Collapse to view only § 4.79 - Schedule of ratings - eye.

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 3 1/2 inches (8.9 cms.) or more, will be taken as loss of use of the hand or foot involved.

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

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

§ 4.64 - Loss of use of both buttocks.

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.

[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 §§ 4.88c and 4.89
5002 Multi-joint arthritis (except post-traumatic and gout), 2 or more joints, 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
Note (1): Examples of conditions rated using this diagnostic code include, but are not limited to, rheumatoid arthritis, psoriatic arthritis, and spondyloarthropathies.
Note (2): For chronic residuals, rate under diagnostic code 5003.
Note (3): The ratings for the active process will not be combined with the residual ratings for limitation of motion, ankylosis, or diagnostic code 5003. Instead, assign the higher evaluation.
5003 Degenerative arthritis, other than post-traumatic:
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 Other specified forms of arthropathy (excluding gout).
Note (1): Other specified forms of arthropathy include, but are not limited to, Charcot neuropathic, hypertrophic, crystalline, and other autoimmune arthropathies.
Note (2): With the types of arthritis, diagnostic codes 5004 through 5009, rate the acute phase under diagnostic code 5002; rate any chronic residuals under diagnostic code 5003.
5010 Post-traumatic arthritis: Rate as limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with § 4.25.
5011 Decompression illness: Rate manifestations under the appropriate diagnostic code within the affected body system, such as arthritis for musculoskeletal residuals; auditory system for vestibular residuals; respiratory system for pulmonary barotrauma residuals; and neurologic system for cerebrovascular accident residuals.
5012 Bones, neoplasm, malignant, primary or secondary100
Note: The 100 percent rating will be continued for 1 year following the cessation of surgical, X-ray, antineoplastic chemotherapy or other prescribed therapeutic procedure. If there has been no local recurrence or metastases, rate based on residuals.
5013 Osteoporosis, residuals of.
5014 Osteomalacia, residuals of.
5015 Bones, neoplasm, benign.
5016 Osteitis deformans.
5017 Gout.
5018 [Removed]
5019 Bursitis.
5020 [Removed]
5021 Myositis.
5022 [Removed]
5023 Heterotopic ossification.
5024 Tenosynovitis, tendinitis, tendinosis or tendinopathy.
Note to DCs 5013 through 5024: Evaluate the diseases under diagnostic codes 5013 through 5024 as degenerative arthritis, based on limitation of motion of affected parts.
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 and Resurfacing

Rating
Major Minor
Note (1): When an evaluation is assigned for joint resurfacing or the prosthetic replacement of a joint under diagnostic codes 5051-5056, an additional rating under § 4.71a may not also be assigned for that joint, unless otherwise directed.
Note (2): Only evaluate a revision procedure in the same manner as the original procedure under diagnostic codes 5051-5056 if all the original components are replaced.
Note (3): The term “prosthetic replacement” in diagnostic codes 5051-5053 and 5055-5056 means a total replacement of the named joint. However, in DC 5054, “prosthetic replacement” means a total replacement of the head of the femur or of the acetabulum.
Note (4): The 100 percent 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 (5): The 100 percent rating for 4 months following implantation of prosthesis or resurfacing under DCs 5054 and 5055 will commence after initial grant of the 1-month total rating assigned under § 4.30 following hospital discharge.
Note (6): Special monthly compensation is assignable during the 100 percent rating period the earliest date permanent use of crutches is established.
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
5054 Hip, resurfacing or replacement (prosthesis):
For 4 months following implantation of prosthesis or resurfacing100
Prosthetic replacement of the head of the femur or of the acetabulum:
Following implantation of prosthesis with painful motion or weakness such as to require the use of crutches1 90
Markedly severe residual weakness, pain or limitation of motion following implantation of prosthesis70
Moderately severe residuals of weakness, pain or limitation of motion50
Minimum evaluation, total replacement only30
Note: At the conclusion of the 100 percent evaluation period, evaluate resurfacing under diagnostic codes 5250 through 5255; there is no minimum evaluation for resurfacing.
5055 Knee, resurfacing or replacement (prosthesis):
For 4 months following implantation of prosthesis or resurfacing100
Prosthetic replacement of knee joint:
With chronic residuals consisting of severe painful motion or weakness in the affected extremity60
With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5256, 5261, or 5262.
Minimum evaluation, total replacement only30
Note: At the conclusion of the 100 percent evaluation period, evaluate resurfacing under diagnostic codes 5256 through 5262; there is no minimum evaluation for resurfacing.
5056 Ankle replacement (prosthesis).
Prosthetic replacement of ankle joint:
For 1 year following implantation of prosthesis100
With chronic residuals consisting of severe painful motion or weakness40
With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to 5270 or 5271.
Minimum rating20
combinations of disabilities
5104 Anatomical loss of one hand and loss of use of one foot1 100
5105 Anatomical loss of one foot and loss of use of one hand1 100
5106 Anatomical loss of both hands1 100
5107 Anatomical loss of both feet1 100
5108 Anatomical loss of one hand and one foot1 100
5109 Loss of use of both hands1 100
5110 Loss of use of both feet1 100
5111 Loss of use of one hand and one foot1 100

1 Also entitled to special monthly compensation.

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

Impairment of one extremity Impairment of other extremity
Anatomical loss or loss of use below elbow Anatomical loss or loss of use below knee Anatomical 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)M 1/2 Code M-5, 38 CFR 3.350 (f)(1)(x)L 1/2 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)L 1/2 Code L-2 b, 38 CFR 3.350 (f)(1)(iii)L 1/2 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)N 1/2 Code N-4, 38 CFR 3.350 (f)(1)(ix)M 1/2 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)M 1/2 Code M-4 b, 38 CFR 3.350 (f)(1)(vii)M 1/2 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
Major Minor
Arm, amputation of:
5120 Complete amputation, upper extremity:
Forequarter amputation (involving complete removal of the humerus along with any portion of the scapula, clavicle, and/or ribs)1 1001 100
Disarticulation (involving complete removal of the humerus only)1 901 90
5121 Above insertion of deltoid1 901 80
5122 Below insertion of deltoid1 801 70
Forearm, amputation of:
5123 Above insertion of pronator teres1 801 70
5124 Below insertion of pronator teres1 701 60
5125 Hand, loss of use of1 701 60
multiple finger amputations
5126 Five digits of one hand, amputation of1 701 60
Four digits of one hand, amputation of:
5127 Thumb, index, long and ring1 701 60
5128 Thumb, index, long and little1 701 60
5129 Thumb, index, ring and little1 701 60
5130 Thumb, long, ring and little1 701 60
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 appliance.
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.

1 Entitled to special monthly compensation.

Amputations: Lower Extremity

Rating
Thigh, amputation of:
5160 Complete amputation, lower extremity:
Trans-pelvic amputation (involving complete removal of the femur and intrinsic pelvic musculature along with any portion of the pelvic bones)2 100
Disarticulation (involving complete removal of the femur and intrinsic pelvic musculature only)2 90
Note: Separately evaluate residuals involving other body systems (e.g., bowel impairment, bladder impairment) under the appropriate diagnostic code.
5161 Upper third, one-third of the distance from perineum to knee joint measured from perineum2 80
5162 Middle or lower thirds2 60
Leg, amputation of:
5163 With defective stump, thigh amputation recommended2 60
5164 Amputation not improvable by prosthesis controlled by natural knee action2 60
5165 At a lower level, permitting prosthesis2 40
5166 Forefoot, amputation proximal to metatarsal bones (more than one-half of metatarsal loss)2 40
5167 Foot, loss of use of2 40
5170 Toes, all, amputation of, without metatarsal loss or transmetatarsal, amputation of, with up to half of 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

2 Also entitled to special monthly compensation.

The Shoulder and Arm

Rating
Major Minor
5200 Scapulohumeral articulation, ankylosis of:
Note: The scapula and humerus move as one piece.
Unfavorable, abduction limited to 25° from side5040
Intermediate between favorable and unfavorable4030
Favorable, abduction to 60°, can reach mouth and head3020
5201 Arm, limitation of motion of:
Flexion and/or abduction limited to 25° from side4030
Midway between side and shoulder level (flexion and/or abduction limited to 45°)3020
At shoulder level (flexion and/or abduction limited to 90°)2020
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 level (flexion and/or abduction at 90 °)2020
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
Major Minor
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
Major Minor
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, degenerative disc disease other than intervertebral disc syndrome (also, see either DC 5003 or 5010)
5243 Intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other disc diagnoses.
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.
5244 Traumatic paralysis, complete:
Paraplegia: Rate under diagnostic code 5110.
Quadriplegia: Rate separately under diagnostic codes 5109 and 5110 and combine evaluations in accordance with § 4.25.
Note: If traumatic paralysis does not cause loss of use of both hands or both feet, it is incomplete paralysis. Evaluate residuals of incomplete traumatic paralysis under the appropriate diagnostic code (e.g., § 4.124a, Diseases of the Peripheral Nerves).
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.

The Hip and Thigh

Rating
5250 Hip, ankylosis of:
Unfavorable, extremely unfavorable ankylosis, the foot not reaching ground, crutches necessitated3 90
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, weight bearing preserved with aid of brace60
Fracture of surgical neck of, with false joint60
Malunion of:
Evaluate under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5250-5254 for the hip, whichever results in the highest evaluation.

