38 C.F.R. PART 4—SCHEDULE FOR RATING DISABILITIES

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38 C.F.R. PART 4—SCHEDULE FOR RATING DISABILITIES

Title 38 - Pensions, Bonuses, and Veterans' Relief

Title 38: Pensions, Bonuses, and Veterans' Relief

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PART 4—SCHEDULE FOR RATING DISABILITIES

Authority: 38 U.S.C. 1155, unless otherwise noted.

Source: 29 FR 6718, May 22, 1964, unless otherwise noted.

Subpart A—General Policy in Rating

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§ 4.1 Essentials of evaluative rating.

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This rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. For the application of this schedule, accurate and fully descriptive medical examinations are required, with emphasis upon the limitation of activity imposed by the disabling condition. Over a period of many years, a veteran's disability claim may require reratings in accordance with changes in laws, medical knowledge and his or her physical or mental condition. It is thus essential, both in the examination and in the evaluation of disability, that each disability be viewed in relation to its history.

[41 FR 11292, Mar. 18, 1976]

§ 4.2 Interpretation of examination reports.

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Different examiners, at different times, will not describe the same disability in the same language. Features of the disability which must have persisted unchanged may be overlooked or a change for the better or worse may not be accurately appreciated or described. It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. Each disability must be considered from the point of view of the veteran working or seeking work. If a diagnosis is not supported by the findings on the examination report or if the report does not contain sufficient detail, it is incumbent upon the rating board to return the report as inadequate for evaluation purposes.

[41 FR 11292, Mar. 18, 1976]

§ 4.3 Resolution of reasonable doubt.

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It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. See §3.102 of this chapter.

[40 FR 42535, Sept. 15, 1975]

§ 4.6 Evaluation of evidence.

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The element of the weight to be accorded the character of the veteran's service is but one factor entering into the considerations of the rating boards in arriving at determinations of the evaluation of disability. Every element in any way affecting the probative value to be assigned to the evidence in each individual claim must be thoroughly and conscientiously studied by each member of the rating board in the light of the established policies of the Department of Veterans Affairs to the end that decisions will be equitable and just as contemplated by the requirements of the law.

§ 4.7 Higher of two evaluations.

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Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned.

§ 4.9 Congenital or developmental defects.

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Mere congenital or developmental defects, absent, displaced or supernumerary parts, refractive error of the eye, personality disorder and mental deficiency are not diseases or injuries in the meaning of applicable legislation for disability compensation purposes.

[41 FR 11292, Mar. 18, 1976]

§ 4.10 Functional impairment.

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The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. Whether the upper or lower extremities, the back or abdominal wall, the eyes or ears, or the cardiovascular, digestive, or other system, or psyche are affected, evaluations are based upon lack of usefulness, of these parts or systems, especially in self-support. This imposes upon the medical examiner the responsibility of furnishing, in addition to the etiological, anatomical, pathological, laboratory and prognostic data required for ordinary medical classification, full description of the effects of disability upon the person's ordinary activity. In this connection, it will be remembered that a person may be too disabled to engage in employment although he or she is up and about and fairly comfortable at home or upon limited activity.

[41 FR 11292, Mar. 18, 1976]

§ 4.13 Effect of change of diagnosis.

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The repercussion upon a current rating of service connection when change is made of a previously assigned diagnosis or etiology must be kept in mind. The aim should be the reconciliation and continuance of the diagnosis or etiology upon which service connection for the disability had been granted. The relevant principle enunciated in §4.125, entitled “Diagnosis of mental disorders,” should have careful attention in this connection. When any change in evaluation is to be made, the rating agency should assure itself that there has been an actual change in the conditions, for better or worse, and not merely a difference in thoroughness of the examination or in use of descriptive terms. This will not, of course, preclude the correction of erroneous ratings, nor will it preclude assignment of a rating in conformity with §4.7.

[29 FR 6718, May 22, 1964, as amended at 61 FR 52700, Oct. 8, 1996]

§ 4.14 Avoidance of pyramiding.

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The evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. Dyspnea, tachycardia, nervousness, fatigability, etc., may result from many causes; some may be service connected, others, not. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation, and the evaluation of the same manifestation under different diagnoses are to be avoided.

§ 4.15 Total disability ratings.

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The ability to overcome the handicap of disability varies widely among individuals. The rating, however, is based primarily upon the average impairment in earning capacity, that is, upon the economic or industrial handicap which must be overcome and not from individual success in overcoming it. However, full consideration must be given to unusual physical or mental effects in individual cases, to peculiar effects of occupational activities, to defects in physical or mental endowment preventing the usual amount of success in overcoming the handicap of disability and to the effect of combinations of disability. Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation; Provided, That permanent total disability shall be taken to exist when the impairment is reasonably certain to continue throughout the life of the disabled person. The following will be considered to be permanent total disability: the permanent loss of the use of both hands, or of both feet, or of one hand and one foot, or of the sight of both eyes, or becoming permanently helpless or permanently bedridden. Other total disability ratings are scheduled in the various bodily systems of this schedule.

§ 4.16 Total disability ratings for compensation based on unemployability of the individual.

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(a) Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: Provided That, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. It is provided further that the existence or degree of nonservice-connected disabilities or previous unemployability status will be disregarded where the percentages referred to in this paragraph for the service-connected disability or disabilities are met and in the judgment of the rating agency such service-connected disabilities render the veteran unemployable. Marginal employment shall not be considered substantially gainful employment. For purposes of this section, marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination.

(Authority: 38 U.S.C. 501)

(b) It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Therefore, rating boards should submit to the Director, Compensation and Pension Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in paragraph (a) of this section. The rating board will include a full statement as to the veteran's service-connected disabilities, employment history, educational and vocational attainment and all other factors having a bearing on the issue.

[40 FR 42535, Sept. 15, 1975, as amended at 54 FR 4281, Jan. 30, 1989; 55 FR 31580, Aug. 3, 1990; 58 FR 39664, July 26, 1993; 61 FR 52700, Oct. 8, 1996]

§ 4.17 Total disability ratings for pension based on unemployability and age of the individual.

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All veterans who are basically eligible and who are unable to secure and follow a substantially gainful occupation by reason of disabilities which are likely to be permanent shall be rated as permanently and totally disabled. For the purpose of pension, the permanence of the percentage requirements of §4.16 is a requisite. When the percentage requirements are met, and the disabilities involved are of a permanent nature, a rating of permanent and total disability will be assigned if the veteran is found to be unable to secure and follow substantially gainful employment by reason of such disability. Prior employment or unemployment status is immaterial if in the judgment of the rating board the veteran's disabilities render him or her unemployable. In making such determinations, the following guidelines will be used:

(a) Marginal employment, for example, as a self-employed farmer or other person, while employed in his or her own business, or at odd jobs or while employed at less than half the usual remuneration will not be considered incompatible with a determination of unemployability, if the restriction, as to securing or retaining better employment, is due to disability.

(b) Claims of all veterans who fail to meet the percentage standards but who meet the basic entitlement criteria and are unemployable, will be referred by the rating board to the Veterans Service Center Manager under §3.321(b)(2) of this chapter.

(Authority: 38 U.S.C. 1155; 38 U.S.C. 3102)

[43 FR 45348, Oct. 2, 1978, as amended at 56 FR 57985, Nov. 15, 1991; 71 FR 28586, May 17, 2006]

§ 4.17a Misconduct etiology.

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A permanent and total disability rating under the provisions of §§4.15, 4.16 and 4.17 will not be precluded by reason of the coexistence of misconduct disability when:

(a) A veteran, regardless of employment status, also has innocently acquired 100 percent disability, or

(b) Where unemployable, the veteran has other disabilities innocently acquired which meet the percentage requirements of §§4.16 and 4.17 and would render, in the judgment of the rating agency, the average person unable to secure or follow a substantially gainful occupation.

[40 FR 42536, Sept. 15, 1975, as amended at 43 FR 45349, Oct. 2, 1978]

§ 4.18 Unemployability.

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A veteran may be considered as unemployable upon termination of employment which was provided on account of disability, or in which special consideration was given on account of the same, when it is satisfactorily shown that he or she is unable to secure further employment. With amputations, sequelae of fractures and other residuals of traumatism shown to be of static character, a showing of continuous unemployability from date of incurrence, or the date the condition reached the stabilized level, is a general requirement in order to establish the fact that present unemployability is the result of the disability. However, consideration is to be given to the circumstances of employment in individual claims, and, if the employment was only occasional, intermittent, tryout or unsuccessful, or eventually terminated on account of the disability, present unemployability may be attributed to the static disability. Where unemployability for pension previously has been established on the basis of combined service-connected and nonservice-connected disabilities and the service-connected disability or disabilities have increased in severity, §4.16 is for consideration.

[40 FR 42536, Sept. 15, 1975, as amended at 43 FR 45349, Oct. 2, 1978]

§ 4.19 Age in service-connected claims.

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Age may not be considered as a factor in evaluating service-connected disability; and unemployability, in service-connected claims, associated with advancing age or intercurrent disability, may not be used as a basis for a total disability rating. Age, as such, is a factor only in evaluations of disability not resulting from service, i.e., for the purposes of pension.

[29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978]

§ 4.20 Analogous ratings.

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When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin.

§ 4.21 Application of rating schedule.

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In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances.

[41 FR 11293, Mar. 18, 1976]

§ 4.22 Rating of disabilities aggravated by active service.

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In cases involving aggravation by active service, the rating will reflect only the degree of disability over and above the degree existing at the time of entrance into the active service, whether the particular condition was noted at the time of entrance into the active service, or it is determined upon the evidence of record to have existed at that time. It is necessary therefore, in all cases of this character to deduct from the present degree of disability the degree, if ascertainable, of the disability existing at the time of entrance into active service, in terms of the rating schedule, except that if the disability is total (100 percent) no deduction will be made. The resulting difference will be recorded on the rating sheet. If the degree of disability at the time of entrance into the service is not ascertainable in terms of the schedule, no deduction will be made.

§ 4.23 Attitude of rating officers.

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It is to be remembered that the majority of applicants are disabled persons who are seeking benefits of law to which they believe themselves entitled. In the exercise of his or her functions, rating officers must not allow their personal feelings to intrude; an antagonistic, critical, or even abusive attitude on the part of a claimant should not in any instance influence the officers in the handling of the case. Fairness and courtesy must at all times be shown to applicants by all employees whose duties bring them in contact, directly or indirectly, with the Department's claimants.

[41 FR 11292, Mar. 18, 1976]

§ 4.24 Correspondence.

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All correspondence relative to the interpretation of the schedule for rating disabilities, requests for advisory opinions, questions regarding lack of clarity or application to individual cases involving unusual difficulties, will be addressed to the Director, Compensation and Pension Service. A clear statement will be made of the point or points upon which information is desired, and the complete case file will be simultaneously forwarded to Central Office. Rating agencies will assure themselves that the recent report of physical examination presents an adequate picture of the claimant's condition. Claims in regard to which the schedule evaluations are considered inadequate or excessive, and errors in the schedule will be similarly brought to attention.

[41 FR 11292, Mar. 18, 1976]

§ 4.25 Combined ratings table.

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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.

(a) To use table I, the disabilities will first be arranged in the exact order of their severity, beginning with the greatest disability and then combined with use of table I as hereinafter indicated. For example, if there are two disabilities, the degree of one disability will be read in the left column and the degree of the other in the top row, whichever is appropriate. The figures appearing in the space where the column and row intersect will represent the combined value of the two. This combined value will then be converted to the nearest number divisible by 10, and combined values ending in 5 will be adjusted upward. Thus, with a 50 percent disability and a 30 percent disability, the combined value will be found to be 65 percent, but the 65 percent must be converted to 70 percent to represent the final degree of disability. Similarly, with a disability of 40 percent, and another disability of 20 percent, the combined value is found to be 52 percent, but the 52 percent must be converted to the nearest degree divisible by 10, which is 50 percent. If there are more than two disabilities, the disabilities will also be arranged in the exact order of their severity and the combined value for the first two will be found as previously described for two disabilities. The combined value, exactly as found in table I, will be combined with the degree of the third disability (in order of severity). The combined value for the three disabilities will be found in the space where the column and row intersect, and if there are only three disabilities will be converted to the nearest degree divisible by 10, adjusting final 5's upward. Thus, if there are three disabilities ratable at 60 percent, 40 percent, and 20 percent, respectively, the combined value for the first two will be found opposite 60 and under 40 and is 76 percent. This 76 will be combined with 20 and the combined value for the three is 81 percent. This combined value will be converted to the nearest degree divisible by 10 which is 80 percent. The same procedure will be employed when there are four or more disabilities. (See table I).

(b) Except as otherwise provided in this schedule, the disabilities arising from a single disease entity, e.g., arthritis, multiple sclerosis, cerebrovascular accident, etc., are to be rated separately as are all other disabiling conditions, if any. All disabilities are then to be combined as described in paragraph (a) of this section. The conversion to the nearest degree divisible by 10 will be done only once per rating decision, will follow the combining of all disabilities, and will be the last procedure in determining the combined degree of disability.

                                         Table I_Combined Ratings Table                                           [10 combined with 10 is 19]----------------------------------------------------------------------------------------------------------------                                            10      20      30      40      50      60      70      80      90----------------------------------------------------------------------------------------------------------------19......................................      27      35      43      51      60      68      76      84      9220......................................      28      36      44      52      60      68      76      84      9221......................................      29      37      45      53      61      68      76      84      9222......................................      30      38      45      53      61      69      77      84      9223......................................      31      38      46      54      62      69      77      85      9224......................................      32      39      47      54      62      70      77      85      9225......................................      33      40      48      55      63      70      78      85      9326......................................      33      41      48      56      63      70      78      85      9327......................................      34      42      49      56      64      71      78      85      9328......................................      35      42      50      57      64      71      78      86      9329......................................      36      43      50      57      65      72      79      86      9330......................................      37      44      51      58      65      72      79      86      9331......................................      38      45      52      59      66      72      79      86      9332......................................      39      46      52      59      66      73      80      86      9333......................................      40      46      53      60      67      73      80      87      9334......................................      41      47      54      60      67      74      80      87      9335......................................      42      48      55      61      68      74      81      87      9436......................................      42      49      55      62      68      74      81      87      9437......................................      43      50      56      62      69      75      81      87      9438......................................      44      50      57      63      69      75      81      88      9439......................................      45      51      57      63      70      76      82      88      9440......................................      46      52      58      64      70      76      82      88      9441......................................      47      53      59      65      71      76      82      88      9442......................................      48      54      59      65      71      77      83      88      9443......................................      49      54      60      66      72      77      83      89      9444......................................      50      55      61      66      72      78      83      89      9445......................................      51      56      62      67      73      78      84      89      9546......................................      51      57      62      68      73      78      84      89      9547......................................      52      58      63      68      74      79      84      89      9548......................................      53      58      64      69      74      79      84      90      9549......................................      54      59      64      69      75      80      85      90      9550......................................      55      60      65      70      75      80      85      90      9551......................................      56      61      66      71      76      80      85      90      9552......................................      57      62      66      71      76      81      86      90      9553......................................      58      62      67      72      77      81      86      91      9554......................................      59      63      68      72      77      82      86      91      9555......................................      60      64      69      73      78      82      87      91      9656......................................      60      65      69      74      78      82      87      91      9657......................................      61      66      70      74      79      83      87      91      9658......................................      62      66      71      75      79      83      87      92      9659......................................      63      67      71      75      80      84      88      92      9660......................................      64      68      72      76      80      84      88      92      9661......................................      65      69      73      77      81      84      88      92      9662......................................      66      70      73      77      81      85      89      92      9663......................................      67      70      74      78      82      85      89      93      9664......................................      68      71      75      78      82      86      89      93      9665......................................      69      72      76      79      83      86      90      93      9766......................................      69      73      76      80      83      86      90      93      9767......................................      70      74      77      80      84      87      90      93      9768......................................      71      74      78      81      84      87      90      94      9769......................................      72      75      78      81      85      88      91      94      9770......................................      73      76      79      82      85      88      91      94      9771......................................      74      77      80      83      86      88      91      94      9772......................................      75      78      80      83      86      89      92      94      9773......................................      76      78      81      84      87      89      92      95      9774......................................      77      79      82      84      87      90      92      95      9775......................................      78      80      83      85      88      90      93      95      9876......................................      78      81      83      86      88      90      93      95      9877......................................      79      82      84      86      89      91      93      95      9878......................................      80      82      85      87      89      91      93      96      9879......................................      81      83      85      87      90      92      94      96      9880......................................      82      84      86      88      90      92      94      96      9881......................................      83      85      87      89      91      92      94      96      9882......................................      84      86      87      89      91      93      95      96      9883......................................      85      86      88      90      92      93      95      97      9884......................................      86      87      89      90      92      94      95      97      9885......................................      87      88      90      91      93      94      96      97      9986......................................      87      89      90      92      93      94      96      97      9987......................................      88      90      91      92      94      95      96      97      9988......................................      89      90      92      93      94      95      96      98      9989......................................      90      91      92      93      95      96      87      38      9990......................................      91      92      93      94      95      96      97      98      9991......................................      92      93      94      95      96      96      97      98      9992......................................      93      94      94      95      96      97      98      98      9993......................................      94      94      95      96      97      97      98      99      9994......................................      95      95      96      96      97      98      98      99      99----------------------------------------------------------------------------------------------------------------

(Authority: 38 U.S.C. 1155)

[41 FR 11293, Mar. 18, 1976, as amended at 54 FR 27161, June 28, 1989; 54 FR 36029, Aug. 31, 1989]

§ 4.26 Bilateral factor.

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When a partial disability results from disease or injury of both arms, or of both legs, or of 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, or converting to degree of disability. The bilateral factor will be applied to such bilateral disabilities before other combinations are carried out and the rating for such disabilities including the bilateral factor in this section will be treated as 1 disability for the purpose of arranging in order of severity and for all further combinations. For example, with disabilities evaluated at 60 percent, 20 percent, 10 percent and 10 percent (the two 10's representing bilateral disabilities), the order of severity would be 60, 21 and 20. The 60 and 21 combine to 68 percent and the 68 and 20 to 74 percent, converted to 70 percent as the final degree of disability.

(a) The use of the terms “arms” and “legs” is not intended to distinguish between the arm, forearm and hand, or the thigh, leg, and foot, but relates to the upper extremities and lower extremities as a whole. Thus with a compensable disability of the right thigh, for example, amputation, and one of the left foot, for example, pes planus, the bilateral factor applies, and similarly whenever there are compensable disabilities affecting use of paired extremities regardless of location or specified type of impairment.

(b) The correct procedure when applying the bilateral factor to disabilities affecting both upper extremities and both lower extremities is to combine the ratings of the disabilities affecting the 4 extremities in the order of their individual severity and apply the bilateral factor by adding, not combining, 10 percent of the combined value thus attained.

(c) The bilateral factor is not applicable unless there is partial disability of compensable degree in each of 2 paired extremities, or paired skeletal muscles.

§ 4.27 Use of diagnostic code numbers.

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The diagnostic code numbers appearing opposite the listed ratable disabilities are arbitrary numbers for the purpose of showing the basis of the evaluation assigned and for statistical analysis in the Department of Veterans Affairs, and as will be observed, extend from 5000 to a possible 9999. Great care will be exercised in the selection of the applicable code number and in its citation on the rating sheet. No other numbers than these listed or hereafter furnished are to be employed for rating purposes, with an exception as described in this section, as to unlisted conditions. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number will be “built-up” as follows: The first 2 digits will be selected from that part of the schedule most closely identifying the part, or system, of the body involved; the last 2 digits will be “99” for all unlisted conditions. This procedure will facilitate a close check of new and unlisted conditions, rated by analogy. In the selection of code numbers, injuries will generally be represented by the number assigned to the residual condition on the basis of which the rating is determined. With diseases, preference is to be given to the number assigned to the disease itself; if the rating is determined on the basis of residual conditions, the number appropriate to the residual condition will be added, preceded by a hyphen. Thus, rheumatoid (atrophic) arthritis rated as ankylosis of the lumbar spine should be coded “5002–5240.” In this way, the exact source of each rating can be easily identified. In the citation of disabilities on rating sheets, the diagnostic terminology will be that of the medical examiner, with no attempt to translate the terms into schedule nomenclature. Residuals of diseases or therapeutic procedures will not be cited without reference to the basic disease.

[41 FR 11293, Mar. 18, 1976, as amended at 70 FR 75399, Dec. 20, 2005]

§ 4.28 Prestabilization rating from date of discharge from service.

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The following ratings may be assigned, in lieu of ratings prescribed elsewhere, under the conditions stated for disability from any disease or injury. The prestabilization rating is not to be assigned in any case in which a total rating is immediately assignable under the regular provisions of the schedule or on the basis of individual unemployability. The prestabilization 50-percent rating is not to be used in any case in which a rating of 50 percent or more is immediately assignable under the regular provisions.

 ------------------------------------------------------------------------                                                                Rating------------------------------------------------------------------------Unstabilized condition with severe disability_  Substantially gainful employment is not feasible or                100   advisable................................................Unhealed or incompletely healed wounds or injuries_  Material impairment of employability likely...............          50------------------------------------------------------------------------

Note (1): Department of Veterans Affairs examination is not required prior to assignment of prestabilization ratings; however, the fact that examination was accomplished will not preclude assignment of these benefits. Prestabilization ratings are for assignment in the immediate postdischarge period. They will continue for a 12-month period following discharge from service. However, prestabilization ratings may be changed to a regular schedular total rating or one authorizing a greater benefit at any time. In each prestabilization rating an examination will be requested to be accomplished not earlier than 6 months nor more than 12 months following discharge. In those prestabilization ratings in which following examination reduction in evaluation is found to be warranted, the higher evaluation will be continued to the end of the 12th month following discharge or to the end of the period provided under §3.105(e) of this chapter, whichever is later. Special monthly compensation should be assigned concurrently in these cases whenever records are adequate to establish entitlement.

Note (2): Diagnosis of disease, injury, or residuals will be cited, with diagnostic code number assigned from this rating schedule for conditions listed therein.

[35 FR 11906, July 24, 1970]

§ 4.29 Ratings for service-connected disabilities requiring hospital treatment or observation.

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A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established that a service-connected disability has required hospital treatment in a Department of Veterans Affairs or an approved hospital for a period in excess of 21 days or hospital observation at Department of Veterans Affairs expense for a service-connected disability for a period in excess of 21 days.

(a) Subject to the provisions of paragraphs (d), (e), and (f) of this section this increased rating will be effective the first day of continuous hospitalization and will be terminated effective the last day of the month of hospital discharge (regular discharge or release to non-bed care) or effective the last day of the month of termination of treatment or observation for the service-connected disability. A temporary release which is approved by an attending Department of Veterans Affairs physician as part of the treatment plan will not be considered an absence.

(1) An authorized absence in excess of 4 days which begins during the first 21 days of hospitalization will be regarded as the equivalent of hospital discharge effective the first day of such authorized absence. An authorized absence of 4 days or less which results in a total of more than 8 days of authorized absence during the first 21 days of hospitalization will be regarded as the equivalent of hospital discharge effective the ninth day of authorized absence.

(2) Following a period of hospitalization in excess of 21 days, an authorized absence in excess of 14 days or a third consecutive authorized absence of 14 days will be regarded as the equivalent of hospital discharge and will interrupt hospitalization effective on the last day of the month in which either the authorized absence in excess of 14 days or the third 14 day period begins, except where there is a finding that convalescence is required as provided by paragraph (e) or (f) of this section. The termination of these total ratings will not be subject to §3.105(e) of this chapter.

(b) Notwithstanding that hospital admission was for disability not connected with service, if during such hospitalization, hospital treatment for a service-connected disability is instituted and continued for a period in excess of 21 days, the increase to a total rating will be granted from the first day of such treatment. If service connection for the disability under treatment is granted after hospital admission, the rating will be from the first day of hospitalization if otherwise in order.

(c) The assignment of a total disability rating on the basis of hospital treatment or observation will not preclude the assignment of a total disability rating otherwise in order under other provisions of the rating schedule, and consideration will be given to the propriety of such a rating in all instances and to the propriety of its continuance after discharge. Particular attention, with a view to proper rating under the rating schedule, is to be given to the claims of veterans discharged from hospital, regardless of length of hospitalization, with indications on the final summary of expected confinement to bed or house, or to inability to work with requirement of frequent care of physician or nurse at home.

(d) On these total ratings Department of Veterans Affairs regulations governing effective dates for increased benefits will control.

(e) The total hospital rating if convalescence is required may be continued for periods of 1, 2, or 3 months in addition to the period provided in paragraph (a) of this section.

(f) Extension of periods of 1, 2 or 3 months beyond the initial 3 months may be made upon approval of the Veterans Service Center Manager.

(g) Meritorious claims of veterans who are discharged from the hospital with less than the required number of days but need post-hospital care and a prolonged period of convalescence will be referred to the Director, Compensation and Pension Service, under §3.321(b)(1) of this chapter.

[29 FR 6718, May 22, 1964, as amended at 41 FR 11294, Mar. 18, 1976; 41 FR 34256, Aug. 13, 1976; 54 FR 4281, Jan. 30, 1989; 54 FR 34981, Aug. 23, 1989; 71 FR 28586, May 17, 2006]

§ 4.30 Convalescent ratings.

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A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established by report at hospital discharge (regular discharge or release to non-bed care) or outpatient release that entitlement is warranted under paragraph (a) (1), (2) or (3) of this section effective the date of hospital admission or outpatient treatment and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge or outpatient release. The termination of these total ratings will not be subject to §3.105(e) of this chapter. Such total rating will be followed by appropriate schedular evaluations. When the evidence is inadequate to assign a schedular evaluation, a physical examination will be scheduled and considered prior to the termination of a total rating under this section.

(a) Total ratings will be assigned under this section if treatment of a service-connected disability resulted in:

(1) Surgery necessitating at least one month of convalescence (Effective as to outpatient surgery March 1, 1989.)

(2) Surgery with severe postoperative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited). (Effective as to outpatient surgery March 1, 1989.)

(3) Immobilization by cast, without surgery, of one major joint or more. (Effective as to outpatient treatment March 10, 1976.)

A reduction in the total rating will not be subject to §3.105(e) of this chapter. The total rating will be followed by an open rating reflecting the appropriate schedular evaluation; where the evidence is inadequate to assign the schedular evaluation, a physcial examination will be scheduled prior to the end of the total rating period.

(b) A total rating under this section will require full justification on the rating sheet and may be extended as follows:

(1) Extensions of 1, 2 or 3 months beyond the initial 3 months may be made under paragraph (a) (1), (2) or (3) of this section.

(2) Extensions of 1 or more months up to 6 months beyond the initial 6 months period may be made under paragraph (a) (2) or (3) of this section upon approval of the Veterans Service Center Manager.

[41 FR 34256, Aug. 13, 1976, as amended at 54 FR 4281, Jan. 30, 1989; 71 FR 28586, May 17, 2006]

§ 4.31 Zero percent evaluations.

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In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met.

[58 FR 52018, Oct. 6, 1993]

Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like.

§ 4.41 History of injury.

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In considering the residuals of injury, it is essential to trace the medical-industrial history of the disabled person from the original injury, considering the nature of the injury and the attendant circumstances, and the requirements for, and the effect of, treatment over past periods, and the course of the recovery to date. The duration of the initial, and any subsequent, period of total incapacity, especially periods reflecting delayed union, inflammation, swelling, drainage, or operative intervention, should be given close attention. This consideration, or the absence of clear cut evidence of injury, may result in classifying the disability as not of traumatic origin, either reflecting congenital or developmental etiology, or the effects of healed disease.

§ 4.42 Complete medical examination of injury cases.

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The importance of complete medical examination of injury cases at the time of first medical examination by the Department of Veterans Affairs cannot be overemphasized. When possible, this should include complete neurological and psychiatric examination, and other special examinations indicated by the physical condition, in addition to the required general and orthopedic or surgical examinations. When complete examinations are not conducted covering all systems of the body affected by disease or injury, it is impossible to visualize the nature and extent of the service connected disability. Incomplete examination is a common cause of incorrect diagnosis, especially in the neurological and psychiatric fields, and frequently leaves the Department of Veterans Affairs in doubt as to the presence or absence of disabling conditions at the time of the examination.

§ 4.43 Osteomyelitis.

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Chronic, or recurring, suppurative osteomyelitis, once clinically identified, including chronic inflammation of bone marrow, cortex, or periosteum, should be considered as a continuously disabling process, whether or not an actively discharging sinus or other obvious evidence of infection is manifest from time to time, and unless the focus is entirely removed by amputation will entitle to a permanent rating to be combined with other ratings for residual conditions, however, not exceeding amputation ratings at the site of election.

§ 4.44 The bones.

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The osseous abnormalities incident to trauma or disease, such as malunion with deformity throwing abnormal stress upon, and causing malalignment of joint surfaces, should be depicted from study and observation of all available data, beginning with inception of injury or disease, its nature, degree of prostration, treatment and duration of convalescence, and progress of recovery with development of permanent residuals. With shortening of a long bone, some degree of angulation is to be expected; the extent and direction should be brought out by X-ray and observation. The direction of angulation and extent of deformity should be carefully related to strain on the neighboring joints, especially those connected with weight-bearing.

§ 4.45 The joints.

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As regards the joints the factors of disability reside in reductions of their normal excursion of movements in different planes. Inquiry will be directed to these considerations:

(a) Less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.).

(b) More movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.).

(c) Weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.).

(d) Excess fatigability.

(e) Incoordination, impaired ability to execute skilled movements smoothly.

(f) Pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing are related considerations. For the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae, are considered groups of minor joints, ratable on a parity with major joints. The lumbosacral articulation and both sacroiliac joints are considered to be a group of minor joints, ratable on disturbance of lumbar spine functions.

§ 4.46 Accurate measurement.

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Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect to landmarks, should be insisted on. The use of a goniometer in the measurement of limitation of motion is indispensable in examinations conducted within the Department of Veterans Affairs. Muscle atrophy must also be accurately measured and reported.

[41 FR 11294, Mar. 18, 1976]

§§ 4.47-4.54 [Reserved]

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§ 4.55 Principles of combined ratings for muscle injuries.

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(a) A muscle injury rating will not be combined with a peripheral nerve paralysis rating of the same body part, unless the injuries affect entirely different functions.

(b) For rating purposes, the skeletal muscles of the body are divided into 23 muscle groups in 5 anatomical regions: 6 muscle groups for the shoulder girdle and arm (diagnostic codes 5301 through 5306); 3 muscle groups for the forearm and hand (diagnostic codes 5307 through 5309); 3 muscle groups for the foot and leg (diagnostic codes 5310 through 5312); 6 muscle groups for the pelvic girdle and thigh (diagnostic codes 5313 through 5318); and 5 muscle groups for the torso and neck (diagnostic codes 5319 through 5323).

(1) In the case of an ankylosed knee, if muscle group XIII is disabled, it will be rated, but at the next lower level than that which would otherwise be assigned.

(2) In the case of an ankylosed shoulder, if muscle groups I and II are severely disabled, the evaluation of the shoulder joint under diagnostic code 5200 will be elevated to the level for unfavorable ankylosis, if not already assigned, but the muscle groups themselves will not be rated.

(d) The combined evaluation of muscle groups acting upon a single unankylosed joint must be lower than the evaluation for unfavorable ankylosis of that joint, except in the case of muscle groups I and II acting upon the shoulder.

(e) For compensable muscle group injuries which are in the same anatomical region but do not act on the same joint, the evaluation for the most severely injured muscle group will be increased by one level and used as the combined evaluation for the affected muscle groups.

(f) For muscle group injuries in different anatomical regions which do not act upon ankylosed joints, each muscle group injury shall be separately rated and the ratings combined under the provisions of §4.25.

(Authority: 38 U.S.C. 1155)

[62 FR 30237, June 3, 1997]

§ 4.56 Evaluation of muscle disabilities.

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(a) An open comminuted fracture with muscle or tendon damage will be rated as a severe injury of the muscle group involved unless, for locations such as in the wrist or over the tibia, evidence establishes that the muscle damage is minimal.

(b) A through-and-through injury with muscle damage shall be evaluated as no less than a moderate injury for each group of muscles damaged.

(c) For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement.

(d) Under diagnostic codes 5301 through 5323, disabilities resulting from muscle injuries shall be classified as slight, moderate, moderately severe or severe as follows:

(1) Slight disability of muscles—(i) Type of injury. Simple wound of muscle without debridement or infection.

(ii) History and complaint. Service department record of superficial wound with brief treatment and return to duty. Healing with good functional results. No cardinal signs or symptoms of muscle disability as defined in paragraph (c) of this section.

(iii) Objective findings. Minimal scar. No evidence of fascial defect, atrophy, or impaired tonus. No impairment of function or metallic fragments retained in muscle tissue.

(2) Moderate disability of muscles—(i) Type of injury. Through and through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection.

(ii) History and complaint. Service department record or other evidence of in-service treatment for the wound. Record of consistent complaint of one or more of the cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section, particularly lowered threshold of fatigue after average use, affecting the particular functions controlled by the injured muscles.

(iii) Objective findings. Entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue. Some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side.

(3) Moderately severe disability of muscles—(i) Type of injury. Through and through or deep penetrating wound by small high velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring.

(ii) History and complaint. Service department record or other evidence showing hospitalization for a prolonged period for treatment of wound. Record of consistent complaint of cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section and, if present, evidence of inability to keep up with work requirements.

(iii) Objective findings. Entrance and (if present) exit scars indicating track of missile through one or more muscle groups. Indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side demonstrate positive evidence of impairment.

(4) Severe disability of muscles—(i) Type of injury. Through and through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring.

(ii) History and complaint. Service department record or other evidence showing hospitalization for a prolonged period for treatment of wound. Record of consistent complaint of cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements.

(iii) Objective findings. Ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track. Palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area. Muscles swell and harden abnormally in contraction. Tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, the following are also signs of severe muscle disability:

(A) X-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile.

(B) Adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle.

(D) Visible or measurable atrophy.

(E) Adaptive contraction of an opposing group of muscles.

(F) Atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle.

(G) Induration or atrophy of an entire muscle following simple piercing by a projectile.

(Authority: 38 U.S.C. 1155

[62 FR 30238, June 3, 1997]

§ 4.57 Static foot deformities.

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It is essential to make an initial distinction between bilateral flatfoot as a congenital or as an acquired condition. The congenital condition, with depression of the arch, but no evidence of abnormal callosities, areas of pressure, strain or demonstrable tenderness, is a congenital abnormality which is not compensable or pensionable. In the acquired condition, it is to be remembered that depression of the longitudinal arch, or the degree of depression, is not the essential feature. The attention should be given to anatomical changes, as compared to normal, in the relationship of the foot and leg, particularly to the inward rotation of the superior portion of the os calcis, medial deviation of the insertion of the Achilles tendon, the medial tilting of the upper border of the astragalus. This is an unfavorable mechanical relationship of the parts. A plumb line dropped from the middle of the patella falls inside of the normal point. The forepart of the foot is abducted, and the foot everted. The plantar surface of the foot is painful and shows demonstrable tenderness, and manipulation of the foot produces spasm of the Achilles tendon, peroneal spasm due to adhesion about the peroneal sheaths, and other evidence of pain and limited motion. The symptoms should be apparent without regard to exercise. In severe cases there is gaping of bones on the inner border of the foot, and rigid valgus position with loss of the power of inversion and adduction. Exercise with undeveloped or unbalanced musculature, producing chronic irritation, can be an aggravating factor. In the absence of trauma or other definite evidence of aggravation, service connection is not in order for pes cavus which is a typically congenital or juvenile disease.

§ 4.58 Arthritis due to strain.

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With service incurred lower extremity amputation or shortening, a disabling arthritis, developing in the same extremity, or in both lower extremities, with indications of earlier, or more severe, arthritis in the injured extremity, including also arthritis of the lumbosacral joints and lumbar spine, if associated with the leg amputation or shortening, will be considered as service incurred, provided, however, that arthritis affecting joints not directly subject to strain as a result of the service incurred amputation will not be granted service connection. This will generally require separate evaluation of the arthritis in the joints directly subject to strain. Amputation, or injury to an upper extremity, is not considered as a causative factor with subsequently developing arthritis, except in joints subject to direct strain or actually injured.

§ 4.59 Painful motion.

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With any form of arthritis, painful motion is an important factor of disability, the facial expression, wincing, etc., on pressure or manipulation, should be carefully noted and definitely related to affected joints. Muscle spasm will greatly assist the identification. Sciatic neuritis is not uncommonly caused by arthritis of the spine. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.

§ 4.60 [Reserved]

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§ 4.61 Examination.

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With any form of arthritis (except traumatic arthritis) it is essential that the examination for rating purposes cover all major joints, with especial reference to Heberden's or Haygarth's nodes.

§ 4.62 Circulatory disturbances.

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The circulatory disturbances, especially of the lower extremity following injury in the popliteal space, must not be overlooked, and require rating generally as phlebitis.

§ 4.63 Loss of use of hand or foot.

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Loss of use of a hand or a foot, for the purpose of special monthly compensation, will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function of the hand or foot, whether the acts of grasping, manipulation, etc., in the case of the hand, or of balance and propulsion, etc., in the case of the foot, could be accomplished equally well by an amputation stump with prosthesis.

(a) Extremely unfavorable complete ankylosis of the knee, or complete ankylosis of 2 major joints of an extremity, or shortening of the lower extremity of 31/2 inches (8.9 cms.) or more, will be taken as loss of use of the hand or foot involved.

(b) Complete paralysis of the external popliteal nerve (common peroneal) and consequent, footdrop, accompanied by characteristic organic changes including trophic and circulatory disturbances and other concomitants confirmatory of complete paralysis of this nerve, will be taken as loss of use of the foot.

[29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978]

§ 4.64 Loss of use of both buttocks.

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Loss of use of both buttocks shall be deemed to exist when there is severe damage to muscle Group XVII, bilateral (diagnostic code number 5317) and additional disability rendering it impossible for the disabled person, without assistance, to rise from a seated position and from a stooped position (fingers to toes position) and to maintain postural stability (the pelvis upon head of femur). The assistance may be rendered by the person's own hands or arms, and, in the matter of postural stability, by a special appliance.

§ 4.65 [Reserved]

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§ 4.66 Sacroiliac joint.

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The common cause of disability in this region is arthritis, to be identified in the usual manner. The lumbosacral and sacroiliac joints should be considered as one anatomical segment for rating purposes. X-ray changes from arthritis in this location are decrease or obliteration of the joint space, with the appearance of increased bone density of the sacrum and ilium and sharpening of the margins of the joint. Disability is manifest from erector spinae spasm (not accounted for by other pathology), tenderness on deep palpation and percussion over these joints, loss of normal quickness of motion and resiliency, and postural defects often accompanied by limitation of flexion and extension of the hip. Traumatism is a rare cause of disability in this connection, except when superimposed upon congenital defect or upon an existent arthritis; to permit assumption of pure traumatic origin, objective evidence of damage to the joint, and history of trauma sufficiently severe to injure this extremely strong and practically immovable joint is required. There should be careful consideration of lumbosacral sprain, and the various symptoms of pain and paralysis attributable to disease affecting the lumbar vertebrae and the intervertebral disc.

§ 4.67 Pelvic bones.

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The variability of residuals following these fractures necessitates rating on specific residuals, faulty posture, limitation of motion, muscle injury, painful motion of the lumbar spine, manifest by muscle spasm, mild to moderate sciatic neuritis, peripheral nerve injury, or limitation of hip motion.

§ 4.68 Amputation rule.

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The combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, were amputation to be performed. For example, the combined evaluations for disabilities below the knee shall not exceed the 40 percent evaluation, diagnostic code 5165. This 40 percent rating may be further combined with evaluation for disabilities above the knee but not to exceed the above the knee amputation elective level. Painful neuroma of a stump after amputation shall be assigned the evaluation for the elective site of reamputation.

§ 4.69 Dominant hand.

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Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. The injured hand, or the most severely injured hand, of an ambidextrous individual will be considered the dominant hand for rating purposes.

(Authority: 38 U.S.C. 1155)

[62 FR 30239, June 3, 1997]

§ 4.70 Inadequate examinations.

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If the report of examination is inadequate as a basis for the required consideration of service connection and evaluation, the rating agency may request a supplementary report from the examiner giving further details as to the limitations of the disabled person's ordinary activity imposed by the disease, injury, or residual condition, the prognosis for return to, or continuance of, useful work. When the best interests of the service will be advanced by personal conference with the examiner, such conference may be arranged through channels.

§ 4.71 Measurement of ankylosis and joint motion.

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Plates I and II provide a standardized description of ankylosis and joint motion measurement. The anatomical position is considered as 0°, with two major exceptions: (a) Shoulder rotation—arm abducted to 90°, elbow flexed to 90° with the position of the forearm reflecting the midpoint 0° between internal and external rotation of the shoulder; and (b) supination and pronation—the arm next to the body, elbow flexed to 90°, and the forearm in midposition 0° between supination and pronation. Motion of the thumb and fingers should be described by appropriate reference to the joints (See Plate III) whose movement is limited, with a statement as to how near, in centimeters, the tip of the thumb can approximate the fingers, or how near the tips of the fingers can approximate the proximal transverse crease of palm.

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[29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978; 67 FR 48785, July 26, 2002]

§ 4.71a Schedule of ratings—musculoskeletal system.

