M21-1 Manual  /  Part V, Subpart iv, Chapter 1, Section C

Coded Conclusion

M21-1, Part V, Subpart iv, Chapter 1, Section C

Overview

In This Section

This section contains the following topics:
TopicTopic Name
1 General Information on the Coded Conclusion
2 Diagnostic Codes (DCs)
3 Evaluations and Effective Dates
4 Combined Evaluations
5Benefit Withholdings
6Other Coding Issues
7Listing Compensation Rating Codes
8Listing Pension Rating Codes
9Coding Denials of Non-Service-Connected (NSC) Conditions

1. General Information on the Coded Conclusion

Introduction

This topic contains general information on the coded conclusion, including
  • definition of coded conclusion
  • coding subsequent ratings, and
  • decisions not requiring a coded conclusion.

Change Date

November 7, 2019

V.iv.1.C.1.a. Definition: Coded Conclusion

A coded conclusion is the section of the Codesheet of a rating decision which contains
  • a summary of information on the status of benefits, and
  • all decided issues.
Reference: For more information on generating a coded conclusion in Veterans Benefits Management System - Rating (VBMS-R), see the VBMS-R User Guide.

V.iv.1.C.1.b. Coding Subsequent Ratings

Subsequent ratings automatically bring forward the coding for all disabilities previously rated whenever coding directly affecting compensation or pension entitlement is added or changed.Reference: For more information on backfilling historical rating data, see M21-1, Part V, Subpart iv, 1.C.3.e.

V.iv.1.C.1.c. Decisions Not Requiring a Coded Conclusion

No coded conclusion is required when only issues such as the following are involved:
  • denial of special monthly compensation, or
  • a finding that a supplemental claim is not supported by new and/or relevant evidence.
There are no codes applicable to the disposition of these issues.

2. DCs

Introduction

This topic contains information about DCs, including
  • components of an analogous code
  • using hyphenated codes to rate residual conditions, and
  • rating multiple disabling manifestations from the same disease.

Change Date

May 29, 2025

V.iv.1.C.2.a. 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 first two digits refer to the body system involved in the rating, and
  • the second two digits are always 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 criteria used to evaluate the claimed disability.
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 it is the first four-digit code in an analogous code. References: For more information on

V.iv.1.C.2.b. Using Hyphenated Codes to Rate Residual Conditions

Hyphenated codes do not necessarily denote analogous ratings. A hyphenated DC may be used to identify the proper evaluation of a disability or a residual from disease.The first DC of a hyphenated code identifies the diagnosed disease or condition. The second DC of a hyphenated code identifies the criteria in the rating schedule used to evaluate the disability.Example: Ankylosis of the wrist from rheumatoid arthritis would be rated under 38 CFR 4.71a, DC 5002-5214.

V.iv.1.C.2.c. Rating Multiple Disabling Manifestations From the Same Disease

When rating multiple disabling manifestations resulting from the same disease, such as multiple sclerosis (MS), Parkinson’s disease, parkinsonism, or cerebrovascular accident, code each disability separately as follows:
  • show the DC of the disease only once by listing it as the lead DC of a hyphenated code
  • follow the lead code and hyphen with a code for the body system that results in the highest evaluation percentage
  • code the involvement of the other manifestations thereafter under the DC for the disability on which the evaluation is based, and
  • show the remaining disabilities as secondary to the primary disease entity.
Example: Multiple disabling manifestations of Parkinson’s disease (38 CFR 4.124a, DC 8004) would result in the following hyphenated and non-hyphenated DCs:
  • 8004-8520 Parkinson’s disease with right lower extremity tremors, muscle rigidity, stiffness, and bradykinesia (sciatic nerve) [the most severely affected residual, followed by the less disabling residuals]
  • 8520 left lower extremity tremors, muscle rigidity, stiffness, and bradykinesia (sciatic nerve) due to Parkinson’s disease
  • 8515 right upper extremity tremors, (median nerve) due to Parkinson’s disease
  • 9434 major depressive disorder due to Parkinson’s disease, and
  • 7204 difficulty swallowing due to Parkinson’s disease.
Exceptions:References: For more information on

3. Evaluations and Effective Dates

Introduction

This topic contains information about evaluations and effective dates, including
  • required evaluations and effective dates for service-connected (SC) disabilities
  • evaluations and effective dates for NSC disabilities
  • recording evaluations
  • showing evaluations in ratings that apply 38 CFR 3.105(e), and
  • backfilling historical rating data.