3 Entitled to special monthly compensation.

The Knee and Leg

Rating
5256 Knee, ankylosis of:
Extremely unfavorable, in flexion at an angle of 45° or 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 instability:
Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation30
One of the following:
(a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation.
(b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation20
Sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation10
Patellar instability:
A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker30
A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker20
A diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker10
Note (1): For patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon.
Note (2): A surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration).
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:
Evaluate under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation.
Medial tibial stress syndrome (MTSS), or shin splints:
Requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities30
Requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, one lower extremity20
Requiring treatment for no less than 12 consecutive months, and unresponsive to either shoe orthotics or other conservative treatment, one or both lower extremities10
Treatment less than 12 consecutive months, one or both lower extremities0
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:
Marked (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion)20
Moderate (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion)10
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.)3 60
3 1/2 to 4 inches (8.9 cms. to 10.2 cms.)3 50
3 to 3 1/2 inches (7.6 cms. to 8.9 cms.)40
2 1/2 to 3 inches (6.4 cms. to 7.6 cms.)30
2 to 2 1/2 inches (5.1 cms. to 6.4 cms.)20
1 1/4 to 2 inches (3.2 cms. to 5.1 cms.)10
Note: Measure both lower extremities from anterior superior spine of the ilium to the internal malleolus of the tibia. Not to be combined with other ratings for fracture or faulty union in the same extremity.

3 Also entitled to special monthly compensation.

The Foot

Rating
5269 Plantar fasciitis:
No relief from both non-surgical and surgical treatment, bilateral30
No relief from both non-surgical and surgical treatment, unilateral20
Otherwise, unilateral or bilateral10
Note (1): With actual loss of use of the foot, rate 40 percent
Note (2): If a veteran has been recommended for surgical intervention, but is not a surgical candidate, evaluate under the 20 percent or 30 percent criteria, whichever is applicable
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 in 2 (7.355 cm 2)50
Area intermediate30
Area smaller than the size of a 25-cent piece or 0.716 in 2 (4.619 cm 2)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; 80 FR 42041, July 16, 2015; 85 FR 76460, Nov. 30, 2020, 85 FR 85523, Dec. 29, 2020, 86 FR 8142, Feb. 4, 2021]

§ 4.72 - [Reserved]

§ 4.73 - Schedule of ratings - muscle injuries.

Note (1):

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.

Note (2):

Ratings of slight, moderate, moderately severe, or severe for diagnostic codes 5301 through 5323 will be determined based upon the criteria contained in § 4.56.

The Shoulder Girdle and Arm

Rating
Dominant Nondominant
5301 Group I. Function: Upward rotation of scapula; elevation of arm above shoulder level. Extrinsic muscles of shoulder girdle: (1) Trapezius; (2) levator scapulae; (3) serratus magnus
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.
5330 Rhabdomyolysis, residuals of:
Rate each affected muscle group separately and combine in accordance with § 4.25
Note: Separately evaluate any chronic renal complications within the appropriate body system.
5331 Compartment syndrome:
Rate each affected muscle group separately and combine in accordance with § 4.25
(Authority: 38 U.S.C. 1155) [62 FR 30239, June 3, 1997, as amemded 85 FR 76464, Nov. 30, 2020]

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

Meridian Normal degrees
Temporally85
Down temporally85
Down65
Down nasally50
Nasally60
Up nasally55
Up45
Up temporally55
Total500

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

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

Remaining field 500° minus 320° = 180°. 180° ÷ 8 = 22 1/2° 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. The examiner must document the results for at least 16 meridians 22 1/2 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 document the results 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.

(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; 83 FR 15320, Apr. 10, 2018]

§ 4.78 - Muscle function.

(a) Examination of muscle function. The examiner must use a Goldmann perimeter chart or the Tangent Screen method 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 document the results of muscle function testing by identifying the quadrant(s) and range(s) of degrees in which diplopia exists.

(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, as amended at 83 FR 15321, Apr. 10, 2018]

§ 4.79 - Schedule of ratings - eye.

Diseases of the Eye

Rating
General Rating Formula for Diseases of the Eye:
Evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation
With documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months60
With documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition during the past 12 months40
With documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months20
With documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months10
Note (1): For the purposes of evaluation under 38 CFR 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes
Note (2): Examples of treatment may include but are not limited to: Systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions
Note (3): For the purposes of evaluating visual impairment due to the particular condition, refer to 38 CFR 4.75-4.78 and to § 4.79, diagnostic codes 6061-6091
6000 Choroidopathy, including uveitis, iritis, cyclitis, or choroiditis.
6001 Keratopathy.
6002 Scleritis.
6006 Retinopathy or maculopathy not otherwise specified
6007 Intraocular hemorrhage.
6008 Detachment of retina.
6009 Unhealed eye injury.
Note: This code includes orbital trauma, as well as penetrating or non-penetrating eye injury
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 the General Rating Formula for Diseases of the Eye, if this would result in a higher evaluation
6012 Angle-closure glaucoma
Evaluate under the General Rating Formula for Diseases of the Eye. Minimum evaluation if continuous medication is required10
6013 Open-angle glaucoma
Evaluate under the General Rating Formula for Diseases of the Eye. Minimum evaluation if continuous medication is required10
6014 Malignant neoplasms of the eye, orbit, and adnexa (excluding skin):
Malignant neoplasms of the eye, orbit, and adnexa (excluding skin) that require therapy that is comparable to those 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 neoplasms of the eye, orbit, and adnexa (excluding skin) that do not require therapy comparable to that for systemic malignancies:
Separately evaluate visual and nonvisual impairment, e.g., disfigurement (diagnostic code 7800), and combine the evaluations
6015 Benign neoplasms of the eye, orbit, and adnexa (excluding skin):
Separately evaluate visual and nonvisual impairment, e.g., disfigurement (diagnostic code 7800), and combine the evaluations
6016 Nystagmus, central10
6017 Trachomatous conjunctivitis:
Active: Evaluate under the General Rating Formula for Diseases of the Eye, minimum rating30
Inactive: Evaluate based on residuals, such as visual impairment and disfigurement (diagnostic code 7800)
6018 Chronic conjunctivitis (nontrachomatous):
Active: Evaluate under the General Rating Formula for Diseases of the Eye, minimum rating10
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
6027 Cataract:
Preoperative: Evaluate under the General Rating Formula for Diseases of the Eye
Postoperative: If a replacement lens is present (pseudophakia), evaluate under the General Rating Formula for Diseases of the Eye. If there is no replacement lens, evaluate based on aphakia (diagnostic code 6029)
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 under the General Rating Formula for Diseases of the Eye, disfigurement (diagnostic code 7800), conjunctivitis (diagnostic code 6018), etc., depending on the particular findings, and combine in accordance with § 4.25
6035 Keratoconus
6036 Status post corneal transplant:
Evaluate under the General Rating Formula for Diseases of the Eye. Minimum, if there is pain, photophobia, and glare sensitivity10
6037 Pinguecula:
Evaluate based on disfigurement (diagnostic code 7800).
6040 Diabetic retinopathy
6042 Retinal dystrophy (including retinitis pigmentosa, wet or dry macular degeneration, early-onset macular degeneration, rod and/or cone dystrophy)
6046 Post-chiasmal disorders
Impairment of Central Visual Acuity
6061 Anatomical loss of both eyes 1100
6062 No more than light perception in both eyes 1100
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

1 Review 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

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

Ratings for Impairment of Muscle Function

Degree of diplopia Equivalent
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 under the General Rating Formula for Diseases of the Eye, lagophthalmos (diagnostic code 6022), disfigurement (diagnostic code 7800), etc., depending on the particular findings, and combine in accordance with § 4.25
(Authority: 38 U.S.C. 1155) [73 FR 66550, Nov. 10, 2008, as amended at 83 FR 15321, Apr. 10, 2018]

§§ 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.

[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.

Note:

Rate any residual disability of infection within the appropriate body system as indicated by the notes in the evaluation criteria. As applicable, consider the long-term health effects potentially associated with infectious diseases as listed in § 3.317(d) of this chapter, specifically Brucellosis, Campylobacter jejuni, Coxiella burnetii (Q fever), Malaria, Mycobacterium Tuberculosis, Nontyphoid Salmonella, Shigella, Visceral Leishmaniasis, and West Nile virus.