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                  Acute, Subacute, or Chronic Diseases------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------5000 Osteomyelitis, acute, subacute, or chronic:  Of the pelvis, vertebrae, or extending into major joints, or       100   with multiple localization or with long history of   intractability and debility, anemia, amyloid liver changes,   or other continuous constitutional symptoms..................  Frequent episodes, with constitutional symptoms...............      60  With definite involucrum or sequestrum, with or without             30   discharging sinus............................................  With discharging sinus or other evidence of active infection        20   within the past 5 years......................................  Inactive, following repeated episodes, without evidence of          10   active infection in past 5 years.............................  Note (1): A rating of 10 percent, as an exception to the   amputation rule, is to be assigned in any case of active   osteomyelitis where the amputation rating for the affected   part is no percent. This 10 percent rating and the other   partial ratings of 30 percent or less are to be combined with   ratings for ankylosis, limited motion, nonunion or malunion,   shortening, etc., subject, of course, to the amputation rule.   The 60 percent rating, as it is based on constitutional   symptoms, is not subject to the amputation rule. A rating for   osteomyelitis will not be applied following cure by removal   or radical resection of the affected bone.  Note (2): The 20 percent rating on the basis of activity   within the past 5 years is not assignable following the   initial infection of active osteomyelitis with no subsequent   reactivation. The prerequisite for this historical rating is   an established recurrent osteomyelitis. To qualify for the 10   percent rating, 2 or more episodes following the initial   infection are required. This 20 percent rating or the 10   percent rating, when applicable, will be assigned once only   to cover disability at all sites of previously active   infection with a future ending date in the case of the 20   percent rating.5001 Bones and joints, tuberculosis of, active or inactive:  Active........................................................     100  Inactive: See §§ 4.88b and 4.89.....................  ......5002 Arthritis rheumatoid (atrophic) As an active process:  With constitutional manifestations associated with active          100   joint involvement, totally incapacitating....................  Less than criteria for 100% but with weight loss and anemia         60   productive of severe impairment of health or severely   incapacitating exacerbations occurring 4 or more times a year   or a lesser number over prolonged periods....................  Symptom combinations productive of definite impairment of           40   health objectively supported by examination findings or   incapacitating exacerbations occurring 3 or more times a year  One or two exacerbations a year in a well-established               20   diagnosis....................................................For chronic residuals:  For residuals such as limitation of motion or ankylosis,   favorable or unfavorable, rate under the appropriate   diagnostic codes for the specific joints involved. Where,   however, the limitation of motion of the specific joint or   joints involved is noncompensable under the codes a rating of   10 percent is for application for each such major joint or   group of minor joints affected by limitation of motion, to be   combined, not added under diagnostic code 5002. Limitation of   motion must be objectively confirmed by findings such as   swelling, muscle spasm, or satisfactory evidence of painful   motion.  Note: The ratings for the active process will not be combined   with the residual ratings for limitation of motion or   ankylosis. Assign the higher evaluation.5003 Arthritis, degenerative (hypertrophic or osteoarthritis):  Degenerative arthritis established by X-ray findings will be   rated on the basis of limitation of motion under the   appropriate diagnostic codes for the specific joint or joints   involved (DC 5200 etc.). When however, the limitation of   motion of the specific joint or joints involved is   noncompensable under the appropriate diagnostic codes, a   rating of 10 pct is for application for each such major joint   or group of minor joints affected by limitation of motion, to   be combined, not added under diagnostic code 5003. Limitation   of motion must be objectively confirmed by findings such as   swelling, muscle spasm, or satisfactory evidence of painful   motion. In the absence of limitation of motion, rate as   below:    With X-ray evidence of involvement of 2 or more major joints      20     or 2 or more minor joint groups, with occasional     incapacitating exacerbations...............................    With X-ray evidence of involvement of 2 or more major joints      10     or 2 or more minor joint groups............................  Note (1): The 20 pct and 10 pct ratings based on X-ray   findings, above, will not be combined with ratings based on   limitation of motion.  Note (2): The 20 pct and 10 pct ratings based on X-ray   findings, above, will not be utilized in rating conditions   listed under diagnostic codes 5013 to 5024, inclusive.5004 Arthritis, gonorrheal.5005 Arthritis, pneumococcic.5006 Arthritis, typhoid.5007 Arthritis, syphilitic.5008 Arthritis, streptococcic.5009 Arthritis, other types (specify).  With the types of arthritis, diagnostic codes 5004 through   5009, rate the disability as rheumatoid arthritis.5010 Arthritis, due to trauma, substantiated by X-ray findings: Rate as arthritis, degenerative.5011 Bones, caisson disease of: Rate as arthritis, cord involvement, or deafness, depending on the severity of disabling manifestations.5012 Bones, new growths of, malignant                                100  Note: The 100 percent rating will be continued for 1 year   following the cessation of surgical, X-ray, antineoplastic   chemotherapy or other therapeutic procedure. At this point,   if there has been no local recurrence or metastases, the   rating will be made on residuals.5013 Osteoporosis, with joint manifestations.5014 Osteomalacia.5015 Bones, new growths of, benign.5016 Osteitis deformans.5017 Gout.5018 Hydrarthrosis, intermittent.5019 Bursitis.5020 Synovitis.5021 Myositis.5022 Periostitis.5023 Myositis ossificans.5024 Tenosynovitis.  The diseases under diagnostic codes 5013 through 5024 will be   rated on limitation of motion of affected parts, as   arthritis, degenerative, except gout which will be rated   under diagnostic code 5002.5025 Fibromyalgia (fibrositis, primary fibromyalgia syndrome)  With widespread musculoskeletal pain and tender points, with   or without associated fatigue, sleep disturbance, stiffness,   paresthesias, headache, irritable bowel symptoms, depression,   anxiety, or Raynaud's-like symptoms:    That are constant, or nearly so, and refractory to therapy..      40    That are episodic, with exacerbations often precipitated by       20     environmental or emotional stress or by overexertion, but     that are present more than one-third of the time...........    That require continuous medication for control..............      10  Note: Widespread pain means pain in both the left and right   sides of the body, that is both above and below the waist,   and that affects both the axial skeleton (i.e., cervical   spine, anterior chest, thoracic spine, or low back) and the   extremities.------------------------------------------------------------------------

Prosthetic Implants------------------------------------------------------------------------ Rating --------------- Major Minor------------------------------------------------------------------------5051 Shoulder replacement (prosthesis). Prosthetic replacement of the shoulder joint: For 1 year following implantation of prosthesis..... 100 100 With chronic residuals consisting of severe, painful 60 50 motion or weakness in the affected extremity....... With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic codes 5200 and 5203. Minimum rating...................................... 30 205052 Elbow replacement (prosthesis). Prosthetic replacement of the elbow joint: For 1 year following implantation of prosthesis..... 100 100 With chronic residuals consisting of severe painful 50 40 motion or weakness in the affected extremity....... With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5205 through 5208. Minimum evaluation.................................. 30 205053 Wrist replacement (prosthesis). Prosthetic replacement of wrist joint: For 1 year following implantation of prosthesis..... 100 100 With chronic residuals consisting of severe, painful 40 30 motion or weakness in the affected extremity....... With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic code 5214. Minimum rating...................................... 20 20 Note: The 100 pct rating for 1 year following implantation of prosthesis will commence after initial grant of the 1-month total rating assigned under § 4.30 following hospital discharge.5054 Hip replacement (prosthesis). Prosthetic replacement of the head of the femur or of the acetabulum: For 1 year following implantation of prosthesis..... ...... 100 Following implantation of prosthesis with painful ...... \1\ 90 motion or weakness such as to require the use of crutches........................................... Markedly severe residual weakness, pain or ...... 70 limitation of motion following implantation of prosthesis......................................... Moderately severe residuals of weakness, pain or ...... 50 limitation of motion............................... Minimum rating...................................... ...... 305055 Knee replacement (prosthesis). Prosthetic replacement of knee joint: For 1 year following implantation of prosthesis..... ...... 100 With chronic residuals consisting of severe painful ...... 60 motion or weakness in the affected extremity....... With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5256, 5261, or 5262. Minimum rating...................................... ...... 305056 Ankle replacement (prosthesis). Prosthetic replacement of ankle joint: For 1 year following implantation of prosthesis..... ...... 100 With chronic residuals consisting of severe painful ...... 40 motion or weakness................................. With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to 5270 or 5271. Minimum rating...................................... ...... 20 Note (1): The 100 pct rating for 1 year following implantation of prosthesis will commence after initial grant of the 1-month total rating assigned under § 4.30 following hospital discharge. Note (2): Special monthly compensation is assignable during the 100 pct rating period the earliest date permanent use of crutches is established.------------------------------------------------------------------------ combinations of disabilities------------------------------------------------------------------------5104 Anatomical loss of one hand and loss of use of one ...... \1\ foot................................................... 1005105 Anatomical loss of one foot and loss of use of one ...... \1\ hand................................................... 1005106 Anatomical loss of both hands...................... ...... \1\ 1005107 Anatomical loss of both feet....................... ...... \1\ 1005108 Anatomical loss of one hand and one foot........... ...... \1\ 1005109 Loss of use of both hands.......................... ...... \1\ 1005110 Loss of use of both feet........................... ...... \1\ 1005111 Loss of use of one hand and one foot............... ...... \1\ 100------------------------------------------------------------------------\1\ Also entitled to special monthly compensation.

                           Table II_Ratings for Multiple Losses of Extremities With Dictator's Rating Code and 38 CFR Citation--------------------------------------------------------------------------------------------------------------------------------------------------------                                                                               Impairment of other extremity                                 -----------------------------------------------------------------------------------------------------------------------                                                                          Anatomical loss or  Anatomical loss or    Anatomical loss     Anatomical loss   Impairment of one extremity    Anatomical loss or  Anatomical loss or   loss of use above   loss of use above     near shoulder         near hip                                   loss of use below   loss of use below   elbow (preventing   knee (preventing   (preventing use of  (preventing use of                                         elbow               knee         use of prosthesis)  use of prosthesis)      prosthesis)         prosthesis)--------------------------------------------------------------------------------------------------------------------------------------------------------Anatomical loss or loss of use    M Codes M-1 a, b,   L Codes L-1 d, e,   M\1/2\ Code M-5,    L\1/2\ Code L-2 c,  N Code N-3, 38 CFR  M Code M-3 c, 38 below elbow.                      or c, 38 CFR        f, or g, 38 CFR     38 CFR 3.350        38 CFR 3.350        3.350 (f)(1)(xi).   CFR 3.350                                   3.350 (c)(1)(i).    3.350(b).           (f)(1)(x).          (f)(1)(vi).                             (f)(1)(viii)Anatomical loss or loss of use    ..................  L Codes L-1 a, b,   L\1/2\ Code L-2 b,  L\1/2\ Code L-2 a,  M Code M-3 b, 38    M Code M-3 a, 38 below knee.                                           or c, 38 CFR        38 CFR 3.350        38 CFR 3.350        CFR 3.350           CFR 3.350                                                       3.350(b).           (f)(1)(iii).        (f)(1)(i).          (f)(1)(iv).         (f)(1)(ii)Anatomical loss or loss of use    ..................  ..................  N Code N-1, 38 CFR  M Code M-2 a, 38    N\1/2\ Code N-4,    M\1/2\ Code M-4 c, above elbow (preventing use of                                            3.350 (d)(1).       CFR 3.350           38 CFR 3.350        38 CFR 3.350 prosthesis).                                                                                  (c)(1)(iii).        (f)(1)(ix).         (f)(1)(xi)Anatomical loss or loss of use    ..................  ..................  ..................  M Code M-2 a, 38    M\1/2\ Code M-4 b,  M\1/2\ Code M-4 a, above knee (preventing use of                                                                 CFR 3.350           38 CFR 3.350        38 CFR 3.350 prosthesis).                                                                                  (c)(1)(ii).         (f)(1)(vii).        (f)(1)(v)Anatomical loss near shoulder     ..................  ..................  ..................  ..................  O Code O-1, 38 CFR  N Code N-2 b, 38 (preventing use of prosthesis).                                                                                   3.350 (e)(1)(i).    CFR 3.350 (d)(3)Anatomical loss near hip          ..................  ..................  ..................  ..................  ..................  N Code N-2 a, 38 (preventing use of prosthesis).                                                                                                       CFR 3.350 (d)(2)--------------------------------------------------------------------------------------------------------------------------------------------------------Note._Need for aid attendance or permanently bedridden qualifies for subpar. L. Code L-1 h, i (38 CFR 3.350(b)). Paraplegia with loss of use of both  lower extremities and loss of anal and bladder sphincter control qualifies for subpar. O. Code O-2 (38 CFR 3.350(e)(2)). Where there are additional  disabilities rated 50% or 100%, or anatomical or loss of use of a third extremity see 38 CFR 3.350(f) (3), (4) or (5).

(Authority: 38 U.S.C. 1115)

                      Amputations: Upper Extremity------------------------------------------------------------------------                                                              Rating                                                         ---------------                                                           Major   Minor------------------------------------------------------------------------  Arm, amputation of:5120 Disarticulation....................................  \1\ 90  \1\ 905121 Above insertion of deltoid.........................  \1\ 90  \1\ 805122 Below insertion of deltoid.........................  \1\ 80  \1\ 70  Forearm, amputation of:5123 Above insertion of pronator teres..................  \1\ 80  \1\ 705124 Below insertion of pronator teres..................  \1\ 70  \1\ 605125 Hand, loss of use of...............................  \1\ 70  \1\ 60------------------------------------------------------------------------                       multiple finger amputations------------------------------------------------------------------------5126 Five digits of one hand, amputation of.............  \1\ 70  \1\ 60  Four digits of one hand, amputation of:5127 Thumb, index, long and ring........................  \1\ 70  \1\ 605128 Thumb, index, long and little......................  \1\ 70  \1\ 605129 Thumb, index, ring and little......................  \1\ 70  \1\ 605130 Thumb, long, ring and little.......................  \1\ 70  \1\ 605131 Index, long, ring and little.......................      60      50  Three digits of one hand, amputation of:5132 Thumb, index and long..............................      60      505133 Thumb, index and ring..............................      60      505134 Thumb, index and little............................      60      505135 Thumb, long and ring...............................      60      505136 Thumb, long and little.............................      60      505137 Thumb, ring and little.............................      60      505138 Index, long and ring...............................      50      405139 Index, long and little.............................      50      405140 Index, ring and little.............................      50      405141 Long, ring and little..............................      40      30  Two digits of one hand, amputation of:5142 Thumb and index....................................      50      405143 Thumb and long.....................................      50      405144 Thumb and ring.....................................      50      405145 Thumb and little...................................      50      405146 Index and long.....................................      40      305147 Index and ring.....................................      40      305148 Index and little...................................      40      305149 Long and ring......................................      30      205150 Long and little....................................      30      205151 Ring and little....................................      30      20  (a) The ratings for multiple finger amputations apply   to amputations at the proximal interphalangeal joints   or through proximal phalanges........................  (b) Amputation through middle phalanges will be rated   as prescribed for unfavorable ankylosis of the   fingers..............................................  (c) Amputations at distal joints, or through distal   phalanges, other than negligible losses, will be   rated as prescribed for favorable ankylosis of the   fingers..............................................  (d) Amputation or resection of metacarpal bones (more   than one-half the bone lost) in multiple fingers   injuries will require a rating of 10 percent added to   (not combined with) the ratings, multiple finger   amputations, subject to the amputation rule applied   to the forearm.  (e) Combinations of finger amputations at various   levels, or finger amputations with ankylosis or   limitation of motion of the fingers will be rated on   the basis of the grade of disability; i.e.,   amputation, unfavorable ankylosis, most   representative of the levels or combinations. With an   even number of fingers involved, and adjacent grades   of disability, select the higher of the two grades.  (f) Loss of use of the hand will be held to exist when   no effective function remains other than that which   would be equally well served by an amputation stump   with a suitable prosthetic applicance.------------------------------------------------------------------------                        single finger amputations------------------------------------------------------------------------5152 Thumb, amputation of:  With metacarpal resection.............................      40      30  At metacarpophalangeal joint or through proximal            30      20   phalanx..............................................  At distal joint or through distal phalanx.............      20      205153 Index finger, amputation of  With metacarpal resection (more than one-half the bone      30      20   lost)................................................  Without metacarpal resection, at proximal                   20      20   interphalangeal joint or proximal thereto............  Through middle phalanx or at distal joint.............      10      105154 Long finger, amputation of:  With metacarpal resection (more than one-half the bone      20      20   lost)................................................  Without metacarpal resection, at proximal                   10      10   interphalangeal joint or proximal thereto............5155 Ring finger, amputation of:  With metacarpal resection (more than one-half the bone      20      20   lost)................................................  Without metacarpal resection, at proximal                   10      10   interphalangeal joint or proximal thereto............5156 Little finger, amputation of:  With metacarpal resection (more than one-half the bone      20      20   lost)................................................  Without metacarpal resection, at proximal                   10      10   interphalangeal joint or proximal thereto............  Note: The single finger amputation ratings are the   only applicable ratings for amputations of whole or   part of single fingers.------------------------------------------------------------------------\1\ Entitled to special monthly compensation.

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                      Amputations: Lower Extremity------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------  Thigh, amputation of:5160 Disarticulation, with loss of extrinsic pelvic girdle        \2\ 90 muscles........................................................5161 Upper third, one-third of the distance from perineum to      \2\ 80 knee joint measured from perineum..............................5162 Middle or lower thirds.....................................  \2\ 60  Leg, amputation of:5163 With defective stump, thigh amputation recommended.........  \2\ 605164 Amputation not improvable by prosthesis controlled by        \2\ 60 natural knee action............................................5165 At a lower level, permitting prosthesis....................  \2\ 405166 Forefoot, amputation proximal to metatarsal bones (more      \2\ 40 than one-half of metatarsal loss)..............................5167 Foot, loss of use of.......................................  \2\ 405170 Toes, all, amputation of, without metatarsal loss..........      305171 Toe, great, amputation of:  With removal of metatarsal head...............................      30  Without metatarsal involvement................................      105172 Toes, other than great, amputation of, with removal of metatarsal head:  One or two....................................................      20  Without metatarsal involvement................................       05173 Toes, three or four, amputation of, without metatarsal involvement:  Including great toe...........................................      20  Not including great toe.......................................      10------------------------------------------------------------------------\2\ Also entitled to special monthly compensation.

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                          The Shoulder and Arm------------------------------------------------------------------------                                                              Rating                                                         ---------------                                                           Major   Minor------------------------------------------------------------------------5200 Scapulohumeral articulation, ankylosis of:  Note: The scapula and humerus move as one piece.  Unfavorable, abduction limited to 25° from side...      50      40  Intermediate between favorable and unfavorable........      40      30  Favorable, abduction to 60°, can reach mouth and        30      20   head.................................................5201 Arm, limitation of motion of:  To 25° from side..................................      40      30  Midway between side and shoulder level................      30      20  At shoulder level.....................................      20      205202 Humerus, other impairment of:  Loss of head of (flail shoulder)......................      80      70  Nonunion of (false flail joint).......................      60      50  Fibrous union of......................................      50      40  Recurrent dislocation of at scapulohumeral joint.    With frequent episodes and guarding of all arm            30      20     movements..........................................    With infrequent episodes, and guarding of movement        20      20     only at shoulder level.............................  Malunion of:    Marked deformity....................................      30      20    Moderate deformity..................................      20      205203 Clavicle or scapula, impairment of:  Dislocation of........................................      20      20  Nonunion of:    With loose movement.................................      20      20    Without loose movement..............................      10      10  Malunion of...........................................      10      10  Or rate on impairment of function of contiguous joint.------------------------------------------------------------------------

                          The Elbow and Forearm------------------------------------------------------------------------                                                              Rating                                                         ---------------                                                           Major   Minor------------------------------------------------------------------------5205 Elbow, ankylosis of:  Unfavorable, at an angle of less than 50° or with       60      50   complete loss of supination or pronation.............  Intermediate, at an angle of more than 90°, or          50      40   between 70° and 50°..........................  Favorable, at an angle between 90° and 70°....      40      305206 Forearm, limitation of flexion of:  Flexion limited to 45°............................      50      40  Flexion limited to 55°............................      40      30  Flexion limited to 70°............................      30      20  Flexion limited to 90°............................      20      20  Flexion limited to 100°...........................      10      10  Flexion limited to 110°...........................       0       05207 Forearm, limitation of extension of:  Extension limited to 110°.........................      50      40  Extension limited to 100°.........................      40      30  Extension limited to 90°..........................      30      20  Extension limited to 75°..........................      20      20  Extension limited to 60°..........................      10      10  Extension limited to 45°..........................      10      105208 Forearm, flexion limited to 100° and extension       20      20 to 45°.............................................5209 Elbow, other impairment of Flail joint.............      60      50  Joint fracture, with marked cubitus varus or cubitus        20      20   valgus deformity or with ununited fracture of head of   radius...............................................5210 Radius and ulna, nonunion of, with flail false           50      40 joint..................................................5211 Ulna, impairment of:  Nonunion in upper half, with false movement:    With loss of bone substance (1 inch (2.5 cms.) or         40      30     more) and marked deformity.........................    Without loss of bone substance or deformity.........      30      20    Nonunion in lower half..............................      20      20    Malunion of, with bad alignment.....................      10      105212 Radius, impairment of:  Nonunion in lower half, with false movement:    With loss of bone substance (1 inch (2.5 cms.) or         40      30     more) and marked deformity.........................    Without loss of bone substance or deformity.........      30      20    Nonunion in upper half..............................      20      20    Malunion of, with bad alignment.....................      10      105213 Supination and pronation, impairment of:  Loss of (bone fusion):    The hand fixed in supination or hyperpronation......      40      30    The hand fixed in full pronation....................      30      20    The hand fixed near the middle of the arc or              20      20     moderate pronation.................................  Limitation of pronation:    Motion lost beyond middle of arc....................      30      20    Motion lost beyond last quarter of arc, the hand          20      20     does not approach full pronation...................  Limitation of supination:    To 30° or less..................................      10      10  Note: In all the forearm and wrist injuries, codes   5205 through 5213, multiple impaired finger movements   due to tendon tie-up, muscle or nerve injury, are to   be separately rated and combined not to exceed rating   for loss of use of hand.------------------------------------------------------------------------

                                The Wrist------------------------------------------------------------------------                                                              Rating                                                         ---------------                                                           Major   Minor------------------------------------------------------------------------5214 Wrist, ankylosis of:  Unfavorable, in any degree of palmar flexion, or with       50      40   ulnar or radial deviation............................  Any other position, except favorable..................      40      30  Favorable in 20° to 30° dorsiflexion..........      30      20  Note: Extremely unfavorable ankylosis will be rated as   loss of use of hands under diagnostic code 5125.5215 Wrist, limitation of motion of:  Dorsiflexion less than 15°........................      10      10  Palmar flexion limited in line with forearm...........      10      10------------------------------------------------------------------------

Evaluation of Ankylosis or Limitation of Motion of Single or Multiple Digits of the Hand------------------------------------------------------------------------ Rating --------------- Major Minor------------------------------------------------------------------------(1) For the index, long, ring, and little fingers ...... ...... (digits II, III, IV, and V), zero degrees of flexion represents the fingers fully extended, making a straight line with the rest of the hand. The position of function of the hand is with the wrist dorsiflexed 20 to 30 degrees, the metacarpophalangeal and proximal interphalangeal joints flexed to 30 degrees, and the thumb (digit I) abducted and rotated so that the thumb pad faces the finger pads. Only joints in these positions are considered to be in favorable position. For digits II through V, the metacarpophalangeal joint has a range of zero to 90 degrees of flexion, the proximal interphalangeal joint has a range of zero to 100 degrees of flexion, and the distal (terminal) interphalangeal joint has a range of zero to 70 or 80 degrees of flexion.....................................(2) When two or more digits of the same hand are ...... ...... affected by any combination of amputation, ankylosis, or limitation of motion that is not otherwise specified in the rating schedule, the evaluation level assigned will be that which best represents the overall disability (i.e., amputation, unfavorable or favorable ankylosis, or limitation of motion), assigning the higher level of evaluation when the level of disability is equally balanced between one level and the next higher level...........................................(3) Evaluation of ankylosis of the index, long, ring, and little fingers: (i) If both the metacarpophalangeal and proximal ...... ...... interphalangeal joints of a digit are ankylosed, and either is in extension or full flexion, or there is rotation or angulation of a bone, evaluate as amputation without metacarpal resection, at proximal interphalangeal joint or proximal thereto. (ii) If both the metacarpophalangeal and proximal interphalangeal joints of a digit are ankylosed, evaluate as unfavorable ankylosis, even if each joint is individually fixed in a favorable position (iii) If only the metacarpophalangeal or proximal ...... ...... interphalangeal joint is ankylosed, and there is a gap of more than two inches (5.1 cm.) between the fingertip(s) and the proximal transverse crease of the palm, with the finger(s) flexed to the extent possible, evaluate as unfavorable ankylosis........ (iv) If only the metacarpophalangeal or proximal ...... ...... interphalangeal joint is ankylosed, and there is a gap of two inches (5.1 cm.) or less between the fingertip(s) and the proximal transverse crease of the palm, with the finger(s) flexed to the extent possible, evaluate as favorable ankylosis..........(4) Evaluation of ankylosis of the thumb: (i) If both the carpometacarpal and interphalangeal ...... ...... joints are ankylosed, and either is in extension or full flexion, or there is rotation or angulation of a bone, evaluate as amputation at metacarpophalangeal joint or through proximal phalanx............................................ (ii) If both the carpometacarpal and interphalangeal ...... ...... joints are ankylosed, evaluate as unfavorable ankylosis, even if each joint is individually fixed in a favorable position............................ (iii) If only the carpometacarpal or interphalangeal ...... ...... joint is ankylosed, and there is a gap of more than two inches (5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, evaluate as unfavorable ankylosis......... (iv) If only the carpometacarpal or interphalangeal ...... ...... joint is ankylosed, and there is a gap of two inches (5.1 cm.) or less between the thumb pad and the fingers, with the thumb attempting to oppose the fingers, evaluate as favorable ankylosis.......(5) If there is limitation of motion of two or more ...... ...... digits, evaluate each digit separately and combine the evaluations............................................------------------------------------------------------------------------ I. Multiple Digits: Unfavorable Ankylosis------------------------------------------------------------------------5216 Five digits of one hand, unfavorable ankylosis of.. 60 50Note: Also consider whether evaluation as amputation is warranted.5217 Four digits of one hand, unfavorable ankylosis of: Thumb and any three fingers......................... 60 50 Index, long, ring, and little fingers............... 50 40Note: Also consider whether evaluation as amputation is warranted.5218 Three digits of one hand, unfavorable ankylosis of: Thumb and any two fingers........................... 50 40 Index, long, and ring; index, long, and little; or 40 30 index, ring, and little fingers.................... Long, ring, and little fingers...................... 30 20Note: Also consider whether evaluation as amputation is warranted.5219 Two digits of one hand, unfavorable ankylosis of: Thumb and any finger................................ 40 30 Index and long; index and ring; or index and little 30 20 fingers............................................ Long and ring; long and little; or ring and little 20 20 fingers............................................Note: Also consider whether evaluation as amputation is warranted.------------------------------------------------------------------------ II. Multiple Digits: Favorable Ankylosis------------------------------------------------------------------------5220 Five digits of one hand, favorable ankylosis of.... 50 405221 Four digits of one hand, favorable ankylosis of: Thumb and any three fingers......................... 50 40 Index, long, ring, and little fingers............... 40 305222 Three digits of one hand, favorable ankylosis of: Thumb and any two fingers........................... 40 30 Index, long, and ring; index, long, and little; or 30 20 index, ring, and little fingers.................... Long, ring and little fingers....................... 20 205223 Two digits of one hand, favorable ankylosis of: Thumb and any finger................................ 30 20 Index and long; index and ring; or index and little 20 20 fingers............................................ Long and ring; long and little; or ring and little 10 10 fingers............................................------------------------------------------------------------------------ III. Ankylosis of Individual Digits------------------------------------------------------------------------5224 Thumb, ankylosis of: Unfavorable......................................... 20 20 Favorable........................................... 10 10Note: Also consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand.5225 Index finger, ankylosis of: Unfavorable or favorable............................ 10 10Note: Also consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand.5226 Long finger, ankylosis of: Unfavorable or favorable............................ 10 10Note: Also consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand.5227 Ring or little finger, ankylosis of: Unfavorable or favorable............................ 0 0Note: Also consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand.------------------------------------------------------------------------ IV. Limitation of Motion of Individual Digits------------------------------------------------------------------------5228 Thumb, limitation of motion: With a gap of more than two inches (5.1 cm.) between 20 20 the thumb pad and the fingers, with the thumb attempting to oppose the fingers................... With a gap of one to two inches (2.5 to 5.1 cm.) 10 10 between the thumb pad and the fingers, with the thumb attempting to oppose the fingers............. With a gap of less than one inch (2.5 cm.) between 0 0 the thumb pad and the fingers, with the thumb attempting to oppose the fingers...................5229 Index or long finger, limitation of motion: With a gap of one inch (2.5 cm.) or more between the 10 10 fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees......................................... With a gap of less than one inch (2.5 cm.) between 0 0 the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, and; extension is limited by no more than 30 degrees.........................................5230 Ring or little finger, limitation of motion: Any limitation of motion............................ 0 0------------------------------------------------------------------------

                                The Spine------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------  General Rating Formula for Diseases and Injuries of the Spine(For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes):    With or without symptoms such as pain (whther or not it     radiates), stiffness, or aching in the area of the spine     affected by residuals of injury or disease        Unfavorable ankylosis of the entire spine...............     100        Unfavorable ankylosis of the entire thoracolumbar spine.      50        Unfavorable ankylosis of the entire cervical spine; or,       40         forward flexion of the thoracolumbar spine 30 degrees         or less; or, favorable ankylosis of the entire         thoracolumbar spine....................................        Forward flexion of the cervical spine 15 degrees or           30         less; or, favorable ankylosis of the entire cervical         spine..................................................        Forward flexion of the thoracolumbar spine greater than       20         30 degrees but not greater than 60 degrees; or, forward         flexion of the cervical spine greater than 15 degrees         but not greater than 30 degrees; or, the combined range         of motion of the thoracolumbar spine not greater than         120 degrees; or, the combined range of motion of the         cervical spine not greater than 170 degrees; or, muscle         spasm or guarding severe enough to result in an         abnormal gait or abnormal spinal contour such as         scoliosis, reversed lordosis, or abnormal kyphosis.....        Forward flexion of the thoracolumbar spine greater than       10         60 degrees but not greater than 85 degrees; or, forward         flexion of the cervical spine greater than 30 degrees         but not greater than 40 degrees; or, combined range of         motion of the thoracolumbar spine greater than 120         degrees but not greater than 235 degrees; or, combined         range of motion of the cervical spine greater than 170         degrees but not greater than 335 degrees; or, muscle         spasm, guarding, or localized tenderness not resulting         in abnormal gait or abnormal spinal contour; or,         vertebral body fracture with loss of 50 percent or more         of the height..........................................Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees.The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.Note (4): Round each range of motion measurement to the nearest five degrees.Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. 5235 Vertebral fracture or dislocation 5236 Sacroiliac injury and weakness 5237 Lumbosacral or cervical strain 5238 Spinal stenosis 5239 Spondylolisthesis or segmental instability 5240 Ankylosing spondylitis 5241 Spinal fusion 5242 Degenerative arthritis of the spine (see also diagnostic code 5003) 5243 Intervertebral disc syndromeEvaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25.    Formula for Rating Intervertebral Disc Syndrome Based on                     Incapacitating EpisodesWith incapacitating episodes having a total duration of at least      60 6 weeks during the past 12 months..............................With incapacitating episodes having a total duration of at least      40 4 weeks but less than 6 weeks during the past 12 months........With incapacitating episodes having a total duration of at least      20 2 weeks but less than 4 weeks during the past 12 months........With incapacitating episodes having a total duration of at least      10 one week but less than 2 weeks during the past 12 months.......Note (1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.Note (2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.------------------------------------------------------------------------

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                            The Hip and Thigh------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------5250 Hip, ankylosis of:  Unfavorable, extremely unfavorable ankylosis, the foot not      \3\ 90   reaching ground, crutches necessitated.......................  Intermediate..................................................      70  Favorable, in flexion at an angle between 20° and 40°,      60   and slight adduction or abduction............................5251 Thigh, limitation of extension of:  Extension limited to 5°...................................      105252 Thigh, limitation of flexion of:  Flexion limited to 10°....................................      40  Flexion limited to 20°....................................      30  Flexion limited to 30°....................................      20  Flexion limited to 45°....................................      105253 Thigh, impairment of:  Limitation of abduction of, motion lost beyond 10°........      20  Limitation of adduction of, cannot cross legs.................      10  Limitation of rotation of, cannot toe-out more than 15°,        10   affected leg.................................................5254 Hip, flail joint...........................................      805255 Femur, impairment of:  Fracture of shaft or anatomical neck of:    With nonunion, with loose motion (spiral or oblique               80     fracture)..................................................    With nonunion, without loose motion, weightbearing preserved      60     with aid of brace..........................................  Fracture of surgical neck of, with false joint................      60  Malunion of:    With marked knee or hip disability..........................      30    With moderate knee or hip disability........................      20    With slight knee or hip disability..........................     10------------------------------------------------------------------------\3\ Entitled to special monthly compensation.

                            The Knee and Leg------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------5256 Knee, ankylosis of:  Extremely unfavorable, in flexion at an angle of 45° or         60   more.........................................................  In flexion between 20° and 45°........................      50  In flexion between 10° and 20°........................      40  Favorable angle in full extension, or in slight flexion             30   between 0° and 10°...................................5257 Knee, other impairment of:  Recurrent subluxation or lateral instability:    Severe......................................................      30    Moderate....................................................      20    Slight......................................................      105258 Cartilage, semilunar, dislocated, with frequent episodes of      20 ``locking,'' pain, and effusion into the joint.................5259 Cartilage, semilunar, removal of, symptomatic..............      105260 Leg, limitation of flexion of:  Flexion limited to 15°....................................      30  Flexion limited to 30°....................................      20  Flexion limited to 45°....................................      10  Flexion limited to 60°....................................       05261 Leg, limitation of extension of:  Extension limited to 45°..................................      50  Extension limited to 30°..................................      40  Extension limited to 20°..................................      30  Extension limited to 15°..................................      20  Extension limited to 10°..................................      10  Extension limited to 5°...................................       05262 Tibia and fibula, impairment of:  Nonunion of, with loose motion, requiring brace...............      40  Malunion of:    With marked knee or ankle disability........................      30    With moderate knee or ankle disability......................      20    With slight knee or ankle disability........................      105263 Genu recurvatum (acquired, traumatic, with weakness and          10 insecurity in weight-bearing objectively demonstrated).........------------------------------------------------------------------------

                                The Ankle------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------5270 Ankle, ankylosis of:  In plantar flexion at more than 40°, or in dorsiflexion at      40   more than 10° or with abduction, adduction, inversion or   eversion deformity...........................................  In plantar flexion, between 30° and 40°, or in              30   dorsiflexion, between 0° and 10°.....................  In plantar flexion, less than 30°.........................      205271 Ankle, limited motion of:  Marked........................................................      20  Moderate......................................................      105272 Subastragalar or tarsal joint, ankylosis of:  In poor weight-bearing position...............................      20  In good weight-bearing position...............................      105273 Os calcis or astragalus, malunion of:  Marked deformity..............................................      20  Moderate deformity............................................      105274 Astragalectomy.............................................      20------------------------------------------------------------------------

                    Shortening of the Lower Extremity------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------5275 Bones, of the lower extremity, shortening of:  Over 4 inches (10.2 cms.).....................................  \3\ 60  3\1/2\ to 4 inches (8.9 cms. to 10.2 cms.)....................  \3\ 50  3 to 3\1/2\ inches (7.6 cms. to 8.9 cms.).....................      40  2\1/2\ to 3 inches (6.4 cms. to 7.6 cms.).....................      30  2 to 2\1/2\ inches (5.1 cms. to 6.4 cms.).....................      20  1\1/4\ to 2 inches (3.2 cms. to 5.1 cms.).....................      10  Note: Measure both lower extremities from anterior superior   spine of the ilium to the internal malleolus of the tibia.   Not to be combined with other ratings for fracture or faulty   union in the same extremity.------------------------------------------------------------------------\3\ Also entitled to special monthly compensation.

                                The Foot------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------5276 Flatfoot, acquired:  Pronounced; marked pronation, extreme tenderness of plantar   surfaces of the feet, marked inward displacement and severe   spasm of the tendo achillis on manipulation, not improved by   orthopedic shoes or appliances...............................  Bilateral.....................................................      50  Unilateral....................................................      30  Severe; objective evidence of marked deformity (pronation,   abduction, etc.), pain on manipulation and use accentuated,   indication of swelling on use, characteristic callosities:    Bilateral...................................................      30    Unilateral..................................................      20  Moderate; weight-bearing line over or medial to great toe,          10   inward bowing of the tendo achillis, pain on manipulation and   use of the feet, bilateral or unilateral.....................  Mild; symptoms relieved by built-up shoe or arch support......       05277 Weak foot, bilateral:  A symptomatic condition secondary to many constitutional   conditions, characterized by atrophy of the musculature,   disturbed circulation, and weakness:    Rate the underlying condition, minimum rating...............      105278 Claw foot (pes cavus), acquired:  Marked contraction of plantar fascia with dropped forefoot,   all toes hammer toes, very painful callosities, marked varus   deformity:    Bilateral...................................................      50    Unilateral..................................................      30  All toes tending to dorsiflexion, limitation of dorsiflexion   at ankle to right angle, shortened plantar fascia, and marked   tenderness under metatarsal heads:    Bilateral...................................................      30    Unilateral..................................................      20  Great toe dorsiflexed, some limitation of dorsiflexion at   ankle, definite tenderness under metatarsal heads:    Bilateral...................................................      10    Unilateral..................................................      10  Slight........................................................       05279 Metatarsalgia, anterior (Morton's disease), unilateral, or       10 bilateral......................................................5280 Hallux valgus, unilateral:  Operated with resection of metatarsal head....................      10  Severe, if equivalent to amputation of great toe..............      105281 Hallux rigidus, unilateral, severe:  Rate as hallux valgus, severe.     Note: Not to be combined with claw foot ratings.5282 Hammer toe:  All toes, unilateral without claw foot........................      10  Single toes...................................................       05283 Tarsal, or metatarsal bones, malunion of, or nonunion of:  Severe........................................................      30  Moderately severe.............................................      20  Moderate......................................................      10  Note: With actual loss of use of the foot, rate 40 percent.5284 Foot injuries, other:  Severe........................................................      30  Moderately severe.............................................      20  Moderate......................................................      10  Note: With actual loss of use of the foot, rate 40 percent.------------------------------------------------------------------------

                                The Skull------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------5296 Skull, loss of part of, both inner and outer tables:  With brain hernia.............................................      80  Without brain hernia:    Area larger than size of a 50-cent piece or 1.140 in \2\          50     (7.355 cm \2\).............................................    Area intermediate...........................................      30    Area smaller than the size of a 25-cent piece or 0.716 in         10     \2\ (4.619 cm \2\).........................................    Note: Rate separately for intracranial complications.------------------------------------------------------------------------

                                The Ribs------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------5297 Ribs, removal of:  More than six.................................................      50  Five or six...................................................      40  Three or four.................................................      30  Two...........................................................      20  One or resection of two or more ribs without regeneration.....      10  Note (1): The rating for rib resection or removal is not to be   applied with ratings for purrulent pleurisy, lobectomy,   pneumonectomy or injuries of pleural cavity.  Note (2): However, rib resection will be considered as rib   removal in thoracoplasty performed for collapse therapy or to   accomplish obliteration of space and will be combined with   the rating for lung collapse, or with the rating for   lobectomy, pneumonectomy or the graduated ratings for   pulmonary tuberculosis.------------------------------------------------------------------------

                               The Coccyx------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------5298 Coccyx, removal of:  Partial or complete, with painful residuals...................      10  Without painful residuals.....................................       0------------------------------------------------------------------------

(Authority: 38 U.S.C. 1155)

[29 FR 6718, May 22, 1964, as amended at 34 FR 5062, Mar. 11, 1969; 40 FR 42536, Sept. 15, 1975; 41 FR 11294, Mar. 18, 1976; 43 FR 45350, Oct. 2, 1978; 51 FR 6411, Feb. 24, 1986; 61 FR 20439, May 7, 1996; 67 FR 48785, July 26, 2002; 67 FR 54349, Aug. 22, 2002; 68 FR 51456, Aug. 27, 2003; 69 FR 32450, June 10, 2004]

§ 4.72 [Reserved]

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§ 4.73 Schedule of ratings—muscle injuries.

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Note: When evaluating any claim involving muscle injuries resulting in loss of use of any extremity or loss of use of both buttocks (diagnostic code 5317, Muscle Group XVII), refer to §3.350 of this chapter to determine whether the veteran may be entitled to special monthly compensation.

                       The Shoulder Girdle and Arm------------------------------------------------------------------------                                                           Rating                                                  ----------------------                                                   Dominant  Nondominant------------------------------------------------------------------------5301 Group I. Function: Upward rotation of scapula; elevation of arm above shoulder level. Extrinsic muscles of shoulder girdle: (1) Trapezius; (2) levator scapulae; (3) serratus magnus..........................................    Severe.......................................       40          30    Moderately Severe............................       30          20    Moderate.....................................       10          10    Slight.......................................        0           05302 Group II. Function: Depression of arm from vertical overhead to hanging at side (1, 2); downward rotation of scapula (3, 4); 1 and 2 act with Group III in forward and backward swing of arm. Extrinsic muscles of shoulder girdle: (1) Pectoralis major II (costosternal); (2) latissimus dorsi and teres major (teres major, although technically an intrinsic muscle, is included with latissimus dorsi); (3) pectoralis minor; (4) rhomboid.............................    Severe.......................................       40          30    Moderately Severe............................       30          20    Moderate.....................................       20          20    Slight.......................................        0           05303 Group III. Function: Elevation and abduction of arm to level of shoulder; act with 1 and 2 of Group II in forward and backward swing of arm. Intrinsic muscles of shoulder girdle: (1) Pectoralis major I (clavicular); (2) deltoid....    Severe.......................................       40          30    Moderately Severe............................       30          20    Moderate.....................................       20          20    Slight.......................................        0           05304 Group IV. Function: Stabilization of shoulder against injury in strong movements, holding head of humerus in socket; abduction; outward rotation and inward rotation of arm. Intrinsic muscles of shoulder girdle: (1) Supraspinatus; (2) infraspinatus and teres minor; (3) subscapularis; (4) coracobrachialis..    Severe.......................................       30          20    Moderately Severe............................       20          20    Moderate.....................................       10          10    Slight.......................................        0           05305 Group V. Function: Elbow supination (1) (long head of biceps is stabilizer of shoulder joint); flexion of elbow (1, 2, 3). Flexor muscles of elbow: (1) Biceps; (2) brachialis; (3) brachioradialis.............................    Severe.......................................       40          30    Moderately Severe............................       30          20    Moderate.....................................       10          10    Slight.......................................        0           05306 Group VI. Function: Extension of elbow (long head of triceps is stabilizer of shoulder joint). Extensor muscles of the elbow: (1) Triceps; (2) anconeus...........................    Severe.......................................       40          30    Moderately Severe............................       30          20    Moderate.....................................       10          10    Slight.......................................        0           0------------------------------------------------------------------------

                          The Forearm and Hand------------------------------------------------------------------------                                                           Rating                                                  ----------------------                                                   Dominant  Nondominant------------------------------------------------------------------------5307 Group VII. Function: Flexion of wrist and fingers. Muscles arising from internal condyle of humerus: Flexors of the carpus and long flexors of fingers and thumb; pronator..........    Severe.......................................       40          30    Moderately Severe............................       30          20    Moderate.....................................       10          10    Slight.......................................        0           05308 Group VIII. Function: Extension of wrist, fingers, and thumb; abduction of thumb. Muscles arising mainly from external condyle of humerus: Extensors of carpus, fingers, and thumb; supinator.......................................    Severe.......................................       30          20    Moderately Severe............................       20          20    Moderate.....................................       10          10    Slight.......................................        0           05309 Group IX. Function: The forearm muscles act in strong grasping movements and are supplemented by the intrinsic muscles in delicate manipulative movements. Intrinsic muscles of hand: Thenar eminence; short flexor, opponens, abductor and adductor of thumb; hypothenar eminence; short flexor, opponens and abductor of little finger; 4 lumbricales; 4 dorsal and 3 palmar interossei..................Note: The hand is so compact a structure that isolated muscle injuries are rare, being nearly always complicated with injuries of bones, joints, tendons, etc. Rate on limitation of motion, minimum 10 percent.------------------------------------------------------------------------

                            The Foot and Leg------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------5310 Group X. Function: Movements of forefoot and toes; propulsion thrust in walking. Intrinsic muscles of the foot: Plantar: (1) Flexor digitorum brevis; (2) abductor hallucis; (3) abductor digiti minimi; (4) quadratus plantae; (5) lumbricales; (6) flexor hallucis brevis; (7) adductor hallucis; (8) flexor digiti minimi brevis; (9) dorsal and plantar interossei. Other important plantar structures: Plantar aponeurosis, long plantar and calcaneonavicular ligament, tendons of posterior tibial, peroneus longus, and long flexors of great and little toes.......................................    Severe......................................................      30    Moderately Severe...........................................      20    Moderate....................................................      10    Slight......................................................       0Dorsal: (1) Extensor hallucis brevis; (2) extensor digitorum brevis. Other important dorsal structures: cruciate, crural, deltoid, and other ligaments; tendons of long extensors of toes and peronei muscles............................................    Severe......................................................      20    Moderately Severe...........................................      10    Moderate....................................................      10    Slight......................................................       0Note: Minimum rating for through-and-through wounds of the foot_10.5311 Group XI. Function: Propulsion, plantar flexion of foot (1); stabilization of arch (2, 3); flexion of toes (4, 5); Flexion of knee (6). Posterior and lateral crural muscles, and muscles of the calf: (1) Triceps surae (gastrocnemius and soleus); (2) tibialis posterior; (3) peroneus longus; (4) peroneus brevis; (5) flexor hallucis longus; (6) flexor digitorum longus; (7) popliteus; (8) plantaris.................    Severe......................................................      30    Moderately Severe...........................................      20    Moderate....................................................      10    Slight......................................................       05312 Group XII. Function: Dorsiflexion (1); extension of toes (2); stabilization of arch (3). Anterior muscles of the leg: (1) Tibialis anterior; (2) extensor digitorum longus; (3) extensor hallucis longus; (4) peroneus tertius.................    Severe......................................................      30    Moderately Severe...........................................      20    Moderate....................................................      10    Slight......................................................       0------------------------------------------------------------------------

                       The Pelvic Girdle and Thigh------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------5313 Group XIII. Function: Extension of hip and flexion of knee; outward and inward rotation of flexed knee; acting with rectus femoris and sartorius (see XIV, 1, 2) synchronizing simultaneous flexion of hip and knee and extension of hip and knee by belt-over-pulley action at knee joint. Posterior thigh group, Hamstring complex of 2-joint muscles: (1) Biceps femoris; (2) semimembranosus; (3) semitendinosus...............    Severe......................................................      40    Moderately Severe...........................................      30    Moderate....................................................      10    Slight......................................................       05314 Group XIV. Function: Extension of knee (2, 3, 4, 5); simultaneous flexion of hip and flexion of knee (1); tension of fascia lata and iliotibial (Maissiat's) band, acting with XVII (1) in postural support of body (6); acting with hamstrings in synchronizing hip and knee (1, 2). Anterior thigh group: (1) Sartorius; (2) rectus femoris; (3) vastus externus; (4) vastus intermedius; (5) vastus internus; (6) tensor vaginae femoris...    Severe......................................................      40    Moderately Severe...........................................      30    Moderate....................................................      10    Slight......................................................       05315 Group XV. Function: Adduction of hip (1, 2, 3, 4); flexion of hip (1, 2); flexion of knee (4). Mesial thigh group: (1) Adductor longus; (2) adductor brevis; (3) adductor magnus; (4) gracilis.......................................................    Severe......................................................      30    Moderately Severe...........................................      20    Moderate....................................................      10    Slight......................................................       05316 Group XVI. Function: Flexion of hip (1, 2, 3). Pelvic girdle group 1: (1) Psoas; (2) iliacus; (3) pectineus..........    Severe......................................................      40    Moderately Severe...........................................      30    Moderate....................................................      10    Slight......................................................       05317 Group XVII. Function: Extension of hip (1); abduction of thigh; elevation of opposite side of pelvis (2, 3); tension of fascia lata and iliotibial (Maissiat's) band, acting with XIV (6) in postural support of body steadying pelvis upon head of femur and condyles of femur on tibia (1). Pelvic girdle group 2: (1) Gluteus maximus; (2) gluteus medius; (3) gluteus minimus    Severe......................................................     *50    Moderately Severe...........................................      40    Moderate....................................................      20    Slight......................................................       05318 Group XVIII. Function: Outward rotation of thigh and stabilization of hip joint. Pelvic girdle group 3: (1) Pyriformis; (2) gemellus (superior or inferior); (3) obturator (external or internal); (4) quadratus femoris..................    Severe......................................................      30    Moderately Severe...........................................      20    Moderate....................................................      10    Slight......................................................       0------------------------------------------------------------------------* If bilateral, see § 3.350(a)(3) of this chapter to determine  whether the veteran may be entitled to special monthly compensation.