Change Date

April 18, 2023

V.iv.1.C.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:
  • current percentage evaluation
  • current effective date
  • future percentage evaluation, if applicable, and
  • future effective date, if applicable.
Note: An effective date of pension entitlement is required only next to rating code 2.Reference: For more information on backfilling historical rating data, see M21-1, Part V, Subpart iv, 1.C.3.e.

V.iv.1.C.3.b. Evaluations and Effective Dates for NSC Disabilities

Effective dates are not required for non-service-connected (NSC) disabilities.Use the table below to determine when evaluations for NSC disabilities are required.

If rating a claim for ...

Then evaluations for NSC disabilities ...

compensation only

are not required.Exception: If the claimant is currently in receipt of pension, but claiming – and being disallowed – entitlement to compensation, then evaluations for NSC disabilities are required.

pension only

are required except as described in M21-1, Part V, Subpart iv, 1.C.8.a.

compensation and pension

are required.

V.iv.1.C.3.c. Recording Evaluations

For each SC disability, record
  • the evaluation in effect
  • the new evaluation assigned, if indicated, and
  • 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: A Veteran has been entitled to 30 percent from January 1, 1993, and 50 percent from January 1, 1994. A retroactive increase of 70 percent from January 1, 1994, has been awarded. The coded conclusion should only show the 30-percent evaluation from January 1, 1993, and the 70-percent evaluation from January 1, 1994.

V.iv.1.C.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 compensation reduction rating, the coded conclusion should show the
  • current evaluation in effect, and
  • future reduced evaluation.

V.iv.1.C.3.e. Backfilling Historical Rating Data

Backfilling refers to the process of entering, by way of VBMS-R’s MASTER RECORD tab, prior rating decision data that does not currently appear on the Codesheet or in the corporate database. When rendering any non-original decision, carefully review the coded conclusion in concert with those of prior determinations and backfill all historical disability decision information in the master record, as necessary.

4. Combined Evaluations

Introduction

This topic contains information about combined evaluations, including
  • combined evaluations contained on the coded conclusion
  • applying the bilateral factor, and
  • rounding combined evaluations.

Change Date

April 18, 2023

V.iv.1.C.4.a. Combined Evaluations Contained on the Coded Conclusion

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

V.iv.1.C.4.b. Applying the Bilateral Factor

38 CFR 4.26 provides for a bilateral factor whenever there are compensable disabilities affecting the use of
  • both arms
  • both legs, or
  • paired skeletal muscles.
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: Exception: Effective April 16, 2023, 38 CFR 4.26 was amended to address instances where certain disabilities including the bilateral factor do not combine to the most favorable percentage. In such cases, the regulation allows one or more bilateral disabilities to be removed from the bilateral factor calculation and combined separately to achieve the higher evaluation. The bilateral factor will still be applied to the bilateral disability or disabilities that are not excluded from the calculation. VBMS-R will automatically make the calculations and assign the higher evaluation when possible. Note: The 38 CFR 4.26 change effective April 16, 2023, is considered a liberalizing Department of Veterans Affairs (VA) issue within the meaning of 38 U.S.C. 5110(g) and 38 CFR 3.114. References: For more information on

V.iv.1.C.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.
If an actual combined evaluation ends in a ...Then round ...
fraction from 0.1 to 0.4down to the nearest whole degree.
fraction from 0.5 to 0.9up to the nearest whole degree.
whole number from 1 to 4down to the nearest number divisible by 10.
whole number from 5 to 9up to the nearest number divisible by 10.

