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Electronic Code of Federal Regulations

e-CFR Data is current as of October 16, 2014

Title 38Chapter IPart 4 → Subpart B


Title 38: Pensions, Bonuses, and Veterans' Relief
PART 4—SCHEDULE FOR RATING DISABILITIES


Subpart B—Disability Ratings


Contents

The Musculoskeletal System

§4.40   Functional loss.
§4.41   History of injury.
§4.42   Complete medical examination of injury cases.
§4.43   Osteomyelitis.
§4.44   The bones.
§4.45   The joints.
§4.46   Accurate measurement.
§§4.47-4.54   [Reserved]
§4.55   Principles of combined ratings for muscle injuries.
§4.56   Evaluation of muscle disabilities.
§4.57   Static foot deformities.
§4.58   Arthritis due to strain.
§4.59   Painful motion.
§4.60   [Reserved]
§4.61   Examination.
§4.62   Circulatory disturbances.
§4.63   Loss of use of hand or foot.
§4.64   Loss of use of both buttocks.
§4.65   [Reserved]
§4.66   Sacroiliac joint.
§4.67   Pelvic bones.
§4.68   Amputation rule.
§4.69   Dominant hand.
§4.70   Inadequate examinations.
§4.71   Measurement of ankylosis and joint motion.
§4.71a   Schedule of ratings—musculoskeletal system.
§4.72   [Reserved]
§4.73   Schedule of ratings—muscle injuries.

The Organs of Special Sense

§4.75   General considerations for evaluating visual impairment.
§4.76   Visual acuity.
§4.76a   Computation of average concentric contraction of visual fields.
§4.77   Visual fields.
§4.78   Muscle function.
§4.79   Schedule of ratings—eye.
§§4.80-4.84   [Reserved]

Impairment of Auditory Acuity

§4.85   Evaluation of hearing impairment.
§4.86   Exceptional patterns of hearing impairment.
§4.87   Schedule of ratings—ear.
§4.87a   Schedule of ratings—other sense organs.

Infectious Diseases, Immune Disorders and Nutritional Deficiencies

§4.88   [Reserved]
§4.88a   Chronic fatigue syndrome.
§4.88b   Schedule of ratings—infectious diseases, immune disorders and nutritional deficiencies.
§4.88c   Ratings for inactive nonpulmonary tuberculosis initially entitled after August 19, 1968.
§4.89   Ratings for inactive nonpulmonary tuberculosis in effect on August 19, 1968.

The Respiratory System

§4.96   Special provisions regarding evaluation of respiratory conditions.
§4.97   Schedule of ratings—respiratory system.

The Cardiovascular System

§4.100   Application of the evaluation criteria for diagnostic codes 7000-7007, 7011, and 7015-7020.
§§4.101-4.103   [Reserved]
§4.104   Schedule of ratings—cardiovascular system.

The Digestive System

§4.110   Ulcers.
§4.111   Postgastrectomy syndromes.
§4.112   Weight loss.
§4.113   Coexisting abdominal conditions.
§4.114   Schedule of ratings—digestive system.

The Genitourinary System

§4.115   Nephritis.
§4.115a   Ratings of the genitourinary system—dysfunctions.
§4.115b   Ratings of the genitourinary system—diagnoses.

Gynecological Conditions and Disorders of the Breast

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

The Hemic and Lymphatic Systems

§4.117   Schedule of ratings—hemic and lymphatic systems.

The Skin

§4.118   Schedule of ratings—skin.

The Endocrine System

§4.119   Schedule of ratings—endocrine system.

Neurological Conditions and Convulsive Disorders

§4.120   Evaluations by comparison.
§4.121   Identification of epilepsy.
§4.122   Psychomotor epilepsy.
§4.123   Neuritis, cranial or peripheral.
§4.124   Neuralgia, cranial or peripheral.
§4.124a   Schedule of ratings—neurological conditions and convulsive disorders.

Mental Disorders

§4.125   Diagnosis of mental disorders.
§4.126   Evaluation of disability from mental disorders.
§4.127   Intellectual disability (intellectual developmental disorder) and personality disorders.
§4.128   Convalescence ratings following extended hospitalization.
§4.129   Mental disorders due to traumatic stress.
§4.130   Schedule of ratings—Mental disorders.

Dental and Oral Conditions

§4.149   [Reserved]
§4.150   Schedule of ratings—dental and oral conditions.
Appendix A to Part 4—Table of Amendments and Effective Dates Since 1946
Appendix B to Part 4—Numerical Index of Disabilities
Appendix C to Part 4—Alphabetical Index of Disabilities

The Musculoskeletal System

§4.40   Functional loss.

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.

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.

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.

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.

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.

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.

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]

§4.55   Principles of combined ratings for muscle injuries.

(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).

(c) There will be no rating assigned for muscle groups which act upon an ankylosed joint, with the following exceptions:

(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.

(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.

(C) Diminished muscle excitability to pulsed electrical current in electrodiagnostic tests.

(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.

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.

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.

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]

§4.61   Examination.

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.

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.

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 312 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.

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]

§4.66   Sacroiliac joint.

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.

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.

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.

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.

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.

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.

Acute, Subacute, or Chronic Diseases

   Rating
5000   Osteomyelitis, acute, subacute, or chronic:
Of the pelvis, vertebrae, or extending into major joints, or with multiple localization or with long history of intractability and debility, anemia, amyloid liver changes, or other continuous constitutional symptoms100
Frequent episodes, with constitutional symptoms60
With definite involucrum or sequestrum, with or without discharging sinus30
With discharging sinus or other evidence of active infection within the past 5 years20
Inactive, following repeated episodes, without evidence of active infection in past 5 years10
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:
Active100
Inactive: See §§4.88b and 4.89.   
5002   Arthritis rheumatoid (atrophic) As an active process:
With constitutional manifestations associated with active joint involvement, totally incapacitating100
Less than criteria for 100% but with weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring 4 or more times a year or a lesser number over prolonged periods60
Symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year40
One or two exacerbations a year in a well-established diagnosis20
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 or 2 or more minor joint groups, with occasional incapacitating exacerbations20
With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups10
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, malignant100
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 therapy40
That are episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time20
That require continuous medication for control10
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
MajorMinor
5051   Shoulder replacement (prosthesis).
Prosthetic replacement of the shoulder joint:
For 1 year following implantation of prosthesis100100
With chronic residuals consisting of severe, painful motion or weakness in the affected extremity6050
With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic codes 5200 and 5203.
Minimum rating3020
5052   Elbow replacement (prosthesis).
Prosthetic replacement of the elbow joint:
For 1 year following implantation of prosthesis100100
With chronic residuals consisting of severe painful motion or weakness in the affected extremity5040
With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5205 through 5208.
Minimum evaluation3020
5053   Wrist replacement (prosthesis).
Prosthetic replacement of wrist joint:
For 1 year following implantation of prosthesis100100
With chronic residuals consisting of severe, painful motion or weakness in the affected extremity4030
With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic code 5214.
Minimum rating2020
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 motion or weakness such as to require the use of crutches   190
Markedly severe residual weakness, pain or limitation of motion following implantation of prosthesis   70
Moderately severe residuals of weakness, pain or limitation of motion   50
Minimum rating   30
5055   Knee replacement (prosthesis).
Prosthetic replacement of knee joint:
For 1 year following implantation of prosthesis   100
With chronic residuals consisting of severe painful motion or weakness in the affected extremity   60
With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5256, 5261, or 5262.
Minimum rating   30
5056   Ankle replacement (prosthesis).
Prosthetic replacement of ankle joint:
For 1 year following implantation of prosthesis   100
With chronic residuals consisting of severe painful motion or weakness   40
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 foot   1100
5105   Anatomical loss of one foot and loss of use of one hand   1100
5106   Anatomical loss of both hands   1100
5107   Anatomical loss of both feet   1100
5108   Anatomical loss of one hand and one foot   1100
5109   Loss of use of both hands   1100
5110   Loss of use of both feet   1100
5111   Loss of use of one hand and one foot   1100

1Also entitled to special monthly compensation.

Table II—Ratings for Multiple Losses of Extremities With Dictator's Rating Code and 38 CFR Citation

Impairment of one extremityImpairment of other extremity
Anatomical loss or loss of use below elbowAnatomical loss or loss of use below kneeAnatomical loss or loss of use above elbow (preventing use of prosthesis)Anatomical loss or loss of use above knee (preventing use of prosthesis)Anatomical loss near shoulder (preventing use of prosthesis)Anatomical loss near hip (preventing use of prosthesis)
Anatomical loss or loss of use below elbowM Codes M-1 a, b, or c, 38 CFR 3.350 (c)(1)(i)L Codes L-1 d, e, f, or g, 38 CFR 3.350(b)M1/2 Code M-5, 38 CFR 3.350 (f)(1)(x)L1/2 Code L-2 c, 38 CFR 3.350 (f)(1)(vi)N Code N-3, 38 CFR 3.350 (f)(1)(xi)M Code M-3 c, 38 CFR 3.350 (f)(1)(viii)
Anatomical loss or loss of use below kneeL Codes L-1 a, b, or c, 38 CFR 3.350(b)L1/2 Code L-2 b, 38 CFR 3.350 (f)(1)(iii)L1/2 Code L-2 a, 38 CFR 3.350 (f)(1)(i)M Code M-3 b, 38 CFR 3.350 (f)(1)(iv)M Code M-3 a, 38 CFR 3.350 (f)(1)(ii)
Anatomical loss or loss of use above elbow (preventing use of prosthesis)N Code N-1, 38 CFR 3.350 (d)(1)M Code M-2 a, 38 CFR 3.350 (c)(1)(iii)N1/2 Code N-4, 38 CFR 3.350 (f)(1)(ix)M1/2 Code M-4 c, 38 CFR 3.350 (f)(1)(xi)
Anatomical loss or loss of use above knee (preventing use of prosthesis)M Code M-2 a, 38 CFR 3.350 (c)(1)(ii)M1/2 Code M-4 b, 38 CFR 3.350 (f)(1)(vii)M1/2 Code M-4 a, 38 CFR 3.350 (f)(1)(v)
Anatomical loss near shoulder (preventing use of prosthesis)O Code O-1, 38 CFR 3.350 (e)(1)(i)N Code N-2 b, 38 CFR 3.350 (d)(3)
Anatomical loss near hip (preventing use of prosthesis)N Code N-2 a, 38 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
MajorMinor
Arm, amputation of:
5120   Disarticulation190190
5121   Above insertion of deltoid190180
5122   Below insertion of deltoid180170
Forearm, amputation of:
5123   Above insertion of pronator teres180170
5124   Below insertion of pronator teres170160
5125   Hand, loss of use of170160
multiple finger amputations
5126   Five digits of one hand, amputation of170160
Four digits of one hand, amputation of:
5127   Thumb, index, long and ring170160
5128   Thumb, index, long and little170160
5129   Thumb, index, ring and little170160
5130   Thumb, long, ring and little170160
5131   Index, long, ring and little6050
Three digits of one hand, amputation of:
5132   Thumb, index and long6050
5133   Thumb, index and ring6050
5134   Thumb, index and little6050
5135   Thumb, long and ring6050
5136   Thumb, long and little6050
5137   Thumb, ring and little6050
5138   Index, long and ring5040
5139   Index, long and little5040
5140   Index, ring and little5040
5141   Long, ring and little4030
Two digits of one hand, amputation of:
5142   Thumb and index5040
5143   Thumb and long5040
5144   Thumb and ring5040
5145   Thumb and little5040
5146   Index and long4030
5147   Index and ring4030
5148   Index and little4030
5149   Long and ring3020
5150   Long and little3020
5151   Ring and little3020
(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 resection4030
At metacarpophalangeal joint or through proximal phalanx3020
At distal joint or through distal phalanx2020
5153   Index finger, amputation of
With metacarpal resection (more than one-half the bone lost)3020
Without metacarpal resection, at proximal interphalangeal joint or proximal thereto2020
Through middle phalanx or at distal joint1010
5154   Long finger, amputation of:
With metacarpal resection (more than one-half the bone lost)2020
Without metacarpal resection, at proximal interphalangeal joint or proximal thereto1010
5155   Ring finger, amputation of:
With metacarpal resection (more than one-half the bone lost)2020
Without metacarpal resection, at proximal interphalangeal joint or proximal thereto1010
5156   Little finger, amputation of:
With metacarpal resection (more than one-half the bone lost)2020
Without metacarpal resection, at proximal interphalangeal joint or proximal thereto1010
Note: The single finger amputation ratings are the only applicable ratings for amputations of whole or part of single fingers.

1Entitled to special monthly compensation.

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Amputations: Lower Extremity

   Rating
Thigh, amputation of:
5160   Disarticulation, with loss of extrinsic pelvic girdle muscles290
5161   Upper third, one-third of the distance from perineum to knee joint measured from perineum280
5162   Middle or lower thirds260
Leg, amputation of:
5163   With defective stump, thigh amputation recommended260
5164   Amputation not improvable by prosthesis controlled by natural knee action260
5165   At a lower level, permitting prosthesis240
5166   Forefoot, amputation proximal to metatarsal bones (more than one-half of metatarsal loss)240
5167   Foot, loss of use of240
5170   Toes, all, amputation of, without metatarsal loss30
5171   Toe, great, amputation of:
With removal of metatarsal head30
Without metatarsal involvement10
5172   Toes, other than great, amputation of, with removal of metatarsal head:
One or two20
Without metatarsal involvement0
5173   Toes, three or four, amputation of, without metatarsal involvement:
Including great toe20
Not including great toe10

2Also entitled to special monthly compensation.

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The Shoulder and Arm

   Rating
MajorMinor
5200   Scapulohumeral articulation, ankylosis of:
Note: The scapula and humerus move as one piece.
Unfavorable, abduction limited to 25° from side5040
Intermediate between favorable and unfavorable4030
Favorable, abduction to 60°, can reach mouth and head3020
5201   Arm, limitation of motion of:
To 25° from side4030
Midway between side and shoulder level3020
At shoulder level2020
5202   Humerus, other impairment of:
Loss of head of (flail shoulder)8070
Nonunion of (false flail joint)6050
Fibrous union of5040
Recurrent dislocation of at scapulohumeral joint.
With frequent episodes and guarding of all arm movements3020
With infrequent episodes, and guarding of movement only at shoulder level2020
Malunion of:
Marked deformity3020
Moderate deformity2020
5203   Clavicle or scapula, impairment of:
Dislocation of2020
Nonunion of:
With loose movement2020
Without loose movement1010
Malunion of1010
Or rate on impairment of function of contiguous joint.

The Elbow and Forearm

   Rating
MajorMinor
5205   Elbow, ankylosis of:
Unfavorable, at an angle of less than 50° or with complete loss of supination or pronation6050
Intermediate, at an angle of more than 90°, or between 70° and 50°5040
Favorable, at an angle between 90° and 70°4030
5206   Forearm, limitation of flexion of:
Flexion limited to 45°5040
Flexion limited to 55°4030
Flexion limited to 70°3020
Flexion limited to 90°2020
Flexion limited to 100°1010
Flexion limited to 110°0   0
5207   Forearm, limitation of extension of:
Extension limited to 110°5040
Extension limited to 100°4030
Extension limited to 90°3020
Extension limited to 75°2020
Extension limited to 60°1010
Extension limited to 45°1010
5208   Forearm, flexion limited to 100° and extension to 45°2020
5209   Elbow, other impairment of Flail joint6050
Joint fracture, with marked cubitus varus or cubitus valgus deformity or with ununited fracture of head of radius2020
5210   Radius and ulna, nonunion of, with flail false joint5040
5211   Ulna, impairment of:
Nonunion in upper half, with false movement:
With loss of bone substance (1 inch (2.5 cms.) or more) and marked deformity4030
Without loss of bone substance or deformity3020
Nonunion in lower half2020
Malunion of, with bad alignment1010
5212   Radius, impairment of:
Nonunion in lower half, with false movement:
With loss of bone substance (1 inch (2.5 cms.) or more) and marked deformity4030
Without loss of bone substance or deformity3020
Nonunion in upper half2020
Malunion of, with bad alignment1010
5213   Supination and pronation, impairment of:
Loss of (bone fusion):
The hand fixed in supination or hyperpronation4030
The hand fixed in full pronation3020
The hand fixed near the middle of the arc or moderate pronation2020
Limitation of pronation:
Motion lost beyond middle of arc3020
Motion lost beyond last quarter of arc, the hand does not approach full pronation2020
Limitation of supination:
To 30° or less1010
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
MajorMinor
5214   Wrist, ankylosis of:
Unfavorable, in any degree of palmar flexion, or with ulnar or radial deviation5040
Any other position, except favorable4030
Favorable in 20° to 30° dorsiflexion3020
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°1010
Palmar flexion limited in line with forearm1010

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 of6050
Note: Also consider whether evaluation as amputation is warranted.
5217   Four digits of one hand, unfavorable ankylosis of:
Thumb and any three fingers6050
Index, long, ring, and little fingers5040
Note: Also consider whether evaluation as amputation is warranted.
5218   Three digits of one hand, unfavorable ankylosis of:
Thumb and any two fingers5040
Index, long, and ring; index, long, and little; or index, ring, and little fingers4030
Long, ring, and little fingers3020
Note: Also consider whether evaluation as amputation is warranted.
5219 Two digits of one hand, unfavorable ankylosis of:
Thumb and any finger4030
Index and long; index and ring; or index and little fingers3020
Long and ring; long and little; or ring and little fingers2020
Note: Also consider whether evaluation as amputation is warranted.
II. Multiple Digits: Favorable Ankylosis
5220   Five digits of one hand, favorable ankylosis of5040
5221   Four digits of one hand, favorable ankylosis of:
Thumb and any three fingers5040
Index, long, ring, and little fingers4030
5222 Three digits of one hand, favorable ankylosis of:
Thumb and any two fingers4030
Index, long, and ring; index, long, and little; or index, ring, and little fingers3020
Long, ring and little fingers2020
5223   Two digits of one hand, favorable ankylosis of:
Thumb and any finger3020
Index and long; index and ring; or index and little fingers2020
Long and ring; long and little; or ring and little fingers1010
III. Ankylosis of Individual Digits
5224   Thumb, ankylosis of:
Unfavorable2020
Favorable1010
Note: 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 favorable1010
Note: 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 favorable1010
Note: 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 favorable00
Note: 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 the thumb pad and the fingers, with the thumb attempting to oppose the fingers2020
With a gap of one to two inches (2.5 to 5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers1010
With a gap of less than one inch (2.5 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers00
5229   Index or long finger, limitation of motion:
With a gap of one inch (2.5 cm.) or more between the 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 degrees1010
With a gap of less than one inch (2.5 cm.) between 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 degrees00
5230   Ring or little finger, limitation of motion:
Any limitation of motion00

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 spine100
Unfavorable ankylosis of the entire thoracolumbar spine50
Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine40
Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine30
Forward flexion of the thoracolumbar spine greater than 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 kyphosis20
Forward flexion of the thoracolumbar spine greater than 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 height10
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 syndrome
Evaluate 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 Episodes
With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months60
With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months40
With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months20
With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months10
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 reaching ground, crutches necessitated390
Intermediate70
Favorable, in flexion at an angle between 20° and 40°, and slight adduction or abduction60
5251   Thigh, limitation of extension of:
Extension limited to 5°10
5252   Thigh, limitation of flexion of:
Flexion limited to 10°40
Flexion limited to 20°30
Flexion limited to 30°20
Flexion limited to 45°10
5253   Thigh, impairment of:
Limitation of abduction of, motion lost beyond 10°20
Limitation of adduction of, cannot cross legs10
Limitation of rotation of, cannot toe-out more than 15°, affected leg10
5254   Hip, flail joint80
5255   Femur, impairment of:
Fracture of shaft or anatomical neck of:
With nonunion, with loose motion (spiral or oblique fracture)80
With nonunion, without loose motion, weightbearing preserved with aid of brace60
Fracture of surgical neck of, with false joint60
Malunion of:
With marked knee or hip disability30
With moderate knee or hip disability20
With slight knee or hip disability10

3Entitled to special monthly compensation.

The Knee and Leg

   Rating
5256   Knee, ankylosis of:
Extremely unfavorable, in flexion at an angle of 45° or more60
In flexion between 20° and 45°50
In flexion between 10° and 20°40
Favorable angle in full extension, or in slight flexion between 0° and 10°30
5257   Knee, other impairment of:
Recurrent subluxation or lateral instability:
Severe30
Moderate20
Slight10
5258   Cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain, and effusion into the joint20
5259   Cartilage, semilunar, removal of, symptomatic10
5260   Leg, limitation of flexion of:
Flexion limited to 15°30
Flexion limited to 30°20
Flexion limited to 45°10
Flexion limited to 60°0
5261   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°0
5262   Tibia and fibula, impairment of:
Nonunion of, with loose motion, requiring brace40
Malunion of:
With marked knee or ankle disability30
With moderate knee or ankle disability20
With slight knee or ankle disability10
5263   Genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated)10

The Ankle

   Rating
5270   Ankle, ankylosis of:
In plantar flexion at more than 40°, or in dorsiflexion at more than 10° or with abduction, adduction, inversion or eversion deformity40
In plantar flexion, between 30° and 40°, or in dorsiflexion, between 0° and 10°30
In plantar flexion, less than 30°20
5271   Ankle, limited motion of:
Marked20
Moderate10
5272   Subastragalar or tarsal joint, ankylosis of:
In poor weight-bearing position20
In good weight-bearing position10
5273   Os calcis or astragalus, malunion of:
Marked deformity20
Moderate deformity10
5274   Astragalectomy20

Shortening of the Lower Extremity

   Rating
5275   Bones, of the lower extremity, shortening of:
Over 4 inches (10.2 cms.)360
31/2 to 4 inches (8.9 cms. to 10.2 cms.)350
3 to 31/2 inches (7.6 cms. to 8.9 cms.)40
21/2 to 3 inches (6.4 cms. to 7.6 cms.)30
2 to 21/2 inches (5.1 cms. to 6.4 cms.)20
11/4 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.

3Also 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
Bilateral50
Unilateral30
Severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities:
Bilateral30
Unilateral20
Moderate; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral10
Mild; symptoms relieved by built-up shoe or arch support0
5277   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 rating10
5278   Claw foot (pes cavus), acquired:
Marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, marked varus deformity:
Bilateral50
Unilateral30
All toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads:
Bilateral30
Unilateral20
Great toe dorsiflexed, some limitation of dorsiflexion at ankle, definite tenderness under metatarsal heads:
Bilateral10
Unilateral10
Slight0
5279   Metatarsalgia, anterior (Morton's disease), unilateral, or bilateral10
5280   Hallux valgus, unilateral:
Operated with resection of metatarsal head10
Severe, if equivalent to amputation of great toe10
5281   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 foot10
Single toes0
5283   Tarsal, or metatarsal bones, malunion of, or nonunion of:
Severe30
Moderately severe20
Moderate10
Note: With actual loss of use of the foot, rate 40 percent.
5284   Foot injuries, other:
Severe30
Moderately severe20
Moderate10
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 hernia80
Without brain hernia:
Area larger than size of a 50-cent piece or 1.140 in2 (7.355 cm2)50
Area intermediate30
Area smaller than the size of a 25-cent piece or 0.716 in2 (4.619 cm2)10
Note: Rate separately for intracranial complications.

The Ribs

   Rating
5297   Ribs, removal of:
More than six50
Five or six40
Three or four30
Two20
One or resection of two or more ribs without regeneration10
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 residuals10
Without painful residuals0

(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]

§4.73   Schedule of ratings—muscle injuries.