                           The Torso and Neck------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------5319 Group XIX. Function: Support and compression of abdominal wall and lower thorax; flexion and lateral motions of spine; synergists in strong downward movements of arm (1). Muscles of the abdominal wall: (1) Rectus abdominis; (2) external oblique; (3) internal oblique; (4) transversalis; (5) quadratus lumborum    Severe......................................................      50    Moderately Severe...........................................      30    Moderate....................................................      10    Slight......................................................       05320 Group XX. Function: Postural support of body; extension and lateral movements of spine. Spinal muscles: Sacrospinalis (erector spinae and its prolongations in thoracic and cervical regions).......................................................    Cervical and thoracic region:...............................    Severe......................................................      40    Moderately Severe...........................................      20    Moderate....................................................      10    Slight......................................................       0    Lumbar region:..............................................    Severe......................................................      60    Moderately Severe...........................................      40    Moderate....................................................      20    Slight......................................................       05321 Group XXI. Function: Respiration. Muscles of respiration: Thoracic muscle group..........................................    Severe or Moderately Severe.................................      20    Moderate....................................................      10    Slight......................................................       05322 Group XXII. Function: Rotary and forward movements of the head; respiration; deglutition. Muscles of the front of the neck: (Lateral, supra-, and infrahyoid group.) (1) Trapezius I (clavicular insertion); (2) sternocleidomastoid; (3) the ``hyoid'' muscles; (4) sternothyroid; (5) digastric............    Severe......................................................      30    Moderately Severe...........................................      20    Moderate....................................................      10    Slight......................................................       05323 Group XXIII. Function: Movements of the head; fixation of shoulder movements. Muscles of the side and back of the neck: Suboccipital; lateral vertebral and anterior vertebral muscles.    Severe......................................................      30    Moderately Severe...........................................      20    Moderate....................................................      10Slight..........................................................       0------------------------------------------------------------------------

Miscellaneous------------------------------------------------------------------------ Rating------------------------------------------------------------------------5324 Diaphragm, rupture of, with herniation. Rate under diagnostic code 7346...........................................5325 Muscle injury, facial muscles. Evaluate functional impairment as seventh (facial) cranial nerve neuropathy (diagnostic code 8207), disfiguring scar (diagnostic code 7800), etc. Minimum, if interfering to any extent with mastication_10.................................................5326 Muscle hernia, extensive. Without other injury to the muscle_10......................................................5327 Muscle, neoplasm of, malignant (excluding soft tissue sarcoma)_100................................................... Note: A rating of 100 percent shall continue beyond the cessation of any surgery, radiation treatment, antineoplastic chemotherapy or other therapeutic procedures. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residual impairment of function.5328 Muscle, neoplasm of, benign, postoperative. Rate on impairment of function, i.e., limitation of motion, or scars, diagnostic code 7805, etc......................................5329 Sarcoma, soft tissue (of muscle, fat, or fibrous connective tissue)_100.................................................... Note: A rating of 100 percent shall continue beyond the cessation of any surgery, radiation treatment, antineoplastic chemotherapy or other therapeutic procedures. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residual impairment of function.------------------------------------------------------------------------

(Authority: 38 U.S.C. 1155)

[62 FR 30239, June 3, 1997]

The Organs of Special Sense

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§ 4.75 Examination of visual acuity.

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Ratings on account of visual impairments considered for service connection are, when practicable, to be based only on examination by specialists. Such special examinations should include uncorrected and corrected central visual acuity for distance and near, with record of the refraction. Snellen's test type or its equivalent will be used. Mydriatics should be routine, except when contraindicated. Funduscopic and ophthalmological findings must be recorded. The best distant vision obtainable after best correction by glasses will be the basis of rating, except in cases of keratoconus in which contact lenses are medically required. Also, if there exists a difference of more than 4 diopters of spherical correction between the two eyes, the best possible visual acuity of the poorer eye without glasses, or with a lens of not more than 4 diopters difference from that used with the better eye will be taken as the visual acuity of the poorer eye. When such a difference exists, close attention will be given to the likelihood of congenital origin in mere refractive error.

[40 FR 42537, Sept. 15, 1975]

§ 4.76 Examination of field vision.

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Measurement of the visual field will be made when there is disease of the optic nerve or when otherwise indicated. The usual perimetric methods will be employed, using a standard perimeter and 3 mm. white test object. At least 16 meridians 221/2 degrees apart will be charted for each eye. (See Figure 1. For the 8 principal meridians, see table III.) The charts will be made a part of the report of examination. Not less than 2 recordings, and when possible, 3 will be made. The minimum limit for this function is established as a concentric central contraction of the visual field to 5°. This type of contraction of the visual field reduces the visual efficiency to zero. Where available the examination for form field should be supplemented, when indicated, by the use of tangent screen or campimeter. This last test is especially valuable in detection of scotoma.

[43 FR 45352, Oct. 2, 1978]

§ 4.76a Computation of average concentric contraction of visual fields.

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The extent of contraction of visual field in each eye is determined by recording the extent of the remaining visual fields in each of the eight 45 degree principal meridians. The number of degrees lost is determined at each meridian by subtracting the remaining degrees from the normal visual fields given in table III. The degrees lost are then added together to determine total degrees lost. This is subtracted from 500. The difference represents the total remaining degrees of visual field. The difference divided by eight represents the average contraction for rating purposes.

      Table III_Normal Visual Field Extent at 8 Principal Meridians------------------------------------------------------------------------                                                                Normal                          Meridian                              degrees------------------------------------------------------------------------Temporally..................................................          85Down temporally.............................................          85Down........................................................          65Down nasally................................................          50Nasally.....................................................          60Up nasally..................................................          55Up..........................................................          45Up temporally...............................................          55                                                             ----------- Total......................................................         500------------------------------------------------------------------------

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Example of computation of concentric contraction under the schedule with abnormal findings taken from Figure 1.

 ------------------------------------------------------------------------                            Loss                                Degrees------------------------------------------------------------------------Temporally..................................................          55Down temporally.............................................          55Down........................................................          45Down nasally................................................          30Nasally.....................................................          40Up nasally..................................................          35Up..........................................................          25Up temporally...............................................          35                                                             ----------- Total loss.................................................         320------------------------------------------------------------------------Remaining field 500° minus 320° = 180°. 180° ÷ 8 =  22\1/2\° average concentric contraction.

[43 FR 45352, Oct. 2, 1978]

§ 4.77 Examination of muscle function.

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The measurement of muscle function will be undertaken only when the history and findings reflect disease or injury of the extrinsic muscles of the eye, or of the motor nerves supplying these muscles. The measurement will be performed using a Goldmann Perimeter Chart as in Figure 2 below. The chart identifies four major quadrants, (upward, downward, and two lateral) plus a central field (20° or less). The examiner will chart the areas in which diplopia exists, and such plotted chart will be made a part of the examination report. Muscle function is considered normal (20/40) when diplopia does not exist within 40° in the lateral or downward quadrants, or within 30° in the upward quadrant. Impairment of muscle function is to be supported in each instance by record of actual appropriate pathology. Diplopia which is only occasional or correctable is not considered a disability.

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[53 FR 30262, Aug. 11, 1988]

§ 4.78 Computing aggravation.

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In determining the effect of aggravation of visual disability, even though the visual impairment of only one eye is service connected, evaluate the vision of both eyes, before and after suffering the aggravation, and subtract the former evaluation from the latter except when the bilateral vision amounts to total disability. In the event of subsequent increase in the disability of either eye, due to intercurrent disease or injury not associated with the service, the condition of the eyes before suffering the subsequent increase will be taken as the basis of compensation subject to the provisions of §3.383(a) of this chapter.

[29 FR 6718, May 22, 1964, as amended at 43 FR 45354, Oct. 2, 1978]

§ 4.79 Loss of use of one eye, having only light perception.

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Loss of use or blindness of one eye, having only light perception, will be held to exist when there is inability to recognize test letters at 1 foot (.30m.) and when further examination of the eyes reveals that perception of objects, hand movements or counting fingers cannot be accomplished at 3 feet (.91m.), lesser extents of visions, particularly perception of objects, hand movements, or counting fingers at distances less than 3 feet (.91 m.), being considered of negligible utility. With visual acuity 5/200 (1.5/60) or less or the visual field reduced to 5° concentric contraction, in either event in both eyes, the question of entitlement on account of regular aid and attendance will be determined on the facts in the individual case.

[43 FR 45354, Oct. 2, 1978]

§ 4.80 Rating of one eye.

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Combined ratings for disabilities of the same eye should not exceed the amount for total loss of vision of that eye unless there is an enucleation or a serious cosmetic defect added to the total loss of vision.

§§ 4.81-4.82 [Reserved]

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§ 4.83 Ratings at scheduled steps and distances.

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In applying the ratings for impairment of visual acuity, a person not having the ability to read at any one of the scheduled steps or distances, but reading at the next scheduled step or distance, is to be rated as reading at this latter step or distance. That is, a person who can read at 20/100 (6/30) but who cannot at 20/70 (6/21), should be rated as seeing at 20/100 (6/30).

[41 FR 34257, Aug. 13, 1976, as amended at 43 FR 45354, Oct. 2, 1978]

§ 4.83a Impairment of central visual acuity.

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The percentage evaluation will be found from table V by intersecting the horizontal row appropriate for the Snellen index for one eye and the vertical column appropriate to the Snellen index of the other eye. For example, if one eye has a Snellen index of 5/200 (1.5/60) and the other eye has a Snellen index of 20/70 (6/21), the percentage evaluation is found in the third horizontal row from the bottom and the fourth vertical column from the left. The evaluation is 50 percent and the diagnostic code 6073.

[41 FR 11297, Mar. 18, 1976, as amended at 43 FR 45354, Oct. 2, 1978]

§ 4.84 Differences between distant and near visual acuity.

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Where there is a substantial difference between the near and distant corrected vision, the case should be referred to the Director, Compensation and Pension Service.

[40 FR 42537, Sept. 15, 1975]

§ 4.84a Schedule of ratings—eye.

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                           Diseases of the Eye------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------6000 Uveitis6001 Keratitis6002 Scleritis6003 Iritis6004 Cyclitis6005 Choroiditis6006 Retinitis6007 Hemorrhage, intra-ocular, recent6008 Retina, detachment of6009 Eye, injury of, unhealed:  The above disabilities, in chronic form, are to be rated from       10   10 percent to 100 percent for impairment of visual acuity or   field loss, pain, rest-requirements, or episodic incapacity,   combining an additional rating of 10 percent during   continuance of active pathology. Minimum rating during active   pathology....................................................6010 Eye, tuberculosis of, active or inactive:  Active........................................................     100  Inactive: See §§ 4.88b and 4.89.6011 Retina, localized scars, atrophy, or irregularities of, centrally located, with irregular, duplicated enlarged or diminished image:  Unilateral or bilateral.......................................      106012 Glaucoma, congestive or inflammatory:  Frequent attacks of considerable duration; during continuance      100   of actual total disability...................................  Or, rate as iritis, diagnostic Code 6003.6013 Glaucoma, simple, primary, noncongestive:  Rate on impairment of visual acuity or field loss.    Minimum rating..............................................      106014 New growths, malignant (eyeball only):  Pending completion of operation or other indicated treatment..     100  Healed; rate on residuals.6015 New growths, benign (eyeball and adnexa, other than superficial)  Rate on impaired vision, minimum..............................      10  Healed; rate on residuals.6016 Nystagmus, central.........................................      106017 Conjunctivitis, trachomatous, chronic:  Active; rate for impairment of visual acuity; minimum rating        30   while there is active pathology..............................  Healed; rate on residuals, if no residuals....................       06018 Conjunctivitis, other, chronic:  Active, with objective symptoms...............................      10  Healed; rate on residuals, if no residuals....................       06019 Ptosis, unilateral or bilateral:  Pupil wholly obscured.  Rate equivalent to 5/200 (1.5/60).  Pupile one-half or more obscured.  Rate equivalent to 20/100 (6/30).  With less interference with vision.  Rate as disfigurement.6020 Ectropion:  Bilateral.....................................................      20  Unilateral....................................................      106021 Entropion:  Bilateral.....................................................      20  Unilateral....................................................      106022 Lagophthalmos:  Bilateral.....................................................      20  Unilateral....................................................      106023 Eyebrows, loss of, complete, unilateral or bilateral.......      106024 Eyelashes, loss of, complete, unilateral or bilateral......      106025 Epiphora (lacrymal duct, interference with, from any cause):  Bilateral.....................................................      20  Unilateral....................................................      106026 Neuritis, optic:  Rate underlying disease, and combine impairment of visual   acuity or field loss.6027 Cataract, traumatic:  Preoperative.  Rate on impairment of vision.  Postoperative.  Rate on impairment of vision and aphakia.6028 Cataract, senile, and others:  Preoperative.  Rate on impairment of vision.  Postoperative.  Rate on impairment of vision and aphakia.6029 Aphakia:  Bilateral or unilateral.......................................      30  Note: The 30 percent rating prescribed for aphakia is a   minimum rating to be applied to the unilateral or bilateral   condition and is not to be combined with any other rating for   impaired vision. When only one eye is aphakic, the eye having   poorer corrected visual acuity will be rated on the basis of   its acuity without correction. When both eyes are aphakic,   both will be rated on corrected vision. The corrected vision   of one or both aphakic eyes will be taken one step worse than   the ascertained value, however, not better than 20/70 (6/21).   Combined ratings for disabilities of the same eye should not   exceed the amount for total loss of vision of that eye unless   there is an enucleation or a serious cosmetic defect added to   the total loss of vision.6030 Accommodation, paralysis of................................      206031 Dacryocystitis  Rate as epiphora.6032 Eyelids, loss of portion of:  Rate as disfigurement. (See diseases of the skin.)6033 Lens, crystalline, dislocation of:  Rate as aphakia.6034 Pterygium:  Rate for loss of vision, if any.6035 Keratoconus: To be evaluated on impairment of corrected visual acuity using contact lenses.  Note: When contact lenses are medically required for   keratoconus, either unilateral or bilateral, the minimum   rating will be 30 percent.------------------------------------------------------------------------

                                 Table IV_Table for Rating Bilateral Blindness or Blindness Combined With Hearing Loss With Dictator's Code and 38 CFR Citations------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------                                                       Vision other eye                                                       Plus service-connected Hearing loss                                 ---------------------------------------------------------------------------------------------------------------------------------------------------------------         Vision one eye                                                        No light                                   5/200 (1.5/60) or   Light perception      perception or    Total deafness one     10% or 20% at     30% at least one    40% at least one     60% or more at                                         less                only           anatomical loss           ear          least one ear SC         ear SC              ear SC         least one ear SC------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------5/200 (1.5/60) or less..........  L \1\ Code LB-1 38  L+\1/2\ \1\ Code    M Code MB-2 a or b  Add \1/2\ step      No additional SMC.  Add a full step     Add a full step     O Code OB-1 38 CFR                                   CFR 3.350(b)(2).    LB-2 38 CFR         38 CFR              Code PB-1 38 CFR                        Code PB-3 38 CFR    Code PB-3 38 CFR    3.350(e)(1)(iii)                                                       3.350(f)(2)(i).     3.350(f)(2)(ii).    3.350(f)(2)(iv).                        3.350(f)(2)(vi).    3.350(f)(2)(vi).Light perception only...........  ..................  M Code MB-1 a 38    M+\1/2\ Code MB-3   O Code OB-2 38 CFR  Add \1/2\ step      Add a full step     O Code OB-2 38 CFR  O Code OB-1 38 CFR                                                       CFR                 a or b 38 CFR       3.350(e)(1)(iv).    Code PB-2 38 CFR    Code PB-3 38 CFR    3.350(e)(1)(iv).    3.350(e)(1)(iii)                                                       3.350(c)(1)((iv).   3.350(f)(iii).                          3.350(f)(2)(v).     3.350(f)(2)(iv).No light perception or            ..................  ..................  N Code NB-1 a-b or  O Code OB-2 38 CFR  Add \1/2\ step      Add full step Code  O Code OB-2 38 CFR  O Code OB-1 38 CFR anatomical loss.                                                          c 38 CFR            3.350(e)(1)(iv).    Code PB-2 38 CFR    PB-3 38 CFR         3.350(e)(1)(iv).    3.350(e)(1)(iii)                                                                           3.350(d)(4).                            3.350(f)(2)(v).     3.350(f)(2)(vi).------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------\1\ With need for aid and attendance qualifies for Subpar. m. code MB-1, b; 38 CFR 3.350(c)(1)(v).Note. (1) Any of the additional SMC payable under Dictator's Codes PB-1, PB-2, or PB-3 is not to exceed the rate payable under Subpar. O. (2) If in addition to any of the above the veteran has  the service-connected loss or loss of use of an extremity, additional SMC is payable, not to exceed the rate payable under Subpar. O. See Dictator's Codes PB-4, PB-5, PB-6, and 38 CFR  3.350(f)(2)(vii) (A), (B), (C).

(Authority: 38 U.S.C. 1115)

                   Impairment of Central Visual Acuity------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------6061 Anatomical loss both eyes..................................     \5\                                                                     1006062 Blindness in both eyes having only light perception........     \5\                                                                     100  Anatomical loss of 1 eye:6063 In the other eye 5/200 (1.5/60)............................     \5\                                                                     1006064 In the other eye 10/200 (3/60).............................  \6\ 906064 In the other eye 15/200 (4.5/60)...........................  \6\ 806064 In the other eye 20/200 (6/60).............................  \6\ 706065 In the other eye 20/100 (6/30).............................  \6\ 606065 In the other eye 20/70 (6/21)..............................  \6\ 606065 In the other eye 20/50 (6/15)..............................  \6\ 506066 In the other eye 20/40 (6/12)..............................  \6\ 40  Blindness in 1 eye, having only light perception:6067 In the other eye 5/200 (1.5/60)............................     \5\                                                                     1006068 In the other eye 10/200 (3/60).............................  \5\ 906068 In the other eye 15/200 (4.5/60)...........................  \5\ 806068 In the other eye 20/200 (6/60).............................  \5\ 706069 In the other eye 20/100 (6/30).............................  \5\ 606069 In the other eye 20/70 (6/21)..............................  \5\ 506069 In the other eye 20/50 (6/15)..............................  \5\ 406070 In the other eye 20/40 (6/12)..............................  \5\ 30  Vision in 1 eye 5/200 (1.5/60):6071 In the other eye 5/200 (1.5/60)............................     \5\                                                                     1006072 In the other eye 10/200 (3/60).............................      906072 In the other eye 15/200 (4.5/60)...........................      806072 In the other eye 20/200 (6/60).............................      706073 In the other eye 20/100 (6/30).............................      606073 In the other eye 20/70 (6/21)..............................      506073 In the other eye 20/50 (6/15)..............................      406074 In the other eye 20/40 (6/12)..............................      30  Vision in 1 eye 10/200 (3/60):6075 In the other eye 10/200 (3/60).............................      906075 In the other eye 15/200 (4.5/60)...........................      806075 In the other eye 20/200 (6/60).............................      706076 In the other eye 20/100 (6/30).............................      606076 In the other eye 20/70 (6/21)..............................      506076 In the other eye 20/50 (6/15)..............................      406077 In the other eye 20/40 (6/12)..............................      30  Vision in 1 eye 15/200 (4.5/60):6075 In the other eye 15/200 (4.5/60)...........................      806075 In the other eye 20/200 (6/60).............................      706076 In the other eye 20/100 (6/30).............................      606076 In the other eye 20/70 (6/21)..............................      406076 In the other eye 20/50 (6/15)..............................      306077 In the other eye 20/40 (6/12)..............................      20  Vision in 1 eye 20/200 (6/60):6075 In the other eye 20/200 (6/60).............................      706076 In the other eye 20/100 (6/30).............................      606076 In the other eye 20/70 (6/21)..............................      406076 In the other eye 20/50 (6/15)..............................      306077 In the other eye 20/40 (6/12)..............................      20  Vision in 1 eye 20/100 (6/30):6078 In the other eye 20/100 (6/30).............................      506078 In the other eye 20/70 (6/21)..............................      306078 In the other eye 20/50 (6/15)..............................      206079 In the other eye 20/40 (6/12)..............................      10  Vision in 1 eye 20/70 (6/21):6078 In the other eye 20/70 (6/21)..............................      306078 In the other eye 20/50 (6/15)..............................      206079 In the other eye 20/40 (6/12)..............................      10  Vision in 1 eye 20/50 (6/15):6078 In the other eye 20/50 (6/15)..............................      106079 In the other eye 20/40 (6/12)..............................      10  Vision in 1 eye 20/40 (6/12):  In the other eye 20/40 (6/12)                                        0------------------------------------------------------------------------\5\ Also entitled to special monthly compensation.\6\ Add 10% if artificial eye cannot be worn; also entitled to special  monthly compensation.

                              Table V_Ratings for Central Visual Acuity Impairment                                             [With Diagnostic Code]----------------------------------------------------------------------------------------------------------------                                                    Vision in other eye         ------------------------------------------------------------------------------------------------------- Vision                                                                                                Light in one                                                                                             perception   eye    20/40 (6/  20/50 (6/  20/70 (6/  20/100 (6/ 20/200 (6/   15/200   10/200 (3/   5/200         only/             12)        15)        21)        30)        60)      (4.5/60)     60)      (1.5/60)    anatomical                                                                                                       loss----------------------------------------------------------------------------------------------------------------20/40             0(6/12)----------------------------------------------------------------------------------------------------------------20/50            10         10(6/15)       (6079)     (6078)----------------------------------------------------------------------------------------------------------------20/70            10         20         30(6/21)       (6079)     (6078)     (6078)----------------------------------------------------------------------------------------------------------------20/100           10         20         30         50(6/30)       (6079)     (6078)     (6078)     (6078)----------------------------------------------------------------------------------------------------------------20/200           20         30         40         60         70(6/60)       (6077)     (6076)     (6076)     (6076)     (6075)----------------------------------------------------------------------------------------------------------------15/200           20         30         40         60         70         80(4.5/60)     (6077)     (6076)     (6076)     (6076)     (6075)     (6075)----------------------------------------------------------------------------------------------------------------10/200           30         40         50         60         70         80         90(3/60)       (6077)     (6076)     (6076)     (6076)     (6075)     (6075)     (6075)----------------------------------------------------------------------------------------------------------------5/200            30         40         50         60         70         80         90    \5\ 100(1.5/60)     (6074)     (6073)     (6073)     (6073)     (6072)     (6072)     (6072)     (6071)----------------------------------------------------------------------------------------------------------------Light        \5\ 30     \5\ 40     \5\ 50     \5\ 60     \5\ 70     \5\ 80     \5\ 90    \5\ 100         \5\ 100 percept ion only             (6070)     (6069)     (6069)     (6069)     (6068)     (6068)     (6068)     (6067)          (6062)----------------------------------------------------------------------------------------------------------------Anatomic     \6\ 40     \6\ 50     \6\ 60     \6\ 60     \6\ 70     \6\ 80     \6\ 90    \5\ 100         \5\ 100 al loss of one eye             (6066)     (6065)     (6065)     (6065)     (6064)     (6064)     (6064)     (6063)          (6061)----------------------------------------------------------------------------------------------------------------\5\ Also entitled to special monthly compensation.\6\Add 10 percent if artificial eye cannot be worn; also entitled to special monthly compensation.

                 Ratings for Impairment of Field Vision------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------6080 Field vision, impairment of:  Homonymous hemianopsia........................................      30Field, visual, loss of temporal half:  Bilateral.....................................................      30  Unilateral....................................................      10  Or rate as 20/70 (6/21).Field, visual, loss of nasal half:  Bilateral.....................................................      20  Unilateral....................................................      10  Or rate as 20/50 (6/15).Field, visual, concentric contraction of: To 5°:  Bilateral.....................................................     100  Unilateral....................................................      30  Or rate as 5/200 (1.5/60). To 15° but not to 5°:  Bilateral.....................................................      70  Unilateral....................................................      20  Or rate as 20/200 (6/60). To 30° but not to 15°:  Bilateral.....................................................      50  Unilateral....................................................      10  Or rate as 20/100 (6/30). To 45° but not to 30°:  Bilateral.....................................................      30  Unilateral....................................................      10  Or rate as 20/70 (6/21): To 60° but not to 45°:  Bilateral.....................................................      20  Unilateral....................................................      10  Or rate as 20/50 (6/15).  Note (1): Correct diagnosis reflecting disease or injury   should be cited..............................................  Note (2): Demonstrable pathology commensurate with the   functional loss will be required. The concentric contraction   ratings require contraction within the stated degrees,   temporally; the nasal contraction may be less. The   alternative ratings are to be employed when there is ratable   defect of visual acuity, or a different impairment of the   visual field in the other eye. Concentric contraction   resulting from demonstrable pathology to 5 degrees or less   will be considered on a parity with reduction of central   visual acuity to 5/200 (1.5/60) or less for all purposes   including entitlement under § 3.350(b)(2) of this   chapter; not however, for the purpose of § 3.350(a) of   this chapter. Entitlement on account of blindness requiring   regular aid and attendance, § 3.350(c) of this chapter,   will continue to be determined on the facts in the individual   case.........................................................6081 Scotoma, pathological, unilateral:  Large or centrally located, minimum...........................      10  Note: Rate on loss of central visual acuity or impairment of   field vision. Do not combine with any other rating for visual   impairment.------------------------------------------------------------------------

Ratings for Impairment of Muscle Function [6090 Diplopia (double vision)]------------------------------------------------------------------------ Equivalent Degree of diplopia visual acuity------------------------------------------------------------------------(a) Central 20°......................................... 5/200(b) 21° to 30°:(1) Down.................................................... 15/200(2) Lateral................................................. 20/100(3) Up...................................................... 20/70(c) 31° to 40°:(1) Down.................................................... 20/200(2) Lateral................................................. 20/70(3) Up...................................................... 20/40 Note: (1) Correct diagnosis reflecting disease or injury should be cited.......................................... Note: (2) The above ratings will be applied to only one eye. Ratings will not be applied for both diplopia and decreased visual acuity or field of vision in the same eye. When diplopia is present and there is also ratable impairment of visual acuity or field of vision of both eyes the above diplopia ratings will be applied to the poorer eye while the better eye is rated according to the best corrected visual acuity or visual field............. Note: (3) When the diplopia field extends beyond more than one quadrant or more than one range of degrees, the evaluation for diplopia will be based on the quadrant and degree range that provide the highest evaluation......... Note: (4) When diplopia exists in two individual and separate areas of the same eye, the equivalent visual acuity will be taken one step worse, but no worse than 5/ 200......................................................6091 Symblepharon...........................................Rate as limited muscle function, diagnostic code 6090.......6092 Diplopia, due to limited muscle function...............Rate as diagnostic code 6090................................------------------------------------------------------------------------

[29 FR 6718, May 22, 1964, as amended at 34 FR 5062, Mar. 11, 1969; 40 FR 42537, Sept. 15, 1975; 41 FR 11297, Mar. 18, 1976; 43 FR 45354, Oct. 2, 1978; 51 FR 6411, Feb. 24, 1986; 53 FR 30264, Aug. 11, 1988; 53 FR 50955, Dec. 19, 1988; 57 FR 24364, June 9, 1992]

Impairment of Auditory Acuity

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§ 4.85 Evaluation of hearing impairment.

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(a) An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. Examinations will be conducted without the use of hearing aids.

(b) Table VI, “Numeric Designation of Hearing Impairment Based on Puretone Threshold Average and Speech Discrimination,” is used to determine a Roman numeral designation (I through XI) for hearing impairment based on a combination of the percent of speech discrimination (horizontal rows) and the puretone threshold average (vertical columns). The Roman numeral designation is located at the point where the percentage of speech discrimination and puretone threshold average intersect.

(c) Table VIa, “Numeric Designation of Hearing Impairment Based Only on Puretone Threshold Average,” is used to determine a Roman numeral designation (I through XI) for hearing impairment based only on the puretone threshold average. Table VIa will be used when the examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of §4.86.

(d) “Puretone threshold average,” as used in Tables VI and VIa, is the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz, divided by four. This average is used in all cases (including those in §4.86) to determine the Roman numeral designation for hearing impairment from Table VI or VIa.

(e) Table VII, “Percentage Evaluations for Hearing Impairment,” is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment of each ear. The horizontal rows represent the ear having the better hearing and the vertical columns the ear having the poorer hearing. The percentage evaluation is located at the point where the row and column intersect.

(f) If impaired hearing is service-connected in only one ear, in order to determine the percentage evaluation from Table VII, the non-service-connected ear will be assigned a Roman Numeral designation for hearing impairment of I, subject to the provisions of §3.383 of this chapter.

(g) When evaluating any claim for impaired hearing, refer to §3.350 of this chapter to determine whether the veteran may be entitled to special monthly compensation due either to deafness, or to deafness in combination with other specified disabilities.

(h) Numeric tables VI, VIA*, and VII.

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[64 FR 25206, May 11, 1999]

§ 4.86 Exceptional patterns of hearing impairment.

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(a) When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately.

(b) When the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately.

(Authority: 38 U.S.C. 1155)

[64 FR 25209, May 11, 1999]

§ 4.87 Schedule of ratings—ear.

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                           Diseases of the Ear------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------6200 Chronic suppurative otitis media, mastoiditis, or cholesteatoma (or any combination):  During suppuration, or with aural polyps......................      10  Note: Evaluate hearing impairment, and complications such as   labyrinthitis, tinnitus, facial nerve paralysis, or bone loss   of skull, separately.6201 Chronic nonsuppurative otitis media with effusion (serous otitis media):  Rate hearing impairment6202 Otosclerosis:  Rate hearing impairment6204 Peripheral vestibular disorders:  Dizziness and occasional staggering...........................      30  Occasional dizziness..........................................      10  Note: Objective findings supporting the diagnosis of   vestibular disequilibrium are required before a compensable   evaluation can be assigned under this code. Hearing   impairment or suppuration shall be separately rated and   combined.6205 Meniere's syndrome (endolymphatic hydrops):  Hearing impairment with attacks of vertigo and cerebellar gait     100   occurring more than once weekly, with or without tinnitus....  Hearing impairment with attacks of vertigo and cerebellar gait      60   occurring from one to four times a month, with or without   tinnitus.....................................................  Hearing impairment with vertigo less than once a month, with        30   or without tinnitus..........................................  Note: Evaluate Meniere's syndrome either under these criteria   or by separately evaluating vertigo (as a peripheral   vestibular disorder), hearing impairment, and tinnitus,   whichever method results in a higher overall evaluation. But   do not combine an evaluation for hearing impairment,   tinnitus, or vertigo with an evaluation under diagnostic code   6205.6207 Loss of auricle:  Complete loss of both.........................................      50  Complete loss of one..........................................      30  Deformity of one, with loss of one-third or more of the             10   substance....................................................6208 Malignant neoplasm of the ear (other than skin only).......     100  Note: A rating of 100 percent shall continue beyond the   cessation of any surgical, radiation treatment,   antineoplastic chemotherapy or other therapeutic procedure.   Six months after discontinuance of such treatment, the   appropriate disability rating shall be determined by   mandatory VA examination. Any change in evaluation based on   that or any subsequent examination shall be subject to the   provisions of § 3.105(e) of this chapter. If there has   been no local recurrence or metastasis, rate on residuals.6209 Benign neoplasms of the ear (other than skin only):  Rate on impairment of function.6210 Chronic otitis externa:  Swelling, dry and scaly or serous discharge, and itching            10   requiring frequent and prolonged treatment...................6211 Tympanic membrane, perforation of..........................       06260 Tinnitus, recurrent........................................      10  Note (1): A separate evaluation for tinnitus may be combined   with an evaluation under diagnostic codes 6100, 6200, 6204,   or other diagnostic code, except when tinnitus supports an   evaluation under one of those diagnostic codes.  Note (2): Assign only a single evaluation for recurrent   tinnitus, whether the sound is perceived in one ear, both   ears, or in the head.  Note (3): Do not evaluate objective tinnitus (in which the   sound is audible to other people and has a definable cause   that may or may not be pathologic) under this diagnostic   code, but evaluate it as part of any underlying condition   causing it.------------------------------------------------------------------------

(Authority: 38 U.S.C. 1155)

[64 FR 25210, May 11, 1999, as amended at 68 FR 25823, May 14, 2003]

§ 4.87a Schedule of ratings—other sense organs.

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 ------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------6275 Sense of smell, complete loss..............................      106276 Sense of taste, complete loss..............................      10  Note: Evaluation will be assigned under diagnostic codes 6275   or 6276 only if there is an anatomical or pathological basis   for the condition.------------------------------------------------------------------------

(Authority: 38 U.S.C. 1155)

[64 FR 25210, May 11, 1999]

Infectious Diseases, Immune Disorders and Nutritional Deficiencies

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§ 4.88 [Reserved]

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§ 4.88a Chronic fatigue syndrome.

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(a) For VA purposes, the diagnosis of chronic fatigue syndrome requires:

(1) new onset of debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least six months; and

(2) the exclusion, by history, physical examination, and laboratory tests, of all other clinical conditions that may produce similar symptoms; and

(3) six or more of the following:

(i) acute onset of the condition,

(ii) low grade fever,

(iii) nonexudative pharyngitis,

(iv) palpable or tender cervical or axillary lymph nodes,

(v) generalized muscle aches or weakness,

(vi) fatigue lasting 24 hours or longer after exercise,

(vii) headaches (of a type, severity, or pattern that is different from headaches in the pre-morbid state),

(viii) migratory joint pains,

(ix) neuropsychologic symptoms,

(x) sleep disturbance.

(b) [Reserved]

[59 FR 60902, Nov. 29, 1994]

§ 4.88b Schedule of ratings—infectious diseases, immune disorders and nutritional deficiencies.

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 ------------------------------------------------------------------------                                                                Rating------------------------------------------------------------------------6300 Cholera, Asiatic:    As active disease, and for 3 months convalescence......         100    Thereafter rate residuals such as renal necrosis under the     appropriate system6301 Visceral Leishmaniasis:    During treatment for active disease....................          100    Note: A 100 percent evaluation shall continue beyond the cessation     of treatment for active disease. Six months after discontinuance of     such treatment, the appropriate disability rating shall be     determined by mandatory VA examination. Any change in evaluation     based upon that or any subsequent examination shall be subject to     the provisions of § 3.105(e) of this chapter. Rate residuals     such as liver damage or lymphadenopathy under the appropriate     system.6302 Leprosy (Hansen's Disease):    As active disease......................................          100    Note: A 100 percent evaluation shall continue beyond the date that     an examining physician has determined that this has become     inactive. Six months after the date of inactivity, the appropriate     disability rating shall be determined by mandatory VA examination.     Any change in evaluation based upon that or any subsequent     examination shall be subject to the provisions of § 3.105(e)     of this chapter. Rate residuals such as skin lesions or peripheral     neuropathy under the appropriate system.6304 Malaria:    As active disease......................................          100    Note: The diagnosis of malaria depends on the identification of the     malarial parasites in blood smears. If the veteran served in an     endemic area and presents signs and symptoms compatible with     malaria, the diagnosis may be based on clinical grounds alone.     Relapses must be confirmed by the presence of malarial parasites in     blood smears.    Thereafter rate residuals such as liver or spleen     damage under the appropriate system6305 Lymphatic Filariasis:    As active disease......................................         100    Thereafter rate residuals such as epididymitis or lymphangitis under     the appropriate system6306 Bartonellosis:    As active disease, and for 3 months convalescence......         100    Thereafter rate residuals such as skin lesions under the appropriate     system6307 Plague:    As active disease......................................         100    Thereafter rate residuals such as lymphadenopathy under the     appropriate system6308 Relapsing Fever:    As active disease......................................         100    Thereafter rate residuals such as liver or spleen damage or central     nervous system involvement under the appropriate system6309 Rheumatic fever:    As active disease......................................         100    Thereafter rate residuals such as heart damage under the appropriate     system6310 Syphilis, and other treponemal infections:    Rate the complications of nervous system, vascular system, eyes or     ears. (See DC 7004, syphilitic heart disease, DC 8013,     cerebrospinal syphilis, DC 8014, meningovascular syphilis, DC 8015,     tabes dorsalis, and DC 9301, dementia associated with central     nervous system syphilis)6311 Tuberculosis, miliary:    As active disease......................................          100    Inactive: See §§ 4.88c and 4.89.6313 Avitaminosis:    Marked mental changes, moist dermatitis, inability to            100     retain adequate nourishment, exhaustion, and cachexia.    With all of the symptoms listed below, plus mental                60     symptoms and impaired bodily vigor....................    With stomatitis, diarrhea, and symmetrical dermatitis..           40    With stomatitis, or achlorhydria, or diarrhea..........           20    Confirmed diagnosis with nonspecific symptoms such as:            10     decreased appetite, weight loss, abdominal discomfort,     weakness, inability to concentrate and irritability...6314 Beriberi:    As active disease:    With congestive heart failure, anasarca, or Wernicke-            100     Korsakoff syndrome....................................    With cardiomegaly, or; with peripheral neuropathy with            60     footdrop or atrophy of thigh or calf muscles..........    With peripheral neuropathy with absent knee or ankle              30     jerks and loss of sensation, or; with symptoms such as     weakness, fatigue, anorexia, dizziness, heaviness and     stiffness of legs, headache or sleep disturbance......    Thereafter rate residuals under the appropriate body     system.6315 Pellagra:    Marked mental changes, moist dermatitis, inability to            100     retain adequate nourishment, exhaustion, and cachexia.    With all of the symptoms listed below, plus mental                60     symptoms and impaired bodily vigor....................    With stomatitis, diarrhea, and symmetrical dermatitis..           40    With stomatitis, or achlorhydria, or diarrhea..........           20    Confirmed diagnosis with nonspecific symptoms such as:            10     decreased appetite, weight loss, abdominal discomfort,     weakness, inability to concentrate and irritability...6316 Brucellosis:    As active disease......................................         100    Thereafter rate residuals such as liver or spleen damage or     meningitis under the appropriate system6317 Typhus, scrub:    As active disease, and for 3 months convalescence......         100    Thereafter rate residuals such as spleen damage or skin conditions     under the appropriate system6318 Melioidosis:    As active disease......................................         100    Thereafter rate residuals such as arthritis, lung lesions or     meningitis under the appropriate system6319 Lyme Disease:    As active disease......................................         100    Thereafter rate residuals such as arthritis under the appropriate     system6320 Parasitic diseases otherwise not specified:    As active disease......................................         100    Thereafter rate residuals such as spleen or liver damage under the     appropriate system6350 Lupus erythematosus, systemic (disseminated):    Not to be combined with ratings under DC 7809 Acute,             100     with frequent exacerbations, producing severe     impairment of health..................................    Exacerbations lasting a week or more, 2 or 3 times per            60     year..................................................    Exacerbations once or twice a year or symptomatic                 10     during the past 2 years...............................    Note: Evaluate this condition either by combining the evaluations     for residuals under the appropriate system, or by evaluating DC     6350, whichever method results in a higher evaluation.6351 HIV-Related Illness:    AIDS with recurrent opportunistic infections or with             100     secondary diseases afflicting multiple body systems;     HIV-related illness with debility and progressive     weight loss, without remission, or few or brief     remissions............................................    Refractory constitutional symptoms, diarrhea, and                 60     pathological weight loss, or; minimum rating following     development of AIDS-related opportunistic infection or     neoplasm..............................................    Recurrent constitutional symptoms, intermittent                   30     diarrhea, and on approved medication(s), or; minimum     rating with T4 cell count less than 200, or Hairy Cell     Leukoplakia, or Oral Candidiasis......................    Following development of definite medical symptoms, T4            10     cell of 200 or more and less than 500, and on approved     medication(s), or; with evidence of depression or     memory loss with employment limitations...............    Asymptomatic, following initial diagnosis of HIV                   0     infection, with or without lymphadenopathy or     decreased T4 cell count...............................    Note (1): The term ``approved medication(s)'' includes medications     prescribed as part of a research protocol at an accredited medical     institution.    Note (2): Psychiatric or central nervous system     manifestations, opportunistic infections, and     neoplasms may be rated separately under appropriate     codes if higher overall evaluation results, but not in     combination with percentages otherwise assignable     above.6354 Chronic Fatigue Syndrome (CFS):    Debilitating fatigue, cognitive impairments (such as inability to     concentrate, forgetfulness, confusion), or a combination of other     signs and symptoms:    Which are nearly constant and so severe as to restrict           100     routine daily activities almost completely and which     may occasionally preclude self-care...................    Which are nearly constant and restrict routine daily              60     activities to less than 50 percent of the pre-illness     level, or; which wax and wane, resulting in periods of     incapacitation of at least six weeks total duration     per year..............................................    Which are nearly constant and restrict routine daily              40     activities to 50 to 75 percent of the pre-illness     level, or; which wax and wane, resulting in periods of     incapacitation of at least four but less than six     weeks total duration per year.........................    Which are nearly constant and restrict routine daily              20     activities by less than 25 percent of the pre-illness     level, or; which wax and wane, resulting in periods of     incapacitation of at least two but less than four     weeks total duration per year.........................    Which wax and wane but result in periods of                      10     incapacitation of at least one but less than two weeks     total duration per year, or; symptoms controlled by     continuous medication.................................    Note: For the purpose of evaluating this disability, the condition     will be considered incapacitating only while it requires bed rest     and treatment by a physician.------------------------------------------------------------------------

[61 FR 39875, July 31, 1996]

§ 4.88c Ratings for inactive nonpulmonary tuberculosis initially entitled after August 19, 1968.