5. Benefit Withholdings


Introduction

This topic contains information about coding and Codesheet entries needed to identify benefits subject to withholding, including
  • general information on VBMS-R’s withholding functionality
  • identifying disabilities for which combat-related disability severance pay was awarded
  • identifying periods of service for which separation benefits were awarded, and
  • examples of separation benefit Codesheet annotations.

Change Date

 August 23, 2018

V.iv.1.C.5.a. General Information on VBMS-R’s Withholding Functionality

VBMS-R includes functionality that facilitates offsets to VA benefit awards when beneficiaries have received certain concurrent payments
  • 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.
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 to identify the
  • type of concurrent payment for which VA benefit withholding is necessary and,
  • if applicable, the percentage of VA benefit withholding needed.
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 VI, Subpart ii, 2.3.e and f. Instead, identify such disability(ies) by following the procedures in M21-1, Part V, Subpart iv, 1.C.5.b. References: For more information on

V.iv.1.C.5.b. Identifying Disabilities for Which Combat-Related Disability Severance Pay Was Awarded

When awarding service connection (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 VI, Subpart ii, 2.3.e and f, identify each such disability by selecting Enhanced Disability Severance Pay from the SPECIAL ISSUE INFORMATION drop-down menu in VBMS-R.

V.iv.1.C.5.c. Identifying Periods of Service for Which Separation Benefits Were Awarded

As is discussed in M21-1, Part VI, Subpart ii, 2.2.k, 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 War at the time of discharge.
  • 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.
When awarding SC to a Veteran who received a separation benefit other than disability 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.
StepAction
1Has the Veteran performed multiple periods of service?
  • If yes, go to the next step.
  • If no, disregard the remaining steps in this table. No form of annotation or service-period differentiation is required, as all payable compensation is subject to the recoupment of separation benefits.
2Did the Veteran incur one or more SC disabilities during a period of service that followed the discharge for which separation benefits were paid?
  • If yes, go to the next step.
  • If no,
    • use the SPECIAL NOTATION field on VBMS-R’s PROFILE screen to include a Codesheet annotation that reads, All SC disabilities subject to recoupment, and
    • disregard the remaining steps in this table.
3Use the SPECIAL NOTATION field on VBMS-R’s PROFILE screen to include a Codesheet annotation that identifies
  • each SC disability, and
  • the period of service during which it was incurred.
Notes:
  • Examples of the above-referenced Codesheet annotations are shown in M21-1, Part V, Subpart iv, 1.C.5.d.
  • If all SC disabilities were incurred during one single period of service, a summary annotation to that effect (e.g. All SC disabilities incurred during period of service spanning 06/11/2007-08/25/2011) is sufficient.
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

V.iv.1.C.5.d. Examples: Separation Benefit Codesheet Annotations

Scenario 1: A Veteran served from February 13, 1985, to September 26, 1991, and October 28, 1992, to December 4, 1996, and 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 May 30, 2011, to April 18, 2016, and 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, and 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
  • denying
    • individual unemployability (IU), and
    • special monthly pension (SMP)
  • coding competency, and
  • removing active duty discontinuance coding.

Change Date

August 23, 2018

V.iv.1.C.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.

V.iv.1.C.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.

V.iv.1.C.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
  • 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.
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 X, Subpart ii, 6.F.Reference: For more information on the process for making competency determinations, see M21-1, Part X, Subpart ii, 6.A.3.

V.iv.1.C.6.d. Removing Active Duty Discontinuance Coding

As is discussed in M21-1, Part X, Subpart v, 2.B.1.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 X, Subpart v, 2.B.1.g, rating action to reinstate benefits following a Veteran’s release from active duty is not necessary unless 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.Reference: For more information on rating decisions that show loss of entitlement during periods of active duty, see M21-1, Part X, Subpart v, 2.B.1.h.