Rating
General Rating Formula for Infectious Diseases:
For active disease100
After active disease has resolved, rate at 0 percent for infection. Rate any residual disability of infection within the appropriate body system.
6300 Vibriosis (Cholera, Non-cholera):
Evaluate under the General Rating Formula.
Note: Rate residuals of cholera and non-cholera vibrio infections, such as renal failure, skin, and musculoskeletal conditions, within the appropriate body system.
6301 Visceral leishmaniasis:
As active disease100
Note 1: Continue a 100 percent evaluation beyond the cessation of treatment for active disease. Six months after discontinuance of such treatment, determine the appropriate disability rating 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. Thereafter, rate under the appropriate body system any residual disability of infection, which includes, but is not limited to liver damage and bone marrow disease.
Note 2: Confirm the recurrence of active infection by culture, histopathology, or other diagnostic laboratory testing.
6302 Leprosy (Hansen's disease):
As active disease100
Note: Continue a 100 percent evaluation beyond the cessation of treatment for active disease. Six months after discontinuance of such treatment, determine the appropriate disability rating 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. Thereafter, rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, skin lesions, peripheral neuropathy, or amputations.
6304 Malaria:
Evaluate under the General Rating Formula.
Note 1: The diagnosis of malaria, both initially and during relapse, depends on the identification of the malarial parasites in blood smears or other specific diagnostic laboratory tests such as antigen detection, immunologic (immunochromatographic) tests, and molecular testing such as polymerase chain reaction tests.
Note 2: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, liver or splenic damage, and central nervous system conditions.
6305 Lymphatic filariasis, to include elephantiasis:
Evaluate under the General Rating Formula.
Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, epididymitis, lymphangitis, lymphatic obstruction, or lymphedema affecting extremities, genitals, and/or breasts.
6306 Bartonellosis:
Evaluate under the General Rating Formula.
Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, endocarditis or skin lesions.
6307 Plague:
Evaluate under the General Rating Formula.
Note: Rate under the appropriate body system any residual disability of infection.
6308 Relapsing Fever:
Evaluate under the General Rating Formula.
Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, liver or spleen damage, iritis, uveitis, or central nervous system involvement.
6309 Rheumatic fever:
Evaluate under the General Rating Formula.
Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, heart damage.
6310 Syphilis, and other treponema infections:
Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, diseases of the nervous system, vascular system, eyes, or ears (see DC 7004, DC 8013, DC 8014, DC 8015, and DC 9301).
6311 Tuberculosis, miliary:
As active disease100
Inactive disease: See §§ 4.88c and 4.89.
Note 1: Confirm the recurrence of active infection by culture, histopathology, or other diagnostic laboratory testing.
Note 2: Rate under the appropriate body system any residual disability of infection which includes, but is not limited to, skin conditions and conditions of the respiratory, central nervous, musculoskeletal, ocular, gastrointestinal, and genitourinary systems and those residuals listed in § 4.88c.
6312 Nontuberculosis mycobacterium infection:
As active disease100
Note 1: Continue the rating of 100 percent for the duration of treatment for active disease followed by a mandatory VA exam. If there is no relapse, rate on residuals. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter.
Note 2: Confirm the recurrence of active infection by culture, histopathology, or other diagnostic laboratory testing.
Note 3: Rate under the appropriate body system any residual disability of infection which includes, but is not limited to, skin conditions and conditions of the respiratory, central nervous, musculoskeletal, ocular, gastrointestinal, and genitourinary systems and those residuals listed in § 4.88c.
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:
Evaluate under the General Rating Formula.
Note 1: Culture, serologic testing, or both must confirm the initial diagnosis and recurrence of active infection.
Note 2: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, meningitis, liver, spleen and musculoskeletal conditions.
6317 Rickettsial, ehrlichia, and anaplasma infections:
Evaluate under the General Rating Formula.
Note 1: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, bone marrow, spleen, central nervous system, and skin conditions.
Note 2: This diagnostic code includes, but is not limited to, scrub typhus, Rickettsial pox, African tick-borne fever, Rocky Mountain spotted fever, ehrlichiosis, or anaplasmosis.
6318 Melioidosis:
Evaluate under the General Rating Formula.
Note 1: Confirm by culture or other specific diagnostic laboratory tests the initial diagnosis and any relapse or chronic activity of infection.
Note 2: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, arthritis, lung lesions, or meningitis.
6319 Lyme disease:
Evaluate under the General Rating Formula.
Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, arthritis, Bell's palsy, radiculopathy, ocular, or cognitive dysfunction.
6320 Parasitic diseases otherwise not specified:
Evaluate under the General Rating Formula.
Note: Rate under the appropriate body system any residual disability of infection.
6325 Hyperinfection syndrome or disseminated strongyloidiasis:
As active disease100
Note: Continue the rating of 100 percent through active disease followed by a mandatory VA exam. If there is no relapse, rate on residual disability. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter.
6326 Schistosomiasis:
As acute or asymptomatic chronic disease0
Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, conditions of the liver, intestinal system, female genital tract, genitourinary tract, or central nervous system.
6329 Hemorrhagic fevers, including dengue, yellow fever, and others:
Evaluate under the General Rating Formula.
Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, conditions of the central nervous system, liver, or kidney.
6330 Campylobacter jejuni infection:
Evaluate under the General Rating Formula.
Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, Guillain-Barre syndrome, reactive arthritis, or uveitis.
6331 Coxiella burnetii infection (Q fever):
Evaluate under the General Rating Formula.
Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, chronic hepatitis, endocarditis, osteomyelitis, post Q-fever chronic fatigue syndrome, or vascular infections.
6333 Nontyphoid salmonella infections:
Evaluate under the General Rating Formula.
Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, reactive arthritis.
6334 Shigella infections:
Evaluate under the General Rating Formula.
Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, hemolytic-uremic syndrome or reactive arthritis.
6335 West Nile virus infection:
Evaluate under the General Rating Formula.
Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, variable physical, functional, or cognitive disabilities.
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 (see Note 3) or with secondary diseases afflicting multiple body systems; HIV-related illness with debility and progressive weight loss100
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 use of approved medication(s); or minimum rating with T4 cell count less than 20030
Following development of HIV-related constitutional symptoms; T4 cell count between 200 and 500; use of 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: In addition to standard therapies and regimens, the term “approved medication(s)” includes treatment regimens and medications prescribed as part of a research protocol at an accredited medical institution.
Note 2: Diagnosed psychiatric illness, central nervous system manifestations, opportunistic infections, and neoplasms may be rated separately under the appropriate diagnostic codes if a higher overall evaluation results, provided the disability symptoms do not overlap with evaluations otherwise assignable above.
Note 3: The following list of opportunistic infections are considered AIDS-defining conditions, that is, a diagnosis of AIDS follows if a person has HIV and one more of these infections, regardless of the CD4 count - candidiasis of the bronchi, trachea, esophagus, or lungs; invasive cervical cancer; coccidioidomycosis; cryptococcosis; cryptosporidiosis; cytomegalovirus (particularly CMV retinitis); HIV-related encephalopathy; herpes simplex-chronic ulcers for greater than one month, or bronchitis, pneumonia, or esophagitis; histoplasmosis; isosporiasis (chronic intestinal); Kaposi's sarcoma; lymphoma; mycobacterium avium complex; tuberculosis; pneumocystis jirovecii (carinii) pneumonia; pneumonia, recurrent; progressive multifocal leukoencephalopathy; salmonella septicemia, recurrent; toxoplasmosis of the brain; and wasting syndrome due to HIV.
6354 Chronic fatigue syndrome (CFS):
Debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or 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 from 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, incapacitation exists only when a licensed physician prescribes bed rest and treatment.
[61 FR 39875, July 31, 1996, as amended at 84 FR 28230, June 18, 2019]

§ 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.1 100
Rate the residuals of partial laryngectomy as laryngitis (DC 6516), aphonia (DC 6519), or stenosis of larynx (DC 6520).
6519 Aphonia, complete organic:
Constant inability to communicate by speech1 100
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

1 Review for entitlement to special monthly compensation under § 3.350 of this chapter.

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

The Cardiovascular System

§ 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.Rate under the appropriate cardiovascular diagnostic code, depending on particular findings.
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 FR 52460, Sept. 6, 2006; 79 FR 2100, Jan. 13, 2014; 82 FR 50804, Nov. 2, 2017]

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
Urinary 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 - 20 1
7523 Testis, atrophy complete:
Both - 20 1
One - 0 1
7524 Testis, removal:
Both - 30 1
One - 0 1
Note: In cases of the removal of one testis as the result of a service-incurred injury or disease, other than an undescended or congenitally undeveloped testis, with the absence or nonfunctioning of the other testis unrelated to service, an evaluation of 30 percent will be assigned for the service-connected testicular loss. Testis, underscended, or congenitally undeveloped is not a ratable disability.
7525 Epididymo-orchitis, chronic only:
Rate as urinary tract infection.
For tubercular infections: Rate in accordance with §§ 4.88b or 4.89, whichever is appropriate.
7527 Prostate gland injuries, infections, hypertrophy, postoperative residuals:
Rate as voiding dysfunction or urinary tract infection, whichever is predominant.
7528 Malignant neoplasms of the genitourinary 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.