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 ------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------For 1 year after date of inactivity, following active                100 tuberculosis...................................................Thereafter: Rate residuals under the specific body system or systems affected.Following the total rating for the 1 year period after date of inactivity, the schedular evaluation for residuals of nonpulmonary tuberculosis, i.e., ankylosis, surgical removal of a part, etc., will be assigned under the appropriate diagnostic code for the residual preceded by the diagnostic code for tuberculosis of the body part affected. For example, tuberculosis of the hip joint with residual ankylosis would be coded 5001-5250. Where there are existing residuals of pulmonary and nonpulmonary conditions, the evaluations for residual separate functional impairment may be combined.Where there are existing pulmonary and nonpulmonary conditions, the total rating for the 1 year, after attainment of inactivity, may not be applied to both conditions during the same period. However, the total rating during the 1-year period for the pulmonary or for the nonpulmonary condition will be utilized, combined with evaluation for residuals of the condition not covered by the 1-year total evaluation, so as to allow any additional benefit provided during such period.------------------------------------------------------------------------

[34 FR 5062, Mar. 11, 1969. Redesignated at 59 FR 60902, Nov. 29, 1994]

§ 4.89 Ratings for inactive nonpulmonary tuberculosis in effect on August 19, 1968.

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Public Law 90–493 repealed section 356 of title 38, United States Code which provided graduated ratings for inactive tuberculosis. The repealed section, however, still applies to the case of any veteran who on August 19, 1968, was receiving or entitled to receive compensation for tuberculosis. The use of the protective provisions of Pub. L. 90–493 should be mentioned in the discussion portion of all ratings in which these provisions are applied. For use in rating cases in which the protective provisions of Pub. L. 90–493 apply, the former evaluations are retained in this section.

 ------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------For 2 years after date of inactivity, following active               100 tuberculosis, which was clinically identified during service or subsequently...................................................Thereafter, for 4 years, or in any event, to 6 years after date       50 of inactivity..................................................Thereafter, for 5 years, or to 11 years after date of inactivity      30Thereafter, in the absence of a schedular compensable permanent        0 residual.......................................................Following the total rating for the 2-year period after date of inactivity, the schedular evaluation for residuals of nonpulmonary tuberculosis, i.e., ankylosis, surgical removal of a part, etc., if in excess of 50 percent or 30 percent will be assigned under the appropriate diagnostic code for the specific residual preceded by the diagnostic code for tuberculosis of the body part affected. For example, tuberculosis of the hipjoint with residual ankylosis would be coded 5001-5250.The graduated ratings for nonpulmonary tuberculosis will not be combined with residuals of nonpulmonary tuberculosis unless the graduated rating and the rating for residual disability cover separate functional losses, e.g., graduated ratings for tuberculosis of the kidney and residuals of tuberculosis of the spine. Where there are existing pulmonary and nonpulmonary conditions, the graduated evaluation for the pulmonary, or for the nonpulmonary, condition will be utilized, combined with evaluations for residuals of the condition not covered by the graduated evaluation utilized, so as to provide the higher evaluation over such period.The ending dates of all graduated ratings of nonpulmonary tuberculosis will be controlled by the date of attainment of inactivity.These ratings are applicable only to veterans with nonpulmonary tuberculosis active on or after October 10, 1949.------------------------------------------------------------------------

[29 FR 6718, May 22, 1964, as amended at 34 FR 5062, Mar. 11, 1969; 43 FR 45361, Oct. 2, 1978]

The Respiratory System

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§ 4.96 Special provisions regarding evaluation of respiratory conditions.

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(a) Rating coexisting respiratory conditions. Ratings under diagnostic codes 6600 through 6817 and 6822 through 6847 will not be combined with each other. Where there is lung or pleural involvement, ratings under diagnostic codes 6819 and 6820 will not be combined with each other or with diagnostic codes 6600 through 6817 or 6822 through 6847. A single rating will be assigned under the diagnostic code which reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. However, in cases protected by the provisions of Pub. L. 90–493, the graduated ratings of 50 and 30 percent for inactive tuberculosis will not be elevated.

(b) Rating “protected” tuberculosis cases. Public Law 90–493 repealed section 356 of title 38, United States Code which had provided graduated ratings for inactive tuberculosis. The repealed section, however, still applies to the case of any veteran who on August 19, 1968, was receiving or entitled to receive compensation for tuberculosis. The use of the protective provisions of Pub. L. 90–493 should be mentioned in the discussion portion of all ratings in which these provisions are applied. For application in rating cases in which the protective provisions of Pub. L. 90–493 apply the former evaluations pertaining to pulmonary tuberculosis are retained in §4.97.

(c) Special monthly compensation. When evaluating any claim involving complete organic aphonia, refer to §3.350 of this chapter to determine whether the veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.

(Authority: 38 U.S.C. 1155)

[34 FR 5062, Mar. 11, 1969, as amended at 61 FR 46727, Sept. 5, 1996]

§ 4.97 Schedule of ratings—respiratory system.

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 ------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------                     DISEASES OF THE NOSE AND THROAT------------------------------------------------------------------------6502 Septum, nasal, deviation of:    Traumatic only,        With 50-percent obstruction of the nasal passage on           10         both sides or complete obstruction on one side........6504 Nose, loss of part of, or scars:    Exposing both nasal passages...............................       30    Loss of part of one ala, or other obvious disfigurement....       10Note: Or evaluate as DC 7800, scars, disfiguring, head, face, or neck.6510 Sinusitis, pansinusitis, chronic.6511 Sinusitis, ethmoid, chronic.6512 Sinusitis, frontal, chronic.6513 Sinusitis, maxillary, chronic.6514 Sinusitis, sphenoid, chronic.    General Rating Formula for Sinusitis (DC's 6510 through     6514):        Following radical surgery with chronic osteomyelitis,         50         or; near constant sinusitis characterized by         headaches, pain and tenderness of affected sinus, and         purulent discharge or crusting after repeated         surgeries.............................................        Three or more incapacitating episodes per year of             30         sinusitis requiring prolonged (lasting four to six         weeks) antibiotic treatment, or; more than six non-         incapacitating episodes per year of sinusitis         characterized by headaches, pain, and purulent         discharge or crusting.................................        One or two incapacitating episodes per year of                10         sinusitis requiring prolonged (lasting four to six         weeks) antibiotic treatment, or; three to six non-         incapacitating episodes per year of sinusitis         characterized by headaches, pain, and purulent         discharge or crusting.................................        Detected by X-ray only.................................        0    Note: An incapacitating episode of sinusitis means one that     requires bed rest and treatment by a physician.6515 Laryngitis, tuberculous, active or inactive.    Rate under §§ 4.88c or 4.89, whichever is     appropriate.6516 Laryngitis, chronic:    Hoarseness, with thickening or nodules of cords, polyps,          30     submucous infiltration, or pre-malignant changes on biopsy    Hoarseness, with inflammation of cords or mucous membrane..       106518 Laryngectomy, total.......................................  \1\ 100    Rate the residuals of partial laryngectomy as laryngitis     (DC 6516), aphonia (DC 6519), or stenosis of larynx (DC     6520).6519 Aphonia, complete organic:    Constant inability to communicate by speech................  \1\ 100    Constant inability to speak above a whisper................       60    Note: Evaluate incomplete aphonia as laryngitis, chronic     (DC 6516).6520 Larynx, stenosis of, including residuals of laryngeal trauma (unilateral or bilateral):    Forced expiratory volume in one second (FEV-1) less than 40      100     percent of predicted value, with Flow-Volume Loop     compatible with upper airway obstruction, or; permanent     tracheostomy..............................................    FEV-1 of 40- to 55-percent predicted, with Flow-Volume Loop       60     compatible with upper airway obstruction..................    FEV-1 of 56- to 70-percent predicted, with Flow-Volume Loop       30     compatible with upper airway obstruction..................    FEV-1 of 71- to 80-percent predicted, with Flow-Volume Loop       10     compatible with upper airway obstruction..................    Note: Or evaluate as aphonia (DC 6519).6521 Pharynx, injuries to:    Stricture or obstruction of pharynx or nasopharynx, or;           50     absence of soft palate secondary to trauma, chemical burn,     or granulomatous disease, or; paralysis of soft palate     with swallowing difficulty (nasal regurgitation) and     speech impairment.........................................6522 Allergic or vasomotor rhinitis:    With polyps................................................       30    Without polyps, but with greater than 50-percent                  10     obstruction of nasal passage on both sides or complete     obstruction on one side...................................6523 Bacterial rhinitis:    Rhinoscleroma..............................................       50    With permanent hypertrophy of turbinates and with greater         10     than 50-percent obstruction of nasal passage on both sides     or complete obstruction on one side.......................6524 Granulomatous rhinitis:    Wegener's granulomatosis, lethal midline granuloma.........      100    Other types of granulomatous infection.....................       20------------------------------------------------------------------------                   DISEASES OF THE TRACHEA AND BRONCHI------------------------------------------------------------------------6600 Bronchitis, chronic:    FEV-1 less than 40 percent of predicted value, or; the           100     ratio of Forced Expiratory Volume in one second to Forced     Vital Capacity (FEV-1/FVC) less than 40 percent, or;     Diffusion Capacity of the Lung for Carbon Monoxide by the     Single Breath Method (DLCO (SB)) less than 40-percent     predicted, or; maximum exercise capacity less than 15 ml/     kg/min oxygen consumption (with cardiac or respiratory     limitation), or; cor pulmonale (right heart failure), or;     right ventricular hypertrophy, or; pulmonary hypertension     (shown by Echo or cardiac catheterization), or; episode(s)     of acute respiratory failure, or; requires outpatient     oxygen therapy............................................    FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40         60     to 55 percent, or; DLCO (SB) of 40- to 55-percent     predicted, or; maximum oxygen consumption of 15 to 20 ml/     kg/min (with cardiorespiratory limit).....................    FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56         30     to 70 percent, or; DLCO (SB) 56- to 65-percent predicted..    FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71         10     to 80 percent, or; DLCO (SB) 66- to 80-percent predicted..6601 Bronchiectasis:    With incapacitating episodes of infection of at least six        100     weeks total duration per year.............................    With incapacitating episodes of infection of four to six          60     weeks total duration per year, or; near constant findings     of cough with purulent sputum associated with anorexia,     weight loss, and frank hemoptysis and requiring antibiotic     usage almost continuously.................................    With incapacitating episodes of infection of two to four          30     weeks total duration per year, or; daily productive cough     with sputum that is at times purulent or blood-tinged and     that requires prolonged (lasting four to six weeks)     antibiotic usage more than twice a year...................    Intermittent productive cough with acute infection                10     requiring a course of antibiotics at least twice a year...    Or rate according to pulmonary impairment as for chronic     bronchitis (DC 6600).    Note: An incapacitating episode is one that requires     bedrest and treatment by a physician.6602 Asthma, bronchial:    FEV-1 less than 40-percent predicted, or; FEV-1/FVC less         100     than 40 percent, or; more than one attack per week with     episodes of respiratory failure, or; requires daily use of     systemic (oral or parenteral) high dose corticosteroids or     immuno-suppressive medications............................    FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40         60     to 55 percent, or; at least monthly visits to a physician     for required care of exacerbations, or; intermittent (at     least three per year) courses of systemic (oral or     parenteral) corticosteroids...............................    FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56         30     to 70 percent, or; daily inhalational or oral     bronchodilator therapy, or; inhalational anti-inflammatory     medication................................................    FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71         10     to 80 percent, or; intermittent inhalational or oral     bronchodilator therapy....................................    Note: In the absence of clinical findings of asthma at time     of examination, a verified history of asthmatic attacks     must be of record.6603 Emphysema, pulmonary:    FEV-1 less than 40 percent of predicted value, or; the           100     ratio of Forced Expiratory Volume in one second to Forced     Vital Capacity (FEV-1/FVC) less than 40 percent, or;     Diffusion Capacity of the Lung for Carbon Monoxide by the     Single Breath Method (DLCO (SB)) less than 40-percent     predicted, or; maximum exercise capacity less than 15 ml/     kg/min oxygen consumption (with cardiac or respiratory     limitation), or; cor pulmonale (right heart failure), or;     right ventricular hypertrophy, or; pulmonary hypertension     (shown by Echo or cardiac catheterization), or; episode(s)     of acute respiratory failure, or; requires outpatient     oxygen therapy............................................    FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40         60     to 55 percent, or; DLCO (SB) of 40- to 55-percent     predicted, or; maximum oxygen consumption of 15 to 20 ml/     kg/min (with cardiorespiratory limit).....................    FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56         30     to 70 percent, or; DLCO (SB) 56- to 65-percent predicted..    FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71         10     to 80 percent, or; DLCO (SB) 66- to 80-percent predicted..6604 Chronic obstructive pulmonary disease:    FEV-1 less than 40 percent of predicted value, or; the           100     ratio of Forced Expiratory Volume in one second to Forced     Vital Capacity (FEV-1/FVC) less than 40 percent, or;     Diffusion Capacity of the Lung for Carbon Monoxide by the     Single Breath Method (DLCO (SB)) less than 40-percent     predicted, or; maximum exercise capacity less than 15 ml/     kg/min oxygen consumption (with cardiac or respiratory     limitation), or; cor pulmonale (right heart failure), or;     right ventricular hypertrophy, or; pulmonary hypertension     (shown by Echo or cardiac catheterization), or; episode(s)     of acute respiratory failure, or; requires outpatient     oxygen therapy............................................    FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40         60     to 55 percent, or; DLCO (SB) of 40- to 55-percent     predicted, or; maximum oxygen consumption of 15 to 20 ml/     kg/min (with cardiorespiratory limit).....................    FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56         30     to 70 percent, or; DLCO (SB) 56- to 65-percent predicted..    FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71         10     to 80 percent, or; DLCO (SB) 66- to 80-percent predicted..------------------------------------------------------------------------             DISEASES OF THE LUNGS AND PLEURA_TUBERCULOSIS     Ratings for Pulmonary Tuberculosis Entitled on August 19, 1968------------------------------------------------------------------------6701 Tuberculosis, pulmonary, chronic, far advanced, active....      1006702 Tuberculosis, pulmonary, chronic, moderately advanced,          100 active........................................................6703 Tuberculosis, pulmonary, chronic, minimal, active.........      1006704 Tuberculosis, pulmonary, chronic, active, advancement           100 unspecified...................................................6721 Tuberculosis, pulmonary, chronic, far advanced, inactive..6722 Tuberculosis, pulmonary, chronic, moderately advanced, inactive......................................................6723 Tuberculosis, pulmonary, chronic, minimal, inactive.......6724 Tuberculosis, pulmonary, chronic, inactive, advancement unspecified...................................................    General Rating Formula for Inactive Pulmonary Tuberculosis:      100     For two years after date of inactivity, following active     tuberculosis, which was clinically identified during     service or subsequently...................................    Thereafter for four years, or in any event, to six years          50     after date of inactivity..................................    Thereafter, for five years, or to eleven years after date         30     of inactivity.............................................    Following far advanced lesions diagnosed at any time while        30     the disease process was active, minimum...................    Following moderately advanced lesions, provided there is          20     continued disability, emphysema, dyspnea on exertion,     impairment of health, etc.................................    Otherwise..................................................        0Note (1): The 100-percent rating under codes 6701 through 6724 is not subject to a requirement of precedent hospital treatment. It will be reduced to 50 percent for failure to submit to examination or to follow prescribed treatment upon report to that effect from the medical authorities. When a veteran is placed on the 100-percent rating for inactive tuberculosis, the medical authorities will be appropriately notified of the fact, and of the necessity, as given in footnote 1 to 38 U.S.C. 1156 (and formerly in 38 U.S.C. 356, which has been repealed by Public Law 90-493), to notify the Veterans Service Center in the event of failure to submit to examination or to follow treatment.Note (2): The graduated 50-percent and 30-percent ratings and the permanent 30 percent and 20 percent ratings for inactive pulmonary tuberculosis are not to be combined with ratings for other respiratory disabilities. Following thoracoplasty the rating will be for removal of ribs combined with the rating for collapsed lung. Resection of the ribs incident to thoracoplasty will be rated as removal.------------------------------------------------------------------------ Ratings for Pulmonary Tuberculosis Initially Evaluated After August 19,                                  1968------------------------------------------------------------------------6730 Tuberculosis, pulmonary, chronic, active..................      100    Note: Active pulmonary tuberculosis will be considered     permanently and totally disabling for non-service-     connected pension purposes in the following circumstances:        (a) Associated with active tuberculosis involving other         than the respiratory system.        (b) With severe associated symptoms or with extensive         cavity formation.        (c) Reactivated cases, generally.        (d) With advancement of lesions on successive         examinations or while under treatment.        (e) Without retrogression of lesions or other evidence         of material improvement at the end of six months         hospitalization or without change of diagnosis from         ``active'' at the end of 12 months hospitalization.         Material improvement means lessening or absence of         clinical symptoms, and X-ray findings of a stationary         or retrogressive lesion.6731 Tuberculosis, pulmonary, chronic, inactive:    Depending on the specific findings, rate residuals as     interstitial lung disease, restrictive lung disease, or,     when obstructive lung disease is the major residual, as     chronic bronchitis (DC 6600). Rate thoracoplasty as     removal of ribs under DC 5297.    Note: A mandatory examination will be requested immediately     following notification that active tuberculosis evaluated     under DC 6730 has become inactive. Any change in     evaluation will be carried out under the provisions of     § 3.105(e).6732 Pleurisy, tuberculous, active or inactive:    Rate under §§ 4.88c or 4.89, whichever is     appropriate.------------------------------------------------------------------------                         NONTUBERCULOUS DISEASES------------------------------------------------------------------------6817 Pulmonary Vascular Disease:    Primary pulmonary hypertension, or; chronic pulmonary            100     thromboembolism with evidence of pulmonary hypertension,     right ventricular hypertrophy, or cor pulmonale, or;     pulmonary hypertension secondary to other obstructive     disease of pulmonary arteries or veins with evidence of     right ventricular hypertrophy or cor pulmonale............    Chronic pulmonary thromboembolism requiring anticoagulant         60     therapy, or; following inferior vena cava surgery without     evidence of pulmonary hypertension or right ventricular     dysfunction...............................................    Symptomatic, following resolution of acute pulmonary              30     embolism..................................................    Asymptomatic, following resolution of pulmonary                    0     thromboembolism...........................................    Note: Evaluate other residuals following pulmonary embolism     under the most appropriate diagnostic code, such as     chronic bronchitis (DC 6600) or chronic pleural effusion     or fibrosis (DC 6844), but do not combine that evaluation     with any of the above evaluations.    6819 Neoplasms, malignant, any specified part of                 100     respiratory system exclusive of skin growths..............    Note: A rating of 100 percent shall continue beyond the     cessation of any surgical, X-ray, antineoplastic     chemotherapy or other therapeutic procedure. Six months     after discontinuance of such treatment, the appropriate     disability rating shall be determined by mandatory VA     examination. Any change in evaluation based upon that or     any subsequent examination shall be subject to the     provisions of § 3.105(e) of this chapter. If there     has been no local recurrence or metastasis, rate on     residuals.6820 Neoplasms, benign, any specified part of respiratory system. Evaluate using an appropriate respiratory analogy.------------------------------------------------------------------------                    Bacterial Infections of the Lung------------------------------------------------------------------------6822 Actinomycosis.6823 Nocardiosis.6824 Chronic lung abscess.    General Rating Formula for Bacterial Infections of the Lung     (diagnostic codes 6822 through 6824):        Active infection with systemic symptoms such as fever,       100         night sweats, weight loss, or hemoptysis..............    Depending on the specific findings, rate residuals as     interstitial lung disease, restrictive lung disease, or,     when obstructive lung disease is the major residual, as     chronic bronchitis (DC 6600).------------------------------------------------------------------------                        Interstitial Lung Disease------------------------------------------------------------------------6825 Diffuse interstitial fibrosis (interstitial pneumonitis, fibrosing alveolitis).6826 Desquamative interstitial pneumonitis.6827 Pulmonary alveolar proteinosis.6828 Eosinophilic granuloma of lung.6829 Drug-induced pulmonary pneumonitis and fibrosis.6830 Radiation-induced pulmonary pneumonitis and fibrosis.6831 Hypersensitivity pneumonitis (extrinsic allergic alveolitis).6832 Pneumoconiosis (silicosis, anthracosis, etc.).6833 Asbestosis.    General Rating Formula for Interstitial Lung Disease     (diagnostic codes 6825 through 6833):        Forced Vital Capacity (FVC) less than 50-percent             100         predicted, or; Diffusion Capacity of the Lung for         Carbon Monoxide by the Single Breath Method (DLCO         (SB)) less than 40-percent predicted, or; maximum         exercise capacity less than 15 ml/kg/min oxygen         consumption with cardiorespiratory limitation, or; cor         pulmonale or pulmonary hypertension, or; requires         outpatient oxygen therapy.............................        FVC of 50- to 64-percent predicted, or; DLCO (SB) of 40-      60          to 55-percent predicted, or; maximum exercise         capacity of 15 to 20 ml/kg/min oxygen consumption with         cardiorespiratory limitation..........................        FVC of 65- to 74-percent predicted, or; DLCO (SB) of 56-      30          to 65-percent predicted..............................        FVC of 75- to 80-percent predicted, or; DLCO (SB) of 66-      10          to 80-percent predicted..............................------------------------------------------------------------------------                          Mycotic Lung Disease------------------------------------------------------------------------6834 Histoplasmosis of lung.6835 Coccidioidomycosis.6836 Blastomycosis.6837 Cryptococcosis.6838 Aspergillosis.6839 Mucormycosis.    General Rating Formula for Mycotic Lung Disease (diagnostic     codes 6834 through 6839):        Chronic pulmonary mycosis with persistent fever, weight      100         loss, night sweats, or massive hemoptysis.............        Chronic pulmonary mycosis requiring suppressive therapy       50         with no more than minimal symptoms such as occasional         minor hemoptysis or productive cough..................        Chronic pulmonary mycosis with minimal symptoms such as       30         occasional minor hemoptysis or productive cough.......        Healed and inactive mycotic lesions, asymptomatic......        0    Note: Coccidioidomycosis has an incubation period up to 21     days, and the disseminated phase is ordinarily manifest     within six months of the primary phase. However, there are     instances of dissemination delayed up to many years after     the initial infection which may have been unrecognized.     Accordingly, when service connection is under     consideration in the absence of record or other evidence     of the disease in service, service in southwestern United     States where the disease is endemic and absence of     prolonged residence in this locality before or after     service will be the deciding factor.------------------------------------------------------------------------                        Restrictive Lung Disease------------------------------------------------------------------------6840 Diaphragm paralysis or paresis.6841 Spinal cord injury with respiratory insufficiency.6842 Kyphoscoliosis, pectus excavatum, pectus carinatum.6843 Traumatic chest wall defect, pneumothorax, hernia, etc.6844 Post-surgical residual (lobectomy, pneumonectomy, etc.).6845 Chronic pleural effusion or fibrosis.    General Rating Formula for Restrictive Lung Disease     (diagnostic codes 6840 through 6845):        FEV-1 less than 40 percent of predicted value, or; the       100         ratio of Forced Expiratory Volume in one second to         Forced Vital Capacity (FEV-1/FVC) less than 40         percent, or; Diffusion Capacity of the Lung for Carbon         Monoxide by the Single Breath Method (DLCO (SB)) less         than 40-percent predicted, or; maximum exercise         capacity less than 15 ml/kg/min oxygen consumption         (with cardiac or respiratory limitation), or; cor         pulmonale (right heart failure), or; right ventricular         hypertrophy, or; pulmonary hypertension (shown by Echo         or cardiac catheterization), or; episode(s) of acute         respiratory failure, or; requires outpatient oxygen         therapy...............................................        FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of        60         40 to 55 percent, or; DLCO (SB) of 40- to 55-percent         predicted, or; maximum oxygen consumption of 15 to 20         ml/kg/min (with cardiorespiratory limit)..............        FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of        30         56 to 70 percent, or; DLCO (SB) 56- to 65-percent         predicted.............................................        FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of        10         71 to 80 percent, or; DLCO (SB) 66- to 80-percent         predicted.............................................    Or rate primary disorder.    Note (1): A 100-percent rating shall be assigned for     pleurisy with empyema, with or without pleurocutaneous     fistula, until resolved.    Note (2): Following episodes of total spontaneous     pneumothorax, a rating of 100 percent shall be assigned as     of the date of hospital admission and shall continue for     three months from the first day of the month after     hospital discharge.    Note (3): Gunshot wounds of the pleural cavity with bullet     or missile retained in lung, pain or discomfort on     exertion, or with scattered rales or some limitation of     excursion of diaphragm or of lower chest expansion shall     be rated at least 20-percent disabling. Disabling injuries     of shoulder girdle muscles (Groups I to IV) shall be     separately rated and combined with ratings for respiratory     involvement. Involvement of Muscle Group XXI (DC 5321),     however, will not be separately rated.6846 Sarcoidosis:    Cor pulmonale, or; cardiac involvement with congestive           100     heart failure, or; progressive pulmonary disease with     fever, night sweats, and weight loss despite treatment....    Pulmonary involvement requiring systemic high dose                60     (therapeutic) corticosteroids for control.................    Pulmonary involvement with persistent symptoms requiring          30     chronic low dose (maintenance) or intermittent     corticosteroids...........................................    Chronic hilar adenopathy or stable lung infiltrates without        0     symptoms or physiologic impairment........................    Or rate active disease or residuals as chronic bronchitis     (DC 6600) and extra-pulmonary involvement under specific     body system involved......................................6847 Sleep Apnea Syndromes (Obstructive, Central, Mixed):    Chronic respiratory failure with carbon dioxide retention        100     or cor pulmonale, or; requires tracheostomy...............    Requires use of breathing assistance device such as               50     continuous airway pressure (CPAP) machine.................    Persistent day-time hypersomnolence........................       30    Asymptomatic but with documented sleep disorder breathing..       0------------------------------------------------------------------------\1\ Review for entitlement to special monthly compensation under §  3.350 of this chapter.

[61 FR 46728, Sept. 5, 1996, as amended at 71 FR 28586, May 17, 2006]

The Cardiovascular System

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§§ 4.100-4.103 [Reserved]

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§ 4.104 Schedule of ratings—cardiovascular system.

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                          Diseases of the Heart------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------Note (1): Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it.Note (2): One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used.7000 Valvular heart disease (including rheumatic heart disease):    During active infection with valvular heart damage and for       100     three months following cessation of therapy for the active     infection..................................................    Thereafter, with valvular heart disease (documented by     findings on physical examination and either echocardiogram,     Doppler echocardiogram, or cardiac catheterization)     resulting in:    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............    Workload of greater than 5 METs but not greater than 7 METs       30     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; evidence of cardiac hypertrophy or dilatation on     electro-cardiogram, echocardiogram, or X-ray...............    Workload of greater than 7 METs but not greater than 10 METs      10     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; continuous medication required.........................7001 Endocarditis:    For three months following cessation of therapy for active       100     infection with cardiac involvement.........................    Thereafter, with endocarditis (documented by findings on     physical examination and either echocardiogram, Doppler     echocardiogram, or cardiac catheterization) resulting in:    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............    Workload of greater than 5 METs but not greater than 7 METs       30     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; evidence of cardiac hypertrophy or dilatation on     electrocardiogram, echocardiogram, or X-ray................    Workload of greater than 7 METs but not greater than 10 METs      10     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; continuous medication required.........................7002 Pericarditis:    For three months following cessation of therapy for active       100     infection with cardiac involvement.........................    Thereafter, with documented pericarditis resulting in:    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............    Workload of greater than 5 METs but not greater than 7 METs       30     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; evidence of cardiac hypertrophy or dilatation on     electro-cardiogram, echocardiogram, or X-ray...............    Workload of greater than 7 METs but not greater than 10 METs      10     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; continuous medication required.........................7003 Pericardial adhesions:    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............    Workload of greater than 5 METs but not greater than 7 METs       30     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; evidence of cardiac hypertrophy or dilatation on     electro-cardiogram, echocardiogram, or X-ray...............    Workload of greater than 7 METs but not greater than 10 METs      10     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; continuous medication required.........................7004 Syphilitic heart disease:    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............    Workload of greater than 5 METs but not greater than 7 METs       30     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; evidence of cardiac hypertrophy or dilatation on     electrocardiogram, echocardiogram, or X-ray................    Workload of greater than 7 METs but not greater than 10 METs      10     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; continuous medication required.........................Note: Evaluate syphilitic aortic aneurysms under DC 7110 (aortic aneurysm).7005 Arteriosclerotic heart disease (Coronary artery disease):    With documented coronary artery disease resulting in:    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............    Workload of greater than 5 METs but not greater than 7 METs       30     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; evidence of cardiac hypertrophy or dilatation on     electrocardiogram, echocardiogram, or X-ray................    Workload of greater than 7 METs but not greater than 10 METs      10     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; continuous medication required.........................Note: If nonservice-connected arteriosclerotic heart disease is superimposed on service-connected valvular or other non- arteriosclerotic heart disease, request a medical opinion as to which condition is causing the current signs and symptoms.7006 Myocardial infarction:    During and for three months following myocardial infarction,     100     documented by laboratory tests.............................    Thereafter:    With history of documented myocardial infarction, resulting     in:    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............    Workload of greater than 5 METs but not greater than 7 METs       30     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; evidence of cardiac hypertrophy or dilatation on     electrocardiogram, echocardiogram, or X-ray................    Workload of greater than 7 METs but not greater than 10 METs      10     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; continuous medication required.........................7007 Hypertensive heart disease:    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............    Workload of greater than 5 METs but not greater than 7 METs       30     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; evidence of cardiac hypertrophy or dilatation on     electrocardiogram, echocardiogram, or X-ray................    Workload of greater than 7 METs but not greater than 10 METs      10     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; continuous medication required.........................7008 Hyperthyroid heart disease:    Include as part of the overall evaluation for     hyperthyroidism under DC 7900. However, when atrial     fibrillation is present, hyperthyroidism may be evaluated     either under DC 7900 or under DC 7010 (supraventricular     arrhythmia), whichever results in a higher evaluation.7010 Supraventricular arrhythmias:    Paroxysmal atrial fibrillation or other supraventricular          30     tachycardia, with more than four episodes per year     documented by ECG or Holter monitor........................    Permanent atrial fibrillation (lone atrial fibrillation),         10     or; one to four episodes per year of paroxysmal atrial     fibrillation or other supraventricular tachycardia     documented by ECG or Holter monitor........................7011 Ventricular arrhythmias (sustained):    For indefinite period from date of hospital admission for        100     initial evaluation and medical therapy for a sustained     ventricular arrhythmia, or; for indefinite period from date     of hospital admission for ventricular aneurysmectomy, or;     with an automatic implantable Cardioverter-Defibrillator     (AICD) in place............................................    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............    Workload of greater than 5 METs but not greater than 7 METs       30     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; evidence of cardiac hypertrophy or dilatation on     electrocardiogram, echocardiogram, or X-ray................    Workload of greater than 7 METs but not greater than 10 METs      10     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; continuous medication required.........................Note: A rating of 100 percent shall be assigned from the date of  hospital admission for initial evaluation and medical therapy    for a sustained ventricular arrhythmia or for ventricular aneurysmectomy. Six months following discharge, the appropriate      disability rating shall be determined by mandatory VA  examination. Any change in evaluation based upon that or any  subsequent examination shall be subject to the provisions of                § 3.105(e) of this chapter.7015 Atrioventricular block:    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............    Workload of greater than 5 METs but not greater than 7 METs       30     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; evidence of cardiac hypertrophy or dilatation on     electrocardiogram, echocardiogram, or X-ray................    Workload of greater than 7 METs but not greater than 10 METs      10     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; continuous medication or a pacemaker required..........Note: Unusual cases of arrhythmia such as atrioventricular block associated with a supraventricular arrhythmia or pathological bradycardia should be submitted to the Director, Compensation and Pension Service. Simple delayed P-R conduction time, in the absence of other evidence of cardiac disease, is not a disability.7016 Heart valve replacement (prosthesis):    For indefinite period following date of hospital admission       100     for valve replacement......................................    Thereafter:    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............    Workload of greater than 5 METs but not greater than 7 METs       30     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; evidence of cardiac hypertrophy or dilatation on     electrocardiogram, echocardiogram, or X-ray................    Workload of greater than 7 METs but not greater than 10 METs      10     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; continuous medication required.........................Note: A rating of 100 percent shall be assigned as of the date of hospital admission for valve replacement. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter.7017 Coronary bypass surgery:    For three months following hospital admission for surgery...     100    Thereafter:    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............    Workload of greater than 5 METs but not greater than 7 METs       30     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; evidence of cardiac hypertrophy or dilatation on     electrocardiogram, echocardiogram, or X-ray................    Workload greater than 7 METs but not greater than 10 METs         10     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; continuous medication required.........................7018 Implantable cardiac pacemakers:    For two months following hospital admission for implantation     100     or reimplantation..........................................    Thereafter:    Evaluate as supraventricular arrhythmias (DC 7010),               10     ventricular arrhythmias (DC 7011), or atrioventricular     block (DC 7015). Minimum...................................Note: Evaluate implantable Cardioverter-Defibrillators (AICD's) under DC 7011.7019 Cardiac transplantation:    For an indefinite period from date of hospital admission for     100     cardiac transplantation....................................    Thereafter:    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............        Minimum.................................................      30Note: A rating of 100 percent shall be assigned as of the date of hospital admission for cardiac transplantation. One year following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter.7020 Cardiomyopathy:    Chronic congestive heart failure, or; workload of 3 METs or      100     less results in dyspnea, fatigue, angina, dizziness, or     syncope, or; left ventricular dysfunction with an ejection     fraction of less than 30 percent...........................    More than one episode of acute congestive heart failure in        60     the past year, or; workload of greater than 3 METs but not     greater than 5 METs results in dyspnea, fatigue, angina,     dizziness, or syncope, or; left ventricular dysfunction     with an ejection fraction of 30 to 50 percent..............    Workload of greater than 5 METs but not greater than 7 METs       30     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; evidence of cardiac hypertrophy or dilatation on     electrocardiogram, echocardiogram, or X-ray................    Workload of greater than 7 METs but not greater than 10 METs      10     results in dyspnea, fatigue, angina, dizziness, or syncope,     or; continuous medication required.........................Diseases of the Arteries and Veins7101 Hypertensive vascular disease (hypertension and isolated systolic hypertension):    Diastolic pressure predominantly 130 or more................      60    Diastolic pressure predominantly 120 or more................      40    Diastolic pressure predominantly 110 or more, or; systolic        20     pressure predominantly 200 or more.........................    Diastolic pressure predominantly 100 or more, or; systolic        10     pressure predominantly 160 or more, or; minimum evaluation     for an individual with a history of diastolic pressure     predominantly 100 or more who requires continuous     medication for control.....................................Note (1): Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm.Note (2): Evaluate hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, as part of the condition causing it rather than by a separate evaluation.7110 Aortic aneurysm:    If five centimeters or larger in diameter, or; if                100     symptomatic, or; for indefinite period from date of     hospital admission for surgical correction (including any     type of graft insertion)...................................    Precluding exertion.........................................      60    Evaluate residuals of surgical correction according to organ     systems affected.Note: A rating of 100 percent shall be assigned as of the date of admission for surgical correction. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter.7111 Aneurysm, any large artery:    If symptomatic, or; for indefinite period from date of           100     hospital admission for surgical correction.................    Following surgery:    Ischemic limb pain at rest, and; either deep ischemic ulcers     100     or ankle/brachial index of 0.4 or less.....................    Claudication on walking less than 25 yards on a level grade       60     at 2 miles per hour, and; persistent coldness of the     extremity, one or more deep ischemic ulcers, or ankle/     brachial index of 0.5 or less..............................    Claudication on walking between 25 and 100 yards on a level       40     grade at 2 miles per hour, and; trophic changes (thin skin,     absence of hair, dystrophic nails) or ankle/brachial index     of 0.7 or less.............................................    Claudication on walking more than 100 yards, and; diminished      20     peripheral pulses or ankle/brachial index of 0.9 or less...Note (1): The ankle/brachial index is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater.Note (2): These evaluations are for involvement of a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine (under § 4.25), using the bilateral factor, if applicable.Note (3): A rating of 100 percent shall be assigned as of the date of hospital admission for surgical correction. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter.7112 Aneurysm, any small artery:    Asymptomatic................................................       0Note: If symptomatic, evaluate according to body system affected. Following surgery, evaluate residuals under the body system affected.7113 Arteriovenous fistula, traumatic:    With high output heart failure..............................     100    Without heart failure but with enlarged heart, wide pulse         60     pressure, and tachycardia..................................    Without cardiac involvement but with edema, stasis     dermatitis, and either ulceration or cellulitis:        Lower extremity.........................................      50        Upper extremity.........................................      40    With edema or stasis dermatitis:        Lower extremity.........................................      30        Upper extremity.........................................      207114 Arteriosclerosis obliterans:    Ischemic limb pain at rest, and; either deep ischemic ulcers     100     or ankle/brachial index of 0.4 or less.....................    Claudication on walking less than 25 yards on a level grade       60     at 2 miles per hour, and; either persistent coldness of the     extremity or ankle/brachial index of 0.5 or less...........    Claudication on walking between 25 and 100 yards on a level       40     grade at 2 miles per hour, and; trophic changes (thin skin,     absence of hair, dystrophic nails) or ankle/brachial index     of 0.7 or less.............................................    Claudication on walking more than 100 yards, and; diminished      20     peripheral pulses or ankle/brachial index of 0.9 or less...Note (1): The ankle/brachial index is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater.Note (2): Evaluate residuals of aortic and large arterial bypass surgery or arterial graft as arteriosclerosis obliterans.Note (3): These evaluations are for involvement of a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine (under § 4.25), using the bilateral factor (§ 4.26), if applicable.7115 Thrombo-angiitis obliterans (Buerger's Disease):    Ischemic limb pain at rest, and; either deep ischemic ulcers     100     or ankle/brachial index of 0.4 or less.....................    Claudication on walking less than 25 yards on a level grade       60     at 2 miles per hour, and; either persistent coldness of the     extremity or ankle/brachial index of 0.5 or less...........    Claudication on walking between 25 and 100 yards on a level       40     grade at 2 miles per hour, and; trophic changes (thin skin,     absence of hair, dystrophic nails) or ankle/brachial index     of 0.7 or less.............................................    Claudication on walking more than 100 yards, and; diminished      20     peripheral pulses or ankle/brachial index of 0.9 or less...Note (1): The ankle/brachial index is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater.Note (2): These evaluations are for involvement of a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine (under § 4.25), using the bilateral factor (§ 4.26), if applicable.7117 Raynaud's syndrome:    With two or more digital ulcers plus autoamputation of one       100     or more digits and history of characteristic attacks.......    With two or more digital ulcers and history of                    60     characteristic attacks.....................................    Characteristic attacks occurring at least daily.............      40    Characteristic attacks occurring four to six times a week...      20    Characteristic attacks occurring one to three times a week..      10Note: For purposes of this section, characteristic attacks consist of sequential color changes of the digits of one or more extremities lasting minutes to hours, sometimes with pain and paresthesias, and precipitated by exposure to cold or by emotional upsets. These evaluations are for the disease as a whole, regardless of the number of extremities involved or whether the nose and ears are involved.7118 Angioneurotic edema:    Attacks without laryngeal involvement lasting one to seven        40     days or longer and occurring more than eight times a year,     or; attacks with laryngeal involvement of any duration     occurring more than twice a year...........................    Attacks without laryngeal involvement lasting one to seven        20     days and occurring five to eight times a year, or; attacks     with laryngeal involvement of any duration occurring once     or twice a year............................................    Attacks without laryngeal involvement lasting one to seven        10     days and occurring two to four times a year................7119 Erythromelalgia:    Characteristic attacks that occur more than once a day, last     100     an average of more than two hours each, respond poorly to     treatment, and that restrict most routine daily activities.    Characteristic attacks that occur more than once a day, last      60     an average of more than two hours each, and respond poorly     to treatment, but that do not restrict most routine daily     activities.................................................    Characteristic attacks that occur daily or more often but         30     that respond to treatment..................................    Characteristic attacks that occur less than daily but at          10     least three times a week and that respond to treatment.....Note: For purposes of this section, a characteristic attack of erythromelalgia consists of burning pain in the hands, feet, or both, usually bilateral and symmetrical, with increased skin temperature and redness, occurring at warm ambient temperatures. These evaluations are for the disease as a whole, regardless of the number of extremities involved.7120 Varicose veins:    With the following findings attributed to the effects of         100     varicose veins: Massive board-like edema with constant pain     at rest....................................................    Persistent edema or subcutaneous induration, stasis               60     pigmentation or eczema, and persistent ulceration..........    Persistent edema and stasis pigmentation or eczema, with or       40     without intermittent ulceration............................    Persistent edema, incompletely relieved by elevation of           20     extremity, with or without beginning stasis pigmentation or     eczema.....................................................    Intermittent edema of extremity or aching and fatigue in leg      10     after prolonged standing or walking, with symptoms relieved     by elevation of extremity or compression hosiery...........    Asymptomatic palpable or visible varicose veins.............       0Note: These evaluations are for involvement of a single extremity. If more than one extremity is involved, evaluate each extremity separately and combine (under § 4.25), using the bilateral factor (§ 4.26), if applicable.7121 Post-phlebitic syndrome of any etiology:    With the following findings attributed to venous disease:        Massive board-like edema with constant pain at rest.....     100        Persistent edema or subcutaneous induration, stasis           60         pigmentation or eczema, and persistent ulceration......        Persistent edema and stasis pigmentation or eczema, with      40         or without intermittent ulceration.....................        Persistent edema, incompletely relieved by elevation of       20         extremity, with or without beginning stasis         pigmentation or eczema.................................        Intermittent edema of extremity or aching and fatigue in      10         leg after prolonged standing or walking, with symptoms         relieved by elevation of extremity or compression         hosiery................................................        Asymptomatic palpable or visible varicose veins.........       0Note: These evaluations are for involvement of a single extremity. If more than one extremity is involved, evaluate each extremity separately and combine (under § 4.25), using the bilateral factor (§ 4.26), if applicable.7122 Cold injury residuals:    With the following in affected parts:        Arthralgia or other pain, numbness, or cold sensitivity       30         plus two or more of the following: tissue loss, nail         abnormalities, color changes, locally impaired         sensation, hyperhidrosis, X-ray abnormalities         (osteoporosis, subarticular punched out lesions, or         osteoarthritis)........................................        Arthralgia or other pain, numbness, or cold sensitivity       20         plus tissue loss, nail abnormalities, color changes,         locally impaired sensation, hyperhidrosis, or X-ray         abnormalities (osteoporosis, subarticular punched out         lesions, or osteoarthritis)............................        Arthralgia or other pain, numbness, or cold sensitivity.      10Note (1): Separately evaluate amputations of fingers or toes, and complications such as squamous cell carcinoma at the site of a cold injury scar or peripheral neuropathy, under other diagnostic codes. Separately evaluate other disabilities that have been diagnosed as the residual effects of cold injury, such as Raynaud's phenomenon, muscle atrophy, etc., unless they are used to support an evaluation under diagnostic code 7122.Note (2): Evaluate each affected part (e.g., hand, foot, ear, nose) separately and combine the ratings in accordance with §§ 4.25 and 4.26.7123 Soft tissue sarcoma (of vascular origin)...................     100Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.------------------------------------------------------------------------

(Authority: 38 U.S.C. 1155)

[62 FR 65219, Dec. 11, 1997, as amended at 63 FR 37779, July 14, 1998]

The Digestive System

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§ 4.110 Ulcers.

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Experience has shown that the term “peptic ulcer” is not sufficiently specific for rating purposes. Manifest differences in ulcers of the stomach or duodenum in comparison with those at an anastomotic stoma are sufficiently recognized as to warrant two separate graduated descriptions. In evaluating the ulcer, care should be taken that the findings adequately identify the particular location.

§ 4.111 Postgastrectomy syndromes.

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There are various postgastrectomy symptoms which may occur following anastomotic operations of the stomach. When present, those occurring during or immediately after eating and known as the “dumping syndrome” are characterized by gastrointestinal complaints and generalized symptoms simulating hypoglycemia; those occurring from 1 to 3 hours after eating usually present definite manifestations of hypoglycemia.

§ 4.112 Weight loss.

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For purposes of evaluating conditions in §4.114, the term “substantial weight loss” means a loss of greater than 20 percent of the individual's baseline weight, sustained for three months or longer; and the term “minor weight loss” means a weight loss of 10 to 20 percent of the individual's baseline weight, sustained for three months or longer. The term “inability to gain weight” means that there has been substantial weight loss with inability to regain it despite appropriate therapy. “Baseline weight” means the average weight for the two-year-period preceding onset of the disease.

(Authority: 38 U.S.C. 1155)

[66 FR 29488, May 31, 2001]

§ 4.113 Coexisting abdominal conditions.

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There are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title “Diseases of the Digestive System,” do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in §4.14.

§ 4.114 Schedule of ratings—digestive system.

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Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.

------------------------------------------------------------------------ Rating------------------------------------------------------------------------7200 Mouth, injuries of. Rate as for disfigurement and impairment of function of mastication.7201 Lips, injuries of. Rate as for disfigurement of face.7202 Tongue, loss of whole or part: With inability to communicate by speech....................... 100 One-half or more.............................................. 60 With marked speech impairment................................. 307203 Esophagus, stricture of: Permitting passage of liquids only, with marked impairment of 80 general health............................................... Severe, permitting liquids only............................... 50 Moderate...................................................... 307204 Esophagus, spasm of (cardiospasm). If not amenable to dilation, rate as for the degree of obstruction (stricture).7205 Esophagus, diverticulum of, acquired. Rate as for obstruction (stricture).7301 Peritoneum, adhesions of: Severe; definite partial obstruction shown by X-ray, with 50 frequent and prolonged episodes of severe colic distension, nausea or vomiting, following severe peritonitis, ruptured appendix, perforated ulcer, or operation with drainage....... Moderately severe; partial obstruction manifested by delayed 30 motility of barium meal and less frequent and less prolonged episodes of pain............................................. Moderate; pulling pain on attempting work or aggravated by 10 movements of the body, or occasional episodes of colic pain, nausea, constipation (perhaps alternating with diarrhea) or abdominal distension......................................... Mild.......................................................... 0 Note: Ratings for adhesions will be considered when there is history of operative or other traumatic or infectious (intraabdominal) process, and at least two of the following: disturbance of motility, actual partial obstruction, reflex disturbances, presence of pain.7304 Ulcer, gastric.7305 Ulcer, duodenal: Severe; pain only partially relieved by standard ulcer 60 therapy, periodic vomiting, recurrent hematemesis or melena, with manifestations of anemia and weight loss productive of definite impairment of health................................ Moderately severe; less than severe but with impairment of 40 health manifested by anemia and weight loss; or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year........................... Moderate; recurring episodes of severe symptoms two or three 20 times a year averaging 10 days in duration; or with continuous moderate manifestations........................... Mild; with recurring symptoms once or twice yearly............ 107306 Ulcer, marginal (gastrojejunal): Pronounced; periodic or continuous pain unrelieved by standard 100 ulcer therapy with periodic vomiting, recurring melena or hematemesis, and weight loss. Totally incapacitating......... Severe; same as pronounced with less pronounced and less 60 continuous symptoms with definite impairment of health....... Moderately severe; intercurrent episodes of abdominal pain at 40 least once a month partially or completely relieved by ulcer therapy, mild and transient episodes of vomiting or melena... Moderate; with episodes of recurring symptoms several times a 20 year......................................................... Mild; with brief episodes of recurring symptoms once or twice 10 yearly.......................................................7307 Gastritis, hypertrophic (identified by gastroscope): Chronic; with severe hemorrhages, or large ulcerated or eroded 60 areas........................................................ Chronic; with multiple small eroded or ulcerated areas, and 30 symptoms..................................................... Chronic; with small nodular lesions, and symptoms............. 10 Gastritis, atrophic. A complication of a number of diseases, including pernicious anemia. Rate the underlying condition.7308 Postgastrectomy syndromes: Severe; associated with nausea, sweating, circulatory 60 disturbance after meals, diarrhea, hypoglycemic symptoms, and weight loss with malnutrition and anemia..................... Moderate; less frequent episodes of epigastric disorders with 40 characteristic mild circulatory symptoms after meals but with diarrhea and weight loss..................................... Mild; infrequent episodes of epigastric distress with 20 characteristic mild circulatory symptoms or continuous mild manifestations...............................................7309 Stomach, stenosis of. Rate as for gastric ulcer.7310 Stomach, injury of, residuals. Rate as peritoneal adhesions.7311 Residuals of injury of the liver: Depending on the specific residuals, separately evaluate as adhesions of peritoneum (diagnostic code 7301), cirrhosis of liver (diagnostic code 7312), and chronic liver disease without cirrhosis (diagnostic code 7345).7312 Cirrhosis of the liver, primary biliary cirrhosis, or cirrhotic phase of sclerosing cholangitis: Generalized weakness, substantial weight loss, and persistent 100 jaundice, or; with one of the following refractory to treatment: ascites, hepatic encephalopathy, hemorrhage from varices or portal gastropathy (erosive gastritis)............ History of two or more episodes of ascites, hepatic 70 encephalopathy, or hemorrhage from varices or portal gastropathy (erosive gastritis), but with periods of remission between attacks.................................... History of one episode of ascites, hepatic encephalopathy, or 50 hemorrhage from varices or portal gastropathy (erosive gastritis)................................................... Portal hypertension and splenomegaly, with weakness, anorexia, 30 abdominal pain, malaise, and at least minor weight loss...... Symptoms such as weakness, anorexia, abdominal pain, and 10 malaise...................................................... Note: For evaluation under diagnostic code 7312, documentation of cirrhosis (by biopsy or imaging) and abnormal liver function tests must be present.7314 Cholecystitis, chronic: Severe; frequent attacks of gall bladder colic................ 30 Moderate; gall bladder dyspepsia, confirmed by X-ray 10 technique, and with infrequent attacks (not over two or three a year) of gall bladder colic, with or without jaundice...... Mild.......................................................... 07315 Cholelithiasis, chronic. Rate as for chronic cholecystitis.7316 Cholangitis, chronic. Rate as for chronic cholecystitis.7317 Gall bladder, injury of. Rate as for peritoneal adhesions.7318 Gall bladder, removal of: With severe symptoms.......................................... 30 With mild symptoms............................................ 10 Nonsymptomatic................................................ 0 Spleen, disease or injury of. See Hemic and Lymphatic Systems.7319 Irritable colon syndrome (spastic colitis, mucous colitis, etc.): Severe; diarrhea, or alternating diarrhea and constipation, 30 with more or less constant abdominal distress................ Moderate; frequent episodes of bowel disturbance with 10 abdominal distress........................................... Mild; disturbances of bowel function with occasional episodes 0 of abdominal distress........................................7321 Amebiasis: Mild gastrointestinal disturbances, lower abdominal cramps, 10 nausea, gaseous distention, chronic constipation interrupted by diarrhea.................................................. Asymptomatic.................................................. 0 Note: Amebiasis with or without liver abscess is parallel in symptomatology with ulcerative colitis and should be rated on the scale provided for the latter. Similarly, lung abscess due to amebiasis will be rated under the respiratory system schedule, diagnostic code 6809.7322 Dysentery, bacillary. Rate as for ulcerative colitis................................7323 Colitis, ulcerative: Pronounced; resulting in marked malnutrition, anemia, and 100 general debility, or with serious complication as liver abscess...................................................... Severe; with numerous attacks a year and malnutrition, the 60 health only fair during remissions........................... Moderately severe; with frequent exacerbations................ 30 Moderate; with infrequent exacerbations....................... 107324 Distomiasis, intestinal or hepatic: Severe symptoms............................................... 30 Moderate symptoms............................................. 10 Mild or no symptoms........................................... 07325 Enteritis, chronic. Rate as for irritable colon syndrome.7326 Enterocolitis, chronic. Rate as for irritable colon syndrome.7327 Diverticulitis. Rate as for irritable colon syndrome, peritoneal adhesions, or colitis, ulcerative, depending upon the predominant disability picture.7328 Intestine, small, resection of: With marked interference with absorption and nutrition, 60 manifested by severe impairment of health objectively supported by examination findings including material weight loss......................................................... With definite interference with absorption and nutrition, 40 manifested by impairment of health objectively supported by examination findings including definite weight loss.......... Symptomatic with diarrhea, anemia and inability to gain weight 20 Note: Where residual adhesions constitute the predominant disability, rate under diagnostic code 7301.7329 Intestine, large, resection of: With severe symptoms, objectively supported by examination 40 findings..................................................... With moderate symptoms........................................ 20 With slight symptoms.......................................... 10 Note: Where residual adhesions constitute the predominant disability, rate under diagnostic code 7301.7330 Intestine, fistula of, persistent, or after attempt at operative closure: Copious and frequent, fecal discharge......................... 100 Constant or frequent, fecal discharge......................... 60 Slight infrequent, fecal discharge............................ 30 Healed; rate for peritoneal adhesions.7331 Peritonitis, tuberculous, active or inactive: Active........................................................ 100 Inactive: See §§ 4.88b and 4.89.7332 Rectum and anus, impairment of sphincter control: Complete loss of sphincter control............................ 100 Extensive leakage and fairly frequent involuntary bowel 60 movements.................................................... Occasional involuntary bowel movements, necessitating wearing 30 of pad....................................................... Constant slight, or occasional moderate leakage............... 10 Healed or slight, without leakage............................. 07333 Rectum and anus, stricture of: Requiring colostomy........................................... 100 Great reduction of lumen, or extensive leakage................ 50 Moderate reduction of lumen, or moderate constant leakage..... 307334 Rectum, prolapse of: Severe (or complete), persistent.............................. 50 Moderate, persistent or frequently recurring.................. 30 Mild with constant slight or occasional moderate leakage...... 107335 Ano, fistula in. Rate as for impairment of sphincter control.7336 Hemorrhoids, external or internal: With persistent bleeding and with secondary anemia, or with 20 fissures..................................................... Large or thrombotic, irreducible, with excessive redundant 10 tissue, evidencing frequent recurrences...................... Mild or moderate.............................................. 07337 Pruritus ani. Rate for the underlying condition.7338 Hernia, inguinal: Large, postoperative, recurrent, not well supported under 60 ordinary conditions and not readily reducible, when considered inoperable........................................ Small, postoperative recurrent, or unoperated irremediable, 30 not well supported by truss, or not readily reducible........ Postoperative recurrent, readily reducible and well supported 10 by truss or belt............................................. Not operated, but remediable.................................. 0 Small, reducible, or without true hernia protrusion........... 0 Note: Add 10 percent for bilateral involvement, provided the second hernia is compensable. This means that the more severely disabling hernia is to be evaluated, and 10 percent, only, added for the second hernia, if the latter is of compensable degree.7339 Hernia, ventral, postoperative: Massive, persistent, severe diastasis of recti muscles or 100 extensive diffuse destruction or weakening of muscular and fascial support of abdominal wall so as to be inoperable..... Large, not well supported by belt under ordinary conditions... 40 Small, not well supported by belt under ordinary conditions, 20 or healed ventral hernia or post-operative wounds with weakening of abdominal wall and indication for a supporting belt......................................................... Wounds, postoperative, healed, no disability, belt not 0 indicated....................................................7340 Hernia, femoral. Rate as for inguinal hernia.7342 Visceroptosis, symptomatic, marked......................... 107343 Malignant neoplasms of the digestive system, exclusive of 100 skin growths................................................... Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.7344 Benign neoplasms, exclusive of skin growths: Evaluate under an appropriate diagnostic code, depending on the predominant disability or the specific residuals after treatment.7345 Chronic liver disease without cirrhosis (including hepatitis B, chronic active hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced hepatitis, etc., but excluding bile duct disorders and hepatitis C): Near-constant debilitating symptoms (such as fatigue, malaise, 100 nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain)............................................... Daily fatigue, malaise, and anorexia, with substantial weight 60 loss (or other indication of malnutrition), and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12-month period, but not occurring constantly................................................... Daily fatigue, malaise, and anorexia, with minor weight loss 40 and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least four weeks, but less than six weeks, during the past 12-month period.............................. Daily fatigue, malaise, and anorexia (without weight loss or 20 hepatomegaly), requiring dietary restriction or continuous medication, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past 12- month period................................................. Intermittent fatigue, malaise, and anorexia, or; 10 incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period....................................................... Nonsymptomatic................................................ 0 Note (1): Evaluate sequelae, such as cirrhosis or malignancy of the liver, under an appropriate diagnostic code, but do not use the same signs and symptoms as the basis for evaluation under DC 7354 and under a diagnostic code for sequelae. (See § 4.14.). Note (2): For purposes of evaluating conditions under diagnostic code 7345, ``incapacitating episode'' means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician. Note (3): Hepatitis B infection must be confirmed by serologic testing in order to evaluate it under diagnostic code 7345.7346 Hernia hiatal: Symptoms of pain, vomiting, material weight loss and 60 hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health....... Persistently recurrent epigastric distress with dysphagia, 30 pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health....................................................... With two or more of the symptoms for the 30 percent evaluation 10 of less severity.............................................7347 Pancreatitis: With frequently recurrent disabling attacks of abdominal pain 100 with few pain free intermissions and with steatorrhea, malabsorption, diarrhea and severe malnutrition.............. With frequent attacks of abdominal pain, loss of normal body 60 weight and other findings showing continuing pancreatic insufficiency between acute attacks.......................... Moderately severe; with at least 4-7 typical attacks of 30 abdominal pain per year with good remission between attacks.. With at least one recurring attack of typical severe abdominal 10 pain in the past year........................................ Note 1: Abdominal pain in this condition must be confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies. Note 2: Following total or partial pancreatectomy, rate under above, symptoms, minimum rating 30 percent.7348 Vagotomy with pyloroplasty or gastroenterostomy: Followed by demonstrably confirmative postoperative 40 complications of stricture or continuing gastric retention... With symptoms and confirmed diagnosis of alkaline gastritis, 30 or of confirmed persisting diarrhea.......................... Recurrent ulcer with incomplete vagotomy...................... 20 Note: Rate recurrent ulcer following complete vagotomy under diagnostic code 7305, minimum rating 20 percent; and rate dumping syndrome under diagnostic code 7308.7351 Liver transplant: For an indefinite period from the date of hospital admission 100 for transplant surgery....................................... Minimum....................................................... 30 Note: A rating of 100 percent shall be assigned as of the date of hospital admission for transplant surgery and shall continue. One year following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter.7354 Hepatitis C (or non-A, non-B hepatitis): With serologic evidence of hepatitis C infection and the following signs and symptoms due to hepatitis C infection: Near-constant debilitating symptoms (such as fatigue, 100 malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain)......................................... Daily fatigue, malaise, and anorexia, with substantial weight 60 loss (or other indication of malnutrition), and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12-month period, but not occurring constantly................................................... Daily fatigue, malaise, and anorexia, with minor weight loss 40 and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least four weeks, but less than six weeks, during the past 12-month period.............................. Daily fatigue, malaise, and anorexia (without weight loss or 20 hepatomegaly), requiring dietary restriction or continuous medication, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past 12- month period................................................. Intermittent fatigue, malaise, and anorexia, or; 10 incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period....................................................... Nonsymptomatic................................................ 0 Note (1): Evaluate sequelae, such as cirrhosis or malignancy of the liver, under an appropriate diagnostic code, but do not use the same signs and symptoms as the basis for evaluation under DC 7354 and under a diagnostic code for sequelae. (See § 4.14.). Note (2): For purposes of evaluating conditions under diagnostic code 7354, ``incapacitating episode'' means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician.------------------------------------------------------------------------

(Authority: 38 U.S.C. 1155)

[29 FR 6718, May 22, 1964, as amended at 34 FR 5063, Mar. 11, 1969; 40 FR 42540, Sept. 15, 1975; 41 FR 11301, Mar. 18, 1976; 66 FR 29488, May 31, 2001]

The Genitourinary System

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§ 4.115 Nephritis.

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Albuminuria alone is not nephritis, nor will the presence of transient albumin and casts following acute febrile illness be taken as nephritis. The glomerular type of nephritis is usually preceded by or associated with severe infectious disease; the onset is sudden, and the course marked by red blood cells, salt retention, and edema; it may clear up entirely or progress to a chronic condition. The nephrosclerotic type, originating in hypertension or arteriosclerosis, develops slowly, with minimum laboratory findings, and is associated with natural progress. Separate ratings are not to be assigned for disability from disease of the heart and any form of nephritis, on account of the close interrelationships of cardiovascular disabilities. If, however, absence of a kidney is the sole renal disability, even if removal was required because of nephritis, the absent kidney and any hypertension or heart disease will be separately rated. Also, in the event that chronic renal disease has progressed to the point where regular dialysis is required, any coexisting hypertension or heart disease will be separately rated.

[41 FR 34258, Aug. 13, 1976, as amended at 59 FR 2527, Jan. 18, 1994]

§ 4.115a Ratings of the genitourinary system—dysfunctions.

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Diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these. The following section provides descriptions of various levels of disability in each of these symptom areas. Where diagnostic codes refer the decisionmaker to these specific areas dysfunction, only the predominant area of dysfunction shall be considered for rating purposes. Since the areas of dysfunction described below do not cover all symptoms resulting from genitourinary diseases, specific diagnoses may include a description of symptoms assigned to that diagnosis.

 ------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------Renal dysfunction:  Requiring regular dialysis, or precluding more than sedentary      100   activity from one of the following: persistent edema and   albuminuria; or, BUN more than 80mg%; or, creatinine more   than 8mg%; or, markedly decreased function of kidney or other   organ systems, estpecially cardiovascular....................  Persistent edema and albuminuria with BUN 40 to 80mg%; or,          80   creatinine 4 to 8mg%; or, generalized poor health   characterized by lethargy, weakness, anorexia, weight loss,   or limitation of exertion....................................  Constant albuminuria with some edema; or, definite decrease in      60   kidney function; or, hypertension at least 40 percent   disabling under diagnostic code 7101.........................  Albumin constant or recurring with hyaline and granular casts       30   or red blood cells; or, transient or slight edema or   hypertension at least 10 percent disabling under diagnostic   code 7101....................................................  Albumin and casts with history of acute nephritis; or,               0   hypertension non-compensable under diagnostic code 7101......Voiding dysfunction:  Rate particular condition as urine leakage, frequency, or       ......   obstructed voiding  Continual Urine Leakage, Post Surgical Urinary Diversion,   Urinary Incontinence, or Stress Incontinence:  Requiring the use of an appliance or the wearing of absorbent       60   materials which must be changed more than 4 times per day....  Requiring the wearing of absorbent materials which must be          40   changed 2 to 4 times per day.................................  Requiring the wearing of absorbent materials which must be          20   changed less than 2 times per day............................Urinary frequency:  Daytime voiding interval less than one hour, or; awakening to       40   void five or more times per night............................  Daytime voiding interval between one and two hours, or;             20   awakening to void three to four times per night..............  Daytime voiding interval between two and three hours, or;           10   awakening to void two times per night........................Obstructed voiding:  Urinary retention requiring intermittent or continuous              30   catheterization..............................................  Marked obstructive symptomatology (hesitancy, slow or weak   stream, decreased force of stream) with any one or   combination of the following:    1. Post void residuals greater than 150 cc.    2. Uroflowmetry; markedly diminished peak flow rate (less     than 10 cc/sec).    3. Recurrent urinary tract infections secondary to     obstruction.    4. Stricture disease requiring periodic dilatation every 2        10     to 3 months................................................  Obstructive symptomatology with or without stricture disease         0   requiring dilatation 1 to 2 times per year...................Urninary tract infection:  Poor renal function: Rate as renal dysfunction.  Recurrent symptomatic infection requiring drainage/frequent         30   hospitalization (greater than two times/year), and/or   requiring continuous intensive management....................  Long-term drug therapy, 1-2 hospitalizations per year and/or        10   requiring intermittent intensive management..................------------------------------------------------------------------------

[59 FR 2527, Jan. 18, 1994; 59 FR 10676, Mar. 7, 1994]

§ 4.115b Ratings of the genitourinary system—diagnoses.

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 ------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------      Note: When evaluating any claim involving loss or loss of       use of one or more creative organs, refer to § 3.350       of this chapter to determine whether the veteran may be       entitled to special monthly compensation. Footnotes in       the schedule indicate conditions which potentially       establish entitlement to special monthly compensation;       however, there are other conditions in this section which       under certain circumstances also establish entitlement to       special monthly compensation.7500 Kidney, removal of one:      Minimum evaluation........................................      30      Or rate as renal dysfunction if there is nephritis,       infection, or pathology of the other.7501 Kidney, abscess of:      Rate as urinary tract infection...........................  ......7502 Nephritis, chronic:      Rate as renal dysfunction.7504 Pyelonephritis, chronic:      Rate as renal dysfunction or urinary tract infection,       whichever is predominant.7505 Kidney, tuberculosis of:      Rate in accordance with §§ 4.88b or 4.89,       whichever is appropriate.7507 Nephrosclerosis, arteriolar:      Rate according to predominant symptoms as renal       dysfunction, hypertension or heart disease. If rated       under the cardiovascular schedule, however, the       percentage rating which would otherwise be assigned will       be elevated to the next higher evaluation.7508 Nephrolithiasis:      Rate as hydronephrosis, except for recurrent stone       formation requiring one or more of the following:        1. diet therapy        2. drug therapy        3. invasive or non-invasive procedures more than two          30         times/year.............................................7509 Hydronephrosis:      Severe; Rate as renal dysfunction.    Frequent attacks of colic with infection (pyonephrosis),          30     kidney function impaired...................................    Frequent attacks of colic, requiring catheter drainage......      20    Only an occasional attack of colic, not infected and not          10     requiring catheter drainage................................7510 Ureterolithiasis:      Rate as hydronephrosis, except for recurrent stone       formation requiring one or more of the following:        1. diet therapy        2. drug therapy        3. invasive or non-invasive procedures more than two          30         times/year.............................................7511 Ureter, stricture of:      Rate as hydronephrosis, except for recurrent stone       formation requiring one or more of the following:        1. diet therapy        2. drug therapy        3. invasive or non-invasive procedures more than two          30         times/year.............................................7512 Cystitis, chronic, includes interstitial and all etiologies, infectious and non-infectious:      Rate as voiding dysfunction.7515 Bladder, calculus in, with symptoms interfering with function:      Rate as voiding dysfunction7516 Bladder, fistula of:      Rate as voiding dysfunction or urinary tract infection,       whichever is predominant.      Postoperative, suprapubic cystotomy.......................     1007517 Bladder, injury of:      Rate as voiding dysfunction.7518 Urethra, stricture of:      Rate as voiding dysfunction.7519 Urethra, fistual of:      Rate as voiding dysfunction.      Multiple urethroperineal fistulae.........................     1007520 Penis, removal of half or more.............................      30      Or rate as voiding dysfunction.7521 Penis removal of glans.....................................      20      Or rate as voiding dysfunction.7522 Penis, deformity, with loss of erectile power_20 \1\.......7523 Testis, atrophy complete:..................................      Both_20 \1\      One_0 \1\7524 Testis, removal:...........................................      Both_30 \1\      One_0 \1\      Note: In cases of the removal of one testis as the result       of a service-incurred injury or disease, other than an       undescended or congenitally undeveloped testis, with the       absence or nonfunctioning of the other testis unrelated       to service, an evaluation of 30 percent will be assigned       for the service-connected testicular loss. Testis,       underscended, or congenitally undeveloped is not a       ratable disability.7525 Epididymo-orchitis, chronic only:      Rate as urinary tract infection.      For tubercular infections: Rate in accordance with       §§ 4.88b or 4.89, whichever is appropriate.7527 Prostate gland injuries, infections, hypertrophy, postoperative residuals:      Rate as voiding dysfunction or urinary tract infection,       whichever is predominant.7528 Malignant neoplasms of the genitourinary system............     100      Note_Following the cessation of surgical, X-ray,       antineoplastic chemotherapy or other therapeutic       procedure, the rating of 100 percent shall continue with       a mandatory VA examination at the expiration of six       months. Any change in evaluation based upon that or any       subsequent examination shall be subject to the provisions       of § 3.105(e) of this chapter. If there has been no       local reoccurrence or metastasis, rate on residuals as       voiding dysfunction or renal dysfunction, whichever is       predominant.7529 Benign neoplasms of the genitourinary system:      Rate as voiding dysfunction or renal dysfunction,       whichever is predominant.7530 Chronic renal disease requiring regular dialysis:      Rate as renal dysfunction.7531 Kidney transplant:      Following transplant surgery..............................     100      Thereafter: Rate on residuals as renal dysfunction,             30       minimum rating...........................................      Note_The 100 percent evaluation shall be assigned as of       the date of hospital admission for transplant surgery and       shall continue with a mandatory VA examination one year       following hospital discharge. Any change in evaluation       based upon that or any subsequent examination shall be       subject to the provisions of § 3.105(e) of this       chapter.7532 Renal tubular disorders (such as renal glycosurias, aminoacidurias, renal tubular acidosis, Fanconi's syndrome, Bartter's syndrome, related disorders of Henle's loop and proximal or distal nephron function, etc.):      Minimum rating for symptomatic condition..................      20      Or rate as renal dysfunction.7533 Cystic diseases of the kidneys (polycystic disease, uremic medullary cystic disease, Medullary sponge kidney, and similar conditions):      Rate as renal dysfunction.7534 Atherosclerotic renal disease (renal artery stenosis or atheroembolic renal disease):      Rate as renal dysfunction.7535 Toxic nephropathy (antibotics, radiocontrast agents, nonsteroidal anti-inflammatory agents, heavy metals, and similar agents):      Rate as renal dysfunction.7536 Glomerulonephritis:      Rate as renal dysfunction.7537 Interstitial nephritis:      Rate as renal dysfunction.7538 Papillary necrosis:      Rate as renal dysfunction.7539 Renal amyloid disease:      Rate as renal dysfunction.7540 Disseminated intravascular coagulation with renal cortical necrosis:      Rate as renal dysfunction.7541 Renal involvement in diabetes mellitus, sickle cell anemia, systemic lupus erythematosus, vasculitis, or other systemic disease processes.      Rate as renal dysfunction.7542 Neurogenic bladder:      Rate as voiding dysfunction.------------------------------------------------------------------------\1\ Review for entitlement to special monthly compensation under §  3.350 of this chapter.

[59 FR 2527, Jan. 18, 1994; 59 FR 14567, Mar. 29, 1994, as amended at 59 FR 46339, Sept. 8, 1994]

Gynecological Conditions and Disorders of the Breast

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§ 4.116 Schedule of ratings—gynecological conditions and disorders of the breast.

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------------------------------------------------------------------------ Rating------------------------------------------------------------------------ Note 1: Natural menopause, primary amenorrhea, and pregnancy and childbirth are not disabilities for rating purposes. Chronic residuals of medical or surgical complications of pregnancy may be disabilities for rating purposes. Note 2: When evaluating any claim involving loss or loss of use of one or more creative organs or anatomical loss of one or both breasts, refer to § 3.350 of this chapter to determine whether the veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, almost any condition in this section might, under certain circumstances, establish entitlement to special monthly compensation.7610 Vulva, disease or injury of (including vulvovaginitis).7611 Vagina, disease or injury of.7612 Cervix, disease or injury of.7613 Uterus, disease, injury, or adhesions of.7614 Fallopian tube, disease, injury, or adhesions of (including pelvic inflammatory disease (PID)).7615 Ovary, disease, injury, or adhesions of.General Rating Formula for Disease, Injury, or Adhesions of Female Reproductive Organs (diagnostic codes 7610 through 7615): Symptoms not controlled by continuous treatment............ 30 Symptoms that require continuous treatment................. 10 Symptoms that do not require continuous treatment.......... 07617 Uterus and both ovaries, removal of, complete: For three months after removal............................. \1\ 100 Thereafter................................................. \1\ 507618 Uterus, removal of, including corpus: For three months after removal............................. \1\ 100 Thereafter................................................. \1\ 307619 Ovary, removal of: For three months after removal............................. \1\ 100 Thereafter: Complete removal of both ovaries....................... \1\ 30 Removal of one with or without partial removal of the \1\ 0 other.................................................7620 Ovaries, atrophy of both, complete........................ \1\ 207621 Uterus, prolapse: Complete, through vagina and introitus..................... 50 Incomplete................................................. 307622 Uterus, displacement of: With marked displacement and frequent or continuous 30 menstrual disturbances.................................... With adhesions and irregular menstruation.................. 107623 Pregnancy, surgical complications of: With rectocele or cystocele................................ 50 With relaxation of perineum................................ 107624 Fistula, rectovaginal: Vaginal fecal leakage at least once a day requiring wearing 100 of pad.................................................... Vaginal fecal leakage four or more times per week, but less 60 than daily, requiring wearing of pad...................... Vaginal fecal leakage one to three times per week requiring 30 wearing of pad............................................ Vaginal fecal leakage less than once a week................ 10 Without leakage............................................ 07625 Fistula, urethrovaginal: Multiple urethrovaginal fistulae........................... 100 Requiring the use of an appliance or the wearing of 60 absorbent materials which must be changed more than four times per day............................................. Requiring the wearing of absorbent materials which must be 40 changed two to four times per day......................... Requiring the wearing of absorbent materials which must be 20 changed less than two times per day.......................7626 Breast, surgery of: Following radical mastectomy: Both................................................... \1\80 One.................................................... \1\50 Following modified radical mastectomy: Both................................................... \1\60 One.................................................... \1\40 Following simple mastectomy or wide local excision with significant alteration of size or form: Both................................................... \1\50 One.................................................... \1\30 Following wide local excision without significant alteration of size or form: Both or one............................................ 0 Note: For VA purposes: (1) Radical mastectomy means removal of the entire breast, underlying pectoral muscles, and regional lymph nodes up to the coracoclavicular ligament....... (2) Modified radical mastectomy means removal of the entire breast and axillary lymph nodes (in continuity with the breast). Pectoral muscles are left intact.... (3) Simple (or total) mastectomy means removal of all of the breast tissue, nipple, and a small portion of the overlying skin, but lymph nodes and muscles are left intact........................................... (4) Wide local excision (including partial mastectomy, lumpectomy, tylectomy, segmentectomy, and quadrantectomy) means removal of a portion of the breast tissue.........................................7627 Malignant neoplasms of gynecological system or breast..... 100 Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.7628 Benign neoplasms of the gynecological system or breast. Rate according to impairment in function of the urinary or gynecological systems, or skin.7629 Endometriosis: Lesions involving bowel or bladder confirmed by 50 laparoscopy, pelvic pain or heavy or irregular bleeding not controlled by treatment, and bowel or bladder symptoms Pelvic pain or heavy or irregular bleeding not controlled 30 by treatment.............................................. Pelvic pain or heavy or irregular bleeding requiring 10 continuous treatment for control.......................... Note: Diagnosis of endometriosis must be substantiated by laparoscopy.------------------------------------------------------------------------\1\ Review for entitlement to special monthly compensation under § 3.350 of this chapter.

[60 FR 19855, Apr. 21, 1995, as amended at 67 FR 6874, Feb. 14, 2002; 67 FR 37695, May 30, 2002]

The Hemic and Lymphatic Systems

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§ 4.117 Schedule of ratings—hemic and lymphatic systems.

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------------------------------------------------------------------------ Rating------------------------------------------------------------------------7700 Anemia, hypochromic-microcytic and megaloblastic, such as iron-deficiency and pernicious anemia: Hemoglobin 5gm/100ml or less, with findings such as high 100 output congestive heart failure or dyspnea at rest........ Hemoglobin 7gm/100ml or less, with findings such as dyspnea 70 on mild exertion, cardiomegaly, tachycardia (100 to 120 beats per minute) or syncope (three episodes in the last six months)............................................... Hemoglobin 8gm/100ml or less, with findings such as 30 weakness, easy fatigability, headaches, lightheadedness, or shortness of breath.................................... Hemoglobin 10gm/100ml or less with findings such as 10 weakness, easy fatigability or headaches.................. Hemoglobin 10gm/100ml or less, asymptomatic................ 0Note: Evaluate complications of pernicious anemia, such as dementia or peripheral neuropathy, separately.7702 Agranulocytosis, acute: Requiring bone marrow transplant, or; requiring transfusion 100 of platelets or red cells at least once every six weeks, or; infections recurring at least once every six weeks.... Requiring transfusion of platelets or red cells at least 60 once every three months, or; infections recurring at least once every three months................................... Requiring transfusion of platelets or red cells at least 30 once per year but less than once every three months, or; infections recurring at least once per year but less than once every three months................................... Requiring continuous medication for control................ 10Note: The 100 percent rating for bone marrow transplant shall be assigned as of the date of hospital admission and shall continue with a mandatory VA examination six months following hospital discharge. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter.7703 Leukemia: With active disease or during a treatment phase............ 100 Otherwise rate as anemia (code 7700) or aplastic anemia (code 7716), whichever would result in the greater benefit.Note: The 100 percent rating shall continue beyond the cessation of any surgical, radiation, antineoplastic chemotherapy or other therapeutic procedures. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no recurrence, rate on residuals.7704 Polycythemia vera: During periods of treatment with myelosuppressants and for 100 three months following cessation of myelosuppressant therapy................................................... Requiring phlebotomy....................................... 40 Stable, with or without continuous medication.............. 10Note: Rate complications such as hypertension, gout, stroke or thrombotic disease separately.7705 Thrombocytopenia, primary, idiopathic or immune: Platelet count of less than 20,000, with active bleeding, 100 requiring treatment with medication and transfusions...... Platelet count between 20,000 and 70,000, not requiring 70 treatment, without bleeding............................... Stable platelet count between 70,000 and 100,000, without 30 bleeding.................................................. Stable platelet count of 100,000 or more, without bleeding. 07706 Splenectomy............................................... 20Note: Rate complications such as systemic infections with encapsulated bacteria separately.7707 Spleen, injury of, healed. Rate for any residuals.7709 Hodgkin's disease: With active disease or during a treatment phase............ 100Note: The 100 percent rating shall continue beyond the cessation of any surgical, radiation, antineoplastic chemotherapy or other therapeutic procedures. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.7710 Adenitis, tuberculous, active or inactive. Rate under §§ 4.88c or 4.89 of this part, whichever is appropriate.7714 Sickle cell anemia: With repeated painful crises, occurring in skin, joints, 100 bones or any major organs caused by hemolysis and sickling of red blood cells, with anemia, thrombosis and infarction, with symptoms precluding even light manual labor..................................................... With painful crises several times a year or with symptoms 60 precluding other than light manual labor.................. Following repeated hemolytic sickling crises with 30 continuing impairment of health........................... Asymptomatic, established case in remission, but with 10 identifiable organ impairment.............................Note: Sickle cell trait alone, without a history of directly attributable pathological findings, is not a ratable disability. Cases of symptomatic sickle cell trait will be forwarded to the Director, Compensation and Pension Service, for consideration under § 3.321(b)(1) of this chapter.7715 Non-Hodgkin's lymphoma: With active disease or during a treatment phase............ 100Note: The 100 percent rating shall continue beyond the cessation of any surgical, radiation, antineoplastic chemotherapy or other therapeutic procedures. Six months after discontinuance of such treatment, the appropriate disability rating shall be dtermined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.7716 Aplastic anemia: Requiring bone marrow transplant, or; requiring transfusion 100 of platelets or red cells at least once every six weeks, or; infections recurring at least once every six weeks.... Requiring transfusion of platelets or red cells at least 60 once every three months, or; infections recurring at least once every three months................................... Requiring transfusion of platelets or red cells at least 30 once per year but less than once every three months, or; infections recurring at least once per year but less than once every three months................................... Requiring continuous medication for control................ 10Note: The 100 percent rating for bone marrow transplant shall be assigned as of the date of hospital admission and shall continue with a mandatory VA examination six months following hospital discharge. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter.------------------------------------------------------------------------

[60 FR 49227, Sept. 22, 1995]

The Skin

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§ 4.118 Schedule of ratings—skin.

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 ------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------7800 Disfigurement of the head, face, or neck:    With visible or palpable tissue loss and either gross             80     distortion or asymmetry of three or more features or paired     sets of features (nose, chin, forehead, eyes (including     eyelids), ears (auricles), cheeks, lips), or; with six or     more characteristics of disfigurement......................    With visible or palpable tissue loss and either gross             50     distortion or asymmetry of two features or paired sets of     features (nose, chin, forehead, eyes (including eyelids),     ears (auricles), cheeks, lips), or; with four or five     characteristics of disfigurement...........................    With visible or palpable tissue loss and either gross             30     distortion or asymmetry of one feature or paired set of     features (nose, chin, forehead, eyes (including eyelids),     ears (auricles), cheeks, lips), or; with two or three     characteristics of disfigurement...........................    With one characteristic of disfigurement....................      10    Note (1):The 8 characteristics of disfigurement, for     purposes of evaluation under § 4.118, are:    Scar 5 or more inches (13 or more cm.) in length.    Scar at least one-quarter inch (0.6 cm.) wide at widest     part.    Surface contour of scar elevated or depressed on palpation.    Scar adherent to underlying tissue.    Skin hypo-or hyper-pigmented in an area exceeding six square     inches (39 sq. cm.).    Skin texture abnormal (irregular, atrophic, shiny, scaly,     etc.) in an area exceeding six square inches (39 sq. cm.).    Underlying soft tissue missing in an area exceeding six     square inches (39 sq. cm.).    Skin indurated and inflexible in an area exceeding six     square inches (39 sq. cm.).    Note (2): Rate tissue loss of the auricle under DC 6207     (loss of auricle) and anatomical loss of the eye under DC     6061 (anatomical loss of both eyes) or DC 6063 (anatomical     loss of one eye), as appropriate.    Note (3): Take into consideration unretouched color     photographs when evaluating under these criteria.7801 Scars, other than head, face, or neck, that are deep or that cause limited motion:    Area or areas exceeding 144 square inches (929 sq.cm.)......      40    Area or areas exceeding 72 square inches (465 sq. cm.)......      30    Area or areas exceeding 12 square inches (77 sq. cm.).......      20    Area or areas exceeding 6 square inches (39 sq. cm.)........      10    Note (1): Scars in widely separated areas, as on two or more     extremities or on anterior and posterior surfaces of     extremities or trunk, will be separately rated and combined     in accordance with § 4.25 of this part.    Note (2): A deep scar is one associated with underlying soft     tissue damage.7802 Scars, other than head, face, or neck, that are superficial and that do not cause limited motion:..........................    Area or areas of 144 square inches (929 sq. cm.) or greater.      10    Note (1): Scars in widely separated areas, as on two or more     extremities or on anterior and posterior surfaces of     extremities or trunk, will be separately rated and combined     in accordance with § 4.25 of this part.    Note (2): A superficial scar is one not associated with     underlying soft tissue damage.7803 Scars, superficial, unstable...............................      10    Note (1): An unstable scar is one where, for any reason,     there is frequent loss of covering of skin over the scar.    Note (2): A superficial scar is one not associated with     underlying soft tissue damage.7804 Scars, superficial, painful on examination.................      10    Note (1): A superficial scar is one not associated with     underlying soft tissue damage.    Note (2): In this case, a 10-percent evaluation will be     assigned for a scar on the tip of a finger or toe even     though amputation of the part would not warrant a     compensable evaluation.    (See § 4.68 of this part on the amputation rule.)7805 Scars, other; Rate on limitation of function of affected part.7806 Dermatitis or eczema.    More than 40 percent of the entire body or more than 40           60     percent of exposed areas affected, or; constant or near-     constant systemic therapy such as corticosteroids or other     immunosuppressive drugs required during the past 12-month     period.....................................................    20 to 40 percent of the entire body or 20 to 40 percent of        30     exposed areas affected, or; systemic therapy such as     corticosteroids or other immunosuppressive drugs required     for a total duration of six weeks or more, but not     constantly, during the past 12-month period................    At least 5 percent, but less than 20 percent, of the entire       10     body, or at least 5 percent, but less than 20 percent, of     exposed areas affected, or; intermittent systemic therapy     such as corticosteroids or other immunosuppressive drugs     required for a total duration of less than six weeks during     the past 12-month period...................................    Less than 5 percent of the entire body or less than 5              0     percent of exposed areas affected, and; no more than     topical therapy required during the past 12-month period...    Or rate as disfigurement of the head, face, or neck (DC     7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805),     depending upon the predominant disability.7807 American (New World) leishmaniasis (mucocutaneous, espundia):    Rate as disfigurement of the head, face, or neck (DC 7800),     scars (DC's 7801, 7802, 7803, 7804, or 7805), or dermatitis     (DC 7806), depending upon the predominant disability.......    Note: Evaluate non-cutaneous (visceral) leishmaniasis under     DC 6301 (visceral leishmaniasis).7808 Old World leishmaniasis (cutaneous, Oriental sore):    Rate as disfigurement of the head, face, or neck (DC 7800),     scars (DC's, 7801, 7802, 7803, 7804, or 7805), or     dermatitis (DC 7806), depending upon the predominant     disabililty................................................    Note: Evaluate non-cutaneous (visceral) leishmaniasis under     DC 6301 (visceral leishmaniasis).7809 Discoid lupus erythematosus or subacute cutaneous lupus erythematosus:    Rate as disfigurement of the head, face, or neck (DC 7800),     scars (DC's 7801, 7802, 7803, 7804, or 7805), or dermatitis     (DC 7806), depending upon the predominant disability. Do     not combine with ratings under DC 6350.....................7811 Tuberculosis luposa (lupus vulgaris), active or inactive:    Rate under §§ 4.88c or 4.89, whichever is     appropriate................................................7813 Dermatophytosis (ringworm: of body, tinea corporis; of head, tinea capitis; of feet, tinea pedis; of beard area, tinea barbae; of nails, tinea unguium; of inguinal area (jock itch), tinea cruris):    Rate as disfigurement of the head, face, or neck (DC 7800),     scars (DC's 7801, 7802, 7803, 7804, or 7805), or dermatitis     (DC 7806), depending upon the predominant disability.......7815 Bullous disorders (including pemphigus vulgaris, pemphigus foliaceous, bullous pemphigoid, dermatitis herpetiformis, epidermolysis bullosa acquisita, benign chronic familial pemphigus (Hailey-Hailey), and porphyria cutanea tarda):    More than 40 percent of the entire body or more than 40           60     percent of exposed areas affected, or; constant or near-     constant systemic therapy such as corticosteroids or other     immunosuppressive drugs required during the past 12-month     period.....................................................    20 to 40 percent of the entire body or 20 to 40 percent of        30     exposed areas affected, or; systemic therapy such as     corticosteroids or other immunosuppressive drugs required     for a total duration of six weeks or more, but not     constantly, during the past 12-month period................    At least 5 percent, but less than 20 percent, of the entire       10     body, or at least 5 percent, but less than 20 percent, of     exposed areas affected, or; intermittent systemic therapy     such as corticosteroids or other immunosuppressive drugs     required for a total duration of less than six weeks during     the past 12-month period...................................    Less than 5 percent of the entire body or exposed areas            0     affected, and; no more than topical therapy required during     the past 12-month period...................................    Or rate as disfigurement of the head, face, or neck (DC     7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805),     depending upon the predominant disability.7816 Psoriasis:    More than 40 percent of the entire body or more than 40           60     percent of exposed areas affected, or; constant or near-     constant systemic therapy such as corticosteroids or other     immunosuppressive drugs required during the past 12-month     period.....................................................    20 to 40 percent of the entire body or 20 to 40 percent of        30     exposed areas affected, or; systemic therapy such as     corticosteroids or other immunosuppressive drugs required     for a total duration of six weeks or more, but not     constantly, during the past 12-month period................    At least 5 percent, but less than 20 percent, of the entire       10     body, or at least 5 percent, but less than 20 percent, of     exposed areas affected, or; intermittent systemic therapy     such as corticosteroids or other immunosuppressive drugs     required for a total duration of less than six weeks during     the past 12-month period...................................    Less than 5 percent of the entire body or exposed areas            0     affected, and; no more than topical therapy required during     the past 12-month period...................................    Or rate as disfigurement of the head, face, or neck (DC     7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805),     depending upon the predominant disability.7817 Exfoliative dermatitis (erythroderma):    Generalized involvement of the skin, plus systemic               100     manifestations (such as fever, weight loss, and     hypoproteinemia), and; constant or near-constant systemic     therapy such as therapeutic doses of corticosteroids,     immunosuppressive retinoids, PUVA (psoralen with long-wave     ultraviolet-A light) or UVB (ultraviolet-B light)     treatments, or electron beam therapy required during the     past 12-month period.......................................    Generalized involvement of the skin without systemic              60     manifestations, and; constant or near-constant systemic     therapy such as therapeutic doses of corticosteroids,     immunosuppressive retinoids, PUVA (psoralen with long-wave     ultraviolet-A light) or UVB (ultraviolet-B light)     treatments, or electron beam therapy required during the     past 12-month period.......................................    Any extent of involvement of the skin, and; systemic therapy      30     such as therapeutic doses of corticosteroids,     immunosuppressive retinoids, PUVA (psoralen with long-wave     ultraviolet-A light) or UVB (ultraviolet-B light)     treatments, or electron beam therapy required for a total     duration of six weeks or more, but not constantly, during     the past 12-month period...................................    Any extent of involvement of the skin, and; systemic therapy      10     such as therapeutic doses of corticosteroids,     immunosuppressive retinoids, PUVA (psoralen with long-wave     ultraviolet-A light) or UVB (ultraviolet-B light)     treatments, or electron beam therapy required for a total     duration of less than six weeks during the past 12-month     period.....................................................    Any extent of involvement of the skin, and; no more than           0     topical therapy required during the past 12-month period...7818 Malignant skin neoplasms (other than malignant melanoma):    Rate as disfigurement of the head, face, or neck (DC 7800),     scars (DC's 7801, 7802, 7803, 7804, or 7805), or impairment     of function................................................    Note: If a skin malignancy requires therapy that is     comparable to that used for systemic malignancies, i.e.,     systemic chemotherapy, X-ray therapy more extensive than to     the skin, or surgery more extensive than wide local     excision, a 100-percent evaluation will be assigned from     the date of onset of treatment, and will continue, with a     mandatory VA examination six months following the     completion of such antineoplastic treatment, and any change     in evaluation based upon that or any subsequent examination     will be subject to the provisions of § 3.105(e) of     this chapter. If there has been no local recurrence or     metastasis, evaluation will then be made on residuals. If     treatment is confined to the skin, the provisions for a 100-     percent evaluation do not apply.7819 Benign skin neoplasms:    Rate as disfigurement of the head, face, or neck (DC 7800),     scars (DC's 7801, 7802, 7803, 7804, or 7805), or impairment     of function................................................7820 Infections of the skin not listed elsewhere (including bacterial, fungal, viral, treponemal and parasitic diseases):    Rate as disfigurement of the head, face, or neck (DC 7800),     scars (DC's 7801, 7802, 7803, 7804, or 7805), or dermatitis     (DC 7806), depending upon the predominant disability.......7821 Cutaneous manifestations of collagen-vascular diseases not listed elsewhere (including scleroderma, calcinosis cutis, and dermatomyositis):    More than 40 percent of the entire body or more than 40           60     percent of exposed areas affected, or; constant or near-     constant systemic therapy such as corticosteroids or other     immunosuppressive drugs required during the past 12-month     period.....................................................    20 to 40 percent of the entire body or 20 to 40 percent of        30     exposed areas affected, or; systemic therapy such as     corticosteroids or other immunosuppressive drugs required     for a total duration of six weeks or more, but not     constantly, during the past 12-month period................    At least 5 percent, but less than 20 percent, of the entire       10     body, or at least 5 percent, but less than 20 percent, of     exposed areas affected, or; intermittent systemic therapy     such as corticosteroids or other immunosuppressive drugs     required for a total duration of less than six weeks during     the past 12-month period...................................    Less than 5 percent of the entire body or exposed areas            0     affected, and; no more than topical therapy required during     the past 12-month period...................................    Or rate as disfigurement of the head, face, or neck (DC     7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805),     depending upon the predominant disability.7822 Papulosquamous disorders not listed elsewhere (including lichen planus, large or small plaque parapsoriasis, pityriasis lichenoides et varioliformis acuta (PLEVA), lymphomatoid papulosus, and pityriasis rubra pilaris (PRP)):    More than 40 percent of the entire body or more than 40           60     percent of exposed areas affected, and; constant or near-     constant systemic medications or intensive light therapy     required during the past 12-month period...................    20 to 40 percent of the entire body or 20 to 40 percent of        30     exposed areas affected, or; systemic therapy or intensive     light therapy required for a total duration of six weeks or     more, but not constantly, during the past 12-month period..    At least 5 percent, but less than 20 percent, of the entire       10     body, or at least 5 percent, but less than 20 percent, of     exposed areas affected, or; systemic therapy or intensive     light therapy required for a total duration of less than     six weeks during the past 12-month period..................    Less than 5 percent of the entire body or exposed areas            0     affected, and; no more than topical therapy required during     the past 12-month period...................................    Or rate as disfigurement of the head, face, or neck (DC     7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805),     depending upon the predominant disability.7823 Vitiligo:    With exposed areas affected.................................      10    With no exposed areas affected..............................       07824 Diseases of keratinization (including icthyoses, Darier's disease, and palmoplantar keratoderma):    With either generalized cutaneous involvement or systemic         60     manifestations, and; constant or near-constant systemic     medication, such as immunosuppressive retinoids, required     during the past 12-month period............................    With either generalized cutaneous involvement or systemic         30     manifestations, and; intermittent systemic medication, such     as immunosuppressive retinoids, required for a total     duration of six weeks or more, but not constantly, during     the past 12-month period...................................    With localized or episodic cutaneous involvement and              10     intermittent systemic medication, such as immunosuppressive     retinoids, required for a total duration of less than six     weeks during the past 12-month period......................    No more than topical therapy required during the past 12-          0     month period...............................................7825 Urticaria:    Recurrent debilitating episodes occurring at least four           60     times during the past 12-month period despite continuous     immunosuppressive therapy..................................    Recurrent debilitating episodes occurring at least four           30     times during the past 12-month period, and; requiring     intermittent systemic immunosuppressive therapy for control    Recurrent episodes occurring at least four times during the       10     past 12-month period, and; responding to treatment with     antihistamines or sympathomimetics.........................7826 Vasculitis, primary cutaneous:    Recurrent debilitating episodes occurring at least four           60     times during the past 12-month period despite continuous     immunosuppressive therapy..................................    Recurrent debilitating episodes occurring at least four           30     times during the past 12-month period, and; requiring     intermittent systemic immunosuppressive therapy for control    Recurrent episodes occurring one to three times during the        10     past 12-month period, and; requiring intermittent systemic     immunosuppressive therapy for control......................    Or rate as disfigurement of the head, face, or neck (DC     7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805),     depending upon the predominant disability.7827 Erythema multiforme; Toxic epidermal necrolysis:    Recurrent debilitating episodes occurring at least four           60     times during the past 12-month period despite ongoing     immunosuppressive therapy..................................    Recurrent episodes occurring at least four times during the       30     past 12-month period, and; requiring intermittent systemic     immunosuppressive therapy..................................    Recurrent episodes occurring during the past 12-month period      10     that respond to treatment with antihistamines or     sympathomimetics, or; one to three episodes occurring     during the past 12-month period requiring intermittent     systemic immunosuppressive therapy.........................    Or rate as disfigurement of the head, face, or neck (DC     7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805),     depending upon the predominant disability.7828 Acne:    Deep acne (deep inflamed nodules and pus-filled cysts)            30     affecting 40 percent or more of the face and neck..........    Deep acne (deep inflamed nodules and pus-filled cysts)            10     affecting less than 40 percent of the face and neck, or;     deep acne other than on the face and neck..................    Superficial acne (comedones, papules, pustules, superficial        0     cysts) of any extent.......................................    Or rate as disfigurement of the head, face, or neck (DC     7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805),     depending upon the predominant disability.7829 Chloracne:    Deep acne (deep inflamed nodules and pus-filled cysts)            30     affecting 40 percent or more of the face and neck..........    Deep acne (deep inflamed nodules and pus-filled cysts)            10     affecting less than 40 percent of the face and neck, or;     deep acne other than on the face and neck..................    Superficial acne (comedones, papules, pustules, superficial        0     cysts) of any extent.......................................    Or rate as disfigurement of the head, face, or neck (DC     7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805),     depending upon the predominant disability.7830 Scarring alopecia:    Affecting more than 40 percent of the scalp.................      20    Affecting 20 to 40 percent of the scalp.....................      10    Affecting less than 20 percent of the scalp.................       07831 Alopecia areata:    With loss of all body hair..................................      10    With loss of hair limited to scalp and face.................       07832 Hyperhidrosis:    Unable to handle paper or tools because of moisture, and          30     unresponsive to therapy....................................    Able to handle paper or tools after therapy.................       07833 Malignant melanoma:    Rate as scars (DC's 7801, 7802, 7803, 7804, or 7805),     disfigurement of the head, face, or neck (DC 7800), or     impairment of function (under the appropriate body system).    Note: If a skin malignancy requires therapy that is     comparable to that used for systemic malignancies, i.e.,     systemic chemotherapy, X-ray therapy more extensive than to     the skin, or surgery more extensive than wide local     excision, a 100-percent evaluation will be assigned from     the date of onset of treatment, and will continue, with a     mandatory VA examination six months following the     completion of such antineoplastic treatment, and any change     in evaluation based upon that or any subsequent examination     will be subject to the provisions of § 3.105(e). If     there has been no local recurrence or metastasis,     evaluation will then be made on residuals. If treatment is     confined to the skin, the provisions for a 100-percent     evaluation do not apply.------------------------------------------------------------------------

(Authority: 38 U.S.C. 1155)

[67 FR 49596, July 31, 2002; 67 FR 58448, 58449, Sept. 16, 2002]

The Endocrine System

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§ 4.119 Schedule of ratings—endocrine system.

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 ------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------7900 Hyperthyroidism  Thyroid enlargement, tachycardia (more than 100 beats per          100   minute), eye involvement, muscular weakness, loss of weight,   and sympathetic nervous system, cardiovascular, or   astrointestinal symptoms.....................................  Emotional instability, tachycardia, fatigability, and               60   increased pulse pressure or blood pressure...................  Tachycardia, tremor, and increased pulse pressure or blood          30   pressure.....................................................  Tachycardia, which may be intermittent, and tremor, or;             10   continuous medication required for control...................  Note (1): If disease of the heart is the predominant finding,   evaluate as hyperthyroid heart disease (DC 7008) if doing so   would result in a higher evaluation than using the criteria   above.  Note (2): If ophthalmopathy is the sole finding, evaluate as   field vision, impairment of (DC 6080); diplopia (DC 6090); or   impairment of central visual acuity (DC 6061-6079).7901 Thyroid gland, toxic adenoma of  Thyroid enlargement, tachycardia (more than 100 beats per          100   minute), eye involvement, muscular weakness, loss of weight,   and sympathetic nervous system, cardiovascular, or   gastrointestinal symptoms....................................  Emotional instability, tachycardia, fatigability, and               60   increased pulse pressure or blood pressure...................  Tachycardia, tremor, and increased pulse pressure or blood          30   pressure.....................................................  Tachycardia, which may be intermittent, and tremor, or;             10   continuous medication required for control...................  Note (1): If disease of the heart is the predominant finding,   evaluate as hyperthyroid heart disease (DC 7008) if doing so   would result in a higher evaluation than using the criteria   above.  Note (2): If ophthalmopathy is the sole finding, evaluate as   field vision, impairment of (DC 6080); diplopia (DC 6090); or   impairment of central visual acuity (DC 6061-6079).7902 Thyroid gland, nontoxic adenoma of  With disfigurement of the head or neck........................      20  Without disfigurement of the head or neck.....................       0  Note: If there are symptoms due to pressure on adjacent organs   such as the trachea, larynx, or esophagus, evaluate under the   diagnostic code for disability of that organ, if doing so   would result in a higher evaluation than using this   diagnostic code.7903 Hypothyroidism  Cold intolerance, muscular weakness, cardiovascular                100   involvement, mental disturbance (dementia, slowing of   thought, depression), bradycardia (less than 60 beats per   minute), and sleepiness......................................  Muscular weakness, mental disturbance, and weight gain........      60  Fatigability, constipation, and mental sluggishness...........      30  Fatigability, or; continuous medication required for control..      107904 Hyperparathyroidism  Generalized decalcification of bones, kidney stones,               100   gastrointestinal symptoms (nausea, vomiting, anorexia,   constipation, weight loss, or peptic ulcer), and weakness....  Gastrointestinal symptoms and weakness........................      60  Continuous medication required for control....................      10  Note: Following surgery or treatment, evaluate as digestive,   skeletal, renal, or cardiovascular residuals or as endocrine   dysfunction.7905 Hypoparathyroidism  Marked neuromuscular excitability (such as convulsions,            100   muscular spasms (tetany), or laryngeal stridor) plus either   cataract or evidence of increased intracranial pressure (such   as papilledema)..............................................  Marked neuromuscular excitability, or; paresthesias (of arms,       60   legs, or circumoral area) plus either cataract or evidence of   increased intracranial pressure..............................  Continuous medication required for control....................      107907 Cushing's syndrome  As active, progressive disease including loss of muscle            100   strength, areas of osteoporosis, hypertension, weakness, and   enlargement of pituitary or adrenal gland....................  Loss of muscle strength and enlargement of pituitary or             60   adrenal gland................................................  With striae, obesity, moon face, glucose intolerance, and           30   vascular fragility...........................................  Note: With recovery or control, evaluate as residuals of   adrenal insufficiency or cardiovascular, psychiatric, skin,   or skeletal complications under appropriate diagnostic code.7908 Acromegaly  Evidence of increased intracranial pressure (such as visual        100   field defect), arthropathy, glucose intolerance, and either   hypertension or cardiomegaly.................................  Arthropathy, glucose intolerance, and hypertension............      60  Enlargement of acral parts or overgrowth of long bones, and         30   enlarged sella turcica.......................................7909 Diabetes insipidus  Polyuria with near-continuous thirst, and more than two            100   documented episodes of dehydration requiring parenteral   hydration in the past year...................................  Polyuria with near-continuous thirst, and one or two                60   documented episodes of dehydration requiring parenteral   hydration in the past year...................................  Polyuria with near-continuous thirst, and one or more episodes      40   of dehydration in the past year not requiring parenteral   hydration....................................................  Polyuria with near-continuous thirst..........................      207911 Addison's disease (Adrenal Cortical Hypofunction)  Four or more crises during the past year......................      60  Three crises during the past year, or; five or more episodes        40   during the past year.........................................  One or two crises during the past year, or; two to four             20   episodes during the past year, or; weakness and fatigability,   or; corticosteroid therapy required for control..............  Note (1): An Addisonian ``crisis'' consists of the rapid onset   of peripheral vascular collapse (with acute hypotension and   shock), with findings that may include: anorexia; nausea;   vomiting; dehydration; profound weakness; pain in abdomen,   legs, and back; fever; apathy, and depressed mentation with   possible progression to coma, renal shutdown, and death.  Note (2): An Addisonian ``episode,'' for VA purposes, is a   less acute and less severe event than an Addisonian crisis   and may consist of anorexia, nausea, vomiting, diarrhea,   dehydration, weakness, malaise, orthostatic hypotension, or   hypoglycemia, but no peripheral vascular collapse.  Note (3): Tuberculous Addison's disease will be evaluated as   active or inactive tuberculosis. If inactive, these   evaluations are not to be combined with the graduated ratings   of 50 percent or 30 percent for non-pulmonary tuberculosis   specified under § 4.88b. Assign the higher rating.7912 Pluriglandular syndrome  Evaluate according to major manifestations.7913 Diabetes mellitus  Requiring more than one daily injection of insulin, restricted     100   diet, and regulation of activities (avoidance of strenuous   occupational and recreational activities) with episodes of   ketoacidosis or hypoglycemic reactions requiring at least   three hospitalizations per year or weekly visits to a   diabetic care provider, plus either progressive loss of   weight and strength or complications that would be   compensable if separately evaluated..........................  Requiring insulin, restricted diet, and regulation of               60   activities with episodes of ketoacidosis or hypoglycemic   reactions requiring one or two hospitalizations per year or   twice a month visits to a diabetic care provider, plus   complications that would not be compensable if separately   evaluated....................................................  Requiring insulin, restricted diet, and regulation of               40   activities...................................................  Requiring insulin and restricted diet, or; oral hypoglycemic        20   agent and restricted diet....................................  Manageable by restricted diet only............................      10  Note (1): Evaluate compensable complications of diabetes   separately unless they are part of the criteria used to   support a 100 percent evaluation. Noncompensable   complications are considered part of the diabetic process   under diagnostic code 7913.  Note (2): When diabetes mellitus has been conclusively   diagnosed, do not request a glucose tolerance test solely for   rating purposes.7914 Neoplasm, malignant, any specified part of the endocrine        100 system.........................................................  Note: A rating of 100 percent shall continue beyond the   cessation of any surgical, X-ray, antineoplastic chemotherapy   or other therapeutic procedure. Six months after   discontinuance of such treatment, the appropriate disability   rating shall be determined by mandatory VA examination. Any   change in evaluation based upon that or any subsequent   examination shall be subject to the provisions of §   3.105(e) of this chapter. If there has been no local   recurrence or metastasis, rate on residuals.7915 Neoplasm, benign, any specified part of the endocrine system rate as residuals of endocrine dysfunction.7916 Hyperpituitarism (prolactin secreting pituitary dysfunction)7917 Hyperaldosteronism (benign or malignant)7918 Pheochromocytoma (benign or malignant)  Note: Evaluate diagnostic codes 7916, 7917, and 7918 as   malignant or benign neoplasm as appropriate.7919 C-cell hyperplasia of the thyroid..........................     100  Note: A rating of 100 percent shall continue beyond the   cessation of any surgical, X-ray, antineoplastic chemotherapy   or other therapeutic procedure. Six months after   discontinuance of such treatment, the appropriate disability   rating shall be determined by mandatory VA examination. Any   change in evaluation based upon that or any subsequent   examination shall be subject to the provisions of §   3.105(e) of this chapter. If there has been no local   recurrence or metastasis, rate on residuals.------------------------------------------------------------------------

[61 FR 20446, May 7, 1996]

Neurological Conditions and Convulsive Disorders

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§ 4.120 Evaluations by comparison.

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Disability in this field is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, injury to the skull, etc. In rating disability from the conditions in the preceding sentence refer to the appropriate schedule. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances.

§ 4.121 Identification of epilepsy.

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When there is doubt as to the true nature of epileptiform attacks, neurological observation in a hospital adequate to make such a study is necessary. To warrant a rating for epilepsy, the seizures must be witnessed or verified at some time by a physician. As to frequency, competent, consistent lay testimony emphasizing convulsive and immediate post-convulsive characteristics may be accepted. The frequency of seizures should be ascertained under the ordinary conditions of life (while not hospitalized).

§ 4.122 Psychomotor epilepsy.

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The term psychomotor epilepsy refers to a condition that is characterized by seizures and not uncommonly by a chronic psychiatric disturbance as well.

(a) Psychomotor seizures consist of episodic alterations in conscious control that may be associated with automatic states, generalized convulsions, random motor movements (chewing, lip smacking, fumbling), hallucinatory phenomena (involving taste, smell, sound, vision), perceptual illusions (deja vu, feelings of loneliness, strangeness, macropsia, micropsia, dreamy states), alterations in thinking (not open to reason), alterations in memory, abnormalities of mood or affect (fear, alarm, terror, anger, dread, well-being), and autonomic disturbances (sweating, pallor, flushing of the face, visceral phenomena such as nausea, vomiting, defecation, a rising feeling of warmth in the abdomen). Automatic states or automatisms are characterized by episodes of irrational, irrelevant, disjointed, unconventional, asocial, purposeless though seemingly coordinated and purposeful, confused or inappropriate activity of one to several minutes (or, infrequently, hours) duration with subsequent amnesia for the seizure. Examples: A person of high social standing remained seated, muttered angrily, and rubbed the arms of his chair while the National Anthem was being played; an apparently normal person suddenly disrobed in public; a man traded an expensive automobile for an antiquated automobile in poor mechanical condition and after regaining conscious control, discovered that he had signed an agreement to pay an additional sum of money in the trade. The seizure manifestations of psychomotor epilepsy vary from patient to patient and in the same patient from seizure to seizure.

(b) A chronic mental disorder is not uncommon as an interseizure manifestation of psychomotor epilepsy and may include psychiatric disturbances extending from minimal anxiety to severe personality disorder (as distinguished from developmental) or almost complete personality disintegration (psychosis). The manifestations of a chronic mental disorder associated with psychomotor epilepsy, like those of the seizures, are protean in character.

§ 4.123 Neuritis, cranial or peripheral.

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Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. See nerve involved for diagnostic code number and rating. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis.

§ 4.124 Neuralgia, cranial or peripheral.

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Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. See nerve involved for diagnostic code number and rating. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve.

§ 4.124a Schedule of ratings—neurological conditions and convulsive disorders.

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[With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves]

Organic Diseases of the Central Nervous System------------------------------------------------------------------------ Rating------------------------------------------------------------------------8000 Encephalitis, epidemic, chronic: As active febrile disease..................................... 100 Rate residuals, minimum....................................... 10 Brain, new growth of:8002 Malignant.................................................. 100 Note: The rating in code 8002 will be continued for 2 years following cessation of surgical, chemotherapeutic or other treatment modality. At this point, if the residuals have stabilized, the rating will be made on neurological residuals according to symptomatology. Minimum rating................................................ 308003 Benign, minimum............................................ 60 Rate residuals, minimum....................................... 108004 Paralysis agitans: Minimum rating................................................ 308005 Bulbar palsy............................................... 1008007 Brain, vessels, embolism of.8008 Brain, vessels, thrombosis of.8009 Brain, vessels, hemorrhage from: Rate the vascular conditions under Codes 8007 through 8009, 100 for 6 months................................................. Rate residuals, thereafter, minimum........................... 108010 Myelitis: Minimum rating................................................ 108011 Poliomyelitis, anterior: As active febrile disease..................................... 100 Rate residuals, minimum....................................... 108012 Hematomyelia: For 6 months.................................................. 100 Rate residuals, minimum....................................... 108013 Syphilis, cerebrospinal.8014 Syphilis, meningovascular.8015 Tabes dorsalis. Note: Rate upon the severity of convulsions, paralysis, visual impairment or psychotic involvement, etc.8017 Amyotrophic lateral sclerosis: Minimum rating................................................ 308018 Multiple sclerosis: Minimum rating................................................ 308019 Meningitis, cerebrospinal, epidemic: As active febrile disease..................................... 100 Rate residuals, minimum....................................... 108020 Brain, abscess of: As active disease............................................. 100 Rate residuals, minimum....................................... 10 Spinal cord, new growths of:..................................8021 Malignant.................................................. 100 Note: The rating in code 8021 will be continued for 2 years following cessation of surgical, chemotherapeutic or other treatment modality. At this point, if the residuals have stabilized, the rating will be made on neurological residuals according to symptomatology. Minimum rating................................................ 308022 Benign, minimum rating..................................... 60 Rate residuals, minimum....................................... 108023 Progressive muscular atrophy: Minimum rating................................................ 308024 Syringomyelia: Minimum rating................................................ 308025 Myasthenia gravis: Minimum rating................................................ 30 Note: It is required for the minimum ratings for residuals under diagnostic codes 8000-8025, that there be ascertainable residuals. Determinations as to the presence of residuals not capable of objective verification, i.e., headaches, dizziness, fatigability, must be approached on the basis of the diagnosis recorded; subjective residuals will be accepted when consistent with the disease and not more likely attributable to other disease or no disease. It is of exceptional importance that when ratings in excess of the prescribed minimum ratings are assigned, the diagnostic codes utilized as bases of evaluation be cited, in addition to the codes identifying the diagnoses.8045 Brain disease due to trauma: Purely neurological disabilities, such as hemiplegia, epileptiform seizures, facial nerve paralysis, etc., following trauma to the brain, will be rated under the diagnostic codes specifically dealing with such disabilities, with citation of a hyphenated diagnostic code (e.g., 8045- 8207). Purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more under diagnostic code 9304. This 10 percent rating will not be combined with any other rating for a disability due to brain trauma. Ratings in excess of 10 percent for brain disease due to trauma under diagnostic code 9304 are not assignable in the absence of a diagnosis of multi-infarct dementia associated with brain trauma.8046 Cerebral arteriosclerosis: Purely neurological disabilities, such as hemiplegia, cranial nerve paralysis, etc., due to cerebral arteriosclerosis will be rated under the diagnostic codes dealing with such specific disabilities, with citation of a hyphenated diagnostic code (e.g., 8046-8207). Purely subjective complaints such as headache, dizziness, tinnitus, insomnia and irritability, recognized as symptomatic of a properly diagnosed cerebral arteriosclerosis, will be rated 10 percent and no more under diagnostic code 9305. This 10 percent rating will not be combined with any other rating for a disability due to cerebral or generalized arteriosclerosis. Ratings in excess of 10 percent for cerebral arteriosclerosis under diagnostic code 9305 are not assignable in the absence of a diagnosis of multi-infarct dementia with cerebral arteriosclerosis. Note: The ratings under code 8046 apply only when the diagnosis of cerebral arteriosclerosis is substantiated by the entire clinical picture and not solely on findings of retinal arteriosclerosis.------------------------------------------------------------------------

                         Miscellaneous Diseases------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------8100 Migraine:  With very frequent completely prostrating and prolonged             50   attacks productive of severe economic inadaptability.........  With characteristic prostrating attacks occurring on an             30   average once a month over last several months................  With characteristic prostrating attacks averaging one in 2          10   months over last several months..............................  With less frequent attacks....................................       08103 Tic, convulsive:  Severe........................................................      30  Moderate......................................................      10  Mild..........................................................       0  Note: Depending upon frequency, severity, muscle groups   involved.8104 Paramyoclonus multiplex (convulsive state, myoclonic type):  Rate as tic; convulsive; severe cases.........................      608105 Chorea, Sydenham's:  Pronounced, progressive grave types...........................     100  Severe........................................................      80  Moderately severe.............................................      50  Moderate......................................................      30  Mild..........................................................      10  Note: Consider rheumatic etiology and complications.8106 Chorea, Huntington's.  Rate as Sydenham's chorea. This, though a familial disease,   has its onset in late adult life, and is considered a ratable   disability.8107 Athetosis, acquired.  Rate as chorea.8108 Narcolepsy.  Rate as for epilepsy, petit mal.------------------------------------------------------------------------

                     Diseases of the Cranial Nerves------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------  Disability from lesions of peripheral portions of first,   second, third, fourth, sixth, and eighth nerves will be rated   under the Organs of Special Sense. The ratings for the   cranial nerves are for unilateral involvement; when   bilateral, combine but without the bilateral factor.  Fifth (trigeminal) cranial nerve8205 Paralysis of:  Complete......................................................      50  Incomplete, severe............................................      30  Incomplete, moderate..........................................      10  Note: Dependent upon relative degree of sensory manifestation   or motor loss.8305 Neuritis.8405 Neuralgia.  Note: Tic douloureux may be rated in accordance with severity,   up to complete paralysis.  Seventh (facial) cranial nerve8207 Paralysis of:    Complete....................................................      30    Incomplete, severe..........................................      20    Incomplete, moderate........................................      10  Note: Dependent upon relative loss of innervation of facial   muscles.8307 Neuritis.8407 Neuralgia.  Ninth (glossopharyngeal) cranial nerve........................8209 Paralysis of:  Complete......................................................      30  Incomplete, severe............................................      20  Incomplete, moderate..........................................      10  Note: Dependent upon relative loss of ordinary sensation in   mucous membrane of the pharynx, fauces, and tonsils.8309 Neuritis.8409 Neuralgia.  Tenth (pneumogastric, vagus) cranial nerve....................8210 Paralysis of:  Complete......................................................      50  Incomplete, severe............................................      30  Incomplete, moderate..........................................      10  Note : Dependent upon extent of sensory and motor loss to   organs of voice, respiration, pharynx, stomach and heart.8310 Neuritis.8410 Neuralgia.  Eleventh (spinal accessory, external branch) cranial nerve.8211 Paralysis of:  Complete......................................................      30  Incomplete, severe............................................      20  Incomplete, moderate..........................................      10  Note: Dependent upon loss of motor function of sternomastoid   and trapezius muscles.8311 Neuritis.8411 Neuralgia.  Twelfth (hypoglossal) cranial nerve.8212 Paralysis of:  Complete......................................................      50  Incomplete, severe............................................      30  Incomplete, moderate..........................................      10  Note: Dependent upon loss of motor function of tongue.8312 Neuritis.8412 Neuralgia.------------------------------------------------------------------------

Diseases of the Peripheral Nerves------------------------------------------------------------------------ Rating Schedule of ratings ----------------- Major Minor------------------------------------------------------------------------The term ``incomplete paralysis,'' with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. Upper radicular group (fifth and sixth cervicals)8510 Paralysis of: Complete; all shoulder and elbow movements lost or 70 60 severely affected, hand and wrist movements not affected........................................... Incomplete: Severe............................................ 50 40 Moderate.......................................... 40 30 Mild.............................................. 20 208610 Neuritis.8710 Neuralgia. Middle radicular group8511 Paralysis of: Complete; adduction, abduction and rotation of arm, 70 60 flexion of elbow, and extension of wrist lost or severely affected.................................. Incomplete: Severe............................................ 50 40 Moderate.......................................... 40 30 Mild.............................................. 20 208611 Neuritis.8711 Neuralgia. Lower radicular group8512 Paralysis of: Complete; all intrinsic muscles of hand, and some or 70 60 all of flexors of wrist and fingers, paralyzed (substantial loss of use of hand).................. Incomplete: Severe............................................ 50 40 Moderate.......................................... 40 30 Mild.............................................. 20 208612 Neuritis.8712 Neuralgia. All radicular groups8513 Paralysis of: Complete............................................ 90 80 Incomplete: Severe............................................ 70 60 Moderate.......................................... 40 30 Mild.............................................. 20 208613 Neuritis.8713 Neuralgia. The musculospiral nerve (radial nerve)8514 Paralysis of: Complete; drop of hand and fingers, wrist and 70 60 fingers perpetually flexed, the thumb adducted falling within the line of the outer border of the index finger; can not extend hand at wrist, extend proximal phalanges of fingers, extend thumb, or make lateral movement of wrist; supination of hand, extension and flexion of elbow weakened, the loss of synergic motion of extensors impairs the hand grip seriously; total paralysis of the triceps occurs only as the greatest rarity................. Incomplete: Severe............................................ 50 40 Moderate.......................................... 30 20 Mild.............................................. 20 208614 Neuritis.8714 Neuralgia. Note: Lesions involving only ``dissociation of extensor communis digitorum'' and ``paralysis below the extensor communis digitorum,'' will not exceed the moderate rating under code 8514. The median nerve8515 Paralysis of: Complete; the hand inclined to the ulnar side, the 70 60 index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances.......................... Incomplete: Severe............................................ 50 40 Moderate.......................................... 30 20 Mild.............................................. 10 108615 Neuritis.8715 Neuralgia. The ulnar nerve8516 Paralysis of: Complete; the ``griffin claw'' deformity, due to 60 50 flexor contraction of ring and little fingers, atrophy very marked in dorsal interspace and thenar and hypothenar eminences; loss of extension of ring and little fingers cannot spread the fingers (or reverse), cannot adduct the thumb; flexion of wrist weakened........................................... Incomplete: Severe............................................ 40 30 Moderate.......................................... 30 20 Mild.............................................. 10 108616 Neuritis.8716 Neuralgia. Musculocutaneous nerve8517 Paralysis of: Complete; weakness but not loss of flexion of elbow 30 20 and supination of forearm.......................... Incomplete: Severe............................................ 20 20 Moderate.......................................... 10 10 Mild.............................................. 0 08617 Neuritis.8717 Neuralgia. Circumflex nerve8518 Paralysis of: Complete; abduction of arm is impossible, outward 50 40 rotation is weakened; muscles supplied are deltoid and teres minor.................................... Incomplete: Severe............................................ 30 20 Moderate.......................................... 10 10 Mild.............................................. 0 08618 Neuritis.8718 Neuralgia. Long thoracic nerve8519 Paralysis of: Complete; inability to raise arm above shoulder 30 20 level, winged scapula deformity.................... Incomplete: Severe............................................ 20 20 Moderate.......................................... 10 10 Mild.............................................. 0 0 Note: Not to be combined with lost motion above shoulder level.8619 Neuritis.8719 Neuralgia. Note: Combined nerve injuries should be rated by reference to the major involvement, or if sufficient in extent, consider radicular group ratings.------------------------------------------------------------------------

 ------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------                         Sciatic nerve8520 Paralysis of:  Complete; the foot dangles and drops, no active movement            80   possible of muscles below the knee, flexion of knee weakened   or (very rarely) lost.......................................  Incomplete:    Severe, with marked muscular atrophy.......................       60    Moderately severe..........................................       40    Moderate...................................................       20    Mild.......................................................       108620 Neuritis.8720 Neuralgia.           External popliteal nerve (common peroneal)8521 Paralysis of:  Complete; foot drop and slight droop of first phalanges of          40   all toes, cannot dorsiflex the foot, extension (dorsal   flexion) of proximal phalanges of toes lost; abduction of   foot lost, adduction weakened; anesthesia covers entire   dorsum of foot and toes.....................................  Incomplete:    Severe.....................................................       30    Moderate...................................................       20    Mild.......................................................       108621 Neuritis.8721 Neuralgia.         Musculocutaneous nerve (superficial peroneal)8522 Paralysis of:  Complete; eversion of foot weakened..........................       30  Incomplete:    Severe.....................................................       20    Moderate...................................................       10    Mild.......................................................        08622 Neuritis.8722 Neuralgia.             Anterior tibial nerve (deep peroneal)8523 Paralysis of:  Complete; dorsal flexion of foot lost........................       30  Incomplete:    Severe.....................................................       20    Moderate...................................................       10    Mild.......................................................        08623 Neuritis.8723 Neuralgia.               Internal popliteal nerve (tibial)8524 Paralysis of:  Complete; plantar flexion lost, frank adduction of foot             40   impossible, flexion and separation of toes abolished; no   muscle in sole can move; in lesions of the nerve high in   popliteal fossa, plantar flexion of foot is lost............  Incomplete:    Severe.....................................................       30    Moderate...................................................       20    Mild.......................................................       108624 Neuritis.8724 Neuralgia.                     Posterior tibial nerve8525 Paralysis of:  Complete; paralysis of all muscles of sole of foot,                 30   frequently with painful paralysis of a causalgic nature;   toes cannot be flexed; adduction is weakened; plantar   flexion is impaired.........................................  Incomplete:    Severe.....................................................       20    Moderate...................................................       10    Mild.......................................................       108625 Neuritis.8725 Neuralgia.                Anterior crural nerve (femoral)8526 Paralysis of:  Complete; paralysis of quadriceps extensor muscles...........       40  Incomplete:    Severe.....................................................       30    Moderate...................................................       20    Mild.......................................................       108626 Neuritis.8726 Neuralgia.                    Internal saphenous nerve8527 Paralysis of:  Severe to complete...........................................       10  Mild to moderate.............................................        08627 Neuritis.8727 Neuralgia.                        Obturator nerve8528 Paralysis of:  Severe to complete...........................................       10  Mild or moderate.............................................        08628 Neuritis.8728 Neuralgia.               External cutaneous nerve of thigh8529 Paralysis of:  Severe to complete...........................................       10  Mild or moderate.............................................        08629 Neuritis.8729 Neuralgia.                      Ilio-inguinal nerve8530 Paralysis of:  Severe to complete...........................................       10  Mild or moderate.............................................        08630 Neuritis.8730 Neuralgia.8540 Soft-tissue sarcoma (of neurogenic origin)................      100  Note: The 100 percent rating will be continued for 6 months following   the cessation of surgical, X-ray, antineoplastic chemotherapy or   other therapeutic procedure. At this point, if there has been no   local recurrence or metastases, the rating will be made on residuals.------------------------------------------------------------------------

                             The Epilepsies------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------  A thorough study of all material in §§ 4.121 and   4.122 of the preface and under the ratings for epilepsy is   necessary prior to any rating action.8910 Epilepsy, grand mal.  Rate under the general rating formula for major seizures.8911 Epilepsy, petit mal.  Rate under the general rating formula for minor seizures.  Note (1): A major seizure is characterized by the generalized   tonic-clonic convulsion with unconsciousness.  Note (2): A minor seizure consists of a brief interruption in   consciousness or conscious control associated with staring or   rhythmic blinking of the eyes or nodding of the head   (``pure'' petit mal), or sudden jerking movements of the   arms, trunk, or head (myoclonic type) or sudden loss of   postural control (akinetic type).  General Rating Formula for Major and Minor Epileptic Seizures:    Averaging at least 1 major seizure per month over the last       100     year.......................................................    Averaging at least 1 major seizure in 3 months over the last      80     year; or more than 10 minor seizures weekly................    Averaging at least 1 major seizure in 4 months over the last      60     year; or 9-10 minor seizures per week......................    At least 1 major seizure in the last 6 months or 2 in the         40     last year; or averaging at least 5 to 8 minor seizures     weekly.....................................................    At least 1 major seizure in the last 2 years; or at least 2       20     minor seizures in the last 6 months........................    A confirmed diagnosis of epilepsy with a history of seizures      10  Note (1): When continuous medication is shown necessary for   the control of epilepsy, the minimum evaluation will be 10   percent. This rating will not be combined with any other   rating for epilepsy.  Note (2): In the presence of major and minor seizures, rate   the predominating type.  Note (3): There will be no distinction between diurnal and   nocturnal major seizures.8912 Epilepsy, Jacksonian and focal motor or sensory.8913 Epilepsy, diencephalic.  Rate as minor seizures, except in the presence of major and   minor seizures, rate the predominating type.8914 Epilepsy, psychomotor.  Major seizures:    Psychomotor seizures will be rated as major seizures under     the general rating formula when characterized by automatic     states and/or generalized convulsions with unconsciousness.  Minor seizures:    Psychomotor seizures will be rated as minor seizures under     the general rating formula when characterized by brief     transient episodes of random motor movements,     hallucinations, perceptual illusions, abnormalities of     thinking, memory or mood, or autonomic disturbances.------------------------------------------------------------------------Mental Disorders in Epilepsies: A nonpsychotic organic brain syndrome  will be rated separately under the appropriate diagnostic code (e.g.,  9304 or 9326). In the absence of a diagnosis of non-psychotic organic  psychiatric disturbance (psychotic, psychoneurotic or personality  disorder) if diagnosed and shown to be secondary to or directly  associated with epilepsy will be rated separately. The psychotic or  psychroneurotic disorder will be rated under the appropriate  diagnostic code. The personality disorder will be rated as a dementia  (e.g., diagnostic code 9304 or 9326).Epilepsy and Unemployability: (1) Rating specialists must bear in mind  that the epileptic, although his or her seizures are controlled, may  find employment and rehabilitation difficult of attainment due to  employer reluctance to the hiring of the epileptic.(2) Where a case is encountered with a definite history of unemployment,  full and complete development should be undertaken to ascertain  whether the epilepsy is the determining factor in his or her inability  to obtain employment.(3) The assent of the claimant should first be obtained for permission  to conduct this economic and social survey. The purpose of this survey  is to secure all the relevant facts and data necessary to permit of a  true judgment as to the reason for his or her unemployment and should  include information as to:(a) Education;(b) Occupations prior and subsequent to service;(c) Places of employment and reasons for termination;(d) Wages received;(e) Number of seizures.(4) Upon completion of this survey and current examination, the case  should have rating board consideration. Where in the judgment of the  rating board the veteran's unemployability is due to epilepsy and  jurisdiction is not vested in that body by reason of schedular  evaluations, the case should be submitted to the Director,  Compensation and Pension Service.

(Authority: 38 U.S.C. 1155)

[29 FR 6718, May 22, 1964, as amended at 40 FR 42540, Sept. 15, 1975; 41 FR 11302, Mar. 18, 1976; 43 FR 45362, Oct. 2, 1978; 54 FR 4282, Jan. 30, 1989; 54 FR 49755, Dec. 1, 1989; 55 FR 154, Jan. 3, 1990; 56 FR 51653, Oct. 15, 1991; 57 FR 24364, June 9, 1992; 70 FR 75399, Dec. 20, 2005]

Mental Disorders

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§ 4.125 Diagnosis of mental disorders.

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(a) If the diagnosis of a mental disorder does not conform to DSM-IV or is not supported by the findings on the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis.

(b) If the diagnosis of a mental disorder is changed, the rating agency shall determine whether the new diagnosis represents progression of the prior diagnosis, correction of an error in the prior diagnosis, or development of a new and separate condition. If it is not clear from the available records what the change of diagnosis represents, the rating agency shall return the report to the examiner for a determination.

(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996]

§ 4.126 Evaluation of disability from mental disorders.

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(a) When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination.

(b) When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment.

(c) Delirium, dementia, and amnestic and other cognitive disorders shall be evaluated under the general rating formula for mental disorders; neurologic deficits or other impairments stemming from the same etiology (e.g., a head injury) shall be evaluated separately and combined with the evaluation for delirium, dementia, or amnestic or other cognitive disorder (see §4.25).

(d) When a single disability has been diagnosed both as a physical condition and as a mental disorder, the rating agency shall evaluate it using a diagnostic code which represents the dominant (more disabling) aspect of the condition (see §4.14).

(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996]

§ 4.127 Mental retardation and personality disorders.

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Mental retardation and personality disorders are not diseases or injuries for compensation purposes, and, except as provided in §3.310(a) of this chapter, disability resulting from them may not be service-connected. However, disability resulting from a mental disorder that is superimposed upon mental retardation or a personality disorder may be service-connected.

(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996]

§ 4.128 Convalescence ratings following extended hospitalization.

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If a mental disorder has been assigned a total evaluation due to a continuous period of hospitalization lasting six months or more, the rating agency shall continue the total evaluation indefinitely and schedule a mandatory examination six months after the veteran is discharged or released to nonbed care. A change in evaluation based on that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.

(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996]

§ 4.129 Mental disorders due to traumatic stress.

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When a mental disorder that develops in service as a result of a highly stressful event is severe enough to bring about the veteran's release from active military service, the rating agency shall assign an evaluation of not less than 50 percent and schedule an examination within the six month period following the veteran's discharge to determine whether a change in evaluation is warranted.

(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996]

§ 4.130 Schedule of ratings—mental disorders.

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The nomenclature employed in this portion of the rating schedule is based upon the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (DSM-IV). Rating agencies must be thoroughly familiar with this manual to properly implement the directives in §4.125 through §4.129 and to apply the general rating formula for mental disorders in §4.130. The schedule for rating for mental disorders is set forth as follows:

 ------------------------------------------------------------------------                                                                Rating------------------------------------------------------------------------               Schizophrenia and Other Psychotic Disorders------------------------------------------------------------------------9201 Schizophrenia, disorganized type9202 Schizophrenia, catatonic type9203 Schizophrenia, paranoid type9204 Schizophrenia, undifferentiated type9205 Schizophrenia, residual type; other and unspecified types9208 Delusional disorder9210 Psychotic disorder, not otherwise specified (atypical psychosis)9211 Schizoaffective disorder------------------------------------------------------------------------     Delirium, Dementia, and Amnestic and Other Cognitive Disorders------------------------------------------------------------------------9300 Delirium9301 Dementia due to infection (HIV infection, syphilis, or other systemic or intracranial infections)9304 Dementia due to head trauma9305 Vascular dementia9310 Dementia of unknown etiology9312 Dementia of the Alzheimer's type9326 Dementia due to other neurologic or general medical conditions (endocrine disorders, metabolic disorders, Pick's disease, brain tumors, etc.) or that are substance- induced (drugs, alcohol, poisons)9327 Organic mental disorder, other (including personality change due to a general medical condition)------------------------------------------------------------------------                            Anxiety Disorders------------------------------------------------------------------------9400 Generalized anxiety disorder9403 Specific (simple) phobia; social phobia9404 Obsessive compulsive disorder9410 Other and unspecified neurosis9411 Post-traumatic stress disorder9412 Panic disorder and/or agoraphobia9413 Anxiety disorder, not otherwise specified------------------------------------------------------------------------                         Dissociative Disorders------------------------------------------------------------------------9416 Dissociative amnesia; dissociative fugue; dissociative identity disorder (multiple personality disorder)9417 Depersonalization disorder------------------------------------------------------------------------                          Somatoform Disorders------------------------------------------------------------------------9421 Somatization disorder9422 Pain disorder9423 Undifferentiated somatoform disorder9424 Conversion disorder9425 Hypochondriasis------------------------------------------------------------------------                             Mood Disorders------------------------------------------------------------------------9431 Cyclothymic disorder9432 Bipolar disorder9433 Dysthymic disorder9434 Major depressive disorder9435 Mood disorder, not otherwise specified------------------------------------------------------------------------                       Chronic Adjustment Disorder------------------------------------------------------------------------9440 Chronic adjustment disorder    General Rating Formula for Mental Disorders:        Total occupational and social impairment, due to             100         such symptoms as: gross impairment in thought         processes or communication; persistent delusions         or hallucinations; grossly inappropriate behavior;         persistent danger of hurting self or others;         intermittent inability to perform activities of         daily living (including maintenance of minimal         personal hygiene); disorientation to time or         place; memory loss for names of close relatives,         own occupation, or own name.......................        Occupational and social impairment, with                      70         deficiencies in most areas, such as work, school,         family relations, judgment, thinking, or mood, due         to such symptoms as: suicidal ideation;         obsessional rituals which interfere with routine         activities; speech intermittently illogical,         obscure, or irrelevant; near-continuous panic or         depression affecting the ability to function         independently, appropriately and effectively;         impaired impulse control (such as unprovoked         irritability with periods of violence); spatial         disorientation; neglect of personal appearance and         hygiene; difficulty in adapting to stressful         circumstances (including work or a worklike         setting); inability to establish and maintain         effective relationships...........................        Occupational and social impairment with reduced               50         reliability and productivity due to such symptoms         as: flattened affect; circumstantial,         circumlocutory, or stereotyped speech; panic         attacks more than once a week; difficulty in         understanding complex commands; impairment of         short- and long-term memory (e.g., retention of         only highly learned material, forgetting to         complete tasks); impaired judgment; impaired         abstract thinking; disturbances of motivation and         mood; difficulty in establishing and maintaining         effective work and social relationships...........        Occupational and social impairment with occasional            30         decrease in work efficiency and intermittent         periods of inability to perform occupational tasks         (although generally functioning satisfactorily,         with routine behavior, self-care, and conversation         normal), due to such symptoms as: depressed mood,         anxiety, suspiciousness, panic attacks (weekly or         less often), chronic sleep impairment, mild memory         loss (such as forgetting names, directions, recent         events)...........................................        Occupational and social impairment due to mild or             10         transient symptoms which decrease work efficiency         and ability to perform occupational tasks only         during periods of significant stress, or; symptoms         controlled by continuous medication...............        A mental condition has been formally diagnosed, but            0         symptoms are not severe enough either to interfere         with occupational and social functioning or to         require continuous medication.....................------------------------------------------------------------------------                            Eating Disorders------------------------------------------------------------------------9520 Anorexia nervosa9521 Bulimia nervosa    Rating Formula for Eating Disorders:        Self-induced weight loss to less than 80 percent of          100         expected minimum weight, with incapacitating         episodes of at least six weeks total duration per         year, and requiring hospitalization more than         twice a year for parenteral nutrition or tube         feeding...........................................        Self-induced weight loss to less than 85 percent of           60         expected minimum weight with incapacitating         episodes of six or more weeks total duration per         year..............................................        Self-induced weight loss to less than 85 percent of           30         expected minimum weight with incapacitating         episodes of more than two but less than six weeks         total duration per year...........................        Binge eating followed by self-induced vomiting or             10         other measures to prevent weight gain, or         resistance to weight gain even when below expected         minimum weight, with diagnosis of an eating         disorder and incapacitating episodes of up to two         weeks total duration per year.....................        Binge eating followed by self-induced vomiting or              0         other measures to prevent weight gain, or         resistance to weight gain even when below expected         minimum weight, with diagnosis of an eating         disorder but without incapacitating episodes......------------------------------------------------------------------------Note: An incapacitating episode is a period during which bed rest and  treatment by a physician are required.

(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996]

Dental and Oral Conditions

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§ 4.149 [Reserved]

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§ 4.150 Schedule of ratings—dental and oral conditions.

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 ------------------------------------------------------------------------                                                                  Rating------------------------------------------------------------------------9900 Maxilla or mandible, chronic osteomyelitis or osteoradionecrosis of:    Rate as osteomyelitis, chronic under diagnostic code 5000...9901 Mandible, loss of, complete, between angles................     1009902 Mandible, loss of approximately one-half:    Involving temporomandibular articulation....................      50    Not involving temporomandibular articulation................      309903 Mandible, nonunion of:    Severe......................................................      30    Moderate....................................................      10    Note_Dependent upon degree of motion and relative loss of     masticatory function.......................................9904 Mandible, malunion of:    Severe displacement.........................................      20    Moderate displacement.......................................      10    Slight displacement.........................................       0    Note_Dependent upon degree of motion and relative loss of     masticatory function.......................................9905 Temporomandibular articulation, limited motion of:    Inter-incisal range:        0 to 10 mm..............................................      40        11 to 20 mm.............................................      30        21 to 30 mm.............................................      20        31 to 40 mm.............................................      10    Range of lateral excursion:        0 to 4 mm...............................................      10    Note_Ratings for limited inter-incisal movement shall not be     combined with ratings for limited lateral excursion........9906 Ramus, loss of whole or part of:    Involving loss of temporomandibular articulation        Bilateral...............................................      50        Unilateral..............................................      30    Not involving loss of temporomandibular articulation        Bilateral...............................................      30        Unilateral..............................................      209907 Ramus, loss of less than one-half the substance of, not involving loss of continuity:    Bilateral...................................................      20    Unilateral..................................................      109908 Condyloid process, loss of, one or both sides..............      309909 Coronoid process, loss of:    Bilateral...................................................      20    Unilateral..................................................      109911 Hard palate, loss of half or more:    Not replaceable by prosthesis...............................      30    Replaceable by prosthesis...................................      109912 Hard palate, loss of less than half of:    Not replaceable by prosthesis...............................      20    Replaceable by prosthesis...................................       09913 Teeth, loss of, due to loss of substance of body of maxilla or mandible without loss of continuity:    Where the lost masticatory surface cannot be restored by     suitable prosthesis:        Loss of all teeth.......................................      40        Loss of all upper teeth.................................      30        Loss of all lower teeth.................................      30        All upper and lower posterior teeth missing.............      20        All upper and lower anterior teeth missing..............      20        All upper anterior teeth missing........................      10        All lower anterior teeth missing........................      10        All upper and lower teeth on one side missing...........      10    Where the loss of masticatory surface can be restored by           0     suitable prosthesis........................................    Note_These ratings apply only to bone loss through trauma or     disease such as osteomyelitis, and not to the loss of the     alveolar process as a result of periodontal disease, since     such loss is not considered disabling......................9914 Maxilla, loss of more than half:    Not replaceable by prosthesis...............................     100    Replaceable by prosthesis...................................      509915 Maxilla, loss of half or less:    Loss of 25 to 50 percent:        Not replaceable by prosthesis...........................      40        Replaceable by prosthesis...............................      30    Loss of less than 25 percent:        Not replaceable by prosthesis...........................      20        Replaceable by prosthesis...............................       09916 Maxilla, malunion or nonunion of:    Severe displacement.........................................      30    Moderate displacement.......................................      10    Slight displacement.........................................       0------------------------------------------------------------------------

[59 FR 2530, Jan. 18, 1994]

Appendix A to Part 4—Table of Amendments and Effective Dates Since 1946

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 ------------------------------------------------------------------------               Sec.------------------------------------------------------------------------4.16                               Last sentence; March 1, 1963.4.17                               October 7, 1948.4.17a                              March 1, 1963.4.29                               Introductory portion preceding                                    paragraph (a); March 1, 1963.                                   Paragraph (a) ``first day of                                    continuous hospitalization''; April                                    8, 1959.                                   Paragraph (a) ``terminated last day                                    of month''; December 1, 1962.                                   Paragraph (a) penultimate sentence;                                    November 13, 1970.                                   Paragraph (b); April 8, 1959.                                   Paragraph (c); August 16, 1948.                                   Paragraph (d); August 16, 1948.                                   Paragraph (e); March 1, 1963.                                   Paragraph (f); August 9, 1976.                                    Note: Application of this section to                                    psychoneurotic and psychophysiologic                                    disorders effective October 1, 1961.4.30                               Introductory portion of paragraph (a)                                    preceding subparagraph (1); July 6,                                    1950.                                   Paragraph (a)(1); June 9, 1952.                                   Paragraph (a)(2); June 9, 1952.                                   Paragraph (a)(3); June 9, 1952.                                    Effective as to outpatient treatment                                    March 10, 1976.                                   Paragraph (b)(1); March 1, 1963.                                   Paragraph (b)(2); August 9, 1976.4.55                               Paragraph (b) first sentence; March                                    1, 1963.4.63                               June 17, 1948.4.64                               October 1, 1956.4.71a                              Diagnostic Code 5000_60 percent;                                    February 1, 1962.                                   Diagnostic Code 5000 Note (2):                                   First three sentences; July 10, 1956.                                   Last sentence; July 6, 1950.                                   Diagnostic Code 5002_100 percent, 60                                    percent, 40 percent, 20 percent;                                    March 1, 1963.                                   Diagnostic Code 5003; July 6, 1950.                                   Diagnostic Code 5012_Note; March 10,                                    1976.                                   In sentence following DC 5024:                                    ``except gout which will be rated                                    under 5002''; March 1, 1963.                                   Diagnostic Code 5051;                                   Diagnostic Code 5052;                                   Diagnostic Code 5053;                                   Diagnostic Code 5054; September 9,                                    1975.                                   Diagnostic Code 5055; September 9,                                    1975.                                   Diagnostic Code 5056;                                   Diagnostic Code 5164_60 percent; June                                    9, 1952.                                   Diagnostic Code 5172; July 6, 1950.                                   Diagnostic Code 5173; June 9, 1952.                                   Diagnostic Code 5255 ``or hip''; July                                    6, 1950.                                   Diagnostic Code 5257_Evaluation; July                                    6, 1950.                                   Diagnostic Code 5297_(Removal of one                                    rib) ``or resection of 2 or more'';                                    August 23, 1948.                                   Diagnostic Code 5297_Note (2):                                    Reference to lobectomy;                                    pneumonectomy and graduated ratings;                                    February 1, 1962.                                   Diagnostic Code 5298; August 23,                                    1948.4.73                               Diagnostic Code 5324; February 1,                                    1962.                                   Diagnostic Code 5327; March 10, 1976.                                   Diagnostic Code 5328; March 10, 1976.4.78                               Last sentence; December 1, 1963.4.84a                              Diagnostic Code 6029_Note; August 23,                                    1948.                                   Diagnostic Code 6035; September 9,                                    1975.                                   Diagnostic Code 6076_60%: Vision 1                                    eye 15/200 and other eye 20/100;                                    August 23, 1948.                                   Diagnostic Code 6080_Note_``as to 38                                    U.S.C. 1114(L)''; July 6, 1950.                                   Diagnostic Code 6081_Words                                    ``unilateral'', ``minimal'' and all                                    of Note; March 10, 1976.4.84b                              Removed-December 18, 1987 (text                                    redesignated § 4.871, December                                    18, 1987)4.85                               March 23, 1956. December 18, 1987.4.86                               March 23, 1956. December 18, 1987.4.86a                              March 23, 1956. December 18, 1987.4.87                               Tables VI and VII replaced by new                                    Tables VI VIa and VII December 18,                                    1987.4.87a                              Diagnostic Codes 6277 through 6297;                                    March 23, 1956; removed December 18,                                    1987. (Text from § 4.84b                                    redesignated § 4.87a, December                                    18, 1987).4.88a                              Diagnostic Code 6304_Notes (1) and                                    (2); August 23, 1948.                                   Diagnostic Code 6309; March 1, 1963.                                   Diagnostic Code 6350; 80% Evaluation                                    and Criterion for 60% and 30%                                    Evaluations; March 10, 1976. Other                                    Evaluations and Note; March 1, 1963.4.89                               Ratings for nonpulmonary TB; December                                    1, 1949.4.97                               Diagnostic Code 6600_100% Evaluations                                    and Criteria for 60%; September 9,                                    1975.                                   Diagnostic Code 6602_Criteria for all                                    Evaluations and Note; September 9,                                    1975.                                   Diagnostic Code 6603; September 9,                                    1975.                                   Second note following Diagnostic Code                                    6724; December 1, 1949.                                   Diagnostic Code 6802_Criteria for all                                    Evaluations; September 9, 1975.                                   Diagnostic Code 6819_Note; March 10,                                    1976.                                   Diagnostic Code 6821_Evaluations and                                    Note; August 23, 1948.4.104                              Diagnostic Code 7000_30 percent; July                                    6, 1950.                                   Diagnostic Code 7000_100 percent                                    inactive ``with signs of congestive                                    failure upon any exertion beyond                                    rest in bed'' revoked;                                   Diagnostic Code 7005_80 percent                                    revoked;                                   Diagnostic Code 7007_80 percent                                    revoked;                                   Diagnostic Code 7015_100 percent                                    Evaluation. Criteria for All                                    Evaluations and Notes (1) and (2);                                    September 9, 1975.                                   Diagnostic Code 7016; September 9,                                    1975.                                   Diagnostic Code 7017;                                   Diagnostic Code 7100_20 percent; July                                    6, 1950.                                   Diagnostic Code 7101 ``or more'';                                    September 1, 1960.                                   Diagnostic Code 7101_Note (2);                                    September 9, 1975.                                   Diagnostic Code 7110_Criteria for 100                                    percent, Note and 60 percent and 20                                    percent Evaluations; September 9,                                    1975.                                   Diagnostic Code 7111_Note; September                                    9, 1975.                                   Diagnostic Codes 7114, 7115, 7116,                                    and Note; June 9, 1952.                                   Diagnostic Code 7117 and Note; June                                    9, 1952.                                   Note following Diagnostic Code 7120;                                    July 6, 1950.                                   Diagnostic Code 7121_100 percent                                    Criterion and Evaluation and 60                                    percent Criterion; March 10, 1976.                                    Criteria for 30 percent and 10                                    percent and Note; July 6, 1950.                                   Last sentence of Note following                                    Diagnostic Code 7122; July 6, 1950.4.114                              Diagnostic Codes 7304 and                                    7305_Evaluations; November 1, 1962.                                   Diagnostic Code 7308_Evaluations;                                    April 8, 1959.                                   Diagnostic Code 7312_70% Evaluation                                    and 50% Evaluation and Criterion;                                    March 10, 1976.                                   Diagnostic Code 7313_20% Evaluation;                                    March 10, 1976.                                   Diagnostic Code 7319_Evaluations;                                    November 1, 1962.                                   Diagnostic Code 7321_Evaluations and                                    Note; July 6, 1950.                                   Diagnostic Code 7328_Evaluations and                                    Note; November 1, 1962.                                   Diagnostic Code 7329_Evaluations and                                    Note; November 1, 1962.                                   Diagnostic Code 7330_60% Evaluation;                                    November 1, 1962.                                   Diagnostic Code 7332_60% Evaluation;                                    November 1, 1962.                                   Diagnostic Code 7334_50% and 30%                                    Evaluations; July 6, 1950.                                   Diagnostic Code 7334_10% Evaluation;                                    November 1, 1962.                                   Diagnostic Code 7339_Criterion for                                    20% Evaluation; March 10, 1976.                                   Diagnostic Code 7343_Note; March 10,                                    1976.                                   Diagnostic Code 7345_100%, 60% and                                    30% Evaluations; August 23, 1948.                                   Diagnostic Code 7345_10% Evaluation;                                    February 17, 1955.                                   Diagnostic Code 7345_10% Evaluation;                                    February 17, 1955.                                   Diagnostic Code 7346_Evaluations;                                    February 1, 1962.                                   Diagnostic Code 7347; September 9,                                    1975.                                   Diagnostic Code 7348; March 10, 1976.4.115a                             Diagnostic Code 7500_Note; July 6,                                    1950.                                   Diagnostic Code 7519_20%, 40% and 60%                                    Evaluations; March 10, 1976.                                   Diagnostic Code 7524_Note; July 6,                                    1950.                                   Diagnostic Code 7528_Note; March 10,                                    1976.                                   Diagnostic Code 7530; September 9,                                    1975.                                   Diagnostic Code 7531; September 9,                                    1975.4.116a                             Diagnostic Code 7627_Note; March 10,                                    1976.4.117                              Diagnostic Code 7703_Evaluations;                                    August 23, 1948.                                   Diagnostic Code 7709_Note; March 10,                                    1976. Evaluations; June 9, 1952.                                   Diagnostic Code 7714; September 9,                                    1975.4.118                              Diagnostic Code 7801_Note (2); July                                    6, 1950.                                   Diagnostic Code 7804_Note; July 6,                                    1950.4.119                              Diagnostic Code 7900_10% Evaluation;                                    and Notes (2) and (3); August 13,                                    1981.                                   Diagnostic Code 7902_20% Evaluation;                                    August 13, 1981.                                   Diagnostic Code 7903_10% Evaluation;                                    August 13, 1981.                                   Diagnostic Code 7905_10% Evaluation;                                    August 13, 1981.                                   Diagnostic Code 7907_60% Evaluation;                                    August 13, 1981.                                   Diagnostic Code 7909_40% and 20%                                    Evaluation; August 13, 1981.                                   Diagnostic Code 7911_Evaluations and                                    Note; March 1, 1963; 40% and 20%                                    Evaluations; August 13, 1981.                                   Diagnostic Code 7913_Note; September                                    9, 1975.                                   Diagnostic Code 7914_Note; March 10,                                    1976.4.122                              October 1, 1961.4.124a                             Diagnostic Code 8002, Note;                                   Diagnostic Code 8021, Note;                                   Diagnostic Code 8045; October 1,                                    1961.                                   Diagnostic Code 8046; October 1,                                    1961.                                   Diagnostic Code 8100_Evaluations;                                    June 9, 1953.                                   Diagnostic Codes 8910 through 8914;                                    October 1, 1961.                                   Diagnostic Codes 8910 through 8914                                    General Rating Formula_Criteria and                                    Evaluations; September 9, 1975.4.125-4.132                        All Diagnostic Codes under Mental                                    Disorders; October 1, 1961, except                                    as to evaluation for Diagnostic                                    Codes 9500 through 9511; September                                    9, 1975.------------------------------------------------------------------------

[29 FR 6718, May 22, 1964, as amended at 34 FR 5064, Mar. 11, 1969; 40 FR 42541, Sept. 15, 1975; 41 FR 11291, Mar. 18, 1976; 41 FR 34258, Aug. 13, 1976; 43 FR 45362, Oct. 2, 1978; 46 FR 43666, Aug. 31, 1981; 52 FR 44122, Nov. 18, 1987; 52 FR 46439, Dec. 7, 1987]

Appendix B to Part 4—Numerical Index of Disabilities

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                 [acute, subacute, or chronic diseases]------------------------------------------------------------------------       Diagnostic Code No.------------------------------------------------------------------------5000                               Osteomyelitis, acute, subacute, or                                    chronic.5001                               Bones and Joints, tuberculosis of.5002                               Arthritis, rheumatoid (atrophic).5003                               Arthritis, degenerative,                                    hypertrophic, or osteoarthritis.5004                               Arthritis, gonorrheal.5005                               Arthritis, pneumococcic.5006                               Arthritis, typhoid.5007                               Arthritis, syphilitic.5008                               Arthritis, streptococcic.5009                               Arthritis, other types.5010                               Arthritis, due to trauma.5011                               Bones, caisson disease of.5012                               Bones, new growths of, malignant.5013                               Osteoporosis, with joint                                    manifestations.5014                               Osteomalacia.5015                               Bones, new growths of, benign.5016                               Osteitis deformans.5017                               Gout.5018                               Hydrarthrosis, intermittent.5019                               Bursitis.5020                               Synovitis.5021                               Myositis.5022                               Periostitis.5023                               Myositis ossificans.5024                               Tenosynovitis.------------------------------------------------------------------------                      combinations of disabilities------------------------------------------------------------------------5100                               Anatomical loss of both hands and                                    both feet.5101                               Loss of use of both hands and both                                    feet.5102                               Anatomical loss of both hands and one                                    foot.5103                               Anatomical loss of both feet and one                                    hand.5104                               Loss of use of both hands and one                                    foot.5105                               Loss of use of both feet and one                                    hand.5106                               Anatomical loss of both hands.5107                               Anatomical loss of both feet.5108                               Anatomical loss of one hand and one                                    foot.5109                               Loss of use of both hands.5110                               Loss of use of both feet.5111                               Loss of use of one hand and one foot.------------------------------------------------------------------------                      amputations: upper extremity------------------------------------------------------------------------                                   Arm, amputation of:5120                                Disarticulation.5121                                Above insertion of deltoid.5122                                Below insertion of deltoid.                                   Forearm, amputation of:5123                                Above insertion of pronator teres.5124                                Below insertion of pronator teres.5125                                Hand, loss of use of.5126                                Five digits of one hand, amputation                                    of:                                   Four digits of one hand, amputation                                    of:5127                                Thumb, index, middle and ring.5128                                Thumb, index, middle and little.5129                                Thumb, index, ring and little.5130                                Thumb, middle, ring and little.5131                                Index, middle, ring and little.                                   Three digits of one hand, amputation                                    of:5132                                Thumb, index and middle.5133                                Thumb, index and ring.5134                                Thumb, index and little.5135                                Thumb, middle and ring.5136                                Thumb, middle and little.5137                                Thumb, ring and little.5138                                Index, middle and ring.5139                                Index, middle and little.5140                                Index, ring and little.5141                                Middle, ring and little.                                   Two digits of one hand, amputation                                    of:5142                                Thumb and index.5143                                Thumb and middle.5144                                Thumb and ring.5145                                Thumb and little.5146                                Index and middle.5147                                Index and ring.5148                                Index and little.5149                                Middle and ring.5150                                Middle and little.5151                                Ring and little.5152                               Thumb, amputation of.5153                               Index finger, amputation of.5154                               Middle finger, amputation of.5155                               Ring finger, amputation of.5156                               Little finger, amputation of.------------------------------------------------------------------------                      amputations: lower extremity------------------------------------------------------------------------                                   Thigh, amputation of:5160                                Disarticulation.5161                                Upper third.5162                                Middle or lower thirds.                                   Leg, amputation of:5163                                With defective stump.5164                                With loss of natural knee action.5165                                At a lower level.5166                               Forefoot, amputation proximal to                                    metatarsal bones.5167                               Foot, loss of use of.5170                               Toes, all, amputation of, without                                    metatarsal loss.5171                               Toe, great, amputation of.5172                               Toe, other, amputation of.5173                               Toes, three or more, amputation of,                                    not including great toe.------------------------------------------------------------------------                          the shoulder and arm------------------------------------------------------------------------5200                               Scapulohumeral articulation,                                    ankylosis of.5201                               Arm, limitation of motion of.5202                               Humerus, other impairment of.5203                               Clavicle or scapula, impairment of.------------------------------------------------------------------------                          the elbow and forearm------------------------------------------------------------------------5205                               Elbow, ankylosis of.5206                               Forearm, limitation of flexion of.5207                               Forearm, limitation of extension of5208                               Forearm, flexion limited to 100°                                    and extension to 45°.5209                               Elbow, other impairment of.5210                               Radius and ulna, nonunion of, with                                    flail false joint.5211                               Ulna, impairment of.5212                               Radius, impairment of.5213                               Supination and pronation, impairment                                    of.------------------------------------------------------------------------                           the wrist and hand------------------------------------------------------------------------5214                               Wrist, ankylosis.5215                               Wrist, limitation of motion of.5216                               Five digits of one hand, unfavorable                                    ankylosis of.5217                               Four digits of one hand, unfavorable                                    ankylosis of.5218                               Three digits of one hand, unfavorable                                    ankylosis of.5219                               Two digits of one hand, unfavorable                                    ankylosis of.5220                               Five digits of one hand, favorable                                    ankylosis of.5221                               Four digits of one hand, favorable                                    ankylosis of.5222                               Three digits of one hand, favorable                                    ankylosis of.5223                               Two digits of one hand, favorable                                    ankylosis of.5224                               Thumb, ankylosis of.5225                               Index finger, ankylosis of.5226                               Middle finger, ankylosis of.5227                               Finger, any other, ankylosis of.------------------------------------------------------------------------                            the hip and thigh------------------------------------------------------------------------5250                               Hip, ankylosis of.5251                               Thigh, limitation of extension of.5252                               Thigh, limitation of flexion of.5253                               Thigh, impairment of.5254                               Hip, flail joint.5255                               Femur, impairment of.------------------------------------------------------------------------                            the knee and leg------------------------------------------------------------------------5256                               Knee, ankylosis of.5257                               Knee, other impairment of.5258                               Cartilage, semilunar, dislocated.5259                               Cartilage, semilunar, removal of.5260                               Leg, limitation of flexion of.5261                               Leg, limitation of extension of.5262                               Tibia and fibula, impairment of.5263                               Genu recurvatum.------------------------------------------------------------------------                                the ankle------------------------------------------------------------------------5270                               Ankle, ankylosis of.5271                               Ankle, limited motion of.5272                               Subastragalar or tarsal joint,                                    ankylosis of.5273                               Os calcis or astragalus, malunion of.5274                               Astragalectomy.------------------------------------------------------------------------                    shortening of the lower extremity------------------------------------------------------------------------5275                               Bones, of the lower extremity,                                    shortening of.------------------------------------------------------------------------                                the foot------------------------------------------------------------------------5276                               Flatfoot, acquired.5277                               Weak foot, bilateral.5278                               Claw foot (pes cavus), acquired.5279                               Metatarsalgia, anterior (Morton's                                    disease).5280                               Hallux valgus.5281                               Hallux rigidus.5282                               Hammer toe.5283                               Tarsal, or metatarsal bones, malunion                                    of, or nonunion of.5284                               Foot injuries, other.------------------------------------------------------------------------                                the spine------------------------------------------------------------------------5285                               Vertebra, fracture of, residuals.5286                               Spine, complete bony fixation                                    (ankylosis) of.5287                               Spine, ankylosis of, cervical.5288                               Spine, ankylosis of, dorsal.5289                               Spine, ankylosis of, lumbar.5290                               Spine, limitation of motion of,                                    cervical.5291                               Spine, limitation of motion of,                                    dorsal.5292                               Spine, limitation of motion of,                                    lumbar.5293                               Intervertebral disc syndrome.5294                               Sacroiliac injury and weakness.5295                               Lumbosacral strain.------------------------------------------------------------------------                                the skull------------------------------------------------------------------------5296                               Skull, loss of part of, both inner                                    and outer tables.------------------------------------------------------------------------                                the ribs------------------------------------------------------------------------5297                               Ribs, removal of.------------------------------------------------------------------------                               the coccyx------------------------------------------------------------------------5298                               Coccyx, removal of.------------------------------------------------------------------------                             muscle injuries------------------------------------------------------------------------5301                               Group I_Extrinsic muscles of shoulder                                    girdle.5302                               Group II_Extrinsic muscles of                                    shoulder girdle.5303                               Group III_Intrinsic muscles of                                    shoulder girdle.5304                               Group IV_Intrinsic muscles of                                    shoulder girdle.5305                               Group V_Flexor muscles of the elbow.5306                               Group VI_Extensor muscles of the                                    elbow.5307                               Group VII_Muscles arising from                                    internal condyle of humerus.5308                               Group VIII_Muscles arising mainly                                    from external condyle of humerus.5309                               Group IX_Intrinsic muscles of the                                    hand.5310                               Group X_Intrinsic muscles of the                                    foot.5311                               Group XI_Posterior and lateral                                    muscles of the leg.5312                               Group XII_Anterior muscles of the                                    leg.5313                               Group XIII_Posterior thigh group.5314                               Group XIV_Anterior thigh group.5315                               Group XV_Mesial thigh group.5316                               Group XVI_Pelvic girdle group 1.5317                               Group XVII_Pelvic girdle group 2.5318                               Group XVIII_Pelvic girdle group 3.5319                               Group XIX_Muscles of the abdominal                                    wall.5320                               Group XX_Spinal muscles.5321                               Group XXI_Muscles of respiration.5322                               Group XXII_Lateral, supra and                                    infrahyoid group.5323                               Group XXIII_Lateral and posterior                                    muscles of the neck.5324                               Diaphragm, rupture of.5325                               Muscle injury, facial muscles.5326                               Muscle hernia.------------------------------------------------------------------------                           diseases of the eye------------------------------------------------------------------------6000                               Uveitis.6001                               Keratitis.6002                               Scleritis.6003                               Iritis.6004                               Cyclitis.6005                               Choroiditis.6006                               Retinitis.6007                               Hemorrhage, intra-ocular, recent.6008                               Retina, detachment of.6009                               Eye, injury of, unhealed.6010                               Eye, tuberculosis of.6011                               Retina, localized scars.6012                               Glaucoma, congestive or inflammatory.6013                               Glaucoma, simple, primary,                                    noncongestive.6014                               New growths, malignant, eyeball.6015                               New growths, benign, eyeball and                                    adnexa.6016                               Nystagmus, central.6017                               Conjunctivitis, trachomatous,                                    chronic.6018                               Conjunctivitis, other, chronic.6019                               Ptosis, eyelids.6020                               Ectropion.6021                               Entropion.6022                               Lagophthalmos.6023                               Eyebrows, loss of.6024                               Eyelashes, loss of.6025                               Epiphora.6026                               Neuritis, optic.6027                               Cataract, traumatic.6028                               Cataract, senile, and others.6029                               Aphakia.6030                               Accommodation, paralysis of.6031                               Dacryocystitis.6032                               Eyelids, loss of portion of.6033                               Lens, crystalline, dislocation of.6034                               Pterygium.------------------------------------------------------------------------                      combinations of disabilities------------------------------------------------------------------------6050                               Blindness in both eyes having only                                    light perception and anatomical loss                                    of both hands and both feet.6051                               Blindness in both eyes having only                                    light perception and loss of use of                                    both hands and both feet.6052                               Blindness in both eyes having only                                    light perception and anatomical loss                                    of both hands.6053                               Blindness in both eyes having only                                    light perception and anatomical loss                                    of both feet.6054                               Blindness in both eyes having only                                    light perception and anatomical loss                                    of one hand and one foot.6055                               Blindness in both eyes having only                                    light perception and loss of use of                                    both hands.6056                               Blindness in both eyes having only                                    light perception and loss of use of                                    both feet.6057                               Blindness in both eyes having only                                    light perception and loss of use of                                    one hand and one foot.6058                               Blindness in both eyes having only                                    light perception and anatomical loss                                    of one hand.6059                               Blindness in both eyes having only                                    light perception and anatomical loss                                    of one foot.6060                               Blindness in both eyes having only                                    light perception and loss of use of                                    one hand.6061                               Blindness in both eyes having only                                    light perception and loss of use of                                    one foot.6062                               Blindness in both eyes having only                                    light perception.------------------------------------------------------------------------                   impairment of central visual acuity------------------------------------------------------------------------                                   Blindness, anatomical loss, one eye:6063                                Other blind (5/200 or less).6064                                Other impaired (20/200 or less).6065                                Other impaired.6066                                Other normal.                                   Blindness, light perception only one                                    eye:6067                                Other blind (5/200 or less).6068                                Other impaired (20/200 or less).6069                                Other impaired.6070                                Other normal.                                   Blindness, total (5/200 or less):6071                                Both eyes.                                   Blindness, total one eye (5/200 or                                    less):6072                                Other impaired (20/200 or less).6073                                Other impaired.6074                                Other normal.                                   Blindness, partial (20/200 or less):6075                                Both eyes.                                    One eye:6076                                Other impaired.6077                                Other normal.                                   Blindness, partial:6078                                Both eyes.6079                                One eye only.6080                               Field vision, impairment of.6081                               Scotoma, pathological.6090                               Muscle function, ocular, impairment                                    of.6091                               Symblepharon.6092                               Diplopia, due to limited muscle                                    function.------------------------------------------------------------------------                      impairment of auditory acuity----------------------------------6100                               0% evaluation based on Table VII6101                               10% evaluation based on Table VII6102                               20% evaluation based on Table VII6103                               30% evaluation based on Table VII6104                               40% evaluation based on Table VII6105                               50% evaluation based on Table VII6106                               60% evaluation based on Table VII6107                               70% evaluation based on Table VII6108                               80% evaluation based on Table VII6109                               90% evaluation based on Table VII6110                               100% evaluation based on Table VII.----------------------------------                           diseases of the ear------------------------------------------------------------------------6200                               Otitis media, suppurative, chronic.6201                               Otitis media, catarrhal, chronic.6202                               Otosclerosis.6203                               Otitis interna.6204                               Labyrinthitis.6205                               Meniere's syndrome.6206                               Mastoiditis.6207                               Auricle, loss or deformity.6208                               New growths, malignant, ear.6209                               New growths, benign, ear.6210                               Auditory canal, disease of.6211                               Tympanic membrane, perforation of.6260                               Tinnitus.------------------------------------------------------------------------                           other sense organs------------------------------------------------------------------------6275                               Smell, loss of sense of.6276                               Taste, loss of sense of.------------------------------------------------------------------------                            systemic diseases------------------------------------------------------------------------6300                               Cholera, Asiatic.6301                               Kala-azar (visceral leishmaniasis).6302                               Leprosy.6304                               Malaria.6305                               Filariasis.6306                               Oroya fever.6307                               Plague.6308                               Relapsing fever.6309                               Rheumatic fever.6310                               Syphilis, unspecified.6311                               Tuberculosis, military.6313                               Avitaminosis.6314                               Beriberi.6315                               Pellagra.6316                               Brucellosis (Malta or undulant                                    fever).6317                               Typhus, scrub.6350                               Lupus erythematosus, systemic.------------------------------------------------------------------------                           respiratory system----------------------------------                           the nose and throat------------------------------------------------------------------------6501                               Rhinitis, atrophic, chronic.6502                               Septum, nasal, deflection of.6504                               Nose, loss of part of, or scars.6510                               Sinusitis, pansinusitis, chronic.6511                               Sinusitis, ethmoid, chronic.6512                               Sinusitis, frontal, chronic.6513                               Sinusitis, maxillary, chronic.6514                               Sinusitis, sphenoid, chronic.6515                               Laryngitis, tuberculous.6516                               Laryngitis, chronic.6517                               Larynx, injuries of, healed.6518                               Laryngectomy.6519                               Aphonia, organic.6520                               Larynx, stenosis of.------------------------------------------------------------------------                         the trachea and bronchi------------------------------------------------------------------------6600                               Bronchitis, chronic.6601                               Bronchiectasis.6602                               Asthma, bronchial.------------------------------------------------------------------------                          the lungs and pleura------------------------------------------------------------------------6701                               Tuberculosis, pulmonary, chronic, far                                    advanced, active.6702                               Tuberculosis, pulmonary, chronic,                                    moderately advanced, active.6703                               Tuberculosis, pulmonary, chronic,                                    minimal, active.6704                               Tuberculosis, pulmonary, chronic,                                    active, advancement unspecified.6707                               Tuberculosis, pulmonary, chronic, far                                    advanced, active.6708                               Tuberculosis, pulmonary, chronic,                                    moderately advanced, active.6709                               Tuberculosis, pulmonary, chronic,                                    minimal, active.6710                               Tuberculosis, pulmonary, chronic,                                    active, advancement unspecified.6721                               Tuberculosis, pulmonary, chronic, far                                    advanced, inactive.6722                               Tuberculosis, pulmonary, chronic,                                    moderately advanced, inactive.6723                               Tuberculosis, pulmonary, chronic,                                    minimal, inactive.6724                               Tuberculosis, pulmonary, chronic,                                    inactive, advancement unspecified.6725                               Tuberculosis, pulmonary, chronic, far                                    advanced, inactive.6726                               Tuberculosis, pulmonary, chronic,                                    moderately advanced, inactive.6727                               Tuberculosis, pulmonary, chronic,                                    minimal, inactive.6728                               Tuberculosis, pulmonary, chronic,                                    inactive, advancement unspecified.6732                               Pleurisy, tuberculous.6800                               Anthracosis.6801                               Silicosis.6802                               Pneumoconiosis, unspecified.6803                               Actinomycosis of lung.6804                               Streptotrichosis of lung.6805                               Blastomycosis of lung.6806                               Sporotrichosis of lung.6807                               Aspergillosis of lung.6808                               Mycosis of lung, unspecified.6809                               Lung, abscess of.6810                               Pleurisy, serofibrinous.6811                               Pleurisy, purulent (empyema).6812                               Fistula, bronchocutaneous, or                                    bronchopleural.6813                               Lung, permanent collapse of.6814                               Pneumothorax, spontaneous.6815                               Pneumonectomy.6816                               Lobectomy.6817                               Lung, chronic passive congestion of.6818                               Pleural cavity, injuries, residuals                                    of, including gunshot wounds.6819                               New growths, malignant, any specified                                    part of respiratory system.6820                               New growths, benign, any specified                                    part of respiratory system.6821                               Coccidioidomycosis.------------------------------------------------------------------------                        the cardiovascular system----------------------------------                                the heart------------------------------------------------------------------------7000                               Rheumatic heart disease.7001                               Endocarditis, bacterial, subacute.7002                               Pericarditis, bacterial or rheumatic,                                    acute.7003                               Adhesions, pericardial.7004                               Syphilitic heart disease.7005                               Arteriosclerotic heart disease.7006                               Myocardium, infarction of, due to                                    thrombosis or embolism.7007                               Hypertensive heart disease.7008                               Hyperthyroid heart disease.7010                               Auricular flutter, paroxysmal.7011                               Auricular fibrillation, paroxysmal.7012                               Auricular fibrillation, permanent.7013                               Tachycardia, paroxysmal.7014                               Sinus tachycardia.7015                               Auriculoventricular block.------------------------------------------------------------------------                         the arteries and veins------------------------------------------------------------------------7100                               Arteriosclerosis, general.7101                               Hypertensive vascular disease                                    (essential arterial hypertension).7110                               Aorta or branches, aneurysm of.7111                               Artery, any large artery, aneurysm                                    of.7112                               Artery, small aneurysmal dilatation.7113                               Arteriovenous aneurysm, traumatic.7114                               Arteriosclerosis obliterans.7115                               Thrombo-angiitis obliterans                                    (Buerger's disease).7116                               Claudication, intermittent.7117                               Raynaud's disease.7118                               Angioneurotic edema.7119                               Erythromelalgia.7120                               Varicose veins.7121                               Phlebitis.7122                               Frozen feet, residuals of (Immersion                                    foot).------------------------------------------------------------------------                          the digestive system------------------------------------------------------------------------7200                               Mouth, injuries of.7201                               Lips, injuries of.7202                               Tongue, loss of, whole or part.7203                               Esophagus, stricture of.7204                               Esophagus, spasm of (cardiospasm).7205                               Esophagus, diverticulum of, acquired.7301                               Peritoneum, adhesions of.7304                               Ulcer, gastric.7305                               Ulcer, duodenal.7306                               Ulcer, marginal (gastrojejunal).7307                               Gastritis, hypertrophic.7308                               Postgastrectomy syndromes.7309                               Stomach, stenosis of.7310                               Stomach, injury of, residuals.7311                               Liver, injury of.7312                               Liver, cirrhosis of.7313                               Liver, abscess of, residuals.7314                               Cholecystitis, chronic.7315                               Cholelithiasis, chronic.7316                               Cholangitis, chronic.7317                               Gall bladder, injury of.7318                               Gall bladder, removal of.7319                               Irritable colon syndrome (spastic                                    colitis, mucous colitis, etc.).7321                               Amebiasis.7322                               Dysentery, bacillary.7323                               Colitis, ulcerative.7324                               Distomiasis, intestinal or hepatic.7325                               Enteritis, chronic.7326                               Enterocolitis, chronic.7327                               Diverticulitis.7328                               Intestine, small, resection of.7329                               Intestine, large, resection of.7330                               Intestine, fistula of.7331                               Peritonitis, tuberculous, active.7332                               Rectum and anus, impairment of                                    sphincter control.7333                               Rectum and anus, stricture of.7334                               Rectum, persistent prolapse of.7335                               Ano, fistula in.7336                               Hemorrhoids, external or internal.7337                               Pruritus ani.7338                               Hernia, inguinal.7339                               Hernia, ventral.7340                               Hernia, femoral.7341                               Wounds, incised, healed, abdominal                                    wall.7342                               Visceroptosis.7343                               New growths, malignant, any specified                                    part of digestive system.7344                               New growths, benign, any specified                                    part of digestive system.7345                               Hepatitis, infectious.7346                               Hernia, hiatal.------------------------------------------------------------------------                        the genitourinary system------------------------------------------------------------------------7500                               Kidney, removal of.7501                               Kidney, abscess of.7502                               Nephritis, chronic.7503                               Pyelitis.7504                               Pyelonephritis, chronic.7505                               Kidney, tuberculosis of, active.7507                               Nephrosclerosis, arteriolar.7508                               Nephrolithiasis.7509                               Hydronephrosis.7510                               Ureterolithiasis.7511                               Ureter, stricture of.7512                               Cystitis, chronic.7513                               Cystitis, interstitial (Hunner),                                    submucous or elusive ulcer.7514                               Bladder, tuberculosis of.7515                               Bladder, calculus in.7516                               Bladder, fistula of.7517                               Bladder, injury of.7518                               Urethra, stricture of.7519                               Urethra, fistula of.7520                               Penis, removal of half or more.7521                               Penis, removal of glans.7522                               Penis, deformity, with loss of                                    erectile power.7523                               Testis, atrophy, complete.7524                               Testis, removal of.7525                               Epididymo-orchitis (tuberculous).7526                               Prostate gland, resection or removal.7527                               Prostate gland injuries, infectious                                    hypertrophy, postoperative                                    residuals.7528                               New growths, malignant, any specified                                    part of genitourinary system.7529                               New growths, benign, any specified                                    part of genitourinary system.------------------------------------------------------------------------                        gynecological conditions------------------------------------------------------------------------7610                               Vulvovaginitis.7611                               Vaginitis.7612                               Cervicitis.7613                               Metritis.7614                               Salpingitis.7615                               Oophoritis.7617                               Uterus and ovaries, removal of,                                    complete.7618                               Uterus, removal of, including corpus.7619                               Ovaries, removal of.7620                               Ovaries, atrophy of both.7621                               Uterus, prolapse.7622                               Uterus, displacement of.7623                               Pregnancy, surgical complications of.7624                               Fistula, rectovaginal.7625                               Fistula, urethrovaginal.7626                               Mammary glands, removal of.7627                               New growth, malignant, gynecological                                    system, or mammary glands.------------------------------------------------------------------------                     the hemic and lymphatic systems------------------------------------------------------------------------7700                               Anemia, pernicious.7701                               Anemia, secondary.7702                               Agranulocytosis, acute.7703                               Leukemia.7704                               Polycythemia, primary.7705                               Purpura hemorrhagica.7706                               Splenectomy.7707                               Spleen, injury of, healed.7709                               Lymphogranulomatosis (Hodgkin's                                    disease).7710                               Adenitis, cervical, tuberculous.7711                               Adenitis, axillary, tuberculous.7712                               Adenitis, inguinal, tuberculous.7713                               Adenitis, secondary.------------------------------------------------------------------------                                the skin------------------------------------------------------------------------7800                               Scars, disfiguring, head, face or                                    neck.7801                               Scars, burns, third degree.7802                               Scars, burns, second degree.7803                               Scars, superficial, poorly nourished.7804                               Scars, superficial, tender and                                    painful.7805                               Scars, others.7806                               Eczema.7807                               Leishmaniasis, americana                                    (mucocutaneous, espundia).7808                               Leishmaniasis, old world (cutaneous,                                    oriental sore).7809                               Lupus erythematosus, discoid.7810                               Pinta.7811                               Tuberculosis luposa (lupus vulgaris).7812                               Verruga peruana.7813                               Dermatophytosis.7814                               Tinea barbae.7815                               Pemphigus.7816                               Psoriasis.7817                               Dermatitis exfoliativa.7818                               New growths, malignant, skin.7819                               New growths, benign, skin.------------------------------------------------------------------------                          the endocrine system------------------------------------------------------------------------7900                               Hyperthyroidism.7901                               Thyroid gland, toxic adenoma of.7902                               Thyroid gland, non-toxic adenoma of.7903                               Hypothyroidism.7904                               Hyperparathyroidism (osteitis fibrosa                                    cystica).7905                               Hypoparathyroidism.7907                               Hyperpituitarism (pituitary                                    basophilism, Cushing's syndrome).7908                               Hyperpituitarism (acromegaly or                                    gigantism).7909                               Hypopituitarism (diabetes inspidus).7910                               Hyperadrenia (adrenogenital                                    syndrome).7911                               Addison's disease.7912                               Pluriglandular syndromes.7913                               Diabetes mellitus.7914                               New growths, malignant, endocrine                                    system.7915                               New growths, benign, endocrine                                    system.------------------------------------------------------------------------            neurological conditions and convulsive disorders------------------------------------------------------------------------8000                               Encephalitis, epidemic, chronic.                                   Brain, new growth of:8002                               Malignant.8003                               Benign.8004                               Paralysis agitans.8005                               Bulbar palsy.8007                               Brain, vessels, embolism of.8008                               Brain, vessels, thrombosis of.8009                               Brain, vessels, hemorrhage from.8010                               Myelitis.8011                               Poliomyelitis, anterior.8012                               Hematomyelia.8013                               Syphilis, cerebrospinal.8014                               Syphilis, meningovascular.8015                               Tabes dorsalis.8017                               Amyotrophic lateral sclerosis.8018                               Multiple sclerosis.8019                               Meningitis, cerebrospinal, epidemic.8020                               Brain, abscess of. Spinal cord, new                                    growths:8021                               Malignant.8022                               Benign.8023                               Progressive muscular atrophy.8024                               Syringomyelia.8025                               Myasthenia gravis.8045                               Brain disease due to trauma.8046                               Cerebral arteriosclerosis.8100                               Migraine.8103                               Tic, convulsive.8104                               Paramyoclonus multiplex (convulsive                                    state, myoclonic type).8105                               Chorea, Sydenham's.8106                               Chorea, Huntington's.8107                               Athetosis, acquired.8108                               Narcolepsy.------------------------------------------------------------------------                           the cranial nerves------------------------------------------------------------------------8205                               Fifth (trigeminal) cranial nerve,                                    paralysis of.8207                               Seventh (facial) cranial nerve,                                    paralysis of.8209                               Ninth (glossopharyngeal) cranial                                    nerve, paralysis of.8210                               Tenth (pneumogastric, vagus) cranial                                    nerve, paralysis of.8211                               Eleventh (spinal accessory, external                                    branch) cranial nerve, paralysis of.8212                               Twelfth (hypoglossal) cranial nerve,                                    paralysis of.8305                               Fifth (trigeminal) cranial nerve,                                    neuritis.8307                               Seventh (facial) cranial nerve,                                    neuritis.8309                               Ninth (glossopharyngeal) cranial                                    nerve, neuritis.8310                               Tenth (pneumogastric, vagus) cranial                                    nerve, neuritis.8311                               Eleventh (spinal accessory, external                                    branch) cranial nerve, neuritis.8312                               Twelfth (hypoglossal) cranial nerve,                                    neuritis.8407                               Seventh (facial) cranial nerve,                                    neuralgia.8409                               Ninth (glossopharyngeal) cranial                                    nerve, neuralgia.8410                               Tenth (pneumogastric, vagus) cranial                                    nerve, neuralgia.8411                               Eleventh (spinal accessory, external                                    branch) cranial nerve, neuralgia.8412                               Twelfth (hypoglossal) cranial nerve,                                    neuralgia.------------------------------------------------------------------------                      peripheral nerves: paralysis------------------------------------------------------------------------8510                               Upper radicular group (fifth and                                    sixth cervicals), paralysis of.8511                               Middle radicular group, paralysis of.8512                               Lower radicular group, paralysis of.8513                               All radicular groups, paralysis of.8514                               The musculospiral nerve (radial                                    nerve), paralysis of.8515                               The median nerve, paralysis of.8516                               The ulnar nerve, paralysis of.8517                               Musculocutaneous nerve, paralysis of.8518                               Circumflex nerve, paralysis of.8519                               Long thoracic nerve, paralysis of.8520                               The sciatic nerve, paralysis of.8521                               External popliteal nerve (common                                    peroneal), paralysis of.8522                               Musculocutaneous nerve (superficial                                    peroneal), paralysis of.8523                               Anterior tibial nerve (deep                                    peroneal), paralysis of.8524                               Internal popliteal nerve (tibial),                                    paralysis of.8525                               Posterior tibial nerve, paralysis of.8526                               Anterior crural nerve (femoral),                                    paralysis of.8527                               Internal saphenous nerve, paralysis                                    of.8528                               Obturator nerve, paralysis of.8529                               External cutaneous nerve of thigh,                                    paralysis of.8530                               Ilio-inguinal nerve, paralysis of.------------------------------------------------------------------------                       peripheral nerves: neuritis------------------------------------------------------------------------8610                               Upper radicular group (fifth and                                    sixth cervicals), neuritis.8611                               Middle radicular group, neuritis.8612                               Lower radicular group, neuritis.8613                               All radicular groups, neuritis.8614                               The musculospiral nerve (radial                                    nerve), neuritis.8615                               The median nerve, neuritis.8616                               The ulnar nerve, neuritis.8617                               Musculocutaneous nerve, neuritis.8618                               Circumflex nerve, neuritis.8619                               Long thoracic nerve, neuritis.8620                               The sciatic nerve, neuritis.8621                               External popliteal nerve (common                                    peroneal), neuritis.8622                               Musculocutaneous nerve (superficial                                    peroneal), neuritis.8623                               Anterior tibial nerve (deep                                    peroneal), neuritis.8624                               Internal popliteal nerve (tibial)                                    neuritis.8625                               Posterior tibial nerve, neuritis.8626                               Anterior crural nerve (femoral),                                    neuritis.8627                               Internal saphenous nerve, neuritis.8628                               Obturator nerve, neuritis.8629                               External cutaneous nerve of thigh,                                    neuritis.8630                               Ilio-inguinal nerve, neuritis.------------------------------------------------------------------------                      peripheral nerves: neuralgia------------------------------------------------------------------------8710                               Upper radicular group (fifth and                                    sixth cervicals), neuralgia.8711                               Middle radicular group, neuralgia.8712                               Lower radicular group, neuralgia.8713                               All radicular groups, neuralgia.8714                               The musculospiral nerve (radial                                    nerve), neuralgia.8715                               The median nerve, neuralgia.8716                               The ulnar nerve, neuralgia.8717                               Musculocutaneous nerve, neuralgia.8718                               Circumflex nerve, neuralgia.8719                               Long thoracic nerve, neuralgia.8720                               The sciatic nerve, neuralgia.8721                               External popliteal nerve (common                                    peroneal), neuralgia.8722                               Musculocutaneous nerve (superficial                                    peroneal), neuralgia.8723                               Anterior tibial nerve (deep                                    peroneal), neuralgia.8724                               Internal popliteal nerve (tibial),                                    neuralgia.8725                               Posterior tibial nerve, neuralgia.8726                               Anterior crural nerve (femoral),                                    neuralgia.8727                               Internal saphenous nerve, neuralgia.8728                               Obturator nerve, neuralgia.8729                               External cutaneous nerve of thigh                                    neuralgia.8730                               Ilio-inguinal nerve, neuralgia.------------------------------------------------------------------------                             the epilepsies------------------------------------------------------------------------8910                               Epilepsy, grand mal.8911                               Epilepsy, petit mal.8912                               Jacksonian type.8913                               Epilepsy, diencephalic.8914                               Epilepsy, psychomotor.------------------------------------------------------------------------                           psychotic disorders------------------------------------------------------------------------9200                               Schizophrenic reaction, simple type.9201                               Schizophrenic reaction, hebephrenic                                    type.9202                               Schizophrenic reaction, catatonic                                    type.9203                               Schizophrenic reaction, paranoid                                    type.9204                               Schizophrenic reaction, chronic                                    undifferentiated type.9205                               Schizophrenic reaction, other.9206                               Manic depressive reaction.9207                               Psychotic depressive reaction.9208                               Paranoid reaction (specify).9209                               Involutional psychotic reaction.9210                               Psychotic reaction, other.------------------------------------------------------------------------                         organic brain disorders------------------------------------------------------------------------9300                               Acute brain syndrome (associated with                                    infection, trauma, circulatory                                    disturbance, etc.).9301                               Chronic brain syndrome associated                                    with central nervous system syphilis                                    (all forms).9302                               Chronic brain syndrome associated                                    with intracranial infections other                                    than syphilis.9303                               Chronic brain syndrome associated                                    with intoxication.9304                               Chronic brain syndrome associated                                    with brain trauma.9305                               Chronic brain syndrome associated                                    with cerebral arteriosclerosis.9306                               Chronic brain syndrome associated                                    with circulatory disturbance other                                    than cerebral arteriosclerosis.9307                               Chronic brain syndrome associated                                    with convulsive disorder (idiopathic                                    epilepsy).9308                               Chronic brain syndrome associated                                    with disturbance of metabolism,                                    growth or nutrition.9309                               Chronic brain syndrome associated                                    with intracranial neoplasm.9310                               Chronic brain syndrome associated                                    with diseases of unknown or                                    uncertain cause.9311                               Chronic brain syndrome of unknown                                    cause.------------------------------------------------------------------------                        psychoneurotic disorders------------------------------------------------------------------------9400                               Anxiety reaction.9401                               Dissociative reaction.9402                               Conversion reaction.9403                               Phobic reaction.9404                               Obsessive compulsive reaction.9405                               Depressive reaction.9406                               Psychoneurotic reaction, other.------------------------------------------------------------------------                       psychophysiologic disorders------------------------------------------------------------------------9500                               Psychophysiologic skin reaction.9501                               Psychophysiologic cardiovascular                                    reaction.9502                               Psychophysiologic gastrointestinal                                    reaction.9503                               Psychophysiologic nervous system                                    reaction.9504                               Psychophysiologic reaction, other.------------------------------------------------------------------------                       dental and oral conditions------------------------------------------------------------------------9900                               Maxilla or mandible, osteomyelitis                                    of.9901                               Mandible, loss of, complete, between                                    angles.9902                               Mandible, loss of approximately one-                                    half.9903                               Mandible, nonunion of.9904                               Mandible, malunion of.9905                               Temporomandibular articulation,                                    limited motion of.9906                               Ramus, loss of whole or part of.9907                               Ramus, loss of less than one-half the                                    substance of, not involving loss of                                    continuity.9908                               Condyloid process, loss of, one or                                    both sides.9909                               Coronoid process, loss of.9910                               Maxilla, loss of whole or part of                                    substance of, nonunion of, or                                    malunion of.9911                               Hard palate, loss of half or more.9912                               Hard palate, loss of less than half                                    of.9913                               Teeth, loss of, due to loss of                                    substance of body of maxilla or                                    mandible.------------------------------------------------------------------------

[29 FR 6718, May 22, 1964, as amended at 34 FR 5064, Mar. 11, 1969, 52 FR 44122, Nov. 18, 1987; 53 FR 24938, July 1, 1988]

Appendix C to Part 4—Alphabetical Index of Disabilities

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 ------------------------------------------------------------------------                                                              Diagnostic                                                               Code No.------------------------------------------------------------------------Abscess:  Brain.....................................................       8020  Kidney....................................................       7501  Liver.....................................................       7313  Lung......................................................       6809Actinomycosis, lung.........................................       6803Addison's disease...........................................       7911Adenitis, secondary.........................................       7713Adenoma, thyroid:  Nontoxic..................................................       7902  Toxic.....................................................       7901Adhesions:  Pericardial...............................................       7003  Peritoneum................................................       7301Agranulocytosis.............................................       7702Amebiasis...................................................       7321Amputation:  Arm:    Disarticulation.........................................       5120    Above deltoid...........................................       5121    Below deltoid...........................................       5122    Feet, both, and hand, one...............................       5103    Feet, both..............................................       5107  Finger (digit) individual:    Thumb...................................................       5152    Index...................................................       5153    Middle..................................................       5154    Ring....................................................       5155    Little..................................................       5156  Fingers (digits) of one hand:    Five....................................................       5126    Four, thumb, index, middle, ring........................       5127    Four, thumb, index, middle, little......................       5128    Four, thumb, index, ring, little........................       5129    Four, thumb, middle, ring, little.......................       5130    Four, index, middle, ring, little.......................       5131    Three, thumb, index, middle.............................       5132    Three, thumb, index, ring...............................       5133    Three, thumb, index, little.............................       5134    Three, thumb, middle, ring..............................       5135    Three, thumb, middle, little............................       5136    Three, thumb, ring, little..............................       5137    Three, index, middle, ring..............................       5138    Three, index, middle, little............................       5139    Three, index, ring, little..............................       5140    Three, middle, ring, little.............................       5141    Two, thumb, index.......................................       5142    Two, thumb, middle......................................       5143    Two, thumb, ring........................................       5144    Two, thumb, little......................................       5145    Two, index, middle......................................       5146    Two, index, ring........................................       5147    Two, index, little......................................       5148    Two, middle, ring.......................................       5149    Two, middle, little.....................................       5150    Two, ring, little.......................................       5151  Forearm:    Above pronator teres....................................       5123    Below pronator teres....................................       5124  Forefoot..................................................       5166  Hand, one, and foot, one..................................       5108  Hands, both, and feet, both...............................       5100  Hands, both, and foot, one................................       5102  Hands, both...............................................       5106  Leg:    With defective stump....................................       5163    With loss of natural knee action........................       5164    At lower level..........................................       5165  Thigh:    Disarticulation.........................................       5160    Upper third.............................................       5161    Middle or lower thirds..................................       5162  Toe, great................................................       5171  Toe, other, with removal metatarsal head..................       5172  Toes, all.................................................       5170  Toes, three or more.......................................       5173Anemia:  Pernicious................................................       7700  Secondary.................................................       7701Aneurysm:  Aorta or branches.........................................       7110  Arteriovenous, traumatic..................................       7113  Artery....................................................       7111Angioneurotic edema.........................................       7118Ankylosis:  Ankle.....................................................       5270  Elbow.....................................................       5205  Finger (digit) individual:    Thumb...................................................       5224    Index...................................................       5225    Middle..................................................       5226    Other...................................................       5227  Fingers (digits) of one hand, unfavorable:    Five....................................................       5216    Four....................................................       5217    Three...................................................       5218    Two.....................................................       5219  Hip.......................................................       5250  Knee......................................................       5256  Scapulohumeral............................................       5200  Spine:    Complete................................................       5286    Cervical................................................       5287    Dorsal..................................................       5288    Lumbar..................................................       5289  Subastragular or Tarsal...................................       5272  Wrist.....................................................       5214Anthracosis.................................................       6800Aphakia.....................................................       6029Aphonia, organic............................................       6519Arteriosclerosis:  Cerebral..................................................       8046  General...................................................       7100  Obliterans................................................       7114Arteriosclerotic heart disease..............................       7005Arthritis:  Atrophic (rheumatoid).....................................       5002  Gonorrheal................................................       5004  Hypertrophic (degenerative)...............................       5003  Other types...............................................       5009  Pneumococcic..............................................       5005  Streptococcic.............................................       5008  Syphilitic................................................       5007  Traumatic.................................................       5010  Typhoid...................................................       5006Aspergillosis, lung.........................................       6807Asthma, bronchial...........................................       6602Astragalectomy..............................................       5274Athetosis...................................................       8107Atrophy:  Muscular, progressive.....................................       8023  Ovaries, both.............................................       7620  Testis, both..............................................       7523Auditory canal, disease.....................................       6210Avitaminosis................................................       6313Beriberi....................................................       6314Blastomycosis, lung.........................................       6805Blindness, anatomical loss, one eye:  Other blind (5/200 or less)...............................       6063  Other impaired (20/200 or less)...........................       6064  Other impaired............................................       6065  Other normal..............................................       6066Blindness, light perception only:  Both eyes.................................................       6062  One eye:    Other blind, 5/200 or less..............................       6067    Other impaired, 20/200 or less..........................       6068    Other impaired..........................................       6069    Other normal............................................       6070Blindness, light perception only and loss or loss of use of   6050-6061 hands and/or feet..........................................Blindness, total (5/200 or less):  Both eyes.................................................       6071  One eye:    Other impaired, (20/200 or less)........................       6072    Other impaired..........................................       6073    Other normal............................................       6074Blindness, partial (20/200 or less):  Both eyes.................................................       6075  One eye:    Other impaired..........................................       6076    Other normal............................................       6077Blindness, partial:  Both eyes.................................................       6078  One eye only..............................................       6079Block, auricular ventricular................................       7015Bones, Caisson disease of...................................       5011Bones and joints, tuberculosis of...........................       5001Bronchiectasis..............................................       6601Bronchitis..................................................       6600Buerger's disease...........................................       7115Brucellosis.................................................       6316Bursitis....................................................       5019Caisson disease.............................................       5011Calculus, bladder...........................................       7515Cataract:  Senile and others.........................................       6028  Traumatic.................................................       6027Cervicitis..................................................       7612Cholangitis.................................................       7316Cholecystitis...............................................       7314Cholelithiasis..............................................       7315Cholera, Asiatic............................................       6300Chorea:  Huntington's..............................................       8106  Sydenham's................................................       8105Choroiditis.................................................       6005Claw-foot (pes cavus) acquired..............................       5278Cirrhosis of liver..........................................       7312Claudication, intermittent..................................       7116Coccidioidomycosis..........................................       6821Colitis:  Mucous (See Colon syndrome, irritable)....................       7319  Spastic (See Colon syndrome, irritable)...................       7319  Ulcerative................................................       7323Collapse, lung, permanent...................................       6813Colon syndrome, irritable...................................       7319Congestion, lung, passive...................................       6817Conjunctivitis:  Trachomatous..............................................       6017  Other.....................................................       6018Coccyx......................................................       5298Cushing's syndrome..........................................       7907Cyclitis....................................................       6004Cystitis:  Chronic...................................................       7512  Interstitial (Hunner).....................................       7513Dacryocystitis..............................................       6031Deafness  0% evaluation based on Table VII..........................       6100  10% evaluation based on Table VII.........................       6101  20% evaluation based on Table VII.........................       6102  30% evaluation based on Table VII.........................       6103  40% evaluation based on Table VII.........................       6104  50% evaluation based on Table VII.........................       6105  60% evaluation based on Table VII.........................       6106  70% evaluation based on Table VII.........................       6107  80% evaluation based on Table VII.........................       6108  90% evaluation based on Table VII.........................       6109  100% evaluation based on Table VII........................       6110Deflection, nasal septum....................................       6502Dermatitis, exfoliativa.....................................       7817Dermatophytosis.............................................       7813Diabetes mellitus...........................................       7913Diabetes insipidus..........................................       7909Diaphragm, rupture..........................................       5324Dilation, aneurysmal artery.................................       7112Diplopia....................................................       6090Disease:  Addison's.................................................       7911  Hodgkin's.................................................       7709  Morton's..................................................       5279  Raynaud's.................................................       7117Dislocation:  Cartilage, semilunar......................................       5258  Lens, crystalline.........................................       6033Disorders, mental:  Organic brain disorders:    Acute brain syndrome....................................       9300    Chronic brain syndrome associated with:      Central nervous system syphilis.......................       9301      Intracranial infections other than syphilis...........       9302      Intoxication..........................................       9303      Brain trauma..........................................       9304      Cerebral arteriosclerosis.............................       9305      Circulatory disturbance other than cerebral                  9306       arteriosclerosis.....................................      Convulsive disorder (idiopathic epilepsy).............       9307      Disturbance of metabolism, growth or nutrition........       9308      Intracranial neoplasm.................................       9309      Diseases of unknown or uncertain cause................       9310      Unknown cause.........................................       9311  Psychoneurotic disorders:    Anxiety reaction........................................       9400    Dissociative reaction...................................       9401    Conversion reaction.....................................       9402    Phobic reaction.........................................       9403    Obsessive compulsive reaction...........................       9404    Depressive reaction.....................................       9405    Psychoneurotic reaction, other..........................       9406  Psychophysiologic disorders:    Psychophysiologic skin reaction.........................       9500    Psychophysiologic cardiovascular reaction...............       9501    Psychophysiologic gastrointestinal reaction.............       9502    Psychophysiologic nervous system reaction...............       9503    Psychophysiologic reaction, other.......................       9504  Psychotic disorders:    Schizophrenic reaction:      Simple type...........................................       9200      Hebephrenic type......................................       9201      Catatonic type........................................       9202      Paranoid type.........................................       9203      Chronic undifferentiated type.........................       9204      Other.................................................       9205      Manic depressive reaction.............................       9206      Psychotic depressive reaction.........................       9207      Paranoid reaction.....................................       9208      Involutional psychotic reaction.......................       9209      Psychotic reaction, other.............................       9210Distomiasis, intestinal.....................................       7324Diverticulitis, intestinal..................................       7327Diverticulum of esophagus...................................       7205Dupuytren's contracture_see Ankylosis, fingers.Dysentery, bacillary........................................       7322Ectropion...................................................       6020Eczema......................................................       7806Edema, angioneurotic........................................       7118Embolism, brain.............................................       8007Emphysema (No DC; follows DC 6602).Encephalitis................................................       8000Endocarditis, bacterial, subacute...........................       7001Enteritis...................................................       7325Enterocolitis...............................................       7326Entropion...................................................       6021Enucleation, eye, see Blindness.Epilepsy:  Grand mal.................................................       8910  Petit mal.................................................       8911  Jacksonian................................................       8912  Diencephalic..............................................       8913  Psychomotor...............................................       8914Epiphora (lacrymal duct)....................................       6025Erythromelalgia.............................................       7119Eyelids, loss of portion of.................................       6032Fever:  Hemoglobinuric, see Malaria.  Malta.....................................................       6316  Oroya.....................................................       6306  Relapsing.................................................       6308  Rheumatic.................................................       6309  Undulant..................................................       6316Fibrillation, auricular:  Paroxysmal................................................       7011  Permanent.................................................       7012Filariasis..................................................       6305Fistula:  Ano.......................................................       7335  Bladder...................................................       7516  Bronchocutaneous or bronchopleural........................       6812  Intestine.................................................       7330  Rectovaginal..............................................       7624  Urethra...................................................       7625Flail hip...................................................       5254Flatfoot (pes planus) acquired..............................       5276Flutter, auricular..........................................       7010Fracture, vertebra, residuals of............................       5285Frozen feet.................................................       7122Gastritis, atrophic (see DC 7307).Gastritis, hypertrophic.....................................       7307Genu, recurvatum............................................       5263Glaucoma:  Congestive................................................       6012  Noncongestive.............................................       6013Gout........................................................       5017Growths, new benign:  Bones, joints and muscles.................................       5015  Brain.....................................................       8003  Digestive system..........................................       7344  Ear.......................................................       6209  Endocrine system..........................................       7915  Eyeball and adnexa........................................       6015  Genitourinary system......................................       7529  Respiratory...............................................       6820  Skin......................................................       7819  Spinal cord...............................................       8022Growths, new, malignant:  Bones.....................................................       5012  Brain.....................................................       8002  Digestive system..........................................       7343  Ear.......................................................       6208  Endocrine system..........................................       7914  Eyeball only..............................................       6014  Genitourinary system......................................       7528  Gynecological system or mammary glands....................       7627  Respiratory...............................................       6819  Skin......................................................       7818  Spinal cord...............................................       8021Hallux rigidus..............................................       5281Hallux valgus...............................................       5280Hammer toe..................................................       5282Hematomyelia................................................       8012Hemorrhage:  Brain.....................................................       8009  Intraocular...............................................       6007Hemorrhoids.................................................       7336Hepatitis, infectious.......................................       7345Hernia:  Femoral...................................................       7340  Hiatal....................................................       7346  Inguinal..................................................       7338  Muscle....................................................       5326  Ventral...................................................       7339Hodgkin's disease...........................................       7709Hydrarthrosis, intermittent.................................       5018Hydronephrosis..............................................       7509Hyperadrenia................................................       7910Hyperparathyroidism.........................................       7904Hyperpituitarism:  Acromegaly or gigantism...................................       7908  Cushing's syndrome........................................       7907Hypertensive heart disease..................................       7007Hypertensive vascular disease...............................       7101Hyperthyroid heart disease..................................       7008Hyperthyroidism.............................................       7900Hypoadrenia.................................................       7911Hypoparathyroidism..........................................       7905Hypopituitarism.............................................       7909Hypothyroidism..............................................       7903Immersion foot..............................................       7122Impairment:  Auditory acuity, see Deafness.  Clavicle..................................................       5203  Elbow.....................................................       5209  Eye (field vision)........................................       6080  Eye (muscle function).....................................       6090  Femur.....................................................       5255  Humerus...................................................       5202  Knee......................................................       5257  Radius....................................................       5212  Sphincter control.........................................       7332  Supination and pronation..................................       5213  Thigh, motion.............................................       5253  Tibia and fibula..........................................       5262  Ulna......................................................       5211  Visual acuity, see Blindness.Infarction of myocardium....................................       7006Injury:  Bladder...................................................       7517  Gall bladder..............................................       7317  Eye, unhealed.............................................       6009  Foot......................................................       5284  Larynx....................................................       6517  Lips......................................................       7201  Liver.....................................................       7311  Mouth.....................................................       7200  Muscle:    Facial..................................................       5325    Group I.................................................       5301    Group II................................................       5302    Group III...............................................       5303    Group IV................................................       5304    Group V.................................................       5305    Group VI................................................       5306    Group VII...............................................       5307    Group VIII..............................................       5308    Group IX................................................       5309    Group X.................................................       5310    Group XI................................................       5311    Group XII...............................................       5312    Group XIII..............................................       5313    Group XIV...............................................       5314    Group XV................................................       5315    Group XVI...............................................       5316    Group XVII..............................................       5317    Group XVIII.............................................       5318    Group XIX...............................................       5319    Group XX................................................       5320    Group XXI...............................................       5321    Group XXII..............................................       5322    Group XXIII.............................................       5323  Pleural cavity............................................       6818  Prostate..................................................       7527  Sacroiliac................................................       5294  Spleen....................................................       7707  Stomach, residuals........................................       7310  Tongue, whole or part.....................................       7202Intervertebral disc.........................................       5293Iritis......................................................       6003Kala-azar...................................................       6301Keratitis...................................................       6001Labyrinthitis...............................................       6204Lagophthalmos...............................................       6022Laryngectomy................................................       6518Laryngitis..................................................       6516Leishmaniasis:  Americana.................................................       7807  Old World.................................................       7808Lens, crystalline, dislocation of...........................       6033Leprosy.....................................................       6302Leukemia....................................................       7703Limitation of extension:  Forearm...................................................       5207  Leg.......................................................       5261  Thigh.....................................................       5251Limitation of field vision..................................       6080Limitation of flexion:  Forearm...................................................       5206  Leg.......................................................       5260  Thigh.....................................................       5252Limitation of flexion and extension:  Forearm...................................................       5208Limitation of motion:  Ankle.....................................................       5271  Arm.......................................................       5201  Cervical..................................................       5290  Dorsal....................................................       5291  Lumbar....................................................       5292  Temporomandibular articulation............................       9905  Wrist.....................................................       5215Limitation, pronation.......................................       5213Limitation, supination......................................       5213Limitation of muscle function, eye..........................       6090Lobectomy...................................................       6816Loss:  Auricle or deformity......................................       6207  Condyloid process.........................................       9908  Coronoid process..........................................       9909  Eyebrows..................................................       6023  Eyelashes.................................................       6024  Mandible:    Complete................................................       9901    One-half................................................       9902  Maxilla...................................................       9910  Teeth.....................................................       9913  Nose, loss of part, or scars..............................       6504  Palate, hard:    Half or more............................................       9911    Less than half..........................................       9912  Ramus:    Less than one-half substance............................       9907    Whole or part...........................................       9906  Skull, part...............................................       5296  Smell, sense of...........................................       6275  Taste, sense of...........................................       6276  Tongue or part............................................       7202  Others, see Amputation, removal, etc.Loss of use:  Feet, both................................................       5110  Feet, both, and hand, one.................................       5105  Foot, one.................................................       5167  Hand, one.................................................       5125  Hand, one, and foot, one..................................       5111  Hands, both, and feet, both...............................       5101  Hands, both, and foot, one................................       5104  Hands, both...............................................       5109Lupus, erythematosus, discoid...............................       7809Lupus, erythematosus systemic (disseminated)................       6350Lupus, vulgaris.............................................       7811Lymphogranulomatosis........................................       7709Malaria.....................................................       6304Malunion:  Clavicle..................................................       5203  Os calcis (or astragalus).................................       5273  Mandible..................................................       9904  Maxilla (or nonunion).....................................       9910  Scapula...................................................       5203  Tarsal or metatarsal (or nonunion)........................       5283  Others, see Impairment.Mastoiditis.................................................       6206Meniere's disease...........................................       6205Meningitis, cerebrospinal...................................       8019Mental disorders_see Disorders, mental.Metatarsalgia...............................................       5279Metritis....................................................       7613Migraine....................................................       8100Muscle injury, see Injury, muscle.Myasthenia gravis...........................................       8025Mycosis, lung, unspecified..................................       6808Myelitis....................................................       8010Myositis....................................................       5021Myositis ossificans.........................................       5023Narcolepsy..................................................       8108Nephritis, chronic..........................................       7502Nephrolithiasis.............................................       7508Nephrosclerosis, arteriolar.................................       7507Neuralgia:  Cranial nerves:    Fifth (trigeminal)......................................       8405    Seventh (facial)........................................       8407    Ninth (glossopharyngeal)................................       8409    Tenth (pneumogastric, vagus)............................       8410    Eleventh (spinal accessory, external branch)............       8411    Twelfth (hypoglossal)...................................       8412Peripheral nerves:  Upper radicular group.....................................       8710  Middle radicular group....................................       8711  Lower radicular group.....................................       8712  All radicular groups......................................       8713  Musculospiral.............................................       8714  Median....................................................       8715  Ulnar.....................................................       8716  Musculocutaneous..........................................       8717  Circumflex................................................       8718  Long thoracic.............................................       8719  Sciatic...................................................       8720  External popliteal........................................       8721  Musculocutaneous (superficial peroneal)...................       8722  Anterior tibial...........................................       8723  Internal popliteal........................................       8724  Posterior tibial..........................................       8725  Anterior crural...........................................       8726  Internal saphenous........................................       8727  Obturator.................................................       8728  External cutaneous, thigh.................................       8729  Ilio-inguinal.............................................       8730Neuritis, optic.............................................       6026Neuritis:  Cranial nerves:    Fifth (trigeminal)......................................       8305    Seventh (facial)........................................       8307    Ninth (glossopharyngeal)................................       8309    Tenth (pneumogastric, vagus)............................       8310    Eleventh (spinal accessory, external branch)............       8311    Twelfth (hypoglossal)...................................       8312  Peripheral:    Upper radicular group...................................       8610    Middle radicular group..................................       8611    Lower radicular group...................................       8612    All radicular groups....................................       8613    Musculospiral...........................................       8614    Median..................................................       8615    Ulnar...................................................       8616    Musculocutaneous........................................       8617    Circumflex..............................................       8618    Long thoracic...........................................       8619    Sciatic.................................................       8620    External popliteal......................................       8621    Musculocutaneous (superficial peroneal).................       8622    Anterior tibial.........................................       8623    Internal popliteal......................................       8624    Posterior tibial........................................       8625    Anterior crural.........................................       8626    Internal saphenous......................................       8627    Obturator...............................................       8628    External cutaneous, thigh...............................       8629    Ilio-inguinal...........................................       8630Non-union of bones:  Mandible..................................................       9903  Radius and Ulna...........................................       5210  Tibia and fibula..........................................       5262  Others, see Impairment.Nystagmus, central..........................................       6016Oophoritis..................................................       7615Oroya fever.................................................       6306Osteitis deformans..........................................       5016Osteomalacia................................................       5014Osteomyelitis, jaw..........................................       9900Osteomyelitis...............................................       5000Osteoporosis................................................       5013Otitis externa..............................................       6210Otitis interna..............................................       6203Otitis media:  Catarrhal.................................................       6201  Suppurative...............................................       6200Otosclerosis................................................       6202Palsy, bulbar...............................................       8005Paralysis:  Accommodation.............................................       6030  Agitans...................................................       8004Paralysis, nerve:  Cranial:    Fifth (trigeminal)......................................       8205    Seventh (facial)........................................       8207    Ninth (glossopharyngeal)................................       8209    Tenth (pneumogastric, vagus)............................       8210    Eleventh (spiral accessory, external branch)............       8211    Twelfth (hypoglossal)...................................       8212  Peripheral:    Upper radicular group...................................       8510    Middle radicular group..................................       8511    Lower radicular group...................................       8512    All radicular groups....................................       8513    Musculospiral...........................................       8514    Median..................................................       8515    Ulnar...................................................       8516    Musculocutaneous........................................       8517    Circumflex..............................................       8518    Long thoracic...........................................       8519    Sciatic.................................................       8520    External popliteal......................................       8521    Musculocutaneous (superficial peroneal).................       8522    Anterior tibial.........................................       8523    Internal popliteal......................................       8524    Posterior tibial........................................       8525    Anterior crural.........................................       8526    Internal saphenous......................................       8527    Obturator...............................................       8528    External cutaneous, thigh...............................       8529    Ilio-inguinal...........................................       8530Paramyoclonus multiplex.....................................       8104Pellagra....................................................       6315Pemphigus...................................................       7815Penis, deformity of.........................................       7522Perforation: Tympanic membrane                                     6211Pericarditis................................................       7002Periostitis.................................................       5022Pes cavus...................................................       5278Pes planus..................................................       5276Phlebitis...................................................       7121Pinta.......................................................       7810Plague......................................................       6307Pleurisy:  Purulent (empyema)........................................       6811  Serofibrinous.............................................       6810Pluriglandular syndrome.....................................       7912Pneumoconiosis..............................................       6802Pneumonectomy...............................................       6815Pneumothorax, spontaneous...................................       6814Poliomyelitis, anterior.....................................       8011Polycythemia................................................       7704Pregnancy, surgical complications of........................       7623Prolapse:  Rectum....................................................       7334  Uterus....................................................       7621Pronation, limitation of....................................       5213Pruritis, ani...............................................       7337Psoriasis...................................................       7816Psychiatric disorders, see Disorders, mental.Pterygium...................................................       6034Ptosis, eyelid..............................................       6019Purpura, hemorrhagica.......................................       7705Pyelitis....................................................       7503Pyelonephritis, chronic.....................................       7504Raynaud's disease...........................................       7117Removal:  Auricle or deformity......................................       6207  Cartilage, semilunar......................................       5259  Coccyx....................................................       5298  Gall bladder..............................................       7318  Kidney....................................................       7500  Mammary glands............................................       7626  Ovaries, both.............................................       7619  Penis, half or more.......................................       7520  Penis, glans..............................................       7521  Prostate, or resection....................................       7526  Ribs......................................................       5297  Testis....................................................       7524  Uterus....................................................       7618  Uterus and ovaries........................................       7617  Others, see Amputation, loss, etc.Resection:  Intestine:    Large...................................................       7329    Small...................................................       7328  Stomach...................................................       7308Retina, detachment of.......................................       6008Retinitis...................................................       6006Rheumatic fever.............................................       6309Rheumatic heart disease.....................................       7000Rhinitis: Atrophic..........................................       6501Rupture, diaphragm..........................................       5324Salpingitis.................................................       7614Scars:  Burns, second degree......................................       7802  Burns, third degree.......................................       7801  Head, etc., disfiguring...................................       7800  Retina....................................................       6011  Superficial, tender.......................................       7804  Superficial, with ulceration..............................       7803  Others....................................................       7805Scleritis...................................................       6002Sclerosis:  Amyotrophic, lateral......................................       8017  Multiple..................................................       8018Scotoma, pathological.......................................       6081Shortening, leg.............................................       5275Silicosis...................................................       6801Sinusitis:  Ethmoid...................................................       6511  Frontal...................................................       6512  Maxillary.................................................       6513  Pansinusitis..............................................       6510  Sphenoid..................................................       6514Spasm, esophagus............................................       7204Splenectomy.................................................       7706Sporotrichosis, lung........................................       6806Stenosis:  Larynx....................................................       6520  Stomach...................................................       7309Strain, lumbosacral.........................................       5295Streptotrichosis, lung......................................       6804Stricture:  Esophagus.................................................       7203  Rectum, anus..............................................       7333  Ureter....................................................       7511  Urethra...................................................       7518Supination, limitation of...................................       5213Symblepharon................................................       6091Syndrome:  Cushing's.................................................       7907  Intervertebral disc.......................................       5293  Meniere's.................................................       6205  Pluriglandular............................................       7912  Postgastrectomy...........................................       7308Synovitis...................................................       5020Syphilis:  Cerebrospinal.............................................       8013  Meningovascular...........................................       8014  Unspecified...............................................       6310Syphilitic heart disease....................................       7004Syringomyelia...............................................       8024Tabes dorsalis..............................................       8015Tachycardia:  Paroxysmal................................................       7013  Sinus.....................................................       7014Tenosynovitis...............................................       5024Thrombo-anglitis obliterans.................................       7115Thrombophlebitis............................................       7121Thrombosis, brain...........................................       8008Tic, convulsive.............................................       8103Tinea barbae................................................       7814Tinnitus....................................................       6260Tuberculosis:  Adenitis, tuberculous:    Axillary................................................       7711    Cervical................................................       7710    Inguinal................................................       7712  Bladder...................................................       7514  Bones and joints..........................................       5001  Epididymo-orchitis, tuberculous...........................       7525  Eye.......................................................       6010  Kidney....................................................       7505  Laryngitis, tuberculous...................................       6515  Luposa....................................................       7811  Miliary...................................................       6311  Nonpulmonary, inactive (see § 4.89)  Peritonitis, tuberculous..................................       7331  Pleurisy, tuberculous.....................................       6732  Pulmonary:    Active:      Far advanced..........................................  6701 &                                                                   6707      Moderately advanced...................................  6702 &                                                                   6708      Minimal...............................................  6703 &                                                                   6709      Advancement unspecified...............................  6704 &                                                                   6710    Inactive:      Far advanced..........................................  6721 &                                                                   6725      Moderately advanced...................................  6722 &                                                                   6726      Minimal...............................................  6723 &                                                                   6727      Advancement unspecified...............................  6724 &                                                                   6728Tympanic membrane, perforation of...........................       6211Typhus, scrub...............................................       6317Ulcer:  Duodenal..................................................       7305  Gastric...................................................       7304  Marginal..................................................       7306Undescended testis (see Note under DC 7524).Uterus, displacement of.....................................       7622Ureterolithiasis............................................       7510Uveitis.....................................................       6000Vaginitis...................................................       7611Varicose veins..............................................       7120Verruga peruana.............................................       7812Vertebra, fracture..........................................       5285Visceroptosis...............................................       7342Vision, impairment of, see Blindness.Vulvovaginitis..............................................       7610Weak foot...................................................       5277Wound, incised, abdominal wall..............................       7341------------------------------------------------------------------------

[29 FR 6718, May 22, 1964, as amended at 34 FR 5064, Mar. 11, 1969; 52 FR 44122, Nov. 18, 1987; 53 FR 24938, July 1, 1988]

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