7. Listing Compensation Rating Codes

Introduction

This topic contains information about listing compensation rating codes, including
  • grouping SC disabilities
  • using diagnostic terminology, and
  • coding
    • compensation awards, and
    • new awards of previously considered issues.

Change Date

August 23, 2018

V.iv.1.C.7.a. Grouping SC Disabilities

Group all disabilities subject to compensation under code 1, showing the
  • disabilities by current evaluation in descending order, and
  • DC followed by the diagnosis.
Note: In VBMS-R, disabilities are grouped automatically and carried forward from rating to rating.

V.iv.1.C.7.b. Using Diagnostic Terminology

Use the diagnostic terminology provided by the medical examiner (or other alternative medical evidence) in the rating decision.Notes:
  • 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 the condition on the application (e.g. tinnitus (claimed as ringing in the ears)) on the Codesheet. Instead, as instructed in M21-1, Part V, Subpart iv, 1.A.3.d, limit use of such annotations to the rating decision Narrative alone.

V.iv.1.C.7.c. Coding Compensation Awards

When first establishing SC for a particular disability, include the following under each diagnosis:

  • 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.
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 the VBMS-R User Guide.

V.iv.1.C.7.d. Coding New Awards of Previously Considered Issues

Use the table below when awarding SC for an issue that was previously
  • denied SC, or
  • rated in order to support entitlement to another non-compensation benefit, such as
    • pension
    • vocational rehabilitation, or
    • SC for treatment purposes under 38 U.S.C. 1702.
    If the newly awarded disability was previously ...Then add the issue to the Service Connected section of the Codesheet, and ...
    denied SCremove its associated entry from the Not Service Connected/Not Subject to Compensation section of the Codesheet.
    rated in order to support entitlement to another non-compensation benefit
    • remove its associated entry from the other respective section of the Codesheet, or
    • if possible, edit the existing Codesheet entry to include a closure date that is equivalent to the effective date of the new award of SC.
    Reference: For more information on editing and deleting existing disability decisions, see the VBMS-R User Guide.

8. Listing Pension Rating Codes

Introduction

This topic contains information about pension rating codes, including
  • when coding and evaluation for NSC disabilities is not required for pension awards, and
  • handling disabilities that result from willful misconduct.

Change Date

April 18, 2023

V.iv.1.C.8.a. When Coding and Evaluation for NSC Disabilities Is Not Required for Pension Awards

Code all claimed and noted disabilities, and show the evaluation of each disability, as appropriate, unless

V.iv.1.C.8.b. Handling Disabilities That Result From 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 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. Reference: For more information on willful misconduct, line-of-duty determinations, and the prohibition of payment of compensation for disability resulting from use of alcohol and drugs, see M21-1, Part X, Subpart iv, 1.C.

9. Coding Denials of NSC Conditions

Introduction

This topic contains information about coding denials of NSC conditions, including
  • showing reasons for denial of NSC conditions, and
  • reflecting the date of original denial.

Change Date

December 16, 2016

V.iv.1.C.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
  • 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
  • a new reason for denial is required, or
  • SC is awarded.
Note: VBMS-R automatically performs these functions if all the issues are correctly entered into the program.

V.iv.1.C.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.
StepAction
1Navigate to the MASTER RECORD tab.
2
  • On the DISABILITY DECISIONS tab, locate the relevant disability, and
  • select VIEW/EDIT.
3
  • Navigate to the DIAGNOSIS INFORMATION tab, and
  • select EDIT.
4
  • Locate the ORIGINAL DATE OF DENIAL field
  • enter the appropriate date, and
  • select SAVE CHANGES.
Reference: For more information on backfilling the master record, see M21-1, Part V, Subpart iv, 1.C.3.e.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part V, Subpart iv, Chapter 1, Section C (U.S. government work, reproduced for reference). Browse all sections →