1 Review for entitlement to special monthly compensation under § 3.350 of this chapter.

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

Gynecological Conditions and Disorders of the Breast

§ 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 or clitoris, 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
Note: For the purpose of VA disability evaluation, a disease, injury, or adhesions of the ovaries resulting in ovarian dysfunction affecting the menstrual cycle, such as dysmenorrhea and secondary amenorrhea, shall be rated under diagnostic code 7615
7617 Uterus and both ovaries, removal of, complete:
For three months after removal1 100
Thereafter1 50
7618 Uterus, removal of, including corpus:
For three months after removal1 100
Thereafter1 30
7619 Ovary, removal of:
For three months after removal1 100
Thereafter:
Complete removal of both ovaries1 30
Removal of one with or without partial removal of the other1 0
Note: In cases of the removal of one ovary as the result of a service-connected injury or disease, with the absence or nonfunctioning of a second ovary unrelated to service, an evaluation of 30 percent will be assigned for the service-connected ovarian loss
7620 Ovaries, atrophy of both, complete1 20
7621 Complete or incomplete pelvic organ prolapse due to injury, disease, or surgical complications of pregnancy10
Note: Pelvic organ prolapse occurs when a pelvic organ such as bladder, urethra, uterus, vagina, small bowel, or rectum drops (prolapse) from its normal place in the abdomen. Conditions associated with pelvic organ prolapse include: uterine or vaginal vault prolapse, cystocele, urethrocele, rectocele, enterocele, or any combination thereof. Evaluate pelvic organ prolapse under DC 7621. Evaluate separately any genitourinary, digestive, or skin symptoms under the appropriate diagnostic code(s) and combine all evaluations with the 10 percent evaluation under DC 7621
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 system100
Note: A rating of 100 percent 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. Rate chronic residuals to include scars, lymphedema, disfigurement, and/or other impairment of function under the appropriate diagnostic code(s) within the appropriate body system
7628 Benign neoplasms of gynecological system. Rate chronic residuals to include scars, lymphedema, disfigurement, and/or other impairment of function under the appropriate diagnostic code(s) within the appropriate body system
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.
7630 Malignant neoplasms of the breast100
Note: A rating of 100 percent shall continue beyond the cessation of any surgical, radiation, 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. Rate chronic residuals according to impairment of function due to scars, lymphedema, or disfigurement (e.g., limitation of arm, shoulder, and wrist motion, or loss of grip strength, or loss of sensation, or residuals from harvesting of muscles for reconstructive purposes), and/or under diagnostic code 7626
7631 Benign neoplasms of the breast and other injuries of the breast. Rate chronic residuals according to impairment of function due to scars, lymphedema, or disfigurement (e.g., limitation of arm, shoulder, and wrist motion, or loss of grip strength, or loss of sensation, or residuals from harvesting of muscles for reconstructive purposes), and/or under diagnostic code 7626
7632 Female sexual arousal disorder (FSAD)1 0

1 Review for entitlement to special monthly compensation under § 3.350 of this chapter.

(Authority: 38 U.S.C. 1155) [60 FR 19855, Apr. 21, 1995, as amended at 67 FR 6874, Feb. 14, 2002; 67 FR 37695, May 30, 2002; 83 FR 15071, Apr. 9, 2018]

The Hematologic and Lymphatic Systems

§ 4.117 - Schedule of ratings - hemic and lymphatic systems.

Rating
7702 Agranulocytosis, acquired:
Requiring bone marrow transplant; or infections recurring, on average, at least once every six weeks per 12-month period100
Requiring intermittent myeloid growth factors (granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF) or continuous immunosuppressive therapy such as cyclosporine to maintain absolute neutrophil count (ANC) greater than 500/microliter (µl) but less than 1000/µl; or infections recurring, on average, at least once every three months per 12-month period60
Requiring intermittent myeloid growth factors to maintain ANC greater than 1000/µl; or infections recurring, on average, at least once per 12-month period but less than once every three months per 12-month period30
Requiring continuous medication (e.g., antibiotics) for control; or requiring intermittent use of a myeloid growth factor to maintain ANC greater than or equal to 1500/µl10
Note: A 100 percent evaluation 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 (except for chronic myelogenous leukemia):
When there is active disease or during a treatment phase100
Otherwise rate residuals under the appropriate diagnostic code(s)
Chronic lymphocytic leukemia or monoclonal B-cell lymphocytosis (MBL), asymptomatic, Rai Stage 00
Note (1): A 100 percent evaluation shall continue beyond the cessation of any surgical therapy, radiation therapy, 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
Note (2): Evaluate symptomatic chronic lymphocytic leukemia that is at Rai Stage I, II, III, or IV the same as any other leukemia evaluated under this diagnostic code
Note (3): Evaluate residuals of leukemia or leukemia therapy under the appropriate diagnostic code(s). Myeloproliferative Disorders: (Diagnostic Codes 7704, 7718, 7719)
7704 Polycythemia vera:
Requiring peripheral blood or bone marrow stem-cell transplant or chemotherapy (including myelosuppressants) for the purpose of ameliorating the symptom burden100
Requiring phlebotomy 6 or more times per 12-month period or molecularly targeted therapy for the purpose of controlling RBC count60
Requiring phlebotomy 4-5 times per 12-month period, or if requiring continuous biologic therapy or myelosuppressive agents, to include interferon, to maintain platelets <200,000 or white blood cells (WBC) <12,00030
Requiring phlebotomy 3 or fewer times per 12-month period or if requiring biologic therapy or interferon on an intermittent basis as needed to maintain all blood values at reference range levels10
Note (1): Rate complications such as hypertension, gout, stroke, or thrombotic disease separately
Note (2): If the condition undergoes leukemic transformation, evaluate as leukemia under diagnostic code 7703
Note (3): A 100 percent evaluation shall be assigned as of the date of hospital admission for peripheral blood or bone marrow stem cell transplant; or during the period of treatment with chemotherapy (including myelosuppressants). Six months following hospital discharge or, in the case of chemotherapy treatment, six months after completion of treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter
7705 Immune thrombocytopenia:
Requiring chemotherapy for chronic refractory thrombocytopenia; or a platelet count 30,000 or below despite treatment100
Requiring immunosuppressive therapy; or for a platelet count higher than 30,000 but not higher than 50,000, with history of hospitalization because of severe bleeding requiring intravenous immune globulin, high-dose parenteral corticosteroids, and platelet transfusions70
Platelet count higher than 30,000 but not higher than 50,000, with either immune thrombocytopenia or mild mucous membrane bleeding which requires oral corticosteroid therapy or intravenous immune globulin30
Platelet count higher than 30,000 but not higher than 50,000, not requiring treatment10
Platelet count above 50,000 and asymptomatic; or for immune thrombocytopenia in remission0
Note (1): Separately evaluate splenectomy under diagnostic code 7706 and combine with an evaluation under this diagnostic code
Note (2): A 100 percent evaluation shall continue beyond the cessation of chemotherapy. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter
7706 Splenectomy20
Note: Separately rate complications such as systemic infections with encapsulated bacteria
Note: Separately rate complications such as systemic infections with encapsulated bacteria
7707 Spleen, injury of, healed.
Rate for any residuals.
7709 Hodgkin's lymphoma:
With active disease or during a treatment phase100
Note: A 100 percent evaluation shall continue beyond the cessation of any surgical therapy, radiation therapy, 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 reduction 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 under the appropriate diagnostic code(s)
7710 Adenitis, tuberculous, active or inactive:
Rate under § 4.88c or 4.89 of this part, whichever is appropriate
7712 Multiple myeloma:
Symptomatic multiple myeloma100
Asymptomatic, smoldering, or monoclonal gammopathy of undetermined significance (MGUS)0
Note (1): Current validated biomarkers of symptomatic multiple myeloma and asymptomatic multiple myeloma, smoldering, or monoclonal gammopathy of undetermined significance (MGUS) are acceptable for the diagnosis of multiple myeloma as defined by the American Society of Hematology (ASH) and International Myeloma Working Group (IMWG)
Note (2): The 100 percent evaluation shall continue for five years after the diagnosis of symptomatic multiple myeloma, at which time the appropriate disability evaluation shall be determined by mandatory VA examination. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) and § 3.344 (a) and (b) of this chapter
7714 Sickle cell anemia:
With at least 4 or more painful episodes per 12-month period, occurring in skin, joints, bones, or any major organs, caused by hemolysis and sickling of red blood cells, with anemia, thrombosis, and infarction, with residual symptoms precluding even light manual labor100
With 3 painful episodes per 12-month period or with symptoms precluding other than light manual labor60
With 1 or 2 painful episodes per 12-month period30
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:
When there is active disease, during treatment phase, or with indolent and non-contiguous phase of low grade NHL100
Note: A 100 percent evaluation shall continue beyond the cessation of any surgical therapy, radiation therapy, antineoplastic chemotherapy, or other therapeutic procedures. Two years after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any reduction 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 under the appropriate diagnostic code(s)
7716 Aplastic anemia:
Requiring peripheral blood or bone marrow stem cell transplant; or requiring transfusion of platelets or red cells, on average, at least once every six weeks per 12-month period; or infections recurring, on average, at least once every six weeks per 12-month period100
Requiring transfusion of platelets or red cells, on average, at least once every three months per 12-month period; or infections recurring, on average, at least once every three months per 12-month period; or using continuous therapy with immunosuppressive agent or newer platelet stimulating factors60
Requiring transfusion of platelets or red cells, on average, at least once per 12-month period; or infections recurring, on average, at least once per 12-month period30
Note (1): A 100 percent evaluation for peripheral blood or bone marrow stem cell 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
Note (2): The term “newer platelet stimulating factors” includes medication, factors, or other agents approved by the United States Food and Drug Administration
7717 AL amyloidosis (primary amyloidosis)100
7718 Essential thrombocythemia and primary myelofibrosis:
Requiring either continuous myelosuppressive therapy or, for six months following hospital admission, peripheral blood or bone marrow stem cell transplant, or chemotherapy, or interferon treatment100
Requiring continuous or intermittent myelosuppressive therapy, or chemotherapy, or interferon treatment to maintain platelet count <500 × 10 9/L70
Requiring continuous or intermittent myelosuppressive therapy, or chemotherapy, or interferon treatment to maintain platelet count of 200,000-400,000, or white blood cell (WBC) count of 4,000-10,00030
Asymptomatic0
Note (1): If the condition undergoes leukemic transformation, evaluate as leukemia under diagnostic code 7703
Note (2): A 100 percent evaluation shall be assigned as of the date of hospital admission for peripheral blood or bone marrow stem cell transplant; or during the period of treatment with chemotherapy (including myelosuppressants). Six months following hospital discharge or, in the case of chemotherapy treatment, six months after completion of treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter
7719 Chronic myelogenous leukemia (CML) (chronic myeloid leukemia or chronic granulocytic leukemia):
Requiring peripheral blood or bone marrow stem cell transplant, or continuous myelosuppressive or immunosuppressive therapy treatment100
Requiring intermittent myelosuppressive therapy, or molecularly targeted therapy with tyrosine kinase inhibitors, or interferon treatment when not in apparent remission60
In apparent remission on continuous molecularly targeted therapy with tyrosine kinase inhibitors30
Note (1): If the condition undergoes leukemic transformation, evaluate as leukemia under diagnostic code 7703
Note (2): A 100 percent evaluation shall be assigned as of the date of hospital admission for peripheral blood or bone marrow stem cell transplant; or during the period of treatment with chemotherapy (including myelosuppressants). Six months following hospital discharge or, in the case of chemotherapy treatment, six months after completion of treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105 of this chapter
7720 Iron deficiency anemia:
Requiring intravenous iron infusions 4 or more times per 12-month period30
Requiring intravenous iron infusions at least 1 time but less than 4 times per 12-month period, or requiring continuous treatment with oral supplementation10
Asymptomatic or requiring treatment only by dietary modification0
Note: Do not evaluate iron deficiency anemia due to blood loss under this diagnostic code. Evaluate iron deficiency anemia due to blood loss under the criteria for the condition causing the blood loss
7721 Folic acid deficiency:
Requiring continuous treatment with high-dose oral supplementation10
Asymptomatic or requiring treatment only by dietary modification0
7722 Pernicious anemia and Vitamin B12 deficiency anemia:
For initial diagnosis requiring transfusion due to severe anemia, or if there are signs or symptoms related to central nervous system impairment, such as encephalopathy, myelopathy, or severe peripheral neuropathy, requiring parenteral B12 therapy100
Requiring continuous treatment with Vitamin B12 injections, Vitamin B12 sublingual or high-dose oral tablets, or Vitamin B12 nasal spray or gel10
Note: A 100 percent evaluation for pernicious anemia and Vitamin B12 deficiency shall be assigned as of the date of the initial diagnosis requiring transfusion due to severe anemia or parenteral B12 therapy and shall continue with a mandatory VA examination six months following hospital discharge or cessation of parenteral B12 therapy. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. Thereafter, evaluate at 10 percent and separately evaluate any residual effects of pernicious anemia, such as neurologic involvement causing peripheral neuropathy, myelopathy, dementia, or related gastrointestinal residuals, under the most appropriate diagnostic code
7723 Acquired hemolytic anemia:
Requiring a bone marrow transplant or continuous intravenous or immunosuppressive therapy (e.g., prednisone, Cytoxan, azathioprine, or rituximab)100
Requiring immunosuppressive medication 4 or more times per 12-month period60
Requiring at least 2 but less than 4 courses of immunosuppressive therapy per 12-month period30
Requiring one course of immunosuppressive therapy per 12-month period10
Asymptomatic0
Note (1): A 100 percent evaluation for bone marrow transplant shall be assigned as of the date of hospital admission and shall continue for six months after hospital discharge with a mandatory VA examination six months following hospital discharge. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter
Note (2): Separately evaluate splenectomy under diagnostic code 7706 and combine with an evaluation under diagnostic code 7723
7724 Solitary plasmacytoma:
Solitary plasmacytoma, when there is active disease or during a treatment phase100
Note (1): A 100 percent evaluation shall continue beyond the cessation of any surgical therapy, radiation therapy, antineoplastic chemotherapy, or other therapeutic procedures (including autologous stem cell transplantation). 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 residuals under the appropriate diagnostic codes
Note (2): Rate a solitary plasmacytoma that has developed into multiple myeloma as symptomatic multiple myeloma
Note (3): Rate residuals of plasma cell dysplasia (e.g., thrombosis) and adverse effects of medical treatment (e.g., neuropathy) under the appropriate diagnostic codes
7725 Myelodysplastic syndromes:
Requiring peripheral blood or bone marrow stem cell transplant; or requiring chemotherapy100
Requiring 4 or more blood or platelet transfusions per 12-month period; or infections requiring hospitalization 3 or more times per 12-month period60
Requiring at least 1 but no more than 3 blood or platelet transfusions per 12-month period; infections requiring hospitalization at least 1 but no more than 2 times per 12-month period; or requiring biologic therapy on an ongoing basis or erythropoiesis stimulating agent (ESA) for 12 weeks or less per 12-month period30
Note (1): If the condition progresses to leukemia, evaluate as leukemia under diagnostic code 7703
Note (2): A 100 percent evaluation shall be assigned as of the date of hospital admission for peripheral blood or bone marrow stem cell transplant, or during the period of treatment with chemotherapy, and shall continue with a mandatory VA examination six months following hospital discharge or, in the case of chemotherapy treatment, six months after completion of treatment. Any reduction 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, residuals will be rated under the appropriate diagnostic codes
[60 FR 49227, Sept. 22, 1995, as amended at 77 FR 6467, Feb. 8, 2012; 79 FR 2100, Jan. 13, 2014; 83 FR 54254, Oct. 29, 2018; 83 FR 54881, Nov. 1, 2018]

The Skin

§ 4.118 - Schedule of ratings - skin.

(a) For the purposes of this section, systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin.

(b) Two or more skin conditions may be combined in accordance with § 4.25 only if separate areas of skin are involved. If two or more skin conditions involve the same area of skin, then only the highest evaluation shall be used.

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 associated with underlying soft tissue damage:
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): For the purposes of DCs 7801 and 7802, the six (6) zones of the body are defined as each extremity, anterior trunk, and posterior trunk. The midaxillary line divides the anterior trunk from the posterior trunk
Note (2): A separate evaluation may be assigned for each affected zone of the body under this diagnostic code if there are multiple scars, or a single scar, affecting multiple zones of the body. Combine the separate evaluations under § 4.25. Alternatively, if a higher evaluation would result from adding the areas affected from multiple zones of the body, a single evaluation may also be assigned under this diagnostic code
7802 Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage:
Area or areas of 144 square inches (929 sq. cm.) or greater10
Note (1): For the purposes of DCs 7801 and 7802, the six (6) zones of the body are defined as each extremity, anterior trunk, and posterior trunk. The midaxillary line divides the anterior trunk from the posterior trunk
Note (2): A separate evaluation may be assigned for each affected zone of the body under this diagnostic code if there are multiple scars, or a single scar, affecting multiple zones of the body. Combine the separate evaluations under § 4.25. Alternatively, if a higher evaluation would result from adding the areas affected from multiple zones of the body, a single evaluation may also be assigned under this diagnostic code
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; and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804:
Evaluate any disabling effect(s) not considered in a rating provided under diagnostic codes 7800-04 under an appropriate diagnostic code
General Rating Formula For The Skin For DCs 7806, 7809, 7813-7816, 7820-7822, and 7824:
At least one of the following60
Characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or
Constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period60
At least one of the following30
Characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or Systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period
At least one of the following10
Characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or
At least 5 percent, but less than 20 percent, of exposed areas affected; or
Intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period
No more than topical therapy required over the past 12-month period and at least one of the following0
Characteristic lesions involving less than 5 percent of the entire body affected; or
Characteristic lesions involving less than 5 percent of exposed areas affected
Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability. This rating instruction does not apply to DC 7824
7806 Dermatitis or eczema.
Evaluate under the General Rating Formula for the Skin
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.
Evaluate under the General Rating Formula for the Skin
Note: 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 (onychomycosis); of inguinal area (jock itch), tinea cruris; tinea versicolor).
Evaluate under the General Rating Formula for the Skin
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).
Evaluate under the General Rating Formula for the Skin
Note: Rate complications and residuals of mucosal involvement (ocular, oral, gastrointestinal, respiratory, or genitourinary) separately under the appropriate diagnostic code
7816 Psoriasis.
Evaluate under the General Rating Formula for the Skin
Note: Rate complications such as psoriatic arthritis and other clinical manifestations (e.g., oral mucosa, nails) separately under the appropriate diagnostic code
7817 Erythroderma:
Generalized involvement of the skin with systemic manifestations (such as fever, weight loss, or hypoproteinemia) AND one of the following100
Constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA (psoralen with long-wave ultraviolet-A light), UVB (ultraviolet-B light) treatments, biologics, or electron beam therapy required over the past 12 month period; or
No current treatment due to a documented history of treatment failure with 2 or more treatment regimens100
Generalized involvement of the skin without systemic manifestations and one of the following
Constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA, UVB treatments, biologics, or electron beam therapy required over the past 12-month period; or
No current treatment due to a documented history of treatment failure with 1 treatment regimen60
Any extent of involvement of the skin, and any of the following therapies required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period: systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA, UVB treatments, biologics, or electron beam therapy30
Any extent of involvement of the skin, and any of the following therapies required for a total duration of less than 6 weeks over the past 12-month period: systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA, UVB treatments, biologics, or electron beam therapy10
Any extent of involvement of the skin, and no more than topical therapy required over the past 12-month period0
Note: Treatment failure is defined as either disease progression, or less than a 25 percent reduction in the extent and severity of disease after four weeks of prescribed therapy, as documented by medical records
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).
Evaluate under the General Rating Formula for the Skin
7821 Cutaneous manifestations of collagen-vascular diseases not listed elsewhere (including scleroderma, calcinosis cutis, subacute cutaneous lupus erythematosus, and dermatomyositis).
Evaluate under the General Rating Formula for the Skin
7822 Papulosquamous disorders not listed elsewhere (including lichen planus, large or small plaque parapsoriasis, pityriasis lichenoides et varioliformis acuta (PLEVA), lymphomatoid papulosus, mycosis fungoides, and pityriasis rubra pilaris (PRP)).
Evaluate under the General Rating Formula for the Skin
7823 Vitiligo:
With exposed areas affected10
With no exposed areas affected0
7824 Diseases of keratinization (including icthyoses, Darier's disease, and palmoplantar keratoderma).
Evaluate under the General Rating Formula for the Skin
7825 Chronic urticaria:
For the purposes of this diagnostic code, chronic urticaria is defined as continuous urticaria at least twice per week, off treatment, for a period of six weeks or more
Chronic refractory urticaria that requires third line treatment for control (e.g., plasmapheresis, immunotherapy, immunosuppressives) due to ineffectiveness with first and second line treatments60
Chronic urticaria that requires second line treatment (e.g., corticosteroids, sympathomimetics, leukotriene inhibitors, neutrophil inhibitors, thyroid hormone) for control30
Chronic urticaria that requires first line treatment (antihistamines) for control10
7826 Vasculitis, primary cutaneous:
Persistent documented vasculitis episodes refractory to continuous immunosuppressive therapy60
All of the following30
Recurrent documented vasculitic episodes occurring four or more times over the past 12-month period; and
Requiring intermittent systemic immunosuppressive therapy for control30
At least one of the following10
Recurrent documented vasculitic episodes occurring one to three times over the past 12-month period, and requiring intermittent systemic immunosuppressive therapy for control; or
Without recurrent documented vasculitic episodes but requiring continuous systemic medication for control
Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability
7827 Erythema multiforme; Toxic epidermal necrolysis:
Recurrent mucosal, palmar, or plantar involvement impairing mastication, use of hands, or ambulation occurring four or more times over the past 12-month period despite ongoing immunosuppressive therapy60
All of the following30
Recurrent mucosal, palmar, or plantar involvement not impairing mastication, use of hands, or ambulation, occurring four or more times over the past 12-month period; and requiring intermittent systemic therapy
At least one of the following10
One to three episodes of mucosal, palmar, or plantar involvement not impairing mastication, use of hands, or ambulation, occurring over the past 12-month period AND requiring intermittent systemic therapy; or
Without recurrent episodes, but requiring continuous systemic medication for control
Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability
Note: For the purposes of this DC only, systemic therapy may consist of one or more of the following treatment agents: immunosuppressives, antihistamines, or sympathomimetics
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) of any extent0
Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 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 the intertriginous areas (the axilla of the arm, the anogenital region, skin folds of the breasts, or between digits)20
Deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck; or deep acne affecting non-intertriginous areas of the body (other than the face and neck)10
Superficial acne (comedones, papules, pustules) of any extent0
Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 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; 83 FR 32597, July 13, 2018; 83 FR 38663, Aug. 7, 2018]

The Endocrine System

§ 4.119 - Schedule of ratings - endocrine system.

Rating
7900 Hyperthyroidism, including, but not limited to, Graves' disease:
For six months after initial diagnosis30
Thereafter, rate residuals of disease or complications of medical treatment within the appropriate diagnostic code(s) within the appropriate body system.
Note (1): If hyperthyroid cardiovascular or cardiac disease is present, separately evaluate under DC 7008 (hyperthyroid heart disease).
Note (2): Separately evaluate eye involvement occurring as a manifestation of Graves' Disease as diplopia (DC 6090); impairment of central visual acuity (DCs 6061-6066); or under the most appropriate DCs in § 4.79.
7901 Thyroid enlargement, toxic:
Note (1): Evaluate symptoms of hyperthyroidism under DC 7900, hyperthyroidism, including, but not limited to, Graves' disease.
Note (2): If disfigurement of the neck is present due to thyroid disease or enlargement, separately evaluate under DC 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).
7902 Thyroid enlargement, nontoxic:
Note (1): Evaluate symptoms due to pressure on adjacent organs (such as the trachea, larynx, or esophagus) under the appropriate diagnostic code(s) within the appropriate body system.
Note (2): If disfigurement of the neck is present due to thyroid disease or enlargement, separately evaluate under DC 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).
7903 Hypothyroidism:
Hypothyroidism manifesting as myxedema (cold intolerance, muscular weakness, cardiovascular involvement (including, but not limited to hypotension, bradycardia, and pericardial effusion), and mental disturbance (including, but not limited to dementia, slowing of thought and depression))100
Note (1): This evaluation shall continue for six months beyond the date that an examining physician has determined crisis stabilization. Thereafter, the residual effects of hypothyroidism shall be rated under the appropriate diagnostic code(s) within the appropriate body system(s) (e.g., eye, digestive, and mental disorders).
Hypothyroidism without myxedema30
Note (2): This evaluation shall continue for six months after initial diagnosis. Thereafter, rate residuals of disease or medical treatment under the most appropriate diagnostic code(s) under the appropriate body system (e.g., eye, digestive, mental disorders).
Note (3): If eye involvement, such as exophthalmos, corneal ulcer, blurred vision, or diplopia, is also present due to thyroid disease, also separately evaluate under the appropriate diagnostic code(s) in § 4.79, Schedule of Ratings - Eye (such as diplopia (DC 6090) or impairment of central visual acuity (DCs 6061-6066)).
7904 Hyperparathyroidism:
For six months from date of discharge following surgery100
Note (1): After six months, rate on residuals under the appropriate diagnostic code(s) within the appropriate body system(s) based on a VA examination.
Hypercalcemia (indicated by at least one of the following: Total Ca greater than 12 mg/dL (3-3.5 mmol/L), Ionized Ca greater than 5.6 mg/dL (2-2.5 mmol/L), creatinine clearance less than 60 mL/min, bone mineral density T-score less than 2.5 SD (below mean) at any site or previous fragility fracture)60
Note (2): Where surgical intervention is indicated, this evaluation shall continue until the day of surgery, at which time the provisions pertaining to a 100-percent evaluation shall apply.
Note (3): Where surgical intervention is not indicated, this evaluation shall continue for six months after pharmacologic treatment begins. After six months, rate on residuals under the appropriate diagnostic code(s) within the appropriate body system(s) based on a VA examination.
Symptoms such as fatigue, anorexia, nausea, or constipation that occur despite surgery; or in individuals who are not candidates for surgery but require continuous medication for control10
Asymptomatic0
Note (4): Following surgery or other treatment, evaluate chronic residuals, such as nephrolithiasis (kidney stones), decreased renal function, fractures, vision problems, and cardiovascular complications, under the appropriate diagnostic codes.
7905 Hypoparathyroidism:
For three months after initial diagnosis100
Thereafter, evaluate chronic residuals, such as nephrolithiasis (kidney stones), cataracts, decreased renal function, and congestive heart failure under the appropriate diagnostic codes.
7906 Thyroiditis:
With normal thyroid function (euthyroid)0
Note: Manifesting as hyperthyroidism, evaluate as hyperthyroidism, including, but not limited to, Graves' disease (DC 7900); manifesting as hypothyroidism, evaluate as hypothyroidism (DC 7903).
7907 Cushing's syndrome:
As active, progressive disease, including areas of osteoporosis, hypertension, and proximal upper and lower extremity muscle wasting that results in inability to rise from squatting position, climb stairs, rise from a deep chair without assistance, or raise arms100
Proximal upper or lower extremity muscle wasting that results in inability to rise from squatting position, climb stairs, rise from a deep chair without assistance, or raise arms60
With striae, obesity, moon face, glucose intolerance, and vascular fragility30
Note: The evaluations specifically indicated under this diagnostic code shall continue for six months following initial diagnosis. After six months, rate on residuals under the appropriate diagnostic code(s) within the appropriate body system(s).
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 bones30
7909 Diabetes insipidus:
For three months after initial diagnosis30
Note: Thereafter, if diabetes insipidus has subsided, rate residuals under the appropriate diagnostic code(s) within the appropriate body system.
With persistent polyuria or requiring continuous hormonal therapy10
7911 Addison's disease (adrenocortical insufficiency):
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 Polyglandular syndrome (multiple endocrine neoplasia, autoimmune polyglandular syndrome):
Evaluate according to major manifestations to include, but not limited to, Type I diabetes mellitus, hyperthyroidism, hypothyroidism, hypoparathyroidism, or Addison's disease.
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 one or more daily injection of 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 one or more daily injection of insulin, restricted diet, and regulation of activities40
Requiring one or more daily injection of 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 DC 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):
Note: Evaluate as malignant or benign neoplasm, as appropriate.
7917 Hyperaldosteronism (benign or malignant):
Note: Evaluate as malignant or benign neoplasm, as appropriate.
7918 Pheochromocytoma (benign or malignant):
Note: Evaluate as malignant or benign neoplasm as appropriate.
7919 C-cell hyperplasia of the thyroid:
If antineoplastic therapy is required, evaluate as a malignant neoplasm under DC 7914. If a prophylactic thyroidectomy is performed (based upon genetic testing) and antineoplastic therapy is not required, evaluate as hypothyroidism under DC 7903.
[61 FR 20446, May 7, 1996, as amended at 82 FR 50804, Nov. 2, 2017]

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. 4, 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
Note (1): For VA compensation purposes, diagnostic imaging studies include, but are not limited to, conventional radiography (X-ray), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), radionuclide bone scanning, or ultrasonography
Note (2): Separately evaluate loss of vocal articulation, loss of smell, loss of taste, neurological impairment, respiratory dysfunction, and other impairments under the appropriate diagnostic code and combine under § 4.25 for each separately rated condition
9900 Maxilla or mandible, chronic osteomyelitis, osteonecrosis or osteoradionecrosis of:
Rate as osteomyelitis, chronic under diagnostic code 5000.
9901 Mandible, loss of, complete, between angles100
9902 Mandible, loss of, including ramus, unilaterally or bilaterally:
Loss of one-half or more,
Involving temporomandibular articulation
Not replaceable by prosthesis70
Replaceable by prosthesis50
Not involving temporomandibular articulation.
Not replaceable by prosthesis40
Replaceable by prosthesis30
Loss of less than one-half,
Involving temporomandibular articulation.
Not replaceable by prosthesis70
Replaceable by prosthesis50
Not involving temporomandibular articulation.
Not replaceable by prosthesis20
Replaceable by prosthesis10
9903 Mandible, nonunion of, confirmed by diagnostic imaging studies:
Severe, with false motion30
Moderate, without false motion10
9904 Mandible, malunion of:
Displacement, causing severe anterior or posterior open bite20
Displacement, causing moderate anterior or posterior open bite10
Displacement, not causing anterior or posterior open bite0
9905 Temporomandibular disorder (TMD):
Interincisal range:
0 to 10 millimeters (mm) of maximum unassisted vertical opening.
With dietary restrictions to all mechanically altered foods50
Without dietary restrictions to mechanically altered foods40
11 to 20 mm of maximum unassisted vertical opening.
With dietary restrictions to all mechanically altered foods40
Without dietary restrictions to mechanically altered foods30
21 to 29 mm of maximum unassisted vertical opening.
With dietary restrictions to full liquid and pureed foods40
With dietary restrictions to soft and semi-solid foods30
Without dietary restrictions to mechanically altered foods20
30 to 34 mm of maximum unassisted vertical opening.
With dietary restrictions to full liquid and pureed foods30
With dietary restrictions to soft and semi-solid foods20
Without dietary restrictions to mechanically altered foods10
Lateral excursion range of motion:
0 to 4 mm10
Note (1): Ratings for limited interincisal movement shall not be combined with ratings for limited lateral excursion
Note (2): For VA compensation purposes, the normal maximum unassisted range of vertical jaw opening is from 35 to 50 mm
Note (3): For VA compensation purposes, mechanically altered foods are defined as altered by blending, chopping, grinding or mashing so that they are easy to chew and swallow. There are four levels of mechanically altered foods: full liquid, puree, soft, and semisolid foods. To warrant elevation based on mechanically altered foods, the use of texture-modified diets must be recorded or verified by a physician
9908 Condyloid process, loss of, one or both sides30
9909 Coronoid process, loss of:
Bilateral20
Unilateral10
9911 Hard palate, loss of:
Loss of half or more, not replaceable by prosthesis30
Loss of less than half, not replaceable by prosthesis20
Loss of half or more, replaceable by prosthesis10
Loss of less than half, 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:
Nonunion,
With false motion30
Without false motion10
Malunion,
With displacement, causing severe anterior or posterior open bite30
With displacement, causing moderate anterior or posterior open bite10
With displacement, causing mild anterior or posterior open bite0
Note: For VA compensation purposes, the severity of maxillary nonunion is dependent upon the degree of abnormal mobility of maxilla fragments following treatment (i.e., presence or absence of false motion), and maxillary nonunion must be confirmed by diagnostic imaging studies
9917 Neoplasm, hard and soft tissue, benign:
Rate as loss of supporting structures (bone or teeth) and/or functional impairment due to scarring.
9918 Neoplasm, hard and soft tissue, malignant100
Note: A rating of 100 percent shall continue beyond the cessation of any surgical, radiation, 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 such as loss of supporting structures (bone or teeth) and/or functional impairment due to scarring
[59 FR 2530, Jan. 18, 1994, as amended at 82 FR 36083, Aug. 3, 2017]

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

Sec. Diagnostic code No.
4.71a5000Evaluation February 1, 1962.
4.71a5001Evaluation March 11, 1969; criterion February 7, 2021.
5002Evaluation March 1, 1963; title, criteria, note February 7, 2021.
5003Added July 6, 1950; title February 7, 2021.
5009Title, evaluation, note February 7, 2021.
5010Title, criteria February 7, 2021.
5011Title, criteria February 7, 2021.
5012Criterion March 10, 1976; title, note February 7, 2021.
5013Title February 7, 2021.
5014Title February 7, 2021.
5015Title February 7, 2021.
5018Removed February 7, 2021.
5020Removed November 30, 2020.
5022Removed February 7, 2021.
5023Title February 7, 2021.
5024Criterion March 1, 1963; title, criteria February 7, 2021.
5025Added May 7, 1996.
5051Added September 22, 1978; note February 7, 2021.
5052Added September 22, 1978; note February 7, 2021.
5053Added September 22, 1978; note February 7, 2021.
5054Added September 22, 1978; title, criterion, and note February 7, 2021.
5055Added September 22, 1978; title, criterion, and note February 7, 2021.
5056Added September 22, 1978; note February 7, 2021.
5100-5103Removed March 10, 1976.
5104Criterion March 10, 1976.
5105Criterion March 10, 1976.
5120Title, criterion February 7, 2021.
5160Title, criterion, note February 7, 2021.
5164Evaluation June 9, 1952.
5166Criterion September 22, 1978.
5170Title February 7, 2021.
5172Added July 6, 1950.
5173Added June 9, 1952.
5174Added September 9, 1975; removed September 22, 1978.
5201Criterion February 7, 2021.
5202Criterion February 7, 2021.
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.
5235Replaces 5285-5295 September 26, 2003.
5236Replaces 5285-5295 September 26, 2003.
5237Replaces 5285-5295 September 26, 2003.
5238Replaces 5285-5295 September 26, 2003.
5239Replaces 5285-5295 September 26, 2003.
5240Replaces 5285-5295 September 26, 2003.
5241Replaces 5285-5295 September 26, 2003.
5242Replaces 5285-5295 September 26, 2003; Title February 7, 2021.
5243Replaces 5285-5295 September 26, 2003; Criterion September 26, 2003; Title February 7, 2021.
5244Added February 7, 2021.
5255Criterion July 6, 1950; criterion February 7, 2021.
5257Evaluation July 6, 1950; criterion and note February 7, 2021.
5262Criterion February 7, 2021.
5264Added September 9, 1975; removed September 22, 1978.
5269Added February 7, 2021.
5271Criterion February 7, 2021.
5275Criterion March 10, 1976; criterion September 22, 1978.
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; second Note added February 7, 2021.
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.
5330Added February 7, 2021.
5331Added February 7, 2021.
4.77Revised May 13, 2018.
4.78Revised May 13, 2018.
4.79Introduction criterion May 13, 2018; Revised General Rating Formula for Diseases of the Eye NOTE revised May 13, 2018.
6000Criterion May 13, 2018.
6001Criterion May 13, 2018.
6002Criterion May 13, 2018.
6006Title May 13, 2018. Criterion May 13, 2018.
6007Criterion May 13, 2018.
6008Criterion May 13, 2018.
6009Criterion May 13, 2018.
6011Evaluation May 13, 2018.
6012Evaluation May 13, 2018.
6013Evaluation May 13, 2018.
6014Title May 13, 2018.
6015Title May 13, 2018.
6017Evaluation May 13, 2018.
6018Evaluation May 13, 2018.
6019Evaluation.
6026Evaluation May 13, 2018.
6027Evaluation May 13, 2018.
6034Evaluation May 13, 2018.
6035Evaluation May 13, 2018.
6036Evaluation May 13, 2018.
6040Added May 13, 2018.
6042Added May 13, 2018.
6046Added May 13, 2018.
6091Evaluation May 13, 2018.
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; General Rating Formula for Infectious Diseases added August 11, 2019.
6300Criterion August 30, 1996; title, criterion, and note August 11, 2019.
6301Criterion, note August 11, 2019.
6302Criterion September 22, 1978; criterion August 30, 1996; criterion, note August 11, 2019.
6304Evaluation August 30, 1996; criterion, note August 11, 2019.
6305Criterion March 1, 1989; evaluation August 30, 1996; title, criterion, note August 11, 2019.
6306Evaluation August 30, 1996; criterion, note August 11, 2019.
6307Criterion May 13, 2018; criterion, note August 11, 2019.
6308Criterion August 30, 1996; criterion, note August 11, 2019.
6309Added March 1, 1963; criterion March 1, 1989; criterion August 30, 1996; criterion, note August 11, 2019.
6310Criterion, note August 11, 2019.
6311Criterion, note August 11, 2019.
6312Added August 11, 2019.
6314Evaluation March 1, 1989; evaluation August 30, 1996.
6315Criterion August 30, 1996.
6316Evaluation March 1, 1989; evaluation August 30, 1996; criterion, note August 11, 2019.
6317Criterion August 30, 1996; title, criterion, note August 11, 2019.
6318Added March 1, 1989; criterion August 30, 1996; criterion, note August 11, 2019.
6319Added August 30, 1996; criterion, note August 11, 2019.
6320Added August 30, 1996; criterion, note August 11, 2019.
6325Added August 11, 2019.
6326Added August 11, 2019.
6329Added August 11, 2019.
6330Added August 11, 2019.
6331Added August 11, 2019.
6333Added August 11, 2019.
6334Added August 11, 2019.
6335Added August 11, 2019.
6350Evaluation March 1, 1963; evaluation March 10, 1976; evaluation August 30, 1996.
6351Added March 1, 1989; evaluation March 24, 1992; criterion August 30, 1996; criterion, note August 11, 2019.
6352Added March 1, 1989; removed March 24, 1992.
6353Added March 1, 1989; removed March 24, 1992.
6354Added November 29, 1994; criterion August 30, 1996; title, criterion, note August 11, 2019.
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; criterion December 10, 2017.
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; title May 13, 2018.
7611Criterion May 22, 1995.
7612Criterion May 22, 1995.
7613Criterion May 22, 1995.
7614Criterion May 22, 1995.
7615Criterion May 22, 1995; note May 13, 2018.
7617Criterion May 22, 1995.
7618Criterion May 22, 1995.
7619Criterion May 22, 1995; note May 13, 2018.
7620Criterion May 22, 1995.
7621Criterion May 22, 1995; evaluation May 13, 2018.
7622Removed May 13, 2018.
7623Removed May 13, 2018.
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; title, note May 13, 2018.
7628Added May 22, 1995; title, criterion May 13, 2018.
7629Added May 22, 1995.
7630Added May 13, 2018.
7631Added May 13, 2018.
7632Added May 13, 2018.
4.1177700Removed December 9, 2018.
7701Removed October 23, 1995.
7702Evaluation October 23, 1995; title December 9, 2018; evaluation December 9, 2018.
7703Evaluation August 23, 1948; criterion October 23, 1995; evaluation December 9, 2018; criterion December 9, 2018.
7704Evaluation October 23, 1995; evaluation December 9, 2018.
7705Evaluation October 23, 1995; title December 9, 2018; evaluation December 9, 2018; criterion December 9, 2018.
7706Evaluation October 23, 1995; note December 9, 2018; criterion October 23, 1995.
7707Criterion October 23, 1995.
7709Evaluation March 10, 1976; criterion October 23, 1995; title December 9, 2018; criterion December 9, 2018.
7710Criterion October 23, 1995; criterion December 9, 2018.
7711Criterion October 23, 1995.
7712Added December 9, 2018.
7713Removed October 23, 1995.
7714Added September 9, 1975; criterion October 23, 1995; criterion December 9, 2018.
7715Added October 26, 1990; criterion December 9, 2018.
7716Added October 23, 1995; evaluation December 9, 2018; criterion December 9, 2018.
7717Added March 9, 2012.
7718Added December 9, 2018.
7719Added December 9, 2018.
7720Added December 9, 2018.
7721Added December 9, 2018.
7722Added December 9, 2018.
7723Added December 9, 2018.
7724Added December 9, 2018.
7725Added December 9, 2018.
4.1187800Evaluation August 30, 2002; criterion October 23, 2008.
7801Criterion July 6, 1950; criterion August 30, 2002; criterion October 23, 2008; title, note 1, note 2 August 13, 2018.
7802Criterion September 22, 1978; criterion August 30, 2002; criterion October 23, 2008; title, note 1, note 2 August 13, 2018.
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; title August 13, 2018.
General Rating Formula for DCs 7806, 7809, 7813-7816, 7820-7822, and 7824 added August 13, 2018.
7806Criterion September 9, 1975; evaluation August 30, 2002; criterion August 13, 2018.
7807Criterion August 30, 2002.
7808Criterion August 30, 2002.
7809Criterion August 30, 2002; title, criterion August 13, 2018.
7810Removed August 30, 2002.
7811Criterion March 11, 1969; evaluation August 30, 2002.
7812Removed August 30, 2002.
7813Criterion August 30, 2002; title, criterion August 13, 2018.
7814Removed August 30, 2002.
7815Evaluation August 30, 2002; criterion, note August 13, 2018.
7816Evaluation August 30, 2002; criterion, note August 13, 2018.
7817Evaluation August 30, 2002; title, criterion, note August 13, 2018.
7818Criterion August 30, 2002.
7819Criterion August 30, 2002.
7820Added August 30, 2002; criterion August 13, 2018.
7821Added August 30, 2002; title, criterion August 13, 2018.
7822Added August 30, 2002; title, criterion August 13, 2018.
7823Added August 30, 2002; criterion August 13, 2018.
7824Added August 30, 2002; criterion August 13, 2018.
7825Added August 30, 2002; title, criterion August 13, 2018.
7826Added August 30, 2002; criterion August 13, 2018.
7827Added August 30, 2002; criterion August 13, 2018.
7828Added August 30, 2002; criterion August 13, 2018.
7829Added August 30, 2002; criterion August 13, 2018.
7830Added August 30, 2002; criterion August 13, 2018.
7831Added August 30, 2002; criterion August 13, 2018.
7832Added August 30, 2002; criterion August 13, 2018.
7833Added August 30, 2002; criterion August 13, 2018.
4.1197900Criterion August 13, 1981; evaluation June 9, 1996; title December 10, 2017; evaluation December 10, 2017; criterion December 10, 2017; note December 10, 2017.
7901Criterion August 13, 1981; evaluation June 9, 1996; title December 10, 2017; evaluation December 10, 2017; criterion December 10, 2017; note December 10, 2017.
7902Evaluation August 13, 1981; criterion June 9, 1996; title December 10, 2017; evaluation December 10, 2017; criterion December 10, 2017; note December 10, 2017.
7903Criterion August 13, 1981; evaluation June 9, 1996; evaluation December 10, 2017; criterion December 10, 2017; note December 10, 2017.
7904Criterion August 13, 1981; evaluation June 9, 1996; evaluation December 10, 2017; criterion December 10, 2017; note December 10, 2017.
7905Evaluation; August 13, 1981; evaluation June 9, 1996; evaluation December 10, 2017; criterion December 10, 2017.
7906Added December 10, 2017.
7907Evaluation; August 13, 1981; evaluation June 9, 1996; criterion December 10, 2017; note December 10, 2017.
7908Criterion August 13, 1981; criterion June 9, 1996; criterion December 10, 2017.
7909Evaluation August 13, 1981; criterion June 9, 1996; evaluation June 9, 1996; criterion December 10, 2017; evaluation December 10, 2017; note December 10, 2017.
7910Removed June 9, 1996.
7911Evaluation March 11, 1969; evaluation August 13, 1981; criterion June 9, 1996; title December 10, 2017; note December 10, 2017.
7912Title December 10, 2017; criterion December 10, 2017.
7913Criterion September 9, 1975; criterion August 13, 1981; criterion June 6, 1996; evaluation June 9, 1996; criterion December 10, 2017; note December 10, 2017.
7914Criterion March 10, 1976; criterion August 13, 1981; criterion June 9, 1996.
7915Criterion June 9, 1996; criterion December 10, 2017.
7916Added June 9, 1996; note December 10, 2017.
7917Added June 9, 1996; note December 10, 2017.
7918Added June 9, 1996; note December 10, 2017.
7919Added June 9, 1996; evaluation June 9, 1996; criterion December 10, 2017; note December 10, 2017.
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; Title August 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; title September 10, 2017.
9901Criterion February 17, 1994.
9902Criterion February 17, 1994; evaluation September 10, 2017; title September 10, 2017.
9903Criterion February 17, 1994; evaluation September 10, 2017; title September 10, 2017.
9904Criterion September 10, 2017.
9905Criterion September 22, 1978; evaluation February 17, 1994; evaluation September 10, 2017; title September 10, 2017.
9906Removed September 10, 2017.
9907Removed September 10, 2017.
9910Removed February 17, 1994.
9911Criterion and title September 10, 2017.
9912Removed September 10, 2017.
9913Criterion February 17, 1994.
9914Added February 17, 1994.
9915Added February 17, 1994.
9916Added February 17, 1994; criterion September 10, 2017.
9917Added September 10, 2017.
9918Added September 10, 2017.
[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; 80 FR 42042, July 16, 2015; 82 FR 36084, Aug. 3, 2017; 82 FR 50806, Nov. 2, 2017; 83 FR 15072, Apr. 9, 2018; 83 FR 15323, Apr. 10, 2018; 83 FR 32600, July 13, 2018; 83 FR 54257, Oct. 29, 2018; 84 FR 28233, June 18, 2019; 85 FR 76464, Nov. 30, 2020; 86 FR 8143, Feb. 4, 2021]

Appendix B - 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.
5002Multi-joint arthritis (except post-traumatic and gout), 2 or more joints, as an active process.
5003Degenerative arthritis, other than post-traumatic.
5004Arthritis, gonorrheal.
5005Arthritis, pneumococcic.
5006Arthritis, typhoid.
5007Arthritis, syphilitic.
5008Arthritis, streptococcic.
5009Other specified forms of arthropathy (excluding gout).
5010Post-traumatic arthritis.
5011Decompression illness.
5012Bones, neoplasm, malignant, primary or secondary.
5013Osteoporosis, residuals of.
5014Osteomalacia, residuals of.
5015Bones, neoplasm, benign.
5016Osteitis deformans.
5017Gout.
5018[Removed]
5019Bursitis.
5020[Removed]
5021Myositis.
5022[Removed]
5023Heterotopic ossification.
5024Tenosynovitