Veterans whose diagnosis appears nowhere in the rating schedule often fear the claim is dead on arrival. 38 CFR 4.20 exists for exactly that case: VA rates the unlisted condition under the closest listed one, matching function, anatomy, and symptoms, and flags it with a diagnostic code ending in 99. The choice of analogue controls the money, and it is worth challenging when a closer fit exists.
When your diagnosis does not appear in the rating schedule, VA rates it by analogy to the closest listed condition under 38 CFR 4.20. The analogy matches function, anatomy, and symptoms, and VA flags it with a diagnostic code ending in 99. The condition VA picks as your analogue controls your percentages, and it is worth challenging when a closer fit exists.
Rating a condition the schedule does not list
The rating schedule cannot name every possible condition. When your diagnosis is not separately listed, VA does not deny the claim for that reason. Instead, it rates the condition by analogy, using the criteria of a closely related listed condition. That is the rule at 38 CFR 4.20.
How an analogous rating works
Under 38 CFR 4.20, VA rates an unlisted condition under a closely related disease or injury where not only the functions affected but also the anatomical location and the symptoms are closely analogous. VA looks for a listed condition that behaves like yours, in the same part of the body, with the same kind of symptoms and functional loss, then applies that condition's percentages to you.
Built-up diagnostic codes explained
When VA rates by analogy, it shows what it did through a built-up diagnostic code, explained in 38 CFR 4.27. The code combines the body system number, the digits 99 to signal an unlisted condition, and the code of the analogous listed condition. A four-digit code ending in 99 paired with another code is your signal that VA rated your condition by analogy rather than under a code of its own.
Partial criteria can still support a rating
38 CFR 4.21 says that in applying the schedule it is not expected that all the listed findings will be present in every case. VA assigns the percentage that most nearly matches your disability picture as a whole. An analogous rating is about the closest overall fit, not a checklist where one missing symptom defeats the rating.
What this means for your claim
If VA rated your unlisted condition by analogy, read which listed condition it chose. That choice controls your percentages and your path to a higher rating. If a different listed condition is a closer match to your symptoms and the body part involved, that is a reasonable point to raise, with medical support.
This is educational information, not legal advice. A VA-accredited representative can review whether the analogous code VA chose is the closest fit for your condition.
Sources
- 38 CFR 4.20 (analogous ratings)
- 38 CFR 4.27 (use of diagnostic code numbers)
- 38 CFR 4.21 (application of the rating schedule)
- 38 CFR 4.7 (higher of two evaluations)
Related on this site
- The pyramiding rule (38 CFR 4.14)
- Browse the condition library
- VA math: how combined ratings really work
Common questions
How does VA rate a condition that is not listed in the rating schedule?
By analogy under 38 CFR 4.20. VA finds a listed condition that is closely related, meaning the functions affected, the anatomical location, and the symptoms all closely match yours, and applies that condition's rating criteria and percentages to your diagnosis. An unlisted condition is not denied just because it has no code of its own.
What does a diagnostic code ending in 99 mean?
It is a built up code under 38 CFR 4.27 signaling an analogous rating. The code combines the body system number, the digits 99 to mark an unlisted condition, and the code of the analogous listed condition VA chose. Seeing 99 paired with another code tells you exactly which listed criteria control your percentage.
Do I need every symptom listed in the rating criteria to qualify?
No. 38 CFR 4.21 says VA does not expect all listed findings in every case. The rating should be the percentage that most nearly matches your disability picture as a whole, so one missing checklist symptom does not defeat an otherwise matching rating.
Can I challenge the analogous code VA picked?
Yes. The chosen code controls your percentages and your path to a higher rating, so if a different listed condition is a closer match for your symptoms and the body part involved, that is a reasonable issue to raise with medical support. An accredited representative can review whether the fit is right.