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Electronic Code of Federal Regulations

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

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


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]



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