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
DominantNondominant
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
Severe4030
Moderately Severe3020
Moderate1010
Slight00
5302   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
Severe4030
Moderately Severe3020
Moderate2020
Slight00
5303   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
Severe4030
Moderately Severe3020
Moderate2020
Slight00
5304   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
Severe3020
Moderately Severe2020
Moderate1010
Slight00
5305   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
Severe4030
Moderately Severe3020
Moderate1010
Slight00
5306   Group VI. Function: Extension of elbow (long head of triceps is stabilizer of shoulder joint). Extensor muscles of the elbow: (1) Triceps; (2) anconeus.
Severe4030
Moderately Severe3020
Moderate1010
Slight00

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
Severe4030
Moderately Severe3020
Moderate1010
Slight00
5308   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
Severe3020
Moderately Severe2020
Moderate1010
Slight00
5309   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
Severe30
Moderately Severe20
Moderate10
Slight0
Dorsal: (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
Severe20
Moderately Severe10
Moderate10
Slight0
Note: 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
Severe30
Moderately Severe20
Moderate10
Slight0
5312   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
Severe30
Moderately Severe20
Moderate10
Slight0

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
Severe40
Moderately Severe30
Moderate10
Slight0
5314   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
Severe40
Moderately Severe30
Moderate10
Slight0
5315   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
Severe30
Moderately Severe20
Moderate10
Slight0
5316   Group XVI. Function: Flexion of hip (1, 2, 3). Pelvic girdle group 1: (1) Psoas; (2) iliacus; (3) pectineus
Severe40
Moderately Severe30
Moderate10
Slight0
5317   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 Severe40
Moderate20
Slight0
5318   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
Severe30
Moderately Severe20
Moderate10
Slight0

*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
Severe50
Moderately Severe30
Moderate10
Slight0
5320   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:
Severe40
Moderately Severe20
Moderate10
Slight0
Lumbar region:
Severe60
Moderately Severe40
Moderate20
Slight0
5321   Group XXI. Function: Respiration. Muscles of respiration: Thoracic muscle group
Severe or Moderately Severe20
Moderate10
Slight0
5322   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
Severe30
Moderately Severe20
Moderate10
Slight0
5323   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
Severe30
Moderately Severe20
Moderate10
Slight0

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

§4.75   General considerations for evaluating visual impairment.

(a) Visual impairment. The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function.

(b) Examination for visual impairment. The examination must be conducted by a licensed optometrist or by a licensed ophthalmologist. The examiner must identify the disease, injury, or other pathologic process responsible for any visual impairment found. Examinations of visual fields or muscle function will be conducted only when there is a medical indication of disease or injury that may be associated with visual field defect or impaired muscle function. Unless medically contraindicated, the fundus must be examined with the claimant's pupils dilated.

(c) Service-connected visual impairment of only one eye. Subject to the provisions of 38 CFR 3.383(a), if visual impairment of only one eye is service-connected, the visual acuity of the other eye will be considered to be 20/40 for purposes of evaluating the service-connected visual impairment.

(d) Maximum evaluation for visual impairment of one eye. The evaluation for visual impairment of one eye must not exceed 30 percent unless there is anatomical loss of the eye. Combine the evaluation for visual impairment of one eye with evaluations for other disabilities of the same eye that are not based on visual impairment (e.g., disfigurement under diagnostic code 7800).

(e) Anatomical loss of one eye with inability to wear a prosthesis. When the claimant has anatomical loss of one eye and is unable to wear a prosthesis, increase the evaluation for visual acuity under diagnostic code 6063 by 10 percent, but the maximum evaluation for visual impairment of both eyes must not exceed 100 percent. A 10-percent increase under this paragraph precludes an evaluation under diagnostic code 7800 based on gross distortion or asymmetry of the eye but not an evaluation under diagnostic code 7800 based on other characteristics of disfigurement.

(f) Special monthly compensation. When evaluating visual impairment, refer to 38 CFR 3.350 to determine whether the claimant may be entitled to special monthly compensation. Footnotes in the schedule indicate levels of visual impairment that potentially establish entitlement to special monthly compensation; however, other levels of visual impairment combined with disabilities of other body systems may also establish entitlement.

(Authority: 38 U.S.C. 1114 and 1155)

[73 FR 66549, Nov. 10, 2008]

§4.76   Visual acuity.

(a) Examination of visual acuity. Examination of visual acuity must include the central uncorrected and corrected visual acuity for distance and near vision using Snellen's test type or its equivalent.

(b) Evaluation of visual acuity. (1) Evaluate central visual acuity on the basis of corrected distance vision with central fixation, even if a central scotoma is present. However, when the lens required to correct distance vision in the poorer eye differs by more than three diopters from the lens required to correct distance vision in the better eye (and the difference is not due to congenital or developmental refractive error), and either the poorer eye or both eyes are service connected, evaluate the visual acuity of the poorer eye using either its uncorrected or corrected visual acuity, whichever results in better combined visual acuity.

(2) Provided that he or she customarily wears contact lenses, evaluate the visual acuity of any individual affected by a corneal disorder that results in severe irregular astigmatism that can be improved more by contact lenses than by eyeglass lenses, as corrected by contact lenses.

(3) In any case where the examiner reports that there is a difference equal to two or more scheduled steps between near and distance corrected vision, with the near vision being worse, the examination report must include at least two recordings of near and distance corrected vision and an explanation of the reason for the difference. In these cases, evaluate based on corrected distance vision adjusted to one step poorer than measured.

(4) To evaluate the impairment of visual acuity where a claimant has a reported visual acuity that is between two sequentially listed visual acuities, use the visual acuity which permits the higher evaluation.

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

[73 FR 66549, Nov. 10, 2008]

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

Table III—Normal Visual Field Extent at 8 Principal Meridians

MeridianNormal degrees
Temporally85
Down temporally85
Down65
Down nasally50
Nasally60
Up nasally55
Up45
Up temporally55
         Total500
eCFR graphic ec04no91.005.gif

View or download PDF

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

LossDegrees
Temporally55
Down temporally55
Down45
Down nasally30
Nasally40
Up nasally35
Up25
Up temporally35
         Total loss320

Remaining field 500° minus 320° = 180°. 180° ÷ 8 = 221/2° average concentric contraction.

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

[43 FR 45352, Oct. 2, 1978, as amended at 73 FR 66549, Nov. 10, 2008]

§4.77   Visual fields.

(a) Examination of visual fields. Examiners must use either Goldmann kinetic perimetry or automated perimetry using Humphrey Model 750, Octopus Model 101, or later versions of these perimetric devices with simulated kinetic Goldmann testing capability. For phakic (normal) individuals, as well as for pseudophakic or aphakic individuals who are well adapted to intraocular lens implant or contact lens correction, visual field examinations must be conducted using a standard target size and luminance, which is Goldmann's equivalent III/4e. For aphakic individuals not well adapted to contact lens correction or pseudophakic individuals not well adapted to intraocular lens implant, visual field examinations must be conducted using Goldmann's equivalent IV/4e. In all cases, the results must be recorded on a standard Goldmann chart (see Figure 2), and the Goldmann chart must be included with the examination report. The examiner must chart at least 16 meridians 2212 degrees apart for each eye and indicate the Goldmann equivalent used. See Table III for the normal extent (in degrees) of the visual fields at the 8 principal meridians (45 degrees apart). When the examiner indicates that additional testing is necessary to evaluate visual fields, the additional testing must be conducted using either a tangent screen or a 30-degree threshold visual field with the Goldmann III stimulus size. The examination report must then include the tracing of either the tangent screen or of the 30-degree threshold visual field with the Goldmann III stimulus size.

(b) Evaluation of visual fields. Determine the average concentric contraction of the visual field of each eye by measuring the remaining visual field (in degrees) at each of eight principal meridians 45 degrees apart, adding them, and dividing the sum by eight.

(c) Combination of visual field defect and decreased visual acuity. To determine the evaluation for visual impairment when both decreased visual acuity and visual field defect are present in one or both eyes and are service connected, separately evaluate the visual acuity and visual field defect (expressed as a level of visual acuity), and combine them under the provisions of §4.25.

eCFR graphic ec04no91.006.gif

View or download PDF

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

[53 FR 30262, Aug. 11, 1988, as amended at 73 FR 66549, Nov. 10, 2008; 74 FR 7648, Feb. 19, 2009]

§4.78   Muscle function.

(a) Examination of muscle function. The examiner must use a Goldmann perimeter chart that identifies the four major quadrants (upward, downward, left and right lateral) and the central field (20 degrees or less) (see Figure 2). The examiner must chart the areas of diplopia and include the plotted chart with the examination report.

(b) Evaluation of muscle function. (1) An evaluation for diplopia will be assigned to only one eye. When a claimant has both diplopia and decreased visual acuity or visual field defect, assign a level of corrected visual acuity for the poorer eye (or the affected eye, if disability of only one eye is service-connected) that is: one step poorer than it would otherwise warrant if the evaluation for diplopia under diagnostic code 6090 is 20/70 or 20/100; two steps poorer if the evaluation under diagnostic code 6090 is 20/200 or 15/200; or three steps poorer if the evaluation under diagnostic code 6090 is 5/200. This adjusted level of corrected visual acuity, however, must not exceed a level of 5/200. Use the adjusted visual acuity for the poorer eye (or the affected eye, if disability of only one eye is service-connected), and the corrected visual acuity for the better eye (or visual acuity of 20/40 for the other eye, if only one eye is service-connected) to determine the percentage evaluation for visual impairment under diagnostic codes 6065 through 6066.

(2) When diplopia extends beyond more than one quadrant or range of degrees, evaluate diplopia based on the quadrant and degree range that provides the highest evaluation.

(3) When diplopia exists in two separate areas of the same eye, increase the equivalent visual acuity under diagnostic code 6090 to the next poorer level of visual acuity, not to exceed 5/200.

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

[73 FR 66550, Nov. 10, 2008]

§4.79   Schedule of ratings—eye.

Diseases of the Eye

    Rating
6000   Choroidopathy, including uveitis, iritis, cyclitis, and choroiditis.
6001   Keratopathy.
6002   Scleritis.
6006   Retinopathy or maculopathy.
6007   Intraocular hemorrhage.
6008   Detachment of retina.
6009   Unhealed eye injury.
General Rating Formula for Diagnostic Codes 6000 through 6009
Evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation.
With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months60
With incapacitating episodes having a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months40
With incapacitating episodes having a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months20
With incapacitating episodes having a total duration of at least 1 week, but less than 2 weeks, during the past 12 months10
Note: For VA purposes, an incapacitating episode is a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider.
6010   Tuberculosis of eye:
Active100
Inactive: Evaluate under §4.88c or §4.89 of this part, whichever is appropriate.
6011   Retinal scars, atrophy, or irregularities:
Localized scars, atrophy, or irregularities of the retina, unilateral or bilateral, that are centrally located and that result in an irregular, duplicated, enlarged, or diminished image10
Alternatively, evaluate based on visual impairment due to retinal scars, atrophy, or irregularities, if this would result in a higher evaluation.
6012   Angle-closure glaucoma:
Evaluate on the basis of either visual impairment due to angle-closure glaucoma or incapacitating episodes, whichever results in a higher evaluation.
With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months60
With incapacitating episodes having a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months40
With incapacitating episodes having a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months20
Minimum evaluation if continuous medication is required10
Note: For VA purposes, an incapacitating episode is a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider.
6013   Open-angle glaucoma:
Evaluate based on visual impairment due to open-angle glaucoma.
Minimum evaluation if continuous medication is required10
6014   Malignant neoplasms (eyeball only):
Malignant neoplasm of the eyeball that requires therapy that is comparable to that used for systemic malignancies, i.e., systemic chemotherapy, X-ray therapy more extensive than to the area of the eye, or surgery more extensive than enucleation100
Note: Continue the 100-percent rating 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 will be determined by mandatory VA examination. 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, evaluate based on residuals.
Malignant neoplasm of the eyeball that does not require therapy comparable to that for systemic malignancies:
Separately evaluate visual impairment and nonvisual impairment, e.g., disfigurement (diagnostic code 7800), and combine the evaluations.
6015   Benign neoplasms (of eyeball and adnexa):
Separately evaluate visual impairment and nonvisual impairment, e.g., disfigurement (diagnostic code 7800), and combine the evaluations.
6016   Nystagmus, central10
6017   Trachomatous conjunctivitis:
Active: Evaluate based on visual impairment, minimum30
Inactive: Evaluate based on residuals, such as visual impairment and disfigurement (diagnostic code 7800).
6018   Chronic conjunctivitis (nontrachomatous):
Active (with objective findings, such as red, thick conjunctivae, mucous secretion, etc.)10
Inactive: Evaluate based on residuals, such as visual impairment and disfigurement (diagnostic code 7800).
6019   Ptosis, unilateral or bilateral:
Evaluate based on visual impairment or, in the absence of visual impairment, on disfigurement (diagnostic code 7800).
6020   Ectropion:
Bilateral20
Unilateral10
6021   Entropion:
Bilateral20
Unilateral10
6022   Lagophthalmos:
Bilateral20
Unilateral10
6023   Loss of eyebrows, complete, unilateral or bilateral10
6024   Loss of eyelashes, complete, unilateral or bilateral10
6025   Disorders of the lacrimal apparatus (epiphora, dacryocystitis, etc.):
Bilateral20
Unilateral10
6026   Optic neuropathy:
Evaluate based on visual impairment.
6027   Cataract of any type:
   Preoperative:
Evaluate based on visual impairment.
   Postoperative:
If a replacement lens is present (pseudophakia), evaluate based on visual impairment. If there is no replacement lens, evaluate based on aphakia.
6029   Aphakia or dislocation of crystalline lens:
Evaluate based on visual impairment, and elevate the resulting level of visual impairment one step.
Minimum (unilateral or bilateral)30
6030   Paralysis of accommodation (due to neuropathy of the Oculomotor Nerve (cranial nerve III)).20
6032   Loss of eyelids, partial or complete:
Separately evaluate both visual impairment due to eyelid loss and nonvisual impairment, e.g., disfigurement (diagnostic code 7800), and combine the evaluations.
6034   Pterygium:
Evaluate based on visual impairment, disfigurement (diagnostic code 7800), conjunctivitis (diagnostic code 6018), etc., depending on the particular findings.
6035   Keratoconus:
Evaluate based on impairment of visual acuity.
6036   Status post corneal transplant:
Evaluate based on visual impairment.
Minimum, if there is pain, photophobia, and glare sensitivity10
6037   Pinguecula:
Evaluate based on disfigurement (diagnostic code 7800).
Impairment of Central Visual Acuity
6061   Anatomical loss of both eyes1100
6062   No more than light perception in both eyes1100
6063   Anatomical loss of one eye:1
In the other eye 5/200 (1.5/60)100
In the other eye 10/200 (3/60)90
In the other eye 15/200 (4.5/60)80
In the other eye 20/200 (6/60)70
In the other eye 20/100 (6/30)60
In the other eye 20/70 (6/21)60
In the other eye 20/50 (6/15)50
In the other eye 20/40 (6/12)40
6064   No more than light perception in one eye:1
In the other eye 5/200 (1.5/60)100
In the other eye 10/200 (3/60)90
In the other eye 15/200 (4.5/60)80
In the other eye 20/200 (6/60)70
In the other eye 20/100 (6/30)60
In the other eye 20/70 (6/21)50
In the other eye 20/50 (6/15)40
In the other eye 20/40 (6/12)30
6065   Vision in one eye 5/200 (1.5/60):
In the other eye 5/200 (1.5/60)1100
In the other eye 10/200 (3/60)90
In the other eye 15/200 (4.5/60)80
In the other eye 20/200 (6/60)70
In the other eye 20/100 (6/30)60
In the other eye 20/70 (6/21)50
In the other eye 20/50 (6/15)40
In the other eye 20/40 (6/12)30
6066   Visual acuity in one eye 10/200 (3/60) or better:
Vision in one eye 10/200 (3/60):
In the other eye 10/200 (3/60)90
In the other eye 15/200 (4.5/60)80
In the other eye 20/200 (6/60)70
In the other eye 20/100 (6/30)60
In the other eye 20/70 (6/21)50
In the other eye 20/50 (6/15)40
In the other eye 20/40 (6/12)30
Vision in one eye 15/200 (4.5/60):
In the other eye 15/200 (4.5/60)80
In the other eye 20/200 (6/60)70
In the other eye 20/100 (6/30)60
In the other eye 20/70 (6/21)40
In the other eye 20/50 (6/15)30
In the other eye 20/40 (6/12)20
Vision in one eye 20/200 (6/60):
In the other eye 20/200 (6/60)70
In the other eye 20/100 (6/30)60
In the other eye 20/70 (6/21)40
In the other eye 20/50 (6/15)30
In the other eye 20/40 (6/12)20
Vision in one eye 20/100 (6/30):
In the other eye 20/100 (6/30)50
In the other eye 20/70 (6/21)30
In the other eye 20/50 (6/15)20
In the other eye 20/40 (6/12)10
Vision in one eye 20/70 (6/21):
In the other eye 20/70 (6/21)30
In the other eye 20/50 (6/15)20
In the other eye 20/40 (6/12)10
Vision in one eye 20/50 (6/15):
In the other eye 20/50 (6/15)10
In the other eye 20/40 (6/12)10
Vision in one eye 20/40 (6/12):
In the other eye 20/40 (6/12)0

1Review for entitlement to special monthly compensation under 38 CFR 3.350.

Ratings for Impairment of Visual Fields

   Rating
6080   Visual field defects:
Homonymous hemianopsia30
Loss of temporal half of visual field:
Bilateral30
Unilateral10
Or evaluate each affected eye as 20/70 (6/21)
Loss of nasal half of visual field:
Bilateral10
Unilateral10
Or evaluate each affected eye as 20/50 (6/15)
Loss of inferior half of visual field:
Bilateral30
Unilateral10
Or evaluate each affected eye as 20/70 (6/21)
Loss of superior half of visual field:
Bilateral10
Unilateral10
Or evaluate each affected eye as 20/50 (6/15)
Concentric contraction of visual field:
With remaining field of 5 degrees:1
Bilateral100
Unilateral30
Or evaluate each affected eye as 5/200 (1.5/60)
With remaining field of 6 to 15 degrees:
Bilateral70
Unilateral20
Or evaluate each affected eye as 20/200 (6/60)
With remaining field of 16 to 30 degrees:
Bilateral50
Unilateral10
Or evaluate each affected eye as 20/100 (6/30)
With remaining field of 31 to 45 degrees:
Bilateral30
Unilateral10
Or evaluate each affected eye as 20/70 (6/21)
With remaining field of 46 to 60 degrees:
Bilateral10
Unilateral10
Or evaluate each affected eye as 20/50 (6/15)
6081   Scotoma, unilateral:
Minimum, with scotoma affecting at least one-quarter of the visual field (quadrantanopsia) or with centrally located scotoma of any size10
Alternatively, evaluate based on visual impairment due to scotoma, if that would result in a higher evaluation

1Review for entitlement to special monthly compensation under 38 CFR 3.350.

Ratings for Impairment of Muscle Function

Degree of diplopiaEquivalent
visual acuity
6090   Diplopia (double vision):
(a) Central 20 degrees5/200 (1.5/60)
(b) 21 degrees to 30 degrees
(1) Down15/200 (4.5/60)
(2) Lateral20/100 (6/30)
(3) Up20/70 (6/21)
(c) 31 degrees to 40 degrees
(1) Down20/200 (6/60)
(2) Lateral20/70 (6/21)
(3) Up20/40 (6/12)
Note: In accordance with 38 CFR 4.31, diplopia that is occasional or that is correctable with spectacles is evaluated at 0 percent.
6091   Symblepharon:
Evaluate based on visual impairment, lagophthalmos (diagnostic code 6022), disfigurement (diagnostic code 7800), etc., depending on the particular findings.

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

[73 FR 66550, Nov. 10, 2008]

§§4.80-4.84   [Reserved]

Impairment of Auditory Acuity

§4.85   Evaluation of hearing impairment.

(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.

eCFR graphic er11my99.005.gif

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eCFR graphic er11my99.006.gif

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[64 FR 25206, May 11, 1999]

§4.86   Exceptional patterns of hearing impairment.

(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.

Diseases of the Ear

   Rating
6200   Chronic suppurative otitis media, mastoiditis, or cholesteatoma (or any combination):
During suppuration, or with aural polyps10
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 impairment
6202   Otosclerosis:
Rate hearing impairment
6204   Peripheral vestibular disorders:
Dizziness and occasional staggering30
Occasional dizziness10
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 occurring more than once weekly, with or without tinnitus100
Hearing impairment with attacks of vertigo and cerebellar gait occurring from one to four times a month, with or without tinnitus60
Hearing impairment with vertigo less than once a month, with or without tinnitus30
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 both50
Complete loss of one30
Deformity of one, with loss of one-third or more of the substance10
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 requiring frequent and prolonged treatment10
6211   Tympanic membrane, perforation of0
6260   Tinnitus, recurrent10
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.

   Rating
6275   Sense of smell, complete loss10
6276   Sense of taste, complete loss10
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

§4.88   [Reserved]

§4.88a   Chronic fatigue syndrome.

(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.

   Rating
6300   Cholera, Asiatic:
As active disease, and for 3 months convalescence100
Thereafter rate residuals such as renal necrosis under the appropriate system
6301   Visceral Leishmaniasis:
During treatment for active disease100
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 disease100
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 disease100
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 system
6305   Lymphatic Filariasis:
As active disease100
Thereafter rate residuals such as epididymitis or lymphangitis under the appropriate system
6306   Bartonellosis:
As active disease, and for 3 months convalescence100
Thereafter rate residuals such as skin lesions under the appropriate system
6307   Plague:
As active disease100
Thereafter rate residuals such as lymphadenopathy under the appropriate system
6308   Relapsing Fever:
As active disease100
Thereafter rate residuals such as liver or spleen damage or central nervous system involvement under the appropriate system
6309   Rheumatic fever:
As active disease100
Thereafter rate residuals such as heart damage under the appropriate system
6310   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 disease100
Inactive: See §§4.88c and 4.89.
6313   Avitaminosis:
Marked mental changes, moist dermatitis, inability to retain adequate nourishment, exhaustion, and cachexia100
With all of the symptoms listed below, plus mental symptoms and impaired bodily vigor60
With stomatitis, diarrhea, and symmetrical dermatitis40
With stomatitis, or achlorhydria, or diarrhea20
Confirmed diagnosis with nonspecific symptoms such as: decreased appetite, weight loss, abdominal discomfort, weakness, inability to concentrate and irritability10
6314   Beriberi:
As active disease:
With congestive heart failure, anasarca, or Wernicke-Korsakoff syndrome100
With cardiomegaly, or; with peripheral neuropathy with footdrop or atrophy of thigh or calf muscles60
With peripheral neuropathy with absent knee or ankle jerks and loss of sensation, or; with symptoms such as weakness, fatigue, anorexia, dizziness, heaviness and stiffness of legs, headache or sleep disturbance30
Thereafter rate residuals under the appropriate body system.
6315   Pellagra:
Marked mental changes, moist dermatitis, inability to retain adequate nourishment, exhaustion, and cachexia100
With all of the symptoms listed below, plus mental symptoms and impaired bodily vigor60
With stomatitis, diarrhea, and symmetrical dermatitis40
With stomatitis, or achlorhydria, or diarrhea20
Confirmed diagnosis with nonspecific symptoms such as: decreased appetite, weight loss, abdominal discomfort, weakness, inability to concentrate and irritability10
6316   Brucellosis:
As active disease100
Thereafter rate residuals such as liver or spleen damage or meningitis under the appropriate system
6317   Typhus, scrub:
As active disease, and for 3 months convalescence100
Thereafter rate residuals such as spleen damage or skin conditions under the appropriate system
6318   Melioidosis:
As active disease100
Thereafter rate residuals such as arthritis, lung lesions or meningitis under the appropriate system
6319   Lyme Disease:
As active disease100
Thereafter rate residuals such as arthritis under the appropriate system
6320   Parasitic diseases otherwise not specified:
As active disease100
Thereafter rate residuals such as spleen or liver damage under the appropriate system
6350   Lupus erythematosus, systemic (disseminated):
Not to be combined with ratings under DC 7809 Acute, with frequent exacerbations, producing severe impairment of health100
Exacerbations lasting a week or more, 2 or 3 times per year60
Exacerbations once or twice a year or symptomatic during the past 2 years10
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 secondary diseases afflicting multiple body systems; HIV-related illness with debility and progressive weight loss, without remission, or few or brief remissions100
Refractory constitutional symptoms, diarrhea, and pathological weight loss, or; minimum rating following development of AIDS-related opportunistic infection or neoplasm60
Recurrent constitutional symptoms, intermittent diarrhea, and on approved medication(s), or; minimum rating with T4 cell count less than 200, or Hairy Cell Leukoplakia, or Oral Candidiasis30
Following development of definite medical symptoms, T4 cell of 200 or more and less than 500, and on approved medication(s), or; with evidence of depression or memory loss with employment limitations10
Asymptomatic, following initial diagnosis of HIV infection, with or without lymphadenopathy or decreased T4 cell count0
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 routine daily activities almost completely and which may occasionally preclude self-care100
Which are nearly constant and restrict routine daily 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 year60
Which are nearly constant and restrict routine daily 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 year40
Which are nearly constant and restrict routine daily 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 year20
Which wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year, or; symptoms controlled by continuous medication10
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.

