran rated with the Individual Unemployabilty label is not allowed to work to a level of gainful employment while the veteran who is schedular rated may work at any profession and achieve any income he or she is able to. "Gainful employment" is usually defined as full time work that earns an income that is about equal to the defined federal poverty level.
Neither rating is fully protected from a future action to lower the rating. Only after 20 years of a continuous rating of 100% is the veteran protected from action by VBA to reduce the rating.
It's simple enough to understand how a schedular rating is achieved. The Individual Unemployability designation is much more complex.
Individual Unemployability
The VBA recognizes that although a veteran may not have a disability or set of disabilities that add up to 100% on The Schedule, the severity of the service connected conditions, when seen as a part of the whole, may prevent the veteran from seeking and holding gainful employment.
If the veteran has a disability or a set of disabilities that add to 100%, the rating is often called "100% Schedular" to differentiate from 100% IU.
In this case the veteran may be assigned a 100% rating as Individually Unemployable. To meet the requirements that will allow the veteran to apply for an IU rating, he or she must have a single rated condition of at least 60% or multiple rated conditions that total 70% with one of those conditions equaling at least 40%.
If the veteran has a disability or a set of disabilities that add to 100%, the rating is often called "100% Schedular" to differentiate from 100% IU.
In this case the veteran may be assigned a 100% rating as Individually Unemployable. To meet the requirements that will allow the veteran to apply for an IU rating, he or she must have a single rated condition of at least 60% or multiple rated conditions that total 70% with one of those conditions equaling at least 40%.
One of the best descriptions available that will clearly define what IU is was made in 2005 as an address to a Senate Veterans Affairs Committee. Click here to read that testimony.
FAQ's
Q: If a veteran is rated 100% IU, is the veteran allowed to work?
A: The veteran may be allowed to pursue part time employment. The IU rating prohibits "substantially gainful employment". Gainful employment is considered to be full time, 12 months per year work that earns an income greatter then the federal poverty threshold.
Q: I received an employment questionnaire from the VA. I haven't worked in years and I'm not ever going to be able to return to work. My rating is P & T. Why do I have to fill out this form?
A: You are currently required to complete this form each year that you are rated 100% IU. The VA should mail it to you on or about the anniversary of your IU benefit award. If you don't complete and return the form, the VA will almost certainly proceed to propose to lower your rating. The wise veteran will remember this annual event and if VA doesn't mail the form, the veteran should download and complete and mail a for to VA. As with all mailing to VA, return the form using certified mail, return receipt requested. Your obligation to return the form ends at age 70.
Q: My spouse has just received a large inheritance. How will this additional family income affect my IU compensation?
A: It won't. A disability compensation award isn't subject to family income or a means test. The award is made only by guidelines that determine a veterans conditions and the resulting degree of disability. Windfall cash in the form of inheritances, gamblings winnings, the sales of property or any other income that isn't the result of substantially gainful employment will not have any effect on the rating.
Q: I've been told by my friends that I should file for more ratings so the I can achieve a schedular 100% rating and get out of the IU category. They say it's somehow a better and safer rating. Is this true?
A: Not particularly. VA may reexamine you at any time no matter if you are rated at 100% schedular or 100% IU. If they believe there has been improvement in your condition, VA may propose to lower your rating to a more appropriate percentage.
Adjudication
FAQ's
Q: If a veteran is rated 100% IU, is the veteran allowed to work?
A: The veteran may be allowed to pursue part time employment. The IU rating prohibits "substantially gainful employment". Gainful employment is considered to be full time, 12 months per year work that earns an income greatter then the federal poverty threshold.
Q: I received an employment questionnaire from the VA. I haven't worked in years and I'm not ever going to be able to return to work. My rating is P & T. Why do I have to fill out this form?
A: You are currently required to complete this form each year that you are rated 100% IU. The VA should mail it to you on or about the anniversary of your IU benefit award. If you don't complete and return the form, the VA will almost certainly proceed to propose to lower your rating. The wise veteran will remember this annual event and if VA doesn't mail the form, the veteran should download and complete and mail a for to VA. As with all mailing to VA, return the form using certified mail, return receipt requested. Your obligation to return the form ends at age 70.
Q: My spouse has just received a large inheritance. How will this additional family income affect my IU compensation?
A: It won't. A disability compensation award isn't subject to family income or a means test. The award is made only by guidelines that determine a veterans conditions and the resulting degree of disability. Windfall cash in the form of inheritances, gamblings winnings, the sales of property or any other income that isn't the result of substantially gainful employment will not have any effect on the rating.
Q: I've been told by my friends that I should file for more ratings so the I can achieve a schedular 100% rating and get out of the IU category. They say it's somehow a better and safer rating. Is this true?
A: Not particularly. VA may reexamine you at any time no matter if you are rated at 100% schedular or 100% IU. If they believe there has been improvement in your condition, VA may propose to lower your rating to a more appropriate percentage.
Adjudication
§ 3.327 Reexaminations.
(a) General. Reexaminations, including periods of hospital observation, will be requested whenever VA determines there is a need to verify either the continued existence or the current severity of a disability.
As a rule, if the veteran holds a 100% schedular rating, to successfully reduce the rating VA must show improvement in the condition. If the veteran holds a 100% IU rating VA must show improvement in the condition and the ability of the veteran to hold substantially gainful employment.
Permanent or Temporary?
The veteran is finally rated 100%. She sees on the award letter “future exams are scheduled”. She learns that this means her spouse isn't eligible for CHAMPVA and her kids won't see the C-35 DEA benefits she hoped would help pay for their college.
The state she is in has generous benefits for permanently disabled vets but the “future exams are scheduled” keeps her out of those benefits. Her disability is one that does not seem to be likely to improve and she believes that she should be P & T and qualified to apply for CHAMPVA and DEA.
Should she ask VA for P & T? Is there a legal or regulatory basis to do so?
For more on Permanent and Total ratings, click here.
The state she is in has generous benefits for permanently disabled vets but the “future exams are scheduled” keeps her out of those benefits. Her disability is one that does not seem to be likely to improve and she believes that she should be P & T and qualified to apply for CHAMPVA and DEA.
Should she ask VA for P & T? Is there a legal or regulatory basis to do so?
For more on Permanent and Total ratings, click here.
Yvette Lessard
Invite as author
Untitled
EditSaveCancelDeleteDeleteBlock this userReport abusive commentHide report window