   Rating
For 1 year after date of inactivity, following active tuberculosis100
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.

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 tuberculosis, which was clinically identified during service or subsequently100
Thereafter, for 4 years, or in any event, to 6 years after date of inactivity50
Thereafter, for 5 years, or to 11 years after date of inactivity30
Thereafter, in the absence of a schedular compensable permanent residual0
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

§4.96   Special provisions regarding evaluation of respiratory conditions.

(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.

(d) Special provisions for the application of evaluation criteria for diagnostic codes 6600, 6603, 6604, 6825-6833, and 6840-6845. (1) Pulmonary function tests (PFT's) are required to evaluate these conditions except:

(i) When the results of a maximum exercise capacity test are of record and are 20 ml/kg/min or less. If a maximum exercise capacity test is not of record, evaluate based on alternative criteria.

(ii) When pulmonary hypertension (documented by an echocardiogram or cardiac catheterization), cor pulmonale, or right ventricular hypertrophy has been diagnosed.

(iii) When there have been one or more episodes of acute respiratory failure.

(iv) When outpatient oxygen therapy is required.

(2) If the DLCO (SB) (Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method) test is not of record, evaluate based on alternative criteria as long as the examiner states why the test would not be useful or valid in a particular case.

(3) When the PFT's are not consistent with clinical findings, evaluate based on the PFT's unless the examiner states why they are not a valid indication of respiratory functional impairment in a particular case.

(4) Post-bronchodilator studies are required when PFT's are done for disability evaluation purposes except when the results of pre-bronchodilator pulmonary function tests are normal or when the examiner determines that post-bronchodilator studies should not be done and states why.

(5) When evaluating based on PFT's, use post-bronchodilator results in applying the evaluation criteria in the rating schedule unless the post-bronchodilator results were poorer than the pre-bronchodilator results. In those cases, use the pre-bronchodilator values for rating purposes.

(6) When there is a disparity between the results of different PFT's (FEV-1 (Forced Expiratory Volume in one second), FVC (Forced Vital Capacity), etc.), so that the level of evaluation would differ depending on which test result is used, use the test result that the examiner states most accurately reflects the level of disability.

(7) If the FEV-1 and the FVC are both greater than 100 percent, do not assign a compensable evaluation based on a decreased FEV-1/FVC ratio.

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

[34 FR 5062, Mar. 11, 1969, as amended at 61 FR 46727, Sept. 5, 1996; 71 FR 52459, Sept. 6, 2006]

§4.97   Schedule of ratings—respiratory system.

   Rating
DISEASES OF THE NOSE AND THROAT
6502   Septum, nasal, deviation of:
Traumatic only,
With 50-percent obstruction of the nasal passage on both sides or complete obstruction on one side10
6504   Nose, loss of part of, or scars:
Exposing both nasal passages30
Loss of part of one ala, or other obvious disfigurement10
Note: 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, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries50
Three or more incapacitating episodes per year of 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 crusting30
One or two incapacitating episodes per year of 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 crusting10
Detected by X-ray only0
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, submucous infiltration, or pre-malignant changes on biopsy30
Hoarseness, with inflammation of cords or mucous membrane10
6518   Laryngectomy, total.1100
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 speech1100
Constant inability to speak above a whisper60
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 percent of predicted value, with Flow-Volume Loop compatible with upper airway obstruction, or; permanent tracheostomy100
FEV-1 of 40- to 55-percent predicted, with Flow-Volume Loop compatible with upper airway obstruction60
FEV-1 of 56- to 70-percent predicted, with Flow-Volume Loop compatible with upper airway obstruction30
FEV-1 of 71- to 80-percent predicted, with Flow-Volume Loop compatible with upper airway obstruction10
Note: Or evaluate as aphonia (DC 6519).
6521   Pharynx, injuries to:
Stricture or obstruction of pharynx or nasopharynx, or; absence of soft palate secondary to trauma, chemical burn, or granulomatous disease, or; paralysis of soft palate with swallowing difficulty (nasal regurgitation) and speech impairment50
6522   Allergic or vasomotor rhinitis:
With polyps30
Without polyps, but with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side10
6523   Bacterial rhinitis:
Rhinoscleroma50
With permanent hypertrophy of turbinates and with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side10
6524   Granulomatous rhinitis:
Wegener's granulomatosis, lethal midline granuloma100
Other types of granulomatous infection20
DISEASES OF THE TRACHEA AND BRONCHI
6600   Bronchitis, chronic:
FEV-1 less than 40 percent of predicted value, or; the 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 therapy100
FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 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)60
FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted30
FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted10
6601   Bronchiectasis:
With incapacitating episodes of infection of at least six weeks total duration per year100
With incapacitating episodes of infection of four to six 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 continuously60
With incapacitating episodes of infection of two to four 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 year30
Intermittent productive cough with acute infection requiring a course of antibiotics at least twice a year10
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 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 medications100
FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 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) corticosteroids60
FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication30
FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy10
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 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.100
FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 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)60
FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted30
FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted10
6604   Chronic obstructive pulmonary disease:
FEV-1 less than 40 percent of predicted value, or; the 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.100
FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 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)60
FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted30
FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted10
DISEASES OF THE LUNGS AND PLEURA—TUBERCULOSIS
Ratings for Pulmonary Tuberculosis Entitled on August 19, 1968
6701   Tuberculosis, pulmonary, chronic, far advanced, active100
6702   Tuberculosis, pulmonary, chronic, moderately advanced, active100
6703   Tuberculosis, pulmonary, chronic, minimal, active100
6704   Tuberculosis, pulmonary, chronic, active, advancement unspecified100
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: For two years after date of inactivity, following active tuberculosis, which was clinically identified during service or subsequently100
Thereafter for four years, or in any event, to six years after date of inactivity50
Thereafter, for five years, or to eleven years after date of inactivity30
Following far advanced lesions diagnosed at any time while the disease process was active, minimum30
Following moderately advanced lesions, provided there is continued disability, emphysema, dyspnea on exertion, impairment of health, etc20
Otherwise0
Note (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, active100
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 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 pulmonale100
Chronic pulmonary thromboembolism requiring anticoagulant therapy, or; following inferior vena cava surgery without evidence of pulmonary hypertension or right ventricular dysfunction60
Symptomatic, following resolution of acute pulmonary embolism30
Asymptomatic, following resolution of pulmonary thromboembolism0
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 respiratory system exclusive of skin growths100
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, night sweats, weight loss, or hemoptysis100
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 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 therapy100
FVC of 50- to 64-percent predicted, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation60
FVC of 65- to 74-percent predicted, or; DLCO (SB) of 56- to 65-percent predicted30
FVC of 75- to 80-percent predicted, or; DLCO (SB) of 66- to 80-percent predicted10
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 loss, night sweats, or massive hemoptysis100
Chronic pulmonary mycosis requiring suppressive therapy with no more than minimal symptoms such as occasional minor hemoptysis or productive cough50
Chronic pulmonary mycosis with minimal symptoms such as occasional minor hemoptysis or productive cough30
Healed and inactive mycotic lesions, asymptomatic0
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 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 therapy100
FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 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)60
FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted30
FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted10
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 heart failure, or; progressive pulmonary disease with fever, night sweats, and weight loss despite treatment100
Pulmonary involvement requiring systemic high dose (therapeutic) corticosteroids for control60
Pulmonary involvement with persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids30
Chronic hilar adenopathy or stable lung infiltrates without symptoms or physiologic impairment0
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 or cor pulmonale, or; requires tracheostomy100
Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine50
Persistent day-time hypersomnolence30
Asymptomatic but with documented sleep disorder breathing0

1Review 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

§4.100   Application of the evaluation criteria for diagnostic codes 7000-7007, 7011, and 7015-7020.

(a) Whether or not cardiac hypertrophy or dilatation (documented by electrocardiogram, echocardiogram, or X-ray) is present and whether or not there is a need for continuous medication must be ascertained in all cases.

(b) Even if the requirement for a 10% (based on the need for continuous medication) or 30% (based on the presence of cardiac hypertrophy or dilatation) evaluation is met, METs testing is required in all cases except:

(1) When there is a medical contraindication.

(2) When the left ventricular ejection fraction has been measured and is 50% or less.

(3) When chronic congestive heart failure is present or there has been more than one episode of congestive heart failure within the past year.

(4) When a 100% evaluation can be assigned on another basis.

(c) If left ventricular ejection fraction (LVEF) testing is not of record, evaluate based on the alternative criteria unless the examiner states that the LVEF test is needed in a particular case because the available medical information does not sufficiently reflect the severity of the veteran's cardiovascular disability.

[71 FR 52460, Sept. 6, 2006]

§§4.101-4.103   [Reserved]

§4.104   Schedule of ratings—cardiovascular system.

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 three months following cessation of therapy for the active infection100
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 less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent100
More than one episode of acute congestive heart failure in 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 percent60
Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electro-cardiogram, echocardiogram, or X-ray30
Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required10
7001   Endocarditis:
For three months following cessation of therapy for active infection with cardiac involvement100
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 less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent100
More than one episode of acute congestive heart failure in 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 percent60
Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray30
Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required10
7002   Pericarditis:
For three months following cessation of therapy for active infection with cardiac involvement100
Thereafter, with documented pericarditis resulting in:
Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent.100
More than one episode of acute congestive heart failure in 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 percent60
Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electro-cardiogram, echocardiogram, or X-ray30
Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required10
7003   Pericardial adhesions:
Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent100
More than one episode of acute congestive heart failure in 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 percent60
Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electro-cardiogram, echocardiogram, or X-ray30
Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required10
7004   Syphilitic heart disease:
Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent100
More than one episode of acute congestive heart failure in 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 percent60
Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray30
Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required10
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 less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent100
More than one episode of acute congestive heart failure in 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 percent60
Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray30
Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required10
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, documented by laboratory tests100
Thereafter:
With history of documented myocardial infarction, resulting in:
Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent100
More than one episode of acute congestive heart failure in 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 percent60
Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray30
Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required10
7007   Hypertensive heart disease:
Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent100
More than one episode of acute congestive heart failure in 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 percent60
Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray30
Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required10
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 tachycardia, with more than four episodes per year documented by ECG or Holter monitor30
Permanent atrial fibrillation (lone atrial fibrillation), or; one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor10
7011   Ventricular arrhythmias (sustained):
For indefinite period from date of hospital admission for 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 place100
Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent100
More than one episode of acute congestive heart failure in 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 percent60
Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray30
Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required10
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 less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent100
More than one episode of acute congestive heart failure in 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 percent60
Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray30
Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication or a pacemaker required10
Note: Unusual cases of arrhythmia such as atrioventricular block associated with a supraventricular arrhythmia or pathological bradycardia should be submitted to the Director, Compensation 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 for valve replacement100
Thereafter:
Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent100
More than one episode of acute congestive heart failure in 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 percent60
Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray30
Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required10
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 surgery100
Thereafter:
Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent100
More than one episode of acute congestive heart failure in 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 percent60
Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray30
Workload greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required10
7018   Implantable cardiac pacemakers:
For two months following hospital admission for implantation or reimplantation100
Thereafter:
Evaluate as supraventricular arrhythmias (DC 7010), ventricular arrhythmias (DC 7011), or atrioventricular block (DC 7015). Minimum10
Note: Evaluate implantable Cardioverter-Defibrillators (AICD's) under DC 7011.
7019   Cardiac transplantation:
For an indefinite period from date of hospital admission for cardiac transplantation100
Thereafter:
Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent100
More than one episode of acute congestive heart failure in 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 percent60
Minimum30
Note: 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 less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent100
More than one episode of acute congestive heart failure in 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 percent60
Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray30
Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required10
Diseases of the Arteries and Veins
7101   Hypertensive vascular disease (hypertension and isolated systolic hypertension):
Diastolic pressure predominantly 130 or more60
Diastolic pressure predominantly 120 or more40
Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more20
Diastolic pressure predominantly 100 or more, or; systolic 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 control10
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.
Note (3): Evaluate hypertension separately from hypertensive heart disease and other types of heart disease.
7110   Aortic aneurysm:
If five centimeters or larger in diameter, or; if symptomatic, or; for indefinite period from date of hospital admission for surgical correction (including any type of graft insertion)100
Precluding exertion60
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 hospital admission for surgical correction100
Following surgery:
Ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/brachial index of 0.4 or less100
Claudication on walking less than 25 yards on a level grade 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 less60
Claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes (thin skin, absence of hair, dystrophic nails) or ankle/brachial index of 0.7 or less40
Claudication on walking more than 100 yards, and; diminished peripheral pulses or ankle/brachial index of 0.9 or less20
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:
Asymptomatic0
Note: 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 failure100
Without heart failure but with enlarged heart, wide pulse pressure, and tachycardia60
Without cardiac involvement but with edema, stasis dermatitis, and either ulceration or cellulitis:
Lower extremity50
Upper extremity40
With edema or stasis dermatitis:
Lower extremity30
Upper extremity20
7114   Arteriosclerosis obliterans:
Ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/brachial index of 0.4 or less100
Claudication on walking less than 25 yards on a level grade at 2 miles per hour, and; either persistent coldness of the extremity or ankle/brachial index of 0.5 or less60
Claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes (thin skin, absence of hair, dystrophic nails) or ankle/brachial index of 0.7 or less40
Claudication on walking more than 100 yards, and; diminished peripheral pulses or ankle/brachial index of 0.9 or less20
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 or ankle/brachial index of 0.4 or less100
Claudication on walking less than 25 yards on a level grade at 2 miles per hour, and; either persistent coldness of the extremity or ankle/brachial index of 0.5 or less60
Claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes (thin skin, absence of hair, dystrophic nails) or ankle/brachial index of 0.7 or less40
Claudication on walking more than 100 yards, and; diminished peripheral pulses or ankle/brachial index of 0.9 or less20
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 or more digits and history of characteristic attacks100
With two or more digital ulcers and history of characteristic attacks60
Characteristic attacks occurring at least daily40
Characteristic attacks occurring four to six times a week20
Characteristic attacks occurring one to three times a week10
Note: 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 days or longer and occurring more than eight times a year, or; attacks with laryngeal involvement of any duration occurring more than twice a year40
Attacks without laryngeal involvement lasting one to seven days and occurring five to eight times a year, or; attacks with laryngeal involvement of any duration occurring once or twice a year20
Attacks without laryngeal involvement lasting one to seven days and occurring two to four times a year10
7119   Erythromelalgia:
Characteristic attacks that occur more than once a day, last an average of more than two hours each, respond poorly to treatment, and that restrict most routine daily activities100
Characteristic attacks that occur more than once a day, last an average of more than two hours each, and respond poorly to treatment, but that do not restrict most routine daily activities60
Characteristic attacks that occur daily or more often but that respond to treatment30
Characteristic attacks that occur less than daily but at least three times a week and that respond to treatment10
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 varicose veins: Massive board-like edema with constant pain at rest100
Persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration60
Persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration40
Persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema20
Intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery10
Asymptomatic palpable or visible varicose veins0
Note: 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 rest100
Persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration60
Persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration40
Persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema20
Intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery10
Asymptomatic palpable or visible varicose veins0
Note: 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 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)30
Arthralgia or other pain, numbness, or cold sensitivity plus tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, or X-ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis)20
Arthralgia or other pain, numbness, or cold sensitivity10
Note (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)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.

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

[62 FR 65219, Dec. 11, 1997, as amended at 63 FR 37779, July 14, 1998; 71 FR52460, Sept. 6, 2006; 79 FR 2100, Jan. 13, 2014]

The Digestive System

§4.110   Ulcers.

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.

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.

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.

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.

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 speech100
One-half or more60
With marked speech impairment30
7203   Esophagus, stricture of:
Permitting passage of liquids only, with marked impairment of general health80
Severe, permitting liquids only50
Moderate30
7204   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 frequent and prolonged episodes of severe colic distension, nausea or vomiting, following severe peritonitis, ruptured appendix, perforated ulcer, or operation with drainage50
Moderately severe; partial obstruction manifested by delayed motility of barium meal and less frequent and less prolonged episodes of pain30
Moderate; pulling pain on attempting work or aggravated by movements of the body, or occasional episodes of colic pain, nausea, constipation (perhaps alternating with diarrhea) or abdominal distension10
Mild0
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 therapy, periodic vomiting, recurrent hematemesis or melena, with manifestations of anemia and weight loss productive of definite impairment of health60
Moderately severe; less than severe but with impairment of 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 year40
Moderate; recurring episodes of severe symptoms two or three times a year averaging 10 days in duration; or with continuous moderate manifestations20
Mild; with recurring symptoms once or twice yearly10
7306   Ulcer, marginal (gastrojejunal):
Pronounced; periodic or continuous pain unrelieved by standard ulcer therapy with periodic vomiting, recurring melena or hematemesis, and weight loss. Totally incapacitating100
Severe; same as pronounced with less pronounced and less continuous symptoms with definite impairment of health60
Moderately severe; intercurrent episodes of abdominal pain at least once a month partially or completely relieved by ulcer therapy, mild and transient episodes of vomiting or melena40
Moderate; with episodes of recurring symptoms several times a year20
Mild; with brief episodes of recurring symptoms once or twice yearly10
7307   Gastritis, hypertrophic (identified by gastroscope):
Chronic; with severe hemorrhages, or large ulcerated or eroded areas60
Chronic; with multiple small eroded or ulcerated areas, and symptoms30
Chronic; with small nodular lesions, and symptoms10
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 disturbance after meals, diarrhea, hypoglycemic symptoms, and weight loss with malnutrition and anemia60
Moderate; less frequent episodes of epigastric disorders with characteristic mild circulatory symptoms after meals but with diarrhea and weight loss40
Mild; infrequent episodes of epigastric distress with characteristic mild circulatory symptoms or continuous mild manifestations20
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 jaundice, or; with one of the following refractory to treatment: ascites, hepatic encephalopathy, hemorrhage from varices or portal gastropathy (erosive gastritis)100
History of two or more episodes of ascites, hepatic encephalopathy, or hemorrhage from varices or portal gastropathy (erosive gastritis), but with periods of remission between attacks70
History of one episode of ascites, hepatic encephalopathy, or hemorrhage from varices or portal gastropathy (erosive gastritis)50
Portal hypertension and splenomegaly, with weakness, anorexia, abdominal pain, malaise, and at least minor weight loss30
Symptoms such as weakness, anorexia, abdominal pain, and malaise10
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 colic30
Moderate; gall bladder dyspepsia, confirmed by X-ray technique, and with infrequent attacks (not over two or three a year) of gall bladder colic, with or without jaundice10
Mild0
7315   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 symptoms30
With mild symptoms10
Nonsymptomatic0
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, with more or less constant abdominal distress30
Moderate; frequent episodes of bowel disturbance with abdominal distress10
Mild; disturbances of bowel function with occasional episodes of abdominal distress0
7321   Amebiasis:
Mild gastrointestinal disturbances, lower abdominal cramps, nausea, gaseous distention, chronic constipation interrupted by diarrhea10
Asymptomatic0
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 general debility, or with serious complication as liver abscess100
Severe; with numerous attacks a year and malnutrition, the health only fair during remissions60
Moderately severe; with frequent exacerbations30
Moderate; with infrequent exacerbations10
7324   Distomiasis, intestinal or hepatic:
Severe symptoms30
Moderate symptoms10
Mild or no symptoms0
7325   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, manifested by severe impairment of health objectively supported by examination findings including material weight loss60
With definite interference with absorption and nutrition, manifested by impairment of health objectively supported by examination findings including definite weight loss40
Symptomatic with diarrhea, anemia and inability to gain weight20
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 findings40
With moderate symptoms20
With slight symptoms10
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 discharge100
Constant or frequent, fecal discharge60
Slight infrequent, fecal discharge30
Healed; rate for peritoneal adhesions.
7331   Peritonitis, tuberculous, active or inactive:
Active100
Inactive: See §§4.88b and 4.89.
7332   Rectum and anus, impairment of sphincter control:
Complete loss of sphincter control100
Extensive leakage and fairly frequent involuntary bowel movements60
Occasional involuntary bowel movements, necessitating wearing of pad30
Constant slight, or occasional moderate leakage10
Healed or slight, without leakage0
7333   Rectum and anus, stricture of:
Requiring colostomy100
Great reduction of lumen, or extensive leakage50
Moderate reduction of lumen, or moderate constant leakage30
7334   Rectum, prolapse of:
Severe (or complete), persistent50
Moderate, persistent or frequently recurring30
Mild with constant slight or occasional moderate leakage10
7335   Ano, fistula in.
Rate as for impairment of sphincter control.
7336   Hemorrhoids, external or internal:
With persistent bleeding and with secondary anemia, or with fissures20
Large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences10
Mild or moderate0
7337   Pruritus ani.
Rate for the underlying condition.
7338   Hernia, inguinal:
Large, postoperative, recurrent, not well supported under ordinary conditions and not readily reducible, when considered inoperable60
Small, postoperative recurrent, or unoperated irremediable, not well supported by truss, or not readily reducible30
Postoperative recurrent, readily reducible and well supported by truss or belt10
Not operated, but remediable0
Small, reducible, or without true hernia protrusion0
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 extensive diffuse destruction or weakening of muscular and fascial support of abdominal wall so as to be inoperable100
Large, not well supported by belt under ordinary conditions40
Small, not well supported by belt under ordinary conditions, or healed ventral hernia or post-operative wounds with weakening of abdominal wall and indication for a supporting belt20
Wounds, postoperative, healed, no disability, belt not indicated0
7340   Hernia, femoral.
Rate as for inguinal hernia.
7342   Visceroptosis, symptomatic, marked10
7343   Malignant neoplasms of the digestive system, exclusive of skin growths100
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, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain)100
Daily fatigue, malaise, and anorexia, with substantial weight 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 constantly60
Daily fatigue, malaise, and anorexia, with minor weight loss 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 period40
Daily fatigue, malaise, and anorexia (without weight loss or 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 period20
Intermittent fatigue, malaise, and anorexia, 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 one week, but less than two weeks, during the past 12-month period10
Nonsymptomatic0
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 hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health60
Persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health30
With two or more of the symptoms for the 30 percent evaluation of less severity10
7347   Pancreatitis:
With frequently recurrent disabling attacks of abdominal pain with few pain free intermissions and with steatorrhea, malabsorption, diarrhea and severe malnutrition100
With frequent attacks of abdominal pain, loss of normal body weight and other findings showing continuing pancreatic insufficiency between acute attacks60
Moderately severe; with at least 4-7 typical attacks of abdominal pain per year with good remission between attacks30
With at least one recurring attack of typical severe abdominal pain in the past year10
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 complications of stricture or continuing gastric retention40
With symptoms and confirmed diagnosis of alkaline gastritis, or of confirmed persisting diarrhea30
Recurrent ulcer with incomplete vagotomy20
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 for transplant surgery100
Minimum30
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, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain)100
Daily fatigue, malaise, and anorexia, with substantial weight 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 constantly60
Daily fatigue, malaise, and anorexia, with minor weight loss 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 period40
Daily fatigue, malaise, and anorexia (without weight loss or 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 period20
Intermittent fatigue, malaise, and anorexia, 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 one week, but less than two weeks, during the past 12-month period10
Nonsymptomatic0
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

§4.115   Nephritis.

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.

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 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 cardiovascular100
Persistent edema and albuminuria with BUN 40 to 80mg%; or, creatinine 4 to 8mg%; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion80
Constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under diagnostic code 710160
Albumin constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema or hypertension at least 10 percent disabling under diagnostic code 710130
Albumin and casts with history of acute nephritis; or, hypertension non-compensable under diagnostic code 71010
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 materials which must be changed more than 4 times per day60
Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day40
Requiring the wearing of absorbent materials which must be changed less than 2 times per day20
Urinary frequency:
Daytime voiding interval less than one hour, or; awakening to void five or more times per night40
Daytime voiding interval between one and two hours, or; awakening to void three to four times per night20
Daytime voiding interval between two and three hours, or; awakening to void two times per night10
Obstructed voiding:
Urinary retention requiring intermittent or continuous catheterization30
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 to 3 months10
Obstructive symptomatology with or without stricture disease requiring dilatation 1 to 2 times per year0
Urninary tract infection:
Poor renal function: Rate as renal dysfunction.
Recurrent symptomatic infection requiring drainage/frequent hospitalization (greater than two times/year), and/or requiring continuous intensive management30
Long-term drug therapy, 1-2 hospitalizations per year and/or requiring intermittent intensive management10

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

§4.115b   Ratings of the genitourinary system—diagnoses.

   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 evaluation30
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 times/year30
7509   Hydronephrosis:
Severe; Rate as renal dysfunction.
Frequent attacks of colic with infection (pyonephrosis), kidney function impaired30
Frequent attacks of colic, requiring catheter drainage20
Only an occasional attack of colic, not infected and not requiring catheter drainage10
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 times/year30
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 times/year30
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 dysfunction
7516   Bladder, fistula of:
Rate as voiding dysfunction or urinary tract infection, whichever is predominant.
Postoperative, suprapubic cystotomy100
7517   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 fistulae100
7520   Penis, removal of half or more30
Or rate as voiding dysfunction.
7521   Penis removal of glans20
Or rate as voiding dysfunction.
7522   Penis, deformity, with loss of erectile power—201
7523   Testis, atrophy complete:
Both—201
One—01
7524   Testis, removal:
Both—301
One—01
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 system100
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 surgery100
Thereafter: Rate on residuals as renal dysfunction, minimum rating30
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 condition20
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.

1Review 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

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

   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 treatment30
Symptoms that require continuous treatment10
Symptoms that do not require continuous treatment0
7617   Uterus and both ovaries, removal of, complete:
For three months after removal1100
Thereafter150
7618   Uterus, removal of, including corpus:
For three months after removal1100
Thereafter130
7619   Ovary, removal of:
For three months after removal1100
Thereafter:
Complete removal of both ovaries130
Removal of one with or without partial removal of the other10
7620   Ovaries, atrophy of both, complete120
7621   Uterus, prolapse:
Complete, through vagina and introitus50
Incomplete30
7622   Uterus, displacement of:
With marked displacement and frequent or continuous menstrual disturbances30
With adhesions and irregular menstruation10
7623   Pregnancy, surgical complications of:
With rectocele or cystocele50
With relaxation of perineum10
7624   Fistula, rectovaginal:
Vaginal fecal leakage at least once a day requiring wearing of pad100
Vaginal fecal leakage four or more times per week, but less than daily, requiring wearing of pad60
Vaginal fecal leakage one to three times per week requiring wearing of pad30
Vaginal fecal leakage less than once a week10
Without leakage0
7625   Fistula, urethrovaginal:
Multiple urethrovaginal fistulae100
Requiring the use of an appliance or the wearing of absorbent materials which must be changed more than four times per day60
Requiring the wearing of absorbent materials which must be changed two to four times per day40
Requiring the wearing of absorbent materials which must be changed less than two times per day20
7626   Breast, surgery of:
Following radical mastectomy:
Both180
One150
Following modified radical mastectomy:
Both160
One140
Following simple mastectomy or wide local excision with significant alteration of size or form:
Both150
One130
Following wide local excision without significant alteration of size or form:
Both or one0
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 breast100
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 laparoscopy, pelvic pain or heavy or irregular bleeding not controlled by treatment, and bowel or bladder symptoms50
Pelvic pain or heavy or irregular bleeding not controlled by treatment30
Pelvic pain or heavy or irregular bleeding requiring continuous treatment for control10
Note: Diagnosis of endometriosis must be substantiated by laparoscopy.

1Review 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

§4.117   Schedule of ratings—hemic and lymphatic systems.

   Rating
7700   Anemia, hypochromic-microcytic and megaloblastic, such as iron-deficiency and pernicious anemia:
Hemoglobin 5gm/100ml or less, with findings such as high output congestive heart failure or dyspnea at rest100
Hemoglobin 7gm/100ml or less, with findings such as dyspnea on mild exertion, cardiomegaly, tachycardia (100 to 120 beats per minute) or syncope (three episodes in the last six months)70
Hemoglobin 8gm/100ml or less, with findings such as weakness, easy fatigability, headaches, lightheadedness, or shortness of breath30
Hemoglobin 10gm/100ml or less with findings such as weakness, easy fatigability or headaches10
Hemoglobin 10gm/100ml or less, asymptomatic0
Note: Evaluate complications of pernicious anemia, such as dementia or peripheral neuropathy, separately.
7702   Agranulocytosis, acute:
Requiring bone marrow transplant, or; requiring transfusion of platelets or red cells at least once every six weeks, or; infections recurring at least once every six weeks100
Requiring transfusion of platelets or red cells at least once every three months, or; infections recurring at least once every three months60
Requiring transfusion of platelets or red cells at least once per year but less than once every three months, or; infections recurring at least once per year but less than once every three months30
Requiring continuous medication for control10
Note: 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 phase100
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 three months following cessation of myelosuppressant therapy100
Requiring phlebotomy40
Stable, with or without continuous medication10
Note: 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, requiring treatment with medication and transfusions100
Platelet count between 20,000 and 70,000, not requiring treatment, without bleeding70
Stable platelet count between 70,000 and 100,000, without bleeding30
Stable platelet count of 100,000 or more, without bleeding0
7706   Splenectomy20
Note: 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 phase100
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 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, 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 labor100
With painful crises several times a year or with symptoms precluding other than light manual labor60
Following repeated hemolytic sickling crises with continuing impairment of health30
Asymptomatic, established case in remission, but with identifiable organ impairment10
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 Service, for consideration under §3.321(b)(1) of this chapter.
7715   Non-Hodgkin's lymphoma:
With active disease or during a treatment phase100
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 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 of platelets or red cells at least once every six weeks, or; infections recurring at least once every six weeks100
Requiring transfusion of platelets or red cells at least once every three months, or; infections recurring at least once every three months60
Requiring transfusion of platelets or red cells at least once per year but less than once every three months, or; infections recurring at least once per year but less than once every three months30
Requiring continuous medication for control10
Note: 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.
7717   AL amyloidosis (primary amyloidosis)100

[60 FR 49227, Sept. 22, 1995, as amended at 77 FR 6467, Feb. 8, 2012; 79 FR 2100, Jan. 13, 2014]

The Skin

§4.118   Schedule of ratings—skin.

A veteran whose scars were rated by VA under a prior version of diagnostic codes 7800, 7801, 7802, 7803, 7804, or 7805, as in effect before October 23, 2008, may request review under diagnostic codes 7800, 7801, 7802, 7804, and 7805, irrespective of whether his or her disability has worsened since the last review. VA will review that veteran's disability rating to determine whether the veteran may be entitled to a higher disability rating under diagnostic codes 7800, 7801, 7802, 7804, and 7805. A request for review pursuant to this rulemaking will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008.

   Rating
7800   Burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck:
With visible or palpable tissue loss and either gross 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 disfigurement80
With visible or palpable tissue loss and either gross 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 disfigurement50
With visible or palpable tissue loss and either gross 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 disfigurement30
With one characteristic of disfigurement10
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.
Note (4): Separately evaluate disabling effects other than disfigurement that are associated with individual scar(s) of the head, face, or neck, such as pain, instability, and residuals of associated muscle or nerve injury, under the appropriate diagnostic code(s) and apply §4.25 to combine the evaluation(s) with the evaluation assigned under this diagnostic code.
Note (5): The characteristic(s) of disfigurement may be caused by one scar or by multiple scars; the characteristic(s) required to assign a particular evaluation need not be caused by a single scar in order to assign that evaluation.
7801   Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear:
Area or areas of 144 square inches (929 sq. cm.) or greater40
Area or areas of at least 72 square inches (465 sq. cm.) but less than 144 square inches (929 sq. cm.)30
Area or areas of at least 12 square inches (77 sq. cm.) but less than 72 square inches (465 sq. cm.)20
Area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.)10
Note (1): A deep scar is one associated with underlying soft tissue damage.
Note (2): If multiple qualifying scars are present, or if a single qualifying scar affects more than one extremity, or a single qualifying scar affects one or more extremities and either the anterior portion or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity, assign a separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assign a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. The midaxillary line on each side separates the anterior and posterior portions of the trunk. Combine the separate evaluations under §4.25. Qualifying scars are scars that are nonlinear, deep, and are not located on the head, face, or neck.
7802   Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear:
Area or areas of 144 square inches (929 sq. cm.) or greater10
Note (1): A superficial scar is one not associated with underlying soft tissue damage
Note (2): If multiple qualifying scars are present, or if a single qualifying scar affects more than one extremity, or a single qualifying scar affects one or more extremities and either the anterior portion or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity, assign a separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assign a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. The midaxillary line on each side separates the anterior and posterior portions of the trunk. Combine the separate evaluations under §4.25. Qualifying scars are scars that are nonlinear, superficial, and are not located on the head, face, or neck.
7804   Scar(s), unstable or painful:
Five or more scars that are unstable or painful30
Three or four scars that are unstable or painful20
One or two scars that are unstable or painful10
Note (1): An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar.
Note (2): If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars
Note (3): Scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable
7805   Scars, other (including linear scars) and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, and 7804:
Evaluate any disabling effect(s) not considered in a rating provided under diagnostic codes 7800-04 under an appropriate diagnostic code.
7806   Dermatitis or eczema.
More than 40 percent of the entire body or more than 40 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 period60
20 to 40 percent of the entire body or 20 to 40 percent of 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 period30
At least 5 percent, but less than 20 percent, of the entire 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 period10
Less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and; no more than topical therapy required during the past 12-month period0
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 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 period60
20 to 40 percent of the entire body or 20 to 40 percent of 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 period30
At least 5 percent, but less than 20 percent, of the entire 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 period10
Less than 5 percent of the entire body or exposed areas affected, and; no more than topical therapy required during the past 12-month period0
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 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 period60
20 to 40 percent of the entire body or 20 to 40 percent of 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 period30
At least 5 percent, but less than 20 percent, of the entire 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 period10
Less than 5 percent of the entire body or exposed areas affected, and; no more than topical therapy required during the past 12-month period0
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 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 period100
Generalized involvement of the skin without systemic 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 period60
Any extent of involvement of the skin, and; 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 for a total duration of six weeks or more, but not constantly, during the past 12-month period30
Any extent of involvement of the skin, and; 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 for a total duration of less than six weeks during the past 12-month period10
Any extent of involvement of the skin, and; no more than topical therapy required during the past 12-month period0
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 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 period60
20 to 40 percent of the entire body or 20 to 40 percent of 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 period30
At least 5 percent, but less than 20 percent, of the entire 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 period10
Less than 5 percent of the entire body or exposed areas affected, and; no more than topical therapy required during the past 12-month period0
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 percent of exposed areas affected, and; constant or near-constant systemic medications or intensive light therapy required during the past 12-month period60
20 to 40 percent of the entire body or 20 to 40 percent of 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 period30
At least 5 percent, but less than 20 percent, of the entire 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 period10
Less than 5 percent of the entire body or exposed areas affected, and; no more than topical therapy required during the past 12-month period0
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 affected10
With no exposed areas affected0
7824 Diseases of keratinization (including icthyoses, Darier's disease, and palmoplantar keratoderma):
With either generalized cutaneous involvement or systemic manifestations, and; constant or near-constant systemic medication, such as immunosuppressive retinoids, required during the past 12-month period60
With either generalized cutaneous involvement or systemic 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 period30
With localized or episodic cutaneous involvement and intermittent systemic medication, such as immunosuppressive retinoids, required for a total duration of less than six weeks during the past 12-month period10
No more than topical therapy required during the past 12-month period0
7825   Urticaria:
Recurrent debilitating episodes occurring at least four times during the past 12-month period despite continuous immunosuppressive therapy60
Recurrent debilitating episodes occurring at least four times during the past 12-month period, and; requiring intermittent systemic immunosuppressive therapy for control30
Recurrent episodes occurring at least four times during the past 12-month period, and; responding to treatment with antihistamines or sympathomimetics10
7826   Vasculitis, primary cutaneous:
Recurrent debilitating episodes occurring at least four times during the past 12-month period despite continuous immunosuppressive therapy60
Recurrent debilitating episodes occurring at least four times during the past 12-month period, and; requiring intermittent systemic immunosuppressive therapy for control30
Recurrent episodes occurring one to three times during the past 12-month period, and; requiring intermittent systemic immunosuppressive therapy for control10
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 times during the past 12-month period despite ongoing immunosuppressive therapy60
Recurrent episodes occurring at least four times during the past 12-month period, and; requiring intermittent systemic immunosuppressive therapy30
Recurrent episodes occurring during the past 12-month period that respond to treatment with antihistamines or sympathomimetics, or; one to three episodes occurring during the past 12-month period requiring intermittent systemic immunosuppressive therapy10
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) affecting 40 percent or more of the face and neck30
Deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck, or; deep acne other than on the face and neck10
Superficial acne (comedones, papules, pustules, superficial cysts) of any extent0
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) affecting 40 percent or more of the face and neck30
Deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck, or; deep acne other than on the face and neck10
Superficial acne (comedones, papules, pustules, superficial cysts) of any extent0
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 scalp20
Affecting 20 to 40 percent of the scalp10
Affecting less than 20 percent of the scalp0
7831   Alopecia areata:
With loss of all body hair10
With loss of hair limited to scalp and face0
7832   Hyperhidrosis:
Unable to handle paper or tools because of moisture, and unresponsive to therapy30
Able to handle paper or tools after therapy0
7833   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; 73 FR 54710, Oct. 23, 2008; 77 FR 2910, Jan. 20, 2012]

The Endocrine System

§4.119   Schedule of ratings—endocrine system.

   Rating
7900   Hyperthyroidism
Thyroid enlargement, tachycardia (more than 100 beats per minute), eye involvement, muscular weakness, loss of weight, and sympathetic nervous system, cardiovascular, or astrointestinal symptoms100
Emotional instability, tachycardia, fatigability, and increased pulse pressure or blood pressure60
Tachycardia, tremor, and increased pulse pressure or blood pressure30
Tachycardia, which may be intermittent, and tremor, or; continuous medication required for control10
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 minute), eye involvement, muscular weakness, loss of weight, and sympathetic nervous system, cardiovascular, or gastrointestinal symptoms100
Emotional instability, tachycardia, fatigability, and increased pulse pressure or blood pressure60
Tachycardia, tremor, and increased pulse pressure or blood pressure30
Tachycardia, which may be intermittent, and tremor, or; continuous medication required for control10
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 neck20
Without disfigurement of the head or neck0
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 involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 beats per minute), and sleepiness100
Muscular weakness, mental disturbance, and weight gain60
Fatigability, constipation, and mental sluggishness30
Fatigability, or; continuous medication required for control10
7904   Hyperparathyroidism
Generalized decalcification of bones, kidney stones, gastrointestinal symptoms (nausea, vomiting, anorexia, constipation, weight loss, or peptic ulcer), and weakness100
Gastrointestinal symptoms and weakness60
Continuous medication required for control10
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, muscular spasms (tetany), or laryngeal stridor) plus either cataract or evidence of increased intracranial pressure (such as papilledema)100
Marked neuromuscular excitability, or; paresthesias (of arms, legs, or circumoral area) plus either cataract or evidence of increased intracranial pressure60
Continuous medication required for control10
7907   Cushing's syndrome
As active, progressive disease including loss of muscle strength, areas of osteoporosis, hypertension, weakness, and enlargement of pituitary or adrenal gland100
Loss of muscle strength and enlargement of pituitary or adrenal gland60
With striae, obesity, moon face, glucose intolerance, and vascular fragility30
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 field defect), arthropathy, glucose intolerance, and either hypertension or cardiomegaly100
Arthropathy, glucose intolerance, and hypertension60
Enlargement of acral parts or overgrowth of long bones, and enlarged sella turcica30
7909   Diabetes insipidus
Polyuria with near-continuous thirst, and more than two documented episodes of dehydration requiring parenteral hydration in the past year100
Polyuria with near-continuous thirst, and one or two documented episodes of dehydration requiring parenteral hydration in the past year60
Polyuria with near-continuous thirst, and one or more episodes of dehydration in the past year not requiring parenteral hydration40
Polyuria with near-continuous thirst20
7911   Addison's disease (Adrenal Cortical Hypofunction)
Four or more crises during the past year60
Three crises during the past year, or; five or more episodes during the past year40
One or two crises during the past year, or; two to four episodes during the past year, or; weakness and fatigability, or; corticosteroid therapy required for control20
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 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 evaluated100
Requiring insulin, restricted diet, and regulation of 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 evaluated60
Requiring insulin, restricted diet, and regulation of activities40
Requiring insulin and restricted diet, or; oral hypoglycemic agent and restricted diet20
Manageable by restricted diet only10
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 system100
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 thyroid100
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

§4.120   Evaluations by comparison.

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.

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.

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.

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.

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.

[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 disease100
Rate residuals, minimum10
Brain, new growth of:
8002   Malignant100
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 rating30
8003   Benign, minimum60
Rate residuals, minimum10
8004   Paralysis agitans:
Minimum rating30
8005   Bulbar palsy100
8007   Brain, vessels, embolism of.
8008   Brain, vessels, thrombosis of.
8009   Brain, vessels, hemorrhage from:
Rate the vascular conditions under Codes 8007 through 8009, for 6 months100
Rate residuals, thereafter, minimum10
8010   Myelitis:
Minimum rating10
8011   Poliomyelitis, anterior:
As active febrile disease100
Rate residuals, minimum10
8012   Hematomyelia:
For 6 months100
Rate residuals, minimum10
8013   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 sclerosis100
Note: Consider the need for special monthly compensation.
8018   Multiple sclerosis:
Minimum rating30
8019   Meningitis, cerebrospinal, epidemic:
As active febrile disease100
Rate residuals, minimum10
8020   Brain, abscess of:
As active disease100
Rate residuals, minimum10
Spinal cord, new growths of:
8021   Malignant100
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 rating30
8022   Benign, minimum rating60
Rate residuals, minimum10
8023   Progressive muscular atrophy:
Minimum rating30
8024   Syringomyelia:
Minimum rating30
8025   Myasthenia gravis:
Minimum rating30
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   Residuals of traumatic brain injury (TBI):
There are three main areas of dysfunction that may result from TBI and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation.
Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Evaluate cognitive impairment under the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.”
Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Evaluate subjective symptoms that are residuals of TBI, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” However, separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere's disease, even if that diagnosis is based on subjective symptoms, rather than under the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table
Evaluate emotional/behavioral dysfunction under §4.130 (Schedule of ratings—mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.”
Evaluate physical (including neurological) dysfunction based on the following list, under an appropriate diagnostic code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions.
The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, evaluate under the most appropriate diagnostic code. Evaluate each condition separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine under §4.25 the evaluations for each separately rated condition. The evaluation assigned based on the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations
Consider the need for special monthly compensation for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc
Evaluation of Cognitive Impairment and Subjective Symptoms
The table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than “total,” since any level of impaired consciousness would be totally disabling. Assign a 100-percent evaluation if “total” is the level of evaluation for one or more facets. If no facet is evaluated as “total,” assign the overall percentage evaluation based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet.
Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled “Evaluation Of Cognitive Impairment And Other Residuals Of TBI Not Otherwise Classified” with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition.
Note (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation.
Note (3): “Instrumental activities of daily living” refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one's own medications, and using a telephone. These activities are distinguished from “Activities of daily living,” which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet.
Note (4): The terms “mild,” “moderate,” and “severe” TBI, which may appear in medical records, refer to a classification of TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under diagnostic code 8045.
Note (5): A veteran whose residuals of TBI are rated under a version of §4.124a, diagnostic code 8045, in effect before October 23, 2008 may request review under diagnostic code 8045, irrespective of whether his or her disability has worsened since the last review. VA will review that veteran's disability rating to determine whether the veteran may be entitled to a higher disability rating under diagnostic code 8045. A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating awarded as a result of such review, VA will apply 38 CFR 3.114, if applicable.
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.

Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified

Facets of cognitive
impairment and other
residuals of TBI not
otherwise classified
Level of
impairment
Criteria
Memory, attention, concentration, executive functions0No complaints of impairment of memory, attention, concentration, or executive functions.
   1A complaint of mild loss of memory (such as having difficulty following a conversation, recalling recent conversations, remembering names of new acquaintances, or finding words, or often misplacing items), attention, concentration, or executive functions, but without objective evidence on testing.
   2Objective evidence on testing of mild impairment of memory, attention, concentration, or executive functions resulting in mild functional impairment.
   3Objective evidence on testing of moderate impairment of memory, attention, concentration, or executive functions resulting in moderate functional impairment.
   TotalObjective evidence on testing of severe impairment of memory, attention, concentration, or executive functions resulting in severe functional impairment.
Judgment0Normal.
   1Mildly impaired judgment. For complex or unfamiliar decisions, occasionally unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision.
   2Moderately impaired judgment. For complex or unfamiliar decisions, usually unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision, although has little difficulty with simple decisions.
   3Moderately severely impaired judgment. For even routine and familiar decisions, occasionally unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision.
   TotalSeverely impaired judgment. For even routine and familiar decisions, usually unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision. For example, unable to determine appropriate clothing for current weather conditions or judge when to avoid dangerous situations or activities.
Social interaction0Social interaction is routinely appropriate.
   1Social interaction is occasionally inappropriate.
   2Social interaction is frequently inappropriate.
   3Social interaction is inappropriate most or all of the time.
Orientation0Always oriented to person, time, place, and situation.
   1Occasionally disoriented to one of the four aspects (person, time, place, situation) of orientation.
   2Occasionally disoriented to two of the four aspects (person, time, place, situation) of orientation or often disoriented to one aspect of orientation.
   3Often disoriented to two or more of the four aspects (person, time, place, situation) of orientation.
   TotalConsistently disoriented to two or more of the four aspects (person, time, place, situation) of orientation.
Motor activity (with intact motor and sensory system)0Motor activity normal.
   1Motor activity normal most of the time, but mildly slowed at times due to apraxia (inability to perform previously learned motor activities, despite normal motor function).
   2Motor activity mildly decreased or with moderate slowing due to apraxia.
   3Motor activity moderately decreased due to apraxia.
   TotalMotor activity severely decreased due to apraxia.
Visual spatial orientation0Normal.
   1Mildly impaired. Occasionally gets lost in unfamiliar surroundings, has difficulty reading maps or following directions. Is able to use assistive devices such as GPS (global positioning system).
   2Moderately impaired. Usually gets lost in unfamiliar surroundings, has difficulty reading maps, following directions, and judging distance. Has difficulty using assistive devices such as GPS (global positioning system).
   3Moderately severely impaired. Gets lost even in familiar surroundings, unable to use assistive devices such as GPS (global positioning system).
   TotalSeverely impaired. May be unable to touch or name own body parts when asked by the examiner, identify the relative position in space of two different objects, or find the way from one room to another in a familiar environment.
Subjective symptoms0Subjective symptoms that do not interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples are: mild or occasional headaches, mild anxiety.
   1Three or more subjective symptoms that mildly interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment are: intermittent dizziness, daily mild to moderate headaches, tinnitus, frequent insomnia, hypersensitivity to sound, hypersensitivity to light.
   2Three or more subjective symptoms that moderately interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment are: marked fatigability, blurred or double vision, headaches requiring rest periods during most days.
Neurobehavioral effects0One or more neurobehavioral effects that do not interfere with workplace interaction or social interaction. Examples of neurobehavioral effects are: Irritability, impulsivity, unpredictability, lack of motivation, verbal aggression, physical aggression, belligerence, apathy, lack of empathy, moodiness, lack of cooperation, inflexibility, and impaired awareness of disability. Any of these effects may range from slight to severe, although verbal and physical aggression are likely to have a more serious impact on workplace interaction and social interaction than some of the other effects.
   1One or more neurobehavioral effects that occasionally interfere with workplace interaction, social interaction, or both but do not preclude them.
   2One or more neurobehavioral effects that frequently interfere with workplace interaction, social interaction, or both but do not preclude them.
   3One or more neurobehavioral effects that interfere with or preclude workplace interaction, social interaction, or both on most days or that occasionally require supervision for safety of self or others.
Communication0Able to communicate by spoken and written language (expressive communication), and to comprehend spoken and written language.
   1Comprehension or expression, or both, of either spoken language or written language is only occasionally impaired. Can communicate complex ideas.
   2Inability to communicate either by spoken language, written language, or both, more than occasionally but less than half of the time, or to comprehend spoken language, written language, or both, more than occasionally but less than half of the time. Can generally communicate complex ideas.
   3Inability to communicate either by spoken language, written language, or both, at least half of the time but not all of the time, or to comprehend spoken language, written language, or both, at least half of the time but not all of the time. May rely on gestures or other alternative modes of communication. Able to communicate basic needs.
   TotalComplete inability to communicate either by spoken language, written language, or both, or to comprehend spoken language, written language, or both. Unable to communicate basic needs.
ConsciousnessTotalPersistently altered state of consciousness, such as vegetative state, minimally responsive state, coma.

Miscellaneous Diseases

   Rating
8100   Migraine:
With very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability50
With characteristic prostrating attacks occurring on an average once a month over last several months30
With characteristic prostrating attacks averaging one in 2 months over last several months10
With less frequent attacks0
8103   Tic, convulsive:
Severe30
Moderate10
Mild0
Note: Depending upon frequency, severity, muscle groups involved.
8104   Paramyoclonus multiplex (convulsive state, myoclonic type):
Rate as tic; convulsive; severe cases60
8105   Chorea, Sydenham's:
Pronounced, progressive grave types100
Severe80
Moderately severe50
Moderate30
Mild10
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 nerve
8205   Paralysis of:
Complete50
Incomplete, severe30
Incomplete, moderate10
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 nerve
8207   Paralysis of:
Complete30
Incomplete, severe20
Incomplete, moderate10
Note: Dependent upon relative loss of innervation of facial muscles.
8307   Neuritis.
8407   Neuralgia.
Ninth (glossopharyngeal) cranial nerve
8209   Paralysis of:
Complete30
Incomplete, severe20
Incomplete, moderate10
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:
Complete50
Incomplete, severe30
Incomplete, moderate10
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:
Complete30
Incomplete, severe20
Incomplete, moderate10
Note: Dependent upon loss of motor function of sternomastoid and trapezius muscles.
8311   Neuritis.
8411   Neuralgia.
Twelfth (hypoglossal) cranial nerve.
8212   Paralysis of:
Complete50
Incomplete, severe30
Incomplete, moderate10
Note: Dependent upon loss of motor function of tongue.
8312   Neuritis.
8412   Neuralgia.

Diseases of the Peripheral Nerves

Schedule of ratings Rating
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 severely affected, hand and wrist movements not affected7060
Incomplete:
Severe5040
Moderate4030
Mild2020
8610   Neuritis.
8710   Neuralgia.
Middle radicular group
8511   Paralysis of:
Complete; adduction, abduction and rotation of arm, flexion of elbow, and extension of wrist lost or severely affected7060
Incomplete:
Severe5040
Moderate4030
Mild2020
8611   Neuritis.
8711   Neuralgia.
Lower radicular group
8512   Paralysis of:
Complete; all intrinsic muscles of hand, and some or all of flexors of wrist and fingers, paralyzed (substantial loss of use of hand)7060
Incomplete:
Severe5040
Moderate4030
Mild2020
8612   Neuritis.
8712   Neuralgia.
All radicular groups
8513   Paralysis of:
Complete9080
Incomplete:
Severe7060
Moderate4030
Mild2020
8613   Neuritis.
8713   Neuralgia.
The musculospiral nerve (radial nerve)
8514   Paralysis of:
Complete; drop of hand and fingers, wrist and 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 rarity7060
Incomplete:
Severe5040
Moderate3020
Mild2020
8614   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 nerve
8515   Paralysis of:
Complete; the hand inclined to the ulnar side, the 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 disturbances7060
Incomplete:
Severe5040
Moderate3020
Mild1010
8615   Neuritis.
8715   Neuralgia.
The ulnar nerve
8516   Paralysis of:
Complete; the “griffin claw” deformity, due to 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 weakened6050
Incomplete:
Severe4030
Moderate3020
Mild1010
8616   Neuritis.
8716   Neuralgia.
Musculocutaneous nerve
8517   Paralysis of:
Complete; weakness but not loss of flexion of elbow and supination of forearm3020
Incomplete:
Severe2020
Moderate1010
Mild00
8617   Neuritis.
8717   Neuralgia.
Circumflex nerve
8518   Paralysis of:
Complete; abduction of arm is impossible, outward rotation is weakened; muscles supplied are deltoid and teres minor5040
Incomplete:
Severe3020
Moderate1010
Mild00
8618   Neuritis.
8718   Neuralgia.
Long thoracic nerve
8519   Paralysis of:
Complete; inability to raise arm above shoulder level, winged scapula deformity3020
Incomplete:
Severe2020
Moderate1010
Mild00
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 nerve
8520   Paralysis of:
Complete; the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost80
Incomplete:
Severe, with marked muscular atrophy60
Moderately severe40
Moderate20
Mild10
8620   Neuritis.
8720   Neuralgia.
External popliteal nerve (common peroneal)
8521   Paralysis of:
Complete; foot drop and slight droop of first phalanges of 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 toes40
Incomplete:
Severe30
Moderate20
Mild10
8621   Neuritis.
8721   Neuralgia.
Musculocutaneous nerve (superficial peroneal)
8522   Paralysis of:
Complete; eversion of foot weakened30
Incomplete:
Severe20
Moderate10
Mild0
8622   Neuritis.
8722   Neuralgia.
Anterior tibial nerve (deep peroneal)
8523   Paralysis of:
Complete; dorsal flexion of foot lost30
Incomplete:
Severe20
Moderate10
Mild0
8623   Neuritis.
8723   Neuralgia.
Internal popliteal nerve (tibial)
8524   Paralysis of:
Complete; plantar flexion lost, frank adduction of foot 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 lost40
Incomplete:
Severe30
Moderate20
Mild10
8624   Neuritis.
8724   Neuralgia.
Posterior tibial nerve
8525   Paralysis of:
Complete; paralysis of all muscles of sole of foot, frequently with painful paralysis of a causalgic nature; toes cannot be flexed; adduction is weakened; plantar flexion is impaired30
Incomplete:
Severe20
Moderate10
Mild10
8625   Neuritis.
8725   Neuralgia.
Anterior crural nerve (femoral)
8526   Paralysis of:
Complete; paralysis of quadriceps extensor muscles40
Incomplete:
Severe30
Moderate20
Mild10
8626   Neuritis.
8726   Neuralgia.
Internal saphenous nerve
8527   Paralysis of:
Severe to complete10
Mild to moderate0
8627   Neuritis.
8727   Neuralgia.
Obturator nerve
8528   Paralysis of:
Severe to complete10
Mild or moderate0
8628   Neuritis.
8728   Neuralgia.
External cutaneous nerve of thigh
8529   Paralysis of:
Severe to complete10
Mild or moderate0
8629   Neuritis.
8729   Neuralgia.
Ilio-inguinal nerve
8530   Paralysis of:
Severe to complete10
Mild or moderate0
8630   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 year100
Averaging at least 1 major seizure in 3 months over the last year; or more than 10 minor seizures weekly80
Averaging at least 1 major seizure in 4 months over the last year; or 9-10 minor seizures per week60
At least 1 major seizure in the last 6 months or 2 in the last year; or averaging at least 5 to 8 minor seizures weekly40
At least 1 major seizure in the last 2 years; or at least 2 minor seizures in the last 6 months20
A confirmed diagnosis of epilepsy with a history of seizures10
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 Compensation Service or the Director, Pension and Fiduciary 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; 73 FR 54705, Sept. 23, 2008; 73 FR 69554, Nov. 19, 2008; 76 FR 78824, Dec. 20, 2011; 79 FR 2100, Jan. 13, 2014]

Mental Disorders

§4.125   Diagnosis of mental disorders.

(a) If the diagnosis of a mental disorder does not conform to DSM-5 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. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association (2013), is incorporated by reference into this section with the approval of the Director of the Federal Register under 5 U.S.C. 552(a) and 1 CFR part 51. To enforce any edition other than that specified in this section, the Department of Veterans Affairs must publish notice of change in the Federal Register and the material must be available to the public. All approved material is available from the American Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209-3901, 703-907-7300, http://www.dsm5.org. It is also available for inspection at the Office of Regulation Policy and Management, Department of Veterans Affairs, 810 Vermont Avenue NW., Room 1068, Washington, DC 20420. It is also available for inspection at the National Archives and Records Administration (NARA). For information on the availability of this information at NARA, call 202-741-6030 or go to http://www.archives.gov/federal_register/code_of_federal_regulations/ibr_publications.html.

(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, as amended at 79 FR 45099, Aug. 4, 2014]

§4.126   Evaluation of disability from mental disorders.

(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) Neurocognitive 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 neurocognitive disorders (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, as amended at 79 FR 45099, Aug. 4, 2014]

§4.127   Intellectual disability (intellectual developmental disorder) and personality disorders.

Intellectual disability (intellectual developmental disorder) 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 intellectual disability (intellectual developmental disorder) or a personality disorder may be service-connected.

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

[79 FR 45100, Aug. 1, 2014]

§4.128   Convalescence ratings following extended hospitalization.

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.

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.

The nomenclature employed in this portion of the rating schedule is based upon the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (see §4.125 for availability information). 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:

9201   Schizophrenia

9202   [Removed]

9203   [Removed]

9204   [Removed]

9205   [Removed]

9208   Delusional disorder

9210   Other specified and unspecified schizophrenia spectrum and other psychotic disorders

9211   Schizoaffective disorder

9300   Delirium

9301   Major or mild neurocognitive disorder due to HIV or other infections

9304   Major or mild neurocognitive disorder due to traumatic brain injury

9305   Major or mild vascular neurocognitive disorder

9310   Unspecified neurocognitive disorder

9312   Major or mild neurocognitive disorder due to Alzheimer's disease

9326   Major or mild neurocognitive disorder due to another medical condition or substance/medication-induced major or mild neurocognitive disorder

9327   [Removed]

9400   Generalized anxiety disorder

9403   Specific phobia; social anxiety disorder (social phobia)

9404   Obsessive compulsive disorder

9410   Other specified anxiety disorder

9411   Posttraumatic stress disorder

9412   Panic disorder and/or agoraphobia

9413   Unspecified anxiety disorder

9416   Dissociative amnesia; dissociative identity disorder

9417   Depersonalization/Derealization disorder

9421   Somatic symptom disorder

9422   Other specified somatic symptom and related disorder

9423   Unspecified somatic symptom and related disorder

9424   Conversion disorder (functional neurological symptom disorder)

9425   Illness anxiety disorder

9431   Cyclothymic disorder

9432   Bipolar disorder

9433   Persistent depressive disorder (dysthymia)

9434   Major depressive disorder

9435   Unspecified depressive disorder

9440   Chronic adjustment disorder

General Rating Formula for Mental Disorders

   Rating
Total occupational and social impairment, due to 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.100
Occupational and social impairment, with 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.70
Occupational and social impairment with reduced 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.50
Occupational and social impairment with occasional 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).30
Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.10
A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.0

9520   Anorexia nervosa

9521   Bulimia nervosa

Rating Formula for Eating Disorders

   Rating
Self-induced weight loss to less than 80 percent of 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.100
Self-induced weight loss to less than 85 percent of expected minimum weight with incapacitating episodes of six or more weeks total duration per year.60
Self-induced weight loss to less than 85 percent of expected minimum weight with incapacitating episodes of more than two but less than six weeks total duration per year.30
Binge eating followed by self-induced vomiting or 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.10
Binge eating followed by self-induced vomiting or 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.0

Note 1: An incapacitating episode is a period during which bed rest and treatment by a physician are required.

Note 2: Ratings under diagnostic codes 9201 to 9440 will be evaluated using the General Rating Formula for Mental Disorders. Ratings under diagnostic codes 9520 and 9521 will be evaluated using the General Rating Formula for Eating Disorders.

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

[79 FR 45100, Aug. 4, 2014]

Dental and Oral Conditions

§4.149   [Reserved]

§4.150   Schedule of ratings—dental and oral conditions.

   Rating
9900   Maxilla or mandible, chronic osteomyelitis or osteoradionecrosis of:
Rate as osteomyelitis, chronic under diagnostic code 5000
9901   Mandible, loss of, complete, between angles100
9902   Mandible, loss of approximately one-half:
Involving temporomandibular articulation50
Not involving temporomandibular articulation30
9903   Mandible, nonunion of:
Severe30
Moderate10
Note—Dependent upon degree of motion and relative loss of masticatory function
9904   Mandible, malunion of:
Severe displacement20
Moderate displacement10
Slight displacement0
Note—Dependent upon degree of motion and relative loss of masticatory function
9905   Temporomandibular articulation, limited motion of:
Inter-incisal range:
0 to 10 mm40
11 to 20 mm30
21 to 30 mm20
31 to 40 mm10
Range of lateral excursion:
0 to 4 mm10
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
Bilateral50
Unilateral30
Not involving loss of temporomandibular articulation
Bilateral30
Unilateral20
9907   Ramus, loss of less than one-half the substance of, not involving loss of continuity:
Bilateral20
Unilateral10
9908   Condyloid process, loss of, one or both sides30
9909   Coronoid process, loss of:
Bilateral20
Unilateral10
9911   Hard palate, loss of half or more:
Not replaceable by prosthesis30
Replaceable by prosthesis10
9912   Hard palate, loss of less than half of:
Not replaceable by prosthesis20
Replaceable by prosthesis0
9913   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 teeth40
Loss of all upper teeth30
Loss of all lower teeth30
All upper and lower posterior teeth missing20
All upper and lower anterior teeth missing20
All upper anterior teeth missing10
All lower anterior teeth missing10
All upper and lower teeth on one side missing10
Where the loss of masticatory surface can be restored by suitable prosthesis0
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 prosthesis100
Replaceable by prosthesis50
9915   Maxilla, loss of half or less:
Loss of 25 to 50 percent:
Not replaceable by prosthesis40
Replaceable by prosthesis30
Loss of less than 25 percent:
Not replaceable by prosthesis20
Replaceable by prosthesis0
9916   Maxilla, malunion or nonunion of:
Severe displacement30
Moderate displacement10
Slight displacement0

[59 FR 2530, Jan. 18, 1994]

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

Sec.Diagnostic code No.   
4.71a5000Evaluation February 1, 1962.
   5001Evaluation March 11, 1969.
   5002Evaluation March 1, 1963.
   5003Added July 6, 1950.
   5012Criterion March 10, 1976.
   5024Criterion March 1, 1963.
   5025Added May 7, 1996.
   5051Added September 22, 1978.
   5052Added September 22, 1978.
   5053Added September 22, 1978.
   5054Added September 22, 1978.
   5055Added September 22, 1978.
   5056Added September 22, 1978.
   5100-5103Removed March 10, 1976.
   5104Criterion March 10, 1976.
   5105Criterion March 10, 1976.
   5164Evaluation June 9, 1952.
   5166Criterion September 22, 1978.
   5172Added July 6, 1950.
   5173Added June 9, 1952.
   5174Added September 9, 1975; removed September 22, 1978.
   5211Criterion September 22, 1978.
   5212Criterion September 22, 1978.
   5214Criterion September 22, 1978.
   5216Preceding paragraph criterion September 22, 1978.
   5217Criterion August 26, 2002.
   5218Criterion August 26, 2002.
   5219Criterion September 22, 1978; criterion August 26, 2002.
   5220Preceding paragraph criterion September 22, 1978; criterion August 26, 2002.
   5223Criterion August 26, 2002.
   5224Criterion August 26, 2002.
   5225Criterion August 26, 2002.
   5226Criterion August 26, 2002.
   5227Criterion September 22, 1978; criterion August 26, 2002.
   5228Added August 26, 2002.
   5229Added August 26, 2002.
   5230Added August 26, 2002.
   5235-5243Replaces 5285-5295 September 26, 2003.
   5243Criterion September 26, 2003.
   5255Criterion July 6, 1950.
   5257Evaluation July 6, 1950.
   5264Added September 9, 1975; removed September 22, 1978.
   5275Criterion March 10, 1976; criterion September 22, 1978.
   5285-5292Revised to 5235-5243 September 26, 2003.
   5293Criterion March 10, 1976; criterion September 23, 2002; revised and moved to 5235-5243 September 26, 2003.
   5294Evaluation March 10, 1976; revised and moved to 5235-5243 September 26, 2003.
   5295Evaluation March 10, 1976; revised and moved to 5235-5243 September 26, 2003.
   5296Criterion March 10, 1976.
   5297Criterion August 23, 1948; criterion February 1, 1962.
   5298Added August 23, 1948.
4.73Introduction NOTE criterion July 3, 1997.
   5317Criterion September 22, 1978.
   5324Added February 1, 1962.
   5325Criterion July 3, 1997.
   5327Added March 10, 1976; criterion October 15, 1991; criterion July 3, 1997.
   5328Added NOTE March 10, 1976.
   5329Added NOTE July 3, 1997.
4.84aTable V criterion July 1, 1994.
   6010Criterion March 11, 1969.
   6019Criterion September 22, 1978.
   6029NOTE August 23, 1948; criterion September 22, 1978.
   6035Added September 9, 1975.
   6050-6062Removed March 10, 1976.
   6061Added March 10, 1976.
   6062Added March 10, 1976.
   6063-6079Criterion September 22, 1978.
   6064Criterion March 10, 1976.
   6071Criterion March 10, 1976.
   6076Evaluation August 23, 1948.
   6080Criterion September 22, 1978.
   6081Criterion March 10, 1976.
   6090Criterion September 22, 1978; criterion September 12, 1988.
4.84b6260Added October 1, 1961; criterion October 1, 1961; evaluation March 10, 1976; removed December 18, 1987; re-designated §4.87a December 18, 1987.
4.87Tables VI and VII replaced by new Tables VI, VIA, and VII December 18, 1987. 6200-6260 revised and re-designated §4.87 June 10, 1999.
4.87a6200-6260Moved to §4.87 June 10, 1999.
   6275-6276Moved from §4.87b June 10, 1999.
   6277-6297March 23, 1956 removed, December 17, 1987; Table II revised Table V March 10, 1976; Table II revised to Table VII September 22, 1978; text from §4.84b Schedule of ratings-ear re-designated from §4.87 December 17, 1987.
   6286Removed December 17, 1987.
   6291Criterion March 10, 1976; removed December 17, 1987.
   6297Criterion March 10, 1976; removed December 17, 1987.
4.87bRemoved June 10, 1999.
4.88aMarch 11, 1969; re-designated §4.88b November 29, 1994; §4.88a added to read “Chronic fatigue syndrome”; criterion November 29, 1994.
4.88bAdded March 11, 1969; re-designated §4.88c November 29, 1994; §4.88a re-designated to §4.88b November 29, 1994.
   6300Criterion August 30, 1996.
   6302Criterion September 22, 1978; criterion August 30, 1996.
   6304Evaluation August 30, 1996.
   6305Criterion March 1, 1989; evaluation August 30, 1996.
   6306Evaluation August 30, 1996.
   6307Criterion August 30, 1996.
   6308Criterion August 30, 1996.
   6309Added March 1, 1963; criterion March 1, 1989; criterion August 30, 1996.
   6314Evaluation March 1, 1989; evaluation August 30, 1996.
   6315Criterion August 30, 1996.
   6316Evaluation March 1, 1989; evaluation August 30, 1996.
   6317Criterion August 30, 1996.
   6318Added March 1, 1989; criterion August 30, 1996.
   6319Added August 30, 1996.
   6320Added August 30, 1996.
   6350Evaluation March 1, 1963; evaluation March 10, 1976; evaluation August 30, 1996.
   6351Added March 1, 1989; evaluation March 24, 1992; criterion August 30, 1996.
   6352Added March 1, 1989; removed March 24, 1992.
   6353Added March 1, 1989; removed March 24, 1992.
   6354Added November 29, 1994; criterion August 30, 1996.
4.88cRe-designated from §4.88b November 29, 1994.
4.89Ratings for nonpulmonary TB December 1, 1949; criterion March 11, 1969.
4.976502Criterion October 7, 1996.
   6504Criterion October 7, 1996.
   6510-6514Criterion October 7, 1996.
   6515Criterion March 11, 1969.
   6516Criterion October 7, 1996.
   6517Removed October 7, 1996.
   6518Criterion October 7, 1996.
   6519Criterion October 7, 1996.
   6520Criterion October 7, 1996.
   6521Added October 7, 1996.
   6522Added October 7, 1996.
   6523Added October 7, 1996.
   6524Added October 7, 1996.
   6600Evaluation September 9, 1975; criterion October 7, 1996.
   6601Criterion October 7, 1996.
   6602Criterion September 9, 1975; criterion October 7, 1996.
   6603Added September 9, 1975; criterion October 7, 1996.
   6604Added October 7, 1996.
   6701Evaluation October 7, 1996.
   6702Evaluation October 7, 1996.
   6703Evaluation October 7, 1996.
   6704Subparagraph (1) following December 1, 1949; criterion March 11, 1969; criterion September 22, 1978.
   6705Removed March 11, 1969.
   6707-6710Added March 11, 1969; removed September 22, 1978.
   6721Criterion July 6, 1950; criterion September 22, 1978.
   6724Second note following December 1, 1949; criterion March 11, 1969; evaluation October 7, 1996.
   6725-6728Added March 11, 1969; removed September 22, 1978.
   6730Added September 22, 1978; criterion October 7, 1996.
   6731Evaluation September 22, 1978; criterion October 7, 1996.
   6732Criterion March 11, 1969.
   6800Criterion September 9, 1975; removed October 7, 1996.
   6801Removed October 7, 1996.
   6802Criterion September 9, 1975; removed October 7, 1996.
   6810-6813Removed October 7, 1996.
   6814Criterion March 10, 1976; removed October 7, 1996.
   6815Removed October 7, 1996.
   6816Removed October 7, 1996.
   6817Evaluation October 7, 1996.
   6818Removed October 7, 1996.
   6819Criterion March 10, 1976; criterion October 7, 1996.
   6821Evaluation August 23, 1948.
   6822-6847Added October 7, 1996.
4.1047000Evaluation July 6, 1950; evaluation September 22, 1978; evaluation January 12, 1998.
   7001Evaluation January 12, 1998.
   7002Evaluation January 12, 1998.
   7003Evaluation January 12, 1998.
   7004Criterion September 22, 1978; evaluation January 12, 1998.
   7005Evaluation September 9, 1975; evaluation September 22, 1978; evaluation January 12, 1998.
   7006Evaluation January 12, 1998.
   7007Evaluation September 22, 1978; evaluation January 12, 1998.
   7008Evaluation January 12, 1998.
   7010Evaluation January 12, 1998.
   7011Evaluation January 12, 1998.
   7013Removed January 12, 1998.
   7014Removed January 12, 1998.
   7015Evaluation September 9, 1975; criterion January 12, 1998.
   7016Added September 9, 1975; evaluation January 12, 1998.
   7017Added September 22, 1978; evaluation January 12, 1998.
   7018Added January 12, 1998.
   7019Added January 12, 1998.
   7020Added January 12, 1998.
   7100Evaluation July 6, 1950.
   7101Criterion September 1, 1960; criterion September 9, 1975; criterion January 12, 1998.
   7110Evaluation September 9, 1975; evaluation January 12, 1998.
   7111Criterion September 9, 1975; evaluation January 12, 1998.
   7112Evaluation January 12, 1998.
   7113Evaluation January 12, 1998.
   7114Added June 9, 1952; evaluation January 12, 1998.
   7115Added June 9, 1952; evaluation January 12, 1998.
   7116Added June 9, 1952; evaluation March 10, 1976; removed January 12, 1998.
   7117Added June 9, 1952; evaluation January 12, 1998.
   7118Criterion January 12, 1998.
   7119Evaluation January 12, 1998.
   7120Note following July 6, 1950; evaluation January 12, 1998.
   7121Criterion July 6, 1950; evaluation March 10, 1976; evaluation January 12, 1998.
   7122Last sentence of Note following July 6, 1950; evaluation January 12, 1998; criterion August 13, 1998.
   7123Added October 15, 1991; criterion January 12, 1998.
4.114Introduction paragraph revised March 10, 1976.
   7304Evaluation November 1, 1962.
   7305Evaluation November 1, 1962.
   7308Evaluation April 8, 1959.
   7311Criterion July 2, 2001.
   7312Evaluation March 10, 1976; evaluation July 2, 2001.
   7313Evaluation March 10, 1976; removed July 2, 2001.
   7319Evaluation November 1, 1962.
   7321Evaluation July 6, 1950; criterion March 10, 1976.
   7328Evaluation November 1, 1962.
   7329Evaluation November 1, 1962.
   7330Evaluation November 1, 1962.
   7331Criterion March 11, 1969.
   7332Evaluation November 1, 1962.
   7334Evaluation July 6, 1950; evaluation November 1, 1962.
   7339Criterion March 10, 1976.
   7341Removed March 10, 1976.
   7343Criterion March 10, 1976; criterion July 2, 2001.
   7344Criterion July 2, 2001.
   7345Evaluation August 23, 1948; evaluation February 17, 1955; evaluation July 2, 2001.
   7346Evaluation February 1, 1962.
   7347Added September 9, 1975.
   7348Added March 10, 1976.
   7351Added July 2, 2001.
   7354Added July 2, 2001.
4.115aRe-designated and revised as §4.115b; new §4.115a “Ratings of the genitourinary system-dysfunctions” added February 17, 1994.
4.115b7500Note July 6, 1950; evaluation February 17, 1994, criterion September 8, 1994.
   7501Evaluation February 17, 1994.
   7502Evaluation February 17, 1994.
   7503Removed February 17, 1994.
   7504Criterion February 17, 1994.
   7505Criterion March 11, 1969; evaluation February 17, 1994.
   7507Criterion February 17, 1994.
   7508Evaluation February 17, 1994.
   7509Criterion February 17, 1994.
   7510Evaluation February 17, 1994.
   7511Evaluation February 17, 1994.
   7512Evaluation February 17, 1994.
   7513Removed February 17, 1994.
   7514Criterion March 11, 1969; removed February 17, 1994.
   7515Criterion February 17, 1994.
   7516Criterion February 17, 1994.
   7517Criterion February 17, 1994.
   7518Evaluation February 17, 1994.
   7519Evaluation March 10, 1976; evaluation February 17, 1994.
   7520Criterion February 17, 1994.
   7521Criterion February 17, 1994.
   7522Criterion September 8, 1994.
   7523Criterion September 8, 1994.
   7524Note July 6, 1950; evaluation February 17, 1994; evaluation September 8, 1994.
   7525Criterion March 11, 1969; evaluation February 17, 1994.
   7526Removed February 17, 1994.
   7527Criterion February 17, 1994.
   7528Criterion March 10, 1976; criterion February 17, 1994.
   7529Criterion February 17, 1994.
   7530Added September 9, 1975; evaluation February 17, 1994.
   7531Added September 9, 1975; criterion February 17, 1994.
   7532-7542Added February 17, 1994.
4.116§4.116 removed and §4.116a re-designated §4.116 “Schedule of ratings-gynecological conditions and disorders of the breasts” May 22, 1995.
   7610Criterion May 22, 1995.
   7611Criterion May 22, 1995.
   7612Criterion May 22, 1995.
   7613Criterion May 22, 1995.
   7614Criterion May 22, 1995.
   7615Criterion May 22, 1995.
   7617Criterion May 22, 1995.
   7618Criterion May 22, 1995.
   7619Criterion May 22, 1995.
   7620Criterion May 22, 1995.
   7621Criterion May 22, 1995.
   7622Evaluation May 22, 1995.
   7623Evaluation May 22, 1995.
   7624Criterion August 9, 1976; evaluation May 22, 1995.
   7625Criterion August 9, 1976; evaluation May 22, 1995.
   7626Criterion May 22, 1995; criterion March 18, 2002.
   7627Criterion March 10, 1976; criterion May 22, 1995.
   7628Added May 22, 1995.
   7629Added May 22, 1995.
4.1177700Evaluation October 23, 1995.
   7701Removed October 23, 1995.
   7702Evaluation October 23, 1995.
   7703Evaluation August 23, 1948; criterion October 23, 1995.
   7704Evaluation October 23, 1995.
   7705Evaluation October 23, 1995.
   7706Evaluation October 23, 1995.
   7707Criterion October 23, 1995.
   7709Evaluation March 10, 1976; criterion October 23, 1995.
   7710Criterion October 23, 1995.
   7711Criterion October 23, 1995.
   7712Criterion October 23, 1995.
   7713Removed October 23, 1995.
   7714Added September 9, 1975; criterion October 23, 1995.
   7715Added October 26, 1990.
   7716Added October 23, 1995.
   7717Added March 9, 2012.
4.1187800Evaluation August 30, 2002; criterion October 23, 2008.
   7801Criterion July 6, 1950; criterion August 30, 2002; criterion October 23, 2008.
   7802Criterion September 22, 1978; criterion August 30, 2002; criterion October 23, 2008.
   7803Criterion August 30, 2002; removed October 23, 2008.
   7804Criterion July 6, 1950; criterion September 22, 1978; criterion and evaluation October 23, 2008.
   7805Criterion October 23, 2008.
   7806Criterion September 9, 1975; evaluation August 30, 2002.
   7807Criterion August 30, 2002.
   7808Criterion August 30, 2002.
   7809Criterion August 30, 2002.
   7810Removed August 30, 2002.
   7811Criterion March 11, 1969; evaluation August 30, 2002.
   7812Removed August 30, 2002.
   7813Criterion August 30, 2002.
   7814Removed August 30, 2002.
   7815Evaluation August 30, 2002.
   7816Evaluation August 30, 2002.
   7817Evaluation August 30, 2002.
   7818Criterion August 30, 2002.
   7819Criterion August 30, 2002.
   7820-7833Added August 30, 2002.
4.1197900Criterion August 13, 1981; evaluation June 9, 1996.
   7901Criterion August 13, 1981; evaluation June 9, 1996.
   7902Evaluation August 13, 1981; criterion June 9, 1996.
   7903Criterion August 13, 1981; evaluation June 9, 1996.
   7904Criterion August 13, 1981; evaluation June 9, 1996.
   7905Evaluation; August 13, 1981; evaluation June 9, 1996.
   7907Evaluation August 13, 1981; evaluation June 9, 1996.
   7908Criterion August 13, 1981; criterion June 9, 1996.
   7909Evaluation August 13, 1981; criterion June 9, 1996.
   7910Removed June 9, 1996.
   7911Evaluation March 11, 1969; evaluation August 13, 1981; criterion June 9, 1996.
   7913Criterion September 9, 1975; criterion August 13, 1981; criterion June 6, 1996.
   7914Criterion March 10, 1976; criterion August 13, 1981; criterion June 9, 1996.
   7916Added June 9, 1996.
   7917Added June 9, 1996.
   7918Added June 9, 1996.
   7919Added June 9, 1996.
4.124a8002Criterion September 22, 1978.
   8021Criterion September 22, 1978; criterion October 1, 1961; criterion March 10, 1976; criterion March 1, 1989.
   8045Criterion and evaluation October 23, 2008.
   8046Added October 1, 1961; criterion March 10, 1976; criterion March 1, 1989.
   8100Evaluation June 9, 1953.
   8540Added October 15, 1991.
   8910Added October 1, 1961.
   8911Added October 1, 1961; evaluation September 9, 1975.
   8912Added October 1, 1961.
   8913Added October 1, 1961.
   8914Added October 1, 1961; criterion September 9, 1975; criterion March 10, 1976.
   8910-8914Evaluations September 9, 1975.
4.125—4.132All Diagnostic Codes under Mental Disorders October 1, 1961; except as to evaluation for Diagnostic Codes 9500 through 9511 September 9, 1975.
4.130Re-designated from §4.132 November 7, 1996.
   9200Removed February 3, 1988.
   9201Criterion February 3, 1988; Title August 4, 2014.
   9202Criterion February 3, 1988; removed August 4, 2014.
   9203Criterion February 3, 1988; removed August 4, 2014.
   9204Criterion February 3, 1988; removed August 4, 2014.
   9205Criterion February 3, 1988; criterion November 7, 1996; Removed August 4, 2014.
   9206Criterion February 3, 1988; removed November 7, 1996.
   9207Criterion February 3, 1988; removed November 7, 1996.
   9208Criterion February 3, 1988; removed November 7, 1996.
   9209Criterion March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9210Criterion March 10, 1976; criterion February 3, 1988; criterion November 7, 1996; Title August 4, 2014.
   9211Added November 7, 1996.
   9300Criterion March 10, 1976; criterion February 3, 1988; criterion November 7, 1996.
   9301Criterion March 10, 1976; criterion February 3, 1988; criterion November 7, 1996; Title August 4, 2014.
   9302Criterion March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9303Criterion March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9304Criterion March 10, 1976; criterion February 3, 1988; criterion November 7, 1996; TitleAugust 4, 2014.
   9305Criterion March 10, 1976; criterion February 3, 1988; criterion November 7, 1996; Title August 4, 2014.
   9306Criterion March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9307Criterion March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9308Criterion March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9309Criterion March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9310Criterion March 10, 1976; criterion February 3, 1988; criterion November 7, 1996; Title August 4, 2014.
   9311Criterion March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9312Added March 10, 1976; criterion February 3, 1988; criterion November 7, 1996; Title August 4, 2014.
   9313Added March 10, 1976; removed February 3, 1988.
   9314Added March 10, 1976; removed February 3, 1988.
   9315Added March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9316-9321Added March 10, 1976; removed February 3, 1988.
   9322Added March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9323Added March 10, 1976; removed February 3, 1988.
   9324Added March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9325Added March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9326Added March 10, 1976; removed February 3, 1988; added November 7, 1996; Title August 4, 2014.
   9327Added November 7, 1996; removed August 4, 2014.
   9400-9411Evaluations February 3, 1988.
   9400Criterion March 10, 1976; criterion February 3, 1988.
   9401Criterion March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9402Criterion March 10, 1976; criterion February 3, 1988; removed November 7, 1996.
   9403Criterion March 10, 1976; criterion February 3, 1988; criterion November 7, 1996; Title August 4, 2014.
   9410Added March 10, 1976; criterion February 3, 1988; Title August 4, 2014.
   9411Added February 3, 1988.
   9412Added November 7, 1996.
   9413Added November 7, 1996; Title August 4, 2014.
   9416Added November 7, 1996; Title August 4, 2014.
   9417Added November 7, 1996; Title August 4, 2014.
   9421Added November 7, 1996; Title August 4, 2014.
   9422Added November 7, 1996; Title August 4, 2014.
   9423Added November 7, 1996; Title August 4, 2014.
   9424Added November 7, 1996; Title August 4, 2014.
   9425Added November 7, 1996; Title August 4, 2014.
   9431Added November 7, 1996.
   9432Added November 7, 1996.
   9433Added November 7, 1996; Title August 4, 2014.
   9434Added November 7, 1996.
   9435Added November 7, 1996; Title August 4, 2014.
   9440Added November 7, 1996.
   9500Criterion March 10, 1976; criterion February 3, 1988.
   9501Criterion March 10, 1976; criterion February 3, 1988.
   9502Criterion March 10, 1976; criterion February 3, 1988.
   9503Removed March 10, 1976.
   9504Criterion September 9, 1975; removed March 10, 1976.
   9505Added March 10, 1976; criterion February 3, 1988.
   9506Added March 10, 1976; criterion February 3, 1988.
   9507Added March 10, 1976; criterion February 3, 1988.
   9508Added March 10, 1976; criterion February 3, 1988.
   9509Added March 10, 1976; criterion February 3, 1988.
   9510Added March 10, 1976; criterion February 3, 1988.
   9511Added March 10, 1976; criterion February 3, 1988.
   9520Added November 7, 1996.
   9521Added November 7, 1996.
4.132Re-designated as §4.130 November 7, 1996.
4.1509900Criterion September 22, 1978; criterion February 17, 1994.
   9901Criterion February 17, 1994.
   9902Criterion February 17, 1994.
   9903Criterion February 17, 1994.
   9905Criterion September 22, 1978; evaluation February 17, 1994.
   9910Removed February 17, 1994.
   9913Criterion February 17, 1994.
   9914Added February 17, 1994.
   9915Added February 17, 1994.
   9916Added February 17, 1994.

[72 FR 12983, Mar. 20, 2007; 72 FR 16728, Apr. 5, 2007, as amended at 73 FR 54708, 54711, Sept. 23, 2008; 73 FR 69554, Nov. 19, 2008; 77 FR 6467, Feb. 8, 2012; 79 FR 45101, Aug. 4, 2014]

Appendix B to Part 4—Numerical Index of Disabilities

Diagnostic Code No.   
THE MUSCULOSKELETAL SYSTEM
Acute, Subacute, or Chronic Diseases
5000Osteomyelitis, acute, subacute, or chronic.
5001Bones and Joints, tuberculosis.
5002Arthritis, rheumatoid (atrophic).
5003Arthritis, degenerative (hypertrophic or osteoarthritis).
5004Arthritis, gonorrheal.
5005Arthritis, pneumococcic.
5006Arthritis, typhoid.
5007Arthritis, syphilitic.
5008Arthritis, streptococcic.
5009Arthritis, other types (specify).
5010Arthritis, due to trauma.
5011Bones, caisson disease.
5012Bones, new growths, malignant.
5013Osteoporosis, with joint manifestations.
5014Osteomalacia.
5015Bones, new growths, benign.
5016Osteitis deformans.
5017Gout.
5018Hydrarthrosis, intermittent.
5019Bursitis.
5020Synovitis.
5021Myositis.
5022Periostitis.
5023Myositis ossificans.
5024Tenosynovitis.
5025Fibromyalgia.
Prosthetic Implants
5051Shoulder replacement (prosthesis).
5052Elbow replacement (prosthesis).
5053Wrist replacement (prosthesis).
5054Hip replacement (prosthesis).
5055Knee replacement (prosthesis).
5056Ankle replacement (prosthesis).
Combination of Disabilities
5104Anatomical loss of one hand and loss of use of one foot.
5105Anatomical loss of one foot and loss of use of one hand.
5106Anatomical loss of both hands.
5107Anatomical loss of both feet.
5108Anatomical loss of one hand and one foot.
5109Loss of use of both hands.
5110Loss of use of both feet.
5111Loss of use of one hand and one foot.
Amputations: Upper Extremity
Arm amputation of:
5120Disarticulation.
5121Above insertion of deltoid.
5122Below insertion of deltoid.
Forearm amputation of:
5123Above insertion of pronator teres.
5124Below insertion of pronator teres.
5125Hand, loss of use of.
Multiple Finger Amputations
5126Five digits of one hand.
Four digits of one hand:
5127Thumb, index, long and ring.
5128Thumb, index, long and little.
5129Thumb, index, ring and little.
5130Thumb, long, ring and little.
5131Index, long, ring and little.
Three digits of one hand:
5132Thumb, index and long.
5133Thumb, index and ring.
5134Thumb, index and little.
5135Thumb, long and ring.
5136Thumb, long and little.
5137Thumb, ring and little.
5138Index, long and ring.
5139Index, long and little.
5140Index, ring and little.
5141Long, ring and little.
Two digits of one hand:
5142Thumb and index.
5143Thumb and long.
5144Thumb and ring.
5145Thumb and little.
5146Index and long.
5147Index and ring.
5148Index and little.
5149Long and ring.
5150Long and little.
5151Ring and little.
Single finger:
5152Thumb.
5153Index finger.
5154Long finger.
5155Ring finger.
5156Little finger.
Amputations: Lower Extremity
Thigh amputation of:
5160Disarticulation.
5161Upper third.
5162Middle or lower thirds.
Leg amputation of:
5163With defective stump.
5164Not improvable by prosthesis controlled by natural knee action.
5165At a lower level, permitting prosthesis.
5166Forefoot, proximal to metatarsal bones.
5167Foot, loss of use of.
5170Toes, all, without metatarsal loss.
5171Toe, great.
5172Toes, other than great, with removal of metatarsal head.
5173Toes, three or more, without metatarsal involvement.
Shoulder and Arm
5200Scapulohumeral articulation, ankylosis.
5201Arm, limitation of motion.
5202Humerus, other impairment.
5203Clavicle or scapula, impairment.
Elbow and Forearm
5205Elbow, ankylosis.
5206Forearm, limitation of flexion.
5207Forearm, limitation of extension.
5208Forearm, flexion limited.
5209Elbow, other impairment.
5210Radius and ulna, nonunion.
5211Ulna, impairment.
5212Radius, impairment.
5213Supination and pronation, impairment.
Wrist
5214Wrist, ankylosis.
5215Wrist, limitation of motion.
Limitation of Motion
Multiple Digits: Unfavorable Ankylosis:
5216Five digits of one hand.
5217Four digits of one hand.
5218Three digits of one hand.
5219Two digits of one hand.
Multiple Digits: Favorable Ankylosis:
5220Five digits of one hand.
5221Four digits of one hand.
5222Three digits of one hand.
5223Two digits of one hand.
Ankylosis of Individual Digits:
5224Thumb.
5225Index finger.
5226Long finger.
5227Ring or little finger.
Limitation of Motion of Individual Digits:
5228Thumb.
5229Index or long finger.
5230Ring or little finger.
Spine
5235Vertebral fracture or dislocation.
5236Sacroiliac injury and weakness.
5237Lumbosacral or cervical strain.
5238Spinal stenosis.
5239Spondylolisthesis or segmental instability.
5240Ankylosing spondylitis.
5241Spinal fusion.
5242Degenerative arthritis.
5243Intervertebral disc syndrome.
Hip and Thigh
5250Hip, ankylosis.
5251Thigh, limitation of extension.
5252Thigh, limitation of flexion.
5253Thigh, impairment.
5254Hip, flail joint.
5255Femur, impairment.
Knee and Leg
5256Knee, ankylosis.
5257Knee, other impairment.
5258Cartilage, semilunar, dislocated.
5259Cartilage, semilunar, removal.
5260Leg, limitation of flexion.
5261Leg, limitation of extension.
5262Tibia and fibula, impairment.
5263Genu recurvatum.
Ankle
5270Ankle, ankylosis.
5271Ankle, limited motion.
5272Subastragalar or tarsal joint, ankylosis.
5273Os calcis or astragalus, malunion.
5274Astragalectomy.
Shortening of the Lower Extremity
5275Bones, of the lower extremity
The Foot
5276Flatfoot, acquired.
5277Weak foot, bilateral.
5278Claw foot (pes cavus), acquired.
5279Metatarsalgia, anterior (Morton's disease).
5280Hallux valgus.
5281Hallux rigidus.
5282Hammer toe.
5283Tarsal or metatarsal bones.
5284Foot injuries, other.
The Skull
5296Loss of part of.
The Ribs
5297Removal of.
The Coccyx
5298Removal of.
MUSCLE INJURIES
Shoulder Girdle and Arm
5301Group I Function: Upward rotation of scapula.
5302Group II Function: Depression of arm.
5303Group III Function: Elevation and abduction of arm.
5304Group IV Function: Stabilization of shoulder.
5305Group V Function: Elbow supination.
5306Group VI Function: Extension of elbow.
Forearm and Hand
5307Group VII Function: Flexion of wrist and fingers.
5308Group VIII Function: Extension of wrist, fingers, thumb.
5309Group IX Function: Forearm muscles.
Foot and Leg
5310Group X Function: Movement of forefoot and toes.
5311Group XI Function: Propulsion of foot.
5312Group XII Function: Dorsiflexion.
Pelvic Girdle and Thigh
5313Group XIII Function: Extension of hip and flexion of knee.
5314Group XIV Function: Extension of knee.
5315Group XV Function: Adduction of hip.
5316Group XVI Function: Flexion of hip.
5317Group XVII Function: Extension of hip.
5318Group XVIII Function: Outward rotation of thigh.
Torso and Neck
5319Group XIX Function: Abdominal wall and lower thorax.
5320Group XX Function: Postural support of body.
5321Group XXI Function: Respiration.
5322Group XXII Function: Rotary and forward movements, head.
5323Group XXIII Function: Movements of head.
Miscellaneous
5324Diaphragm, rupture.
5325Muscle injury, facial muscles.
5326Muscle hernia.
5327Muscle, neoplasm of, malignant.
5328Muscle, neoplasm of, benign.
5329Sarcoma, soft tissue.
THE EYE
Diseases of the Eye
6000Uveitis.
6001Keratitis.
6002Scleritis.
6003Iritis.
6004Cyclitis.
6005Choroiditis.
6006Retinitis.
6007Hemorrhage, intra-ocular, recent.
6008Retina, detachment.
6009Eye, injury of, unhealed.
6010Eye, tuberculosis.
6011Retina, localized scars.
6012Glaucoma, congestive or inflammatory.
6013Glaucoma, simple, primary, noncongestive.
6014New growths, malignant, eyeball.
6015New growths, benign, eyeball and adnexa.
6016Nystagmus, central.
6017Conjunctivitis, trachomatous, chronic.
6018Conjunctivitis, other, chronic.
6019Ptosis unilateral or bilateral.
6020Ectropion.
6021Entropion.
6022Lagophthalmos.
6023Eyebrows, loss.
6024Eyelashes, loss.
6025Epiphora.
6026Neuritis, optic.
6027Cataract, traumatic.
6028Cataract, senile, and others.
6029Aphakia.
6030Accommodation, paralysis.
6031Dacryocystitis.
6032Eyelids, loss of portion.
6033Lens, crystalline, dislocation.
6034Pterygium.
6035Keratoconus.
Impairment of Central Visual Acuity
6061Anatomical loss both eyes.
6062Blindness, both eyes, only light perception.
Anatomical loss of 1 eye:
6063Other eye 5/200 (1.5/60).
6064Other eye 10/200 (3/60).
6064Other eye 15/200 (4.5/60).
6064Other eye 20/200 (6/60).
6065Other eye 20/100 (6/30).
6065Other eye 20/70 (6/21).
6065Other eye 20/50 (6/15).
6066Other eye 20/40 (6/12).
Blindness in 1 eye, only light perception:
6067Other eye 5/200 (1.5/60).
6068Other eye 10/200 (3/60).
6068Other eye 15/200 (4.5/60).
6068Other eye 20/200 (6/60).
6069Other eye 20/100 (6/30).
6069Other eye 20/70 (6/21).
6069Other eye 20/50 (6/15).
6070Other eye 20/40 (6/12).
Vision in 1 eye 5/200 (1.5/60):
6071Other eye 5/200 (1.5/60).
6072Other eye 10/200 (3/60).
6072Other eye 15/200 (4.5/60).
6072Other eye 20/200 (6/60).
6073Other eye 20/100 (6/30).
6073Other eye 20/70 (6/21).
6073Other eye 20/50 (6/15).
6074Other eye 20/40 (6/12).
Vision in 1 eye 10/200 (3/60):
6075Other eye 10/200 (3/60).
6075Other eye 15/200 (4.5/60).
6075Other eye 20/200 (6/60).
6076Other eye 20/100 (6/30).
6076Other eye 20/70 (6/21).
6076Other eye 20/50 (6/15).
6077Other eye 20/40 (6/12).
Vision in 1 eye 15/200 (4.5/60):
6075Other eye 15/200 (4.5/60).
6075Other eye 20/200 (6/60).
6076Other eye 20/100 (6/30).
6076Other eye 20/70 (6/21).
6076Other eye 20/50 (6/15).
6077Other eye 20/40 (6/12).
Vision in 1 eye 20/200 (6/60):
6075Other eye 20/200 (6/60).
6076Other eye 20/100 (6/30).
6076Other eye 20/70 (6/21).
6076Other eye 20/50 (6/15).
6077Other eye 20/40 (6/12).
Vision in 1 eye 20/100 (6/30):
6078Other eye 20/100 (6/30).
6078Other eye 20/70 (6/21).
6078Other eye 20/50 (6/15).
6079Other eye 20/40 (6/12).
Vision in 1 eye 20/70 (6/21):
6078Other eye 20/70 (6/21).
6078Other eye 20/50 (6/15).
6079Other eye 20/40 (6/12).
Vision in 1 eye 20/50 (6/15):
6078Other eye 20/50 (6/15).
6079Other eye 20/40 (6/12).
Impairment of Field Vision:
6080Field vision, impairment.
6081Scotoma.
Impairment of Muscle Function:
6090Diplopia.
6091Symblepharon.
6092Diplopia, limited muscle function.
THE EAR
6200Chronic suppurative otitis media.
6201Chronic nonsuppurative otitis media.
6202Otosclerosis.
6204Peripheral vestibular disorders.
6205Meniere's syndrome.
6207Loss of auricle.
6208Malignant neoplasm.
6209Benign neoplasm.
6210Chronic otitis externa.
6211Tympanic membrane.
6260Tinnitus, recurrent.
OTHER SENSE ORGANS
6275Smell, complete loss.
6276Taste, complete loss.
INFECTIOUS DISEASES, IMMUNE DISORDERS AND NUTRITIONAL DEFICIENCIES
6300Cholera, Asiatic.
6301Visceral Leishmaniasis.
6302Leprosy (Hansen's Disease).
6304Malaria.
6305Lymphatic Filariasis.
6306Bartonellosis.
6307Plague.
6308Relapsing fever.
6309Rheumatic fever.
6310Syphilis.
6311Tuberculosis, miliary.
6313Avitaminosis.
6314Beriberi.
6315Pellagra.
6316Brucellosis.
6317Typhus, scrub.
6318Melioidosis.
6319Lyme disease.
6320Parasitic diseases.
6350Lupus erythematosus.
6351HIV-Related Illness.
6354Chronic Fatigue Syndrome (CFS).
THE RESPIRATORY SYSTEM
Nose and Throat
6502Septum, nasal, deviation.
6504Nose, loss of part of, or scars.
6510Sinusitis, pansinusitis, chronic.
6511Sinusitis, ethmoid, chronic.
6512Sinusitis, frontal, chronic.
6513Sinusitis, maxillary, chronic.
6514Sinusitis, sphenoid, chronic.
6515Laryngitis, tuberculous.
6516Laryngitis, chronic.
6518Laryngectomy, total.
6519Aphonia, complete organic.
6520Larynx, stenosis of.
6521Pharynx, injuries to.
6522Allergic or vasomotor rhinitis.
6523Bacterial rhinitis.
6524Granulomatous rhinitis.
Trachea and Bronchi
6600Bronchitis, chronic.
6601Bronchiectasis.
6602Asthma, bronchial.
6603Emphysema, pulmonary.
6604Chronic obstructive pulmonary disease.
Lungs and Pleura Tuberculosis
Ratings for Pulmonary Tuberculosis (Chronic) Entitled on August 19, 1968:
6701Active, far advanced.
6702Active, moderately advanced.
6703Active, minimal.
6704Active, advancement unspecified.
6721Inactive, far advanced.
6722Inactive, moderately advanced.
6723Inactive, minimal.
6724Inactive, advancement unspecified.
Ratings for Pulmonary Tuberculosis Initially Evaluated After August 19, 1968:
6730Chronic, active.
6731Chronic, inactive.
6732Pleurisy, active or inactive.
Nontuberculous Diseases
6817Pulmonary Vascular Disease.
6819Neoplasms, malignant.
6820Neoplasms, benign.
Bacterial Infections of the Lung
6822Actinomycosis.
6823Nocardiosis.
6824Chronic lung abscess.
Interstitial Lung Disease
6825Fibrosis of lung, diffuse interstitial.
6826Desquamative interstitial pneumonitis.
6827Pulmonary alveolar proteinosis.
6828Eosinophilic granuloma.
6829Drug-induced, pneumonitis & fibrosis.
6830Radiation-induced, pneumonitis & fibrosis.
6831Hypersensitivity pneumonitis.
6832Pneumoconiosis.
6833Asbestosis.
Mycotic Lung Disease
6834Histoplasmosis.
6835Coccidioidomycosis.
6836Blastomycosis.
6837Cryptococcosis.
6838Aspergillosis.
6839Mucormycosis.
Restrictive Lung Disease
6840Diaphragm paralysis or paresis.
6841Spinal cord injury with respiratory insufficiency.
6842Kyphoscoliosis, pectus excavatum/carinatum.
6843Traumatic chest wall defect.
6844Post-surgical residual.
6845Pleural effusion or fibrosis.
6846Sarcoidosis.
6847Sleep Apnea Syndromes.
THE CARDIOVASCULAR SYSTEM
Diseases of the Heart
7000Valvular heart disease.
7001Endocarditis.
7002Pericarditis.
7003Pericardial adhesions.
7004Syphilitic heart disease.
7005Arteriosclerotic heart disease.
7006Myocardial infarction.
7007Hypertensive heart disease.
7008Hyperthyroid heart disease.
7010Supraventricular arrhythmias.
7011Ventricular arrhythmias.
7015Atrioventricular block.
7016Heart valve replacement.
7017Coronary bypass surgery.
7018Implantable cardiac pacemakers.
7019Cardiac transplantation.
7020Cardiomyopathy.
Diseases of the Arteries and Veins
7101Hypertensive vascular disease.
7110Aortic aneurysm.
7111Aneurysm, large artery.
7112Aneurysm, small artery.
7113Arteriovenous fistula, traumatic.
7114Arteriosclerosis obliterans.
7115Thrombo-angiitis obliterans (Buerger's Disease).
7117Raynaud's syndrome.
7118Angioneurotic edema.
7119Erythromelalgia.
7120Varicose veins.
7121Post-phlebitic syndrome.
7122Cold injury residuals.
7123Soft tissue sarcoma.
THE DIGESTIVE SYSTEM
7200Mouth, injuries.
7201Lips, injuries.
7202Tongue, loss.
7203Esophagus, stricture.
7204Esophagus, spasm.
7205Esophagus, diverticulum.
7301Peritoneum, adhesions.
7304Ulcer, gastric.
7305Ulcer, duodenal.
7306Ulcer, marginal.
7307Gastritis, hypertrophic.
7308Postgastrectomy syndromes.
7309Stomach, stenosis.
7310Stomach, injury of, residuals.
7311Liver, injury of, residuals.
7312Liver, cirrhosis.
7314Cholecystitis, chronic.
7315Cholelithiasis, chronic.
7316Cholangitis, chronic.
7317Gall bladder, injury.
7318Gall bladder, removal.
7319Colon, irritable syndrome.
7321Amebiasis.
7322Dysentery, bacillary.
7323Colitis, ulcerative.
7324Distomiasis, intestinal or hepatic.
7325Enteritis, chronic.
7326Enterocolitis, chronic.
7327Diverticulitis.
7328Intestine, small, resection.
7329Intestine, large, resection.
7330Intestine, fistula.
7331Peritonitis.
7332Rectum & anus, impairment.
7333Rectum & anus, stricture.
7334Rectum, prolapse.
7335Ano, fistula in.
7336Hemorrhoids.
7337Pruritus ani.
7338Hernia, inguinal.
7339Hernia, ventral, postoperative.
7340Hernia, femoral.
7342Visceroptosis.
7343Neoplasms, malignant.
7344Neoplasms, benign.
7345Liver disease, chronic, without cirrhosis.
7346Hernia, hiatal.
7347Pancreatitis.
7348Vagotomy.
7351Liver transplant.
7354Hepatitis C.
THE GENITOURINARY SYSTEM
7500Kidney, removal.
7501Kidney, abscess.
7502Nephritis, chronic.
7504Pyelonephritis, chronic.
7505Kidney, tuberculosis.
7507Nephrosclerosis, arteriolar.
7508Nephrolithiasis.
7509Hydronephrosis.
7510Ureterolithiasis.
7511Ureter, stricture.
7512Cystitis, chronic.
7515Bladder, calculus.
7516Bladder, fistula.
7517Bladder, injury.
7518Urethra, stricture.
7519Urethra, fistula.
7520Penis, removal of half or more.
7521Penis, removal of glans.
7522Penis, deformity, with loss of erectile power.
7523Testis, atrophy, complete.
7524Testis, removal.
7525Epididymo-orchitis, chronic only.
7527Prostate gland.
7528Malignant neoplasms.
7529Benign neoplasms.
7530Renal disease, chronic.
7531Kidney transplant.
7532Renal tubular disorders.
7533Kidneys, cystic diseases.
7534Atherosclerotic renal disease.
7535Toxic nephropathy.
7536Glomerulonephritis.
7537Interstitial nephritis.
7538Papillary necrosis.
7539Renal amyloid disease.
7540Disseminated intravascular coagulation.
7541Renal involvement in systemic diseases.
7542Neurogenic bladder.
GYNECOLOGICAL CONDITIONS AND DISORDERS OF THE BREAST
7610Vulva, disease or injury.
7611Vagina, disease or injury.
7612Cervix, disease or injury.
7613Uterus, disease or injury.
7614Fallopian tube, disease or injury.
7615Ovary, disease or injury.
7617Uterus and both ovaries, removal.
7618Uterus, removal.
7619Ovary, removal.
7620Ovaries, atrophy of both.
7621Uterus, prolapse.
7622Uterus, displacement.
7623Pregnancy, surgical complications.
7624Fistula, rectovaginal.
7625Fistula, urethrovaginal.
7626Breast, surgery.
7627Malignant neoplasms.
7628Benign neoplasms.
7629Endometriosis.
THE HEMIC AND LYMPHATIC SYSTEMS
7700Anemia.
7702Agranulocytosis, acute.
7703Leukemia.
7704Polycythemia vera.
7705Thrombocytopenia.
7706Splenectomy.
7707Spleen, injury of, healed.
7709Hodgkin's disease.
7710Adenitis, tuberculous.
7714Sickle cell anemia.
7715Non-Hodgkin's lymphoma.
7716Aplastic anemia.
7717AL amyloidosis (primary amyloidosis).
THE SKIN
7800Burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck.
7801Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear.
7802Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear.
7804Scar(s), unstable or painful.
7805Scars, other.
7806Dermatitis or eczema.
7807Leishmaniasis, American (New World).
7808Leishmaniasis, Old World.
7809Lupus erythematosus, discoid.
7811Tuberculosis luposa (lupus vulgaris).
7813Dermatophytosis.
7815Bullous disorders.
7816Psoriasis.
7817Exfoliative dermatitis.
7818Malignant skin neoplasms.
7819Benign skin neoplasms.
7820Infections of the skin.
7821Cutaneous manifestations of collagen-vascular diseases.
7822Papulosquamous disorders.
7823Vitiligo.
7824Keratinization, diseases.
7825Urticaria.
7826Vasculitis, primary cutaneous.
7827Erythema multiforme.
7828Acne.
7829Chloracne.
7830Scarring alopecia.
7831Alopecia areata.
7832Hyperhidrosis.
7833Malignant melanoma.
THE ENDOCRINE SYSTEM
7900Hyperthyroidism.
7901Thyroid gland, toxic adenoma.
7902Thyroid gland, nontoxic adenoma.
7903Hypothyroidism.
7904Hyperparathyroidism.
7905Hypoparathyroidism.
7907Cushing's syndrome.
7908Acromegaly.
7909Diabetes insipidus.
7911Addison's disease.
7912Pluriglandular syndrome.
7913Diabetes mellitus.
7914Malignant neoplasm.
7915Benign neoplasm.
7916Hyperpituitarism.
7917Hyperaldosteronism.
7918Pheochromocytoma.
7919C-cell hyperplasia, thyroid.
NEUROLOGICAL CONDITIONS AND CONVULSIVE DISORDERS
Organic Diseases of the Central Nervous System
8000Encephalitis, epidemic, chronic.
Brain, New Growth of
8002Malignant.
8003Benign.
8004Paralysis agitans.
8005Bulbar palsy.
8007Brain, vessels, embolism.
8008Brain, vessels, thrombosis.
8009Brain, vessels, hemorrhage.
8010Myelitis.
8011Poliomyelitis, anterior.
8012Hematomyelia.
8013Syphilis, cerebrospinal.
8014Syphilis, meningovascular.
8015Tabes dorsalis.
8017Amyotrophic lateral sclerosis.
8018Multiple sclerosis.
8019Meningitis, cerebrospinal, epidemic.
8020Brain, abscess.
Spinal Cord, New Growths
8021Malignant.
8022Benign.
8023Progressive muscular atrophy.
8024Syringomyelia.
8025Myasthenia gravis.
8045Residuals of traumatic brain injury (TBI).
8046Cerebral arteriosclerosis.
Miscellaneous Diseases
8100Migraine
8103Tic, convulsive.
8104Paramyoclonus multiplex.
8105Chorea, Sydenham's.
8106Chorea, Huntington's.
8107Athetosis, acquired.
8108Narcolepsy.
The Cranial Nerves
8205Fifth (trigeminal), paralysis.
8207Seventh (facial), paralysis.
8209Ninth (glossopharyngeal), paralysis.
8210Tenth (pneumogastric, vagus), paralysis.
8211Eleventh (spinal accessory, external branch), paralysis.
8212Twelfth (hypoglossal), paralysis.
8305Neuritis, fifth cranial nerve.
8307Neuritis, seventh cranial nerve.
8309Neuritis, ninth cranial nerve.
8310Neuritis, tenth cranial nerve.
8311Neuritis, eleventh cranial nerve.
8312Neuritis, twelfth cranial nerve.
8405Neuralgia, fifth cranial nerve.
8407Neuralgia, seventh cranial nerve.
8409Neuralgia, ninth cranial nerve.
8410Neuralgia, tenth cranial nerve.
8411Neuralgia, eleventh cranial nerve.
8412Neuralgia, twelfth cranial nerve.
Peripheral Nerves
8510Upper radicular group, paralysis.
8511Middle radicular group, paralysis.
8512Lower radicular group, paralysis.
8513All radicular groups, paralysis.
8514Musculospiral nerve (radial), paralysis.
8515Median nerve, paralysis.
8516Ulnar nerve, paralysis.
8517Musculocutaneous nerve, paralysis.
8518Circumflex nerve, paralysis.
8519Long thoracic nerve, paralysis.
8520Sciatic nerve, paralysis.
8521External popliteal nerve (common peroneal), paralysis.
8522Musculocutaneous nerve (superficial peroneal), paralysis.
8523Anterior tibial nerve (deep peroneal), paralysis.
8524Internal popliteal nerve (tibial), paralysis.
8525Posterior tibial nerve, paralysis.
8526Anterior crural nerve (femoral), paralysis.
8527Internal saphenous nerve, paralysis.
8528Obturator nerve, paralysis.
8529External cutaneous nerve of thigh, paralysis.
8530Ilio-inguinal nerve, paralysis.
8540Soft-tissue sarcoma (Neurogenic origin).
8610Neuritis, upper radicular group.
8611Neuritis, middle radicular group.
8612Neuritis, lower radicular group.
8613Neuritis, all radicular group.
8614Neuritis, musculospiral (radial) nerve.
8615Neuritis, median nerve.
8616Neuritis, ulnar nerve.
8617Neuritis, musculocutaneous nerve.
8618Neuritis, circumflex nerve.
8619Neuritis, long thoracic nerve.
8620Neuritis, sciatic nerve.
8621Neuritis, external popliteal (common peroneal) nerve.
8622Neuritis, musculocutaneous (superficial peroneal) nerve.
8623Neuritis, anterior tibial (deep peroneal) nerve.
8624Neuritis, internal popliteal (tibial) nerve.
8625Neuritis, posterior tibial nerve.
8626Neuritis, anterior crural (femoral) nerve.
8627Neuritis, internal saphenous nerve.
8628Neuritis, obturator nerve.
8629Neuritis, external cutaneous nerve of thigh.
8630Neuritis, ilio-inguinal nerve.
8710Neuralgia, upper radicular group.
8711Neuralgia, middle radicular group.
8712Neuralgia, lower radicular group.
8713Neuralgia, all radicular groups.
8714Neuralgia, musculospiral nerve (radial).
8715Neuralgia, median nerve.
8716Neuralgia, ulnar nerve.
8717Neuralgia, musculocutaneous nerve.
8718Neuralgia, circumflex nerve.
8719Neuralgia, long thoracic nerve.
8720Neuralgia, sciatic nerve.
8721Neuralgia, external popliteal nerve (common peroneal).
8722Neuralgia, musculocutaneous nerve (superficial peroneal).
8723Neuralgia, anterior tibial nerve (deep peroneal).
8724Neuralgia, internal popliteal nerve (tibial).
8725Neuralgia, posterior tibial nerve.
8726Neuralgia, anterior crural nerve (femoral).
8727Neuralgia, internal saphenous nerve.
8728Neuralgia, obturator nerve.
8729Neuralgia, external cutaneous nerve of thigh.
8730Neuralgia, ilio-inguinal nerve.
The Epilepsies
8910Grand mal.
8911Petit mal.
8912Jacksonian and focal motor or sensory.
8913Diencephalic.
8914Psychomotor.
Mental Disorders
9201Schizophrenia.
9208Delusional disorder.
9210Other specified and unspecified schizophrenia spectrum and other psychotic disorders.
9211Schizoaffective Disorder.
9300Delirium.
9301Major or mild neurocognitive disorder due to HIV or other infections.
9304Major or mild neurocognitive disorder due to traumatic brain injury.
9305Major or mild vascular neurocognitive disorder.
9310Unspecified neurocognitive disorder.
9312Major or mild neurocognitive disorder due to Alzheimer's disease.
9326Major or mild neurocognitive disorder due to another medical condition or substance/medication-induced major or mild neurocognitive disorder.
9400Generalized anxiety disorder.
9403Specific phobia; social anxiety disorder (social phobia).
9404Obsessive compulsive disorder.
9410Other specified anxiety disorder.
9411Posttraumatic stress disorder.
9412Panic disorder and/or agoraphobia.
9413Unspecified anxiety disorder.
9416Dissociative amnesia; dissociative identity disorder.
9417Depersonalization/derealization disorder.
9421Somatic symptom disorder.
9422Other specified somatic symptom and related disorder.
9423Unspecified somatic symptom and related disorder.
9424Conversion disorder (functional neurological symptom disorder).
9425Illness anxiety disorder.
9431Cyclothymic disorder.
9432Bipolar disorder.
9433Persistent depressive disorder (dysthymia).
9434Major depressive disorder.
9435Unspecified depressive disorder.
9440Chronic adjustment disorder.
9520Anorexia nervosa.
9521Bulimia nervosa.
DENTAL AND ORAL CONDITIONS
9900Maxilla or mandible, chronic.
9901Mandible, loss of, complete.
9902Mandible, loss of approximately one-half.
9903Mandible, nonunion.
9904Mandible, malunion.
9905Temporomandibular articulation, limited motion.
9906Ramus, loss of whole or part.
9907Ramus, loss of less than one-half.
9908Condyloid process.
9909Coronoid process.
9911Hard palate, loss of half or more.
9912Hard palate, loss of less than half.
9913Teeth, loss of.
9914Maxilla, loss of more than half.
9915Maxilla, loss of half or less.
9916Maxilla, malunion or nonunion of.

[72 FR 12990, Mar. 20, 2007, as amended at 73 FR 54708, 54711, Sept. 23, 2008; 74 FR 18467, Apr. 23, 2009; 77 FR 6467, Feb. 8, 2012; 79 FR 45102, Aug. 4, 2014]

Appendix C to Part 4—Alphabetical Index of Disabilities

   Diagnostic code No.
Abscess:
Brain8020
Kidney7501
Lung6824
Acne7828
Acromegaly7908
Actinomycosis6822
Addison's disease7911
Agranulocytosis7702
AL amyloidosis7717
Alopecia areata7831
Amebiasis7321
Amputation:
Arm:
Disarticulation5120
Above insertion of deltoid5121
Below insertion of deltoid5122
Digits, five of one hand5126
Digits, four of one hand:
Thumb, index, long and ring5127
Thumb, index, long and little5128
Thumb, index, ring and little5129
Thumb, long, ring and little5130
Index, long, ring and little5131
Digits, three of one hand:
Thumb, index and long5132
Thumb, index and ring5133
Thumb, index and little5134
Thumb, long and ring5135
Thumb, long and little5136
Thumb, ring and little5137
Index, long and ring5138
Index, long and little5139
Index, ring and little5140
Long, ring and little5141
Digits, two of one hand:
Thumb and index5142
Thumb and long5143
Thumb and ring5144
Thumb and little5145
Index and long5146
Index and ring5147
Index and little5148
Long and ring5149
Long and little5150
Ring and little5151
Single finger:
Thumb5152
Index finger5153
Long finger5154
Ring finger5155
Little finger5156
Forearm:
Above insertion of pronator teres5123
Below insertion of pronator teres5124
Leg:
With defective stump5163
Not improvable by prosthesis controlled by natural knee action5164
At a lower level, permitting prosthesis5165
Forefoot, proximal to metatarsal bones5166
Toes, all, without metatarsal loss5170
Toe, great5171
Toes, other than great, with removal of metatarsal head5172
Toes, three or more, without metatarsal involvement5173
Thigh:
Disarticulation5160
Upper third5161
Middle or lower thirds5162
Amyotrophic lateral sclerosis8017
Anatomical loss of:
Both eyes6061
One eye, with visual acuity of other eye:
5/200 (1.5/60)6063
10/200 (3/60); 15/200 (4.5/60); 20/200 (6/60)6064
20/100 (6/30); 20/70 (6/21); 20/50 (6/15)6065
20/40 (6/12)6066
Both feet5107
Both hands5106
One hand and one foot5108
One foot and loss of use of one hand5105
One hand and loss of use of one foot5104
Anemia7700
Aneurysm:
Aortic7110
Large artery7111
Small artery7112
Angioneurotic edema7118
Ankylosis:
Ankle5270
Digits, individual:
Thumb5224
Index finger5225
Long finger5226
Ring or little finger5227
Elbow5205
Hand
Favorable:
Five digits of one hand5220
Four digits of one hand5221
Three digits of one hand5222
Two digits of one hand5223
Unfavorable:
Five digits of one hand5216
Four digits of one hand5217
Three digits of one hand5218
Two digits of one hand5219
Hip5250
Knee5256
Scapulohumeral articulation5200
Subastragalar or tarsal joint5272
Wrist5214
Ankylosing spondylitis5240
Aphakia6029
Aphonia, organic6519
Aplastic anemia7716
Arrhythmia:
Supraventricular7010
Ventricular7011
Arteriosclerosis obliterans7114
Arteriosclerotic heart disease7005
Arteriovenous fistula7113
Arthritis:
Degenerative (hypertrophic or osteoarthritis)5003
Due to trauma5010
Gonorrheal5004
Other types5009
Pneumococcic5005
Rheumatoid (atrophic)5002
Streptococcic5008
Syphilitic5007
Typhoid5006
Asbestosis6833
Aspergillosis6838
Asthma, bronchial6602
Astragalectomy5274
Atherosclerotic renal disease7534
Athetosis8107
Atrioventricular block7015
Avitaminosis6313
Bartonellosis6306
Beriberi6314
Bladder:
Calculus in7515
Fistula in7516
Injury of7517
Neurogenic7542
Blastomycosis6836
Blindness: see also Vision and Anatomical Loss
Both eyes, only light perception6062
One eye, only light perception and other eye:
5/200 (1.5/60)6067
10/200 (3/60); 15/200 (4.5/60); 20/200 (6/60)6068
20/100 (6/30); 20/70 (6/21); 20/50 (6/15)6069
20/40 (6/12)6070
Bones:
Caisson disease5011
New growths, benign5015
New growths, malignant5012
Shortening of the lower extremity5275
Brain:
Abscess8020
Breast surgery7626
Bronchiectasis6601
Bronchitis6600
Brucellosis6316
Buerger's disease7115
Bulbar palsy8005
Bullous disorders7815
Bursitis5019
Cardiac:
Pacemakers, implantable7018
Transplantation7019
Cardiomyopathy7020
C-cell hyperplasia, thyroid7919
Cataract:
Senile and others6028
Traumatic6027
Cerebral arteriosclerosis8046
Cervical strain5237
Cervix disease or injury7612
Chorea:
Huntington's8106
Sydenham's8105
Chloracne7829
Cholangitis, chronic7316
Cholecystitis, chronic7314
Cholelithiasis, chronic7315
Cholera, Asiatic6300
Choroiditis6005
Chronic Fatigue Syndrome (CFS)6354
Chronic lung abscess6824
Chronic obstructive pulmonary disease6604
Coccidioidomycosis6835
Cold injury residuals7122
Colitis, ulcerative7323
Conjunctivitis:
Trachomatous6017
Other6018
Coronary bypass surgery7017
Cryptococcosis6837
Cushing's syndrome7907
Cutaneous manifestations of collagen-vascular diseases7821
Cyclitis6004
Cystitis, chronic7512
Dacryocystitis6031
Dermatitis or eczema7806
Dermatophytosis7813
Desquamative interstitial pneumonitis6826
Diabetes:
Insipidus7909
Mellitus7913
Diaphragm:
Paralysis or paresis6840
Rupture5324
Diplopia6090
Diplopia, limited muscle function, eye6092
Disease:
Addison's7911
Buerger's7115
Chronic obstructive pulmonary disease6604
Hodgkin's7709
Leprosy (Hansen's)6302
Lyme6319
Morton's5279
Parasitic6320
Disfigurement of, head, face or neck7800
Dislocated:
Cartilage, semilunar5258
Lens, crystalline6033
Disseminated intravascular coagulation7540
Distomiasis, intestinal or hepatic7324
Diverticulitis7327
Dysentery, bacillary7322
Ectropion6020
Embolism, brain8007
Emphysema, pulmonary6603
Encephalitis, epidemic, chronic8000
Endocarditis7001
Endometriosis7629
Enteritis, chronic7325
Enterocolitis, chronic7326
Entropion6021
Eosinophilic granuloma of lung6828
Epididymo-orchitis7525
Epilepsies:
Diencephalic8913
Grand mal8910
Jacksonian and focal motor or sensory8912
Petit mal8911
Psychomotor8914
Epiphora6025
Erythema multiforme7827
Erythromelalgia7119
Esophagus:
Diverticulum7205
Spasm7204
Stricture7203
Exfoliative dermatitis7817
Fallopian tube7614
Fever:
Relapsing6308
Rheumatic6309
Fibrosis of lung, diffuse interstitial6825
Fibromyalgia5025
Fistula in ano7335
Fistula:
Rectovaginal7624
Urethrovaginal7625
Flatfoot, acquired5276
Gastritis, hypertrophic7307
Genu recurvatum5263
Glaucoma:
Congestive or inflammatory6012
Simple, primary, noncongestive6013
Glomerulonephritis7536
Gout5017
Hallux:
Rigidus5281
Valgus5280
Hammer toe5282
Heart valve replacement7016
Hematomyelia8012
Hemorrhage:
Brain8009
Intra-ocular6007
Hemorrhoids7336
Hepatitis C7354
Hernia:
Femoral7340
Hiatal7346
Inguinal7338
Muscle5326
Ventral7339
Hip:
Degenerative arthritis5242
Flail joint5254
Histoplasmosis6834
HIV-Related Illness6351
Hodgkin's disease7709
Hydrarthrosis, intermittent5018
Hydronephrosis7509
Hyperaldosteronism7917
Hyperhidrosis7832
Hyperparathyroidism7904
Hyperpituitarism7916
Hypersensitivity6831
Hypertensive:
Heart disease7007
Vascular disease7101
Hyperthyroid heart disease7008
Hyperthyroidism7900
Hypoparathyroidism7905
Hypothyroidism7903
Impairment of:
Humerus5202
Clavicle or scapula5203
Elbow5209
Thigh5253
Femur5255
Knee, other5257
Field vision6080
Tibia and fibula5262
Rectum & anus7332
Ulna5211
Implantable cardiac pacemakers7018
Infections of the skin7820
Injury:
Bladder7517
Eye, unhealed6009
Foot5284
Gall bladder7317
Lips7201
Liver, residuals7311
Mouth7200
Muscle:
Facial5325
Group I Function: Upward rotation of scapula5301
Group II Function: Depression of arm5302
Group III Function: Elevation and abduction of arm5303
Group IV Function: Stabilization of shoulder5304
Group V Function: Elbow supination5305
Group VI Function: Extension of elbow5306
Group VII Function: Flexion of wrist and fingers5307
Group VIII Function: Extension of wrist, fingers, thumb5308
Group IX Function: Forearm muscles5309
Group X Function: Movement of forefoot and toes5310
Group XI Function: Propulsion of foot5311
Group XII Function: Dorsiflexion5312
Group XIII Function: Extension of hip and flexion of knee5313
Group XIV Function: Extension of knee5314
Group XV Function: Adduction of hip5315
Group XVI Function: Flexion of hip5316
Group XVII Function: Extension of hip5317
Group XVIII Function: Outward rotation of thigh5318
Group XIX Function: Abdominal wall and lower thorax5319
Group XX Function: Postural support of body5320
Group XXI Function: Respiration5321
Group XXII Function: Rotary and forward movements, head5322
Group XXIII Function: Movements of head5323
Pharynx6521
Sacroiliac5236
Spinal cord6841
Stomach, residuals of7310
Iritis6003
Interstitial nephritis7537
Intervertebral disc syndrome5243
Intestine, fistula of7330
Irritable colon syndrome7319
Keratinization, diseases of7824
Keratitis6001
Keratoconus6035
Kidney:
Abscess7501
Cystic diseases7533
Removal7500
Transplant7531
Tuberculosis7505
Kyphoscoliosis, pectus excavatum / carinatum6842
Lagophthalmos6022
Laryngectomy6518
Laryngitis:
Tuberculous6515
Chronic6516
Larynx, stenosis of6520
Leishmaniasis:
American (New World)7807
Old World7808
Leprosy (Hansen's Disease)6302
Leukemia7703
Limitation of extension:
Forearm5207
Leg5261
Radius5212
Supination and pronation5213
Thigh5251
Limitation of extension and flexion:
Forearm5208
Limitation of flexion:
Forearm5206
Leg5260
Thigh5252
Limitation of motion:
Ankle5271
Arm5201
Index or long finger5229
Ring or little finger5230
Temporomandibular articulation9905
Thumb5228
Wrist, limitation of motion5215
Liver:
Disease, chronic, without cirrhosis7345
Transplant7351
Cirrhosis7312
Loss of:
Auricle6207
Condyloid process9908
Coronoid process9909
Eyebrows6023
Eyelashes6024
Eyelids6032
Mandible:
One-half9902
Complete9901
Maxilla:
More than half9914
Less than half9915
Nose, part of, or scars6504
Palate, hard:
Half or more9911
Less than half9912
Ramus:
Whole or part9906
Less than one-half9907
Skull, part of5296
Smell, sense of6275
Taste, sense of6276
Teeth, loss of9913
Tongue, loss of whole or part7202
Loss of use of:
Both feet5110
Both hands5109
Foot5167
Hand5125
One hand and one foot5111
Lumbosacral strain5237
Lupus:
Erythematosus6350
Erythematosus, discoid7809
Lyme disease6319
Lymphatic filariasis6305
Malaria6304
Malignant melanoma7833
Malunion:
Mandible9904
Os calcis or astragalus5273
Maxilla, malunion or nonunion9916
Melioidosis6318
Meniere's syndrome6205
Meningitis, cerebrospinal, epidemic8019
Mental disorders:
Anorexia nervosa9520
Bipolar disorder9432
Bulimia nervosa9521
Chronic adjustment disorder9440
Conversion disorder (functional neurological symptom disorder).9424
Cyclothymic disorder9431
Delirium9300
Delusional disorder9208
Depersonalization/derealization disorder9417
Dissociative amnesia; dissociative identity disorder9416
Generalized anxiety disorder9400
Illness anxiety disorder9425
Major depressive disorder9434
Major or mild neurocognitive disorder due to Alzheimer's disease9312
Major or mild neurocognitive disorder due to another medical condition or substance/medication-induced major or mild neurocognitive disorder9326
Major or mild neurocognitive disorder due to HIV or other infections9301
Major or mild neurocognitive disorder due to traumatic brain injury9304
Major or mild vascular neurocognitive disorder9305
Obsessive compulsive disorder9404
Other specified and unspecified schizophrenia spectrum and other psychotic disorders9210
Other specified anxiety disorder9410
Other specified somatic symptom and related disorder9422
Panic disorder and/or agoraphobia9412
Persistent depressive disorder (dysthymia)9433
Posttraumatic stress disorder9411
Schizoaffective disorder9211
Schizophrenia9201
Somatic symptom disorder9421
Specific phobia; social anxiety disorder (social phobia)9403
Unspecified somatic symptom and related disorder9423
Unspecified anxiety disorder9413
Unspecified depressive disorder9435
Unspecified neurocognitive disorder9310
Metatarsalgia5279
Migraine8100
Morton's disease5279
Mucormycosis6839
Multiple sclerosis8018
Myasthenia gravis8025
Myelitis8010
Myocardial infarction7006
Myositis ossificans5023
Myositis5021
Narcolepsy8108
Neoplasms:
Benign:
Digestive system7344
Ear6209
Endocrine7915
Genitourinary7529
Gynecological or breast7628
Muscle5328
Respiratory6820
Skin7819
Malignant:
Digestive system7343
Ear6208
Endocrine7914
Genitourinary7528
Gynecological or breast7627
Muscle5327
Respiratory6819
Skin7818
Nephritis, chronic7502
Nephrolithiasis7508
Nephrosclerosis, arteriolar7507
Neuralgia:
Cranial Nerves
Fifth (trigeminal)8405
Seventh (facial)8407
Ninth (glossopharyngeal)8409
Tenth (pneumogastric, vagus)8410
Eleventh (spinal accessory, external branch)8411
Twelfth (hypoglossal)8412
Peripheral Nerves
Upper radicular group8710
Middle radicular group8711
Lower radicular group8712
All radicular groups8713
Musculospiral (radial)8714
Median8715
Ulnar8716
Musculocutaneous8717
Circumflex8718
Long thoracic8719
Sciatic8720
External popliteal (common peroneal)8721
Musculocutaneous (superficial peroneal)8722
Anterior tibial (deep peroneal)8723
Internal popliteal (tibial)8724
Posterior tibial8725
Anterior crural (femoral)8726
Internal saphenous8727
Obturator8728
External cutaneous nerve of thigh8729
Ilio-inguinal8730
Neuritis:
Cranial nerves
Fifth (trigeminal)8305
Seventh (facial)8307
Ninth (glossopharyngeal)8309
Tenth (pneumogastric, vagus)8310
Eleventh (spinal accessory, external branch)8311
Twelfth (hypoglossal)8312
Optic6026
Peripheral Nerves
Upper radicular group8610
Middle radicular group8611
Lower radicular group8612
All radicular groups8613
Musculospiral (radial)8614
Median8615
Ulnar8616
Musculocutaneous8617
Circumflex8618
Long thoracic8619
Sciatic8620
External popliteal (common peroneal)8621
Musculocutaneous (superficial peroneal)8622
Anterior tibial (deep peroneal)8623
Internal popliteal (tibial)8624
Posterior tibial8625
Anterior crural (femoral)8626
Internal saphenous8627
Obturator8628
External cutaneous nerve of thigh8629
Ilio-inguinal8630
Neurogenic bladder7542
New growths:
Benign
Bones5015
Brain8003
Eyeball and adnexa6015
Spinal cord8022
Malignant
Bones5012
Brain8002
Eyeball6014
Spinal cord8021
Nocardiosis6823
Non-Hodgkin's lymphoma7715
Nonunion:
Mandible9903
Radius and ulna5210
Nystagmus, central6016
Osteitis deformans5016
Osteomalacia5014
Osteomyelitis5000
Osteomyelitis maxilla or mandible9900
Osteoporosis, with joint manifestations5013
Otitis media:
Externa6210
Nonsuppurative6201
Suppurative6200
Otosclerosis6202
Ovaries, atrophy of both7620
Ovary:
Disease or injury7615
Removal7619
Palsy, bulbar8005
Pancreatitis7347
Papillary necrosis7538
Papulosquamous disorders7822
Paralysis:
Accommodation6030
Agitans8004
Paralysis, nerve:
Cranial nerves
Fifth (trigeminal)8205
Seventh (facial)8207
Ninth (glossopharyngeal)8209
Tenth (pneumogastric, vagus)8210
Eleventh (spinal accessory, external branch)8211
Twelfth (hypoglossal)8212
Peripheral Nerves:
Upper radicular group8510
Middle radicular group8511
Lower radicular group8512
All radicular groups8513
Musculospiral (radial)8514
Median8515
Ulnar8516
Musculocutaneous8517
Circumflex8518
Long thoracic8519
Sciatic8520
External popliteal (common peroneal)8521
Musculocutaneous (superficial peroneal)8522
Anterior tibial nerve (deep peroneal)8523
Internal popliteal (tibial)8524
Posterior tibial nerve8525
Anterior crural nerve (femoral)8526
Internal saphenous8527
Obturator8528
External cutaneous nerve of thigh8529
Ilio-inguinal8530
Paramyoclonus multiplex8104
Parasitic disease6320
Pellagra6315
Penis
Deformity, with loss of erectile power7522
Removal of glans7521
Removal of half or more7520
Pericardial adhesions7003
Pericarditis7002
Periostitis5022
Peripheral vestibular disorders6204
Peritoneum, adhesions7301
Peritonitis7331
Pes cavus (Claw foot) acquired5278
Pheochromocytoma7918
Plague6307
Pleural effusion or fibrosis6845
Pluriglandular syndrome7912
Pneumoconiosis6832
Pneumonitis & fibrosis:
Drug-induced6829
Radiation-induced6830
Poliomyelitis, anterior8011
Polycythemia vera7704
Postgastrectomy syndromes7308
Post-phlebitic syndrome7121
Post-surgical residual6844
Pregnancy, surgical complications7623
Progressive muscular atrophy8023
Prostate gland7527
Prosthetic Implants:
Ankle replacement5056
Elbow replacement5052
Hip replacement5054
Knee replacement5055
Shoulder replacement5051
Wrist replacement5053
Psoriasis7816
Pterygium6034
Ptosis6019
Pulmonary:
Alveolar proteinosis6827
Vascular disease6817
Pruritus ani7337
Pyelonephritis, chronic7504
Raynaud's syndrome7117
Rectum:
Rectum & anus, stricture7333
Prolapse7334
Removal:
Cartilage, semilunar5259
Coccyx5298
Gall bladder7318
Kidney7500
Penis glans7521
Penis half or more7520
Ribs5297
Testis7524
Ovary7619
Uterus7618
Uterus and both ovaries7617
Renal:
Amyloid disease7539
Disease, chronic7530
Involvement in systemic diseases7541
Tubular disorders7532
Retina detachment of6008
Retinitis6006
Rhinitis:
Allergic or vasomotor6522
Bacterial6523
Granulomatous6524
Resection of intestine:
Large7329
Small7328
Sarcoidosis6846
Scarring alopecia7830
Scars:
Burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck7800
Burn scar(s) or scars(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear7801
Burn scar(s) or scars(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear7802
Other7805
Retina6011
Unstable or painful7804
Sinusitis:
Ethmoid6511
Frontal6512
Maxillary6513
Pansinusitis6510
Sphenoid6514
Sleep Apnea Syndrome6847
Soft tissue sarcoma:
Muscle, fat, or fibrous connected5329
Neurogenic origin8540
Vascular origin7123
Spinal fusion5241
Spinal stenosis5238
Spleen, injury of, healed7707
Splenectomy7706
Spondylolisthesis or segmental instability, spine5239
Stomach, stenosis of7309
Symblepharon6091
Syndromes:
Chronic Fatigue Syndrome (CFS)6354
Cushing's7907
Meniere's6205
Raynaud's7117
Sleep Apnea6847
Synovitis5020
Syphilis6310
Syphilis:
Cerebrospinal8013
Meningovascular8014
Syphilitic heart disease7004
Syringomyelia8024
Tabes dorsalis8015
Tarsal or metatarsal bones5283
Tenosynovitis5024
Testis:
Atrophy, complete7523
Removal7524
Thrombocytopenia7705
Thrombosis, brain8008
Thyroid gland:
Nontoxic adenoma7902
Toxic adenoma7901
Tic, convulsive8103
Tinnitus, recurrent6260
Toxic nephropathy7535
Traumatic brain injury residuals8045
Traumatic chest wall defect6843
Tuberculosis:
Adenitis7710
Bones and joints5001
Eye6010
Kidney7505
Luposa (lupus vulgaris)7811
Miliary6311
Pleurisy, active or inactive6732
Pulmonary:
Active, far advanced6701
Active, moderately advanced6702
Active, minimal6703
Active, advancement unspecified6704
Active, chronic6730
Inactive, chronic6731
Inactive, far advanced6721
Inactive, moderately advanced6722
Inactive, minimal6723
Inactive, advancement unspecified6724
Tuberculosis luposa (lupus vulgaris)7811
Tympanic membrane6211
Typhus, scrub6317
Ulcer:
Duodenal7305
Gastric7304
Marginal7306
Ureter, stricture of7511
Ureterolithiasis7510
Urethra
Fistula7519
Stricture7518
Urticaria7825
Uterus:
And both ovaries, removal7617
Disease or injury7613
Displacement7622
Prolapse7621
Removal7618
Uveitis6000
Vagina, disease or injury7611
Vagotomy7348
Valvular heart disease7000
Varicose veins7120
Vasculitis, primary cutaneous7826
Vertebral fracture or dislocation5235
Visceral Leishmaniasis6301
Visceroptosis7342
Vision: see also Blindness and Loss of
One eye 5/200 (1.5/60), with visual acuity of other eye:
5/200 (1.5/60)6071
10/200 (3/60); 15/200 (4.5/60); 20/200 (6/60)6072
20/100 (6/30); 20/70 (6/21); 20/50 (6/15)6073
20/40 (6/12)6074
One eye 10/200 (3/60), with visual acuity of other eye:
10/200 (3/60); 15/200 (4.5/60); 20/200 (6/60)6075
20/100 (6/30); 20/70 (6/21); 20/50 (6/15)6076
20/40 (6/12)6077
One eye 15/200 (4.5/60), with visual acuity of other eye:
15/200 (4.5/60) or 20/200 (6/60)6075
20/100 (6/30); 20/70 (6/21); 20/50 (6/15)6076
20/40 (6/12)6077
One eye 20/200 (6/60), with visual acuity of other eye:
20/200 (6/60)6075
20/100 (6/30); 20/70 (6/21); 20/50 (6/15)6076
20/40 (6/12)6077
One eye 20/100 (6/30), with visual acuity of other eye: and other eye:
20/100 (6/30); 20/70 (6/21); 20/50 (6/15)6078
20/40 (6/12)6079
One eye 20/70 (6/21), with visual acuity of other eye:
20/70 (6/21) or 20/50 (6/15)6078
20/40 (6/12)6079
One eye 20/50 (6/15), with visual acuity of other eye:
20/50 (6/15)6078
20/40 (6/12)6079
Each eye 20/40 (6/12)6079
Vitiligo7823
Vulva disease or injury of7610
Weak foot5277

[72 FR 13003, Mar. 20, 2007, as amended at 73 FR 54708, 54712, Sept. 23, 2008; 73 FR 69554, Nov. 19, 2008; 74 FR 18467, Apr. 23, 2009; 77 FR 6467, Feb. 8, 2012; 79 FR 45103, Aug. 4, 2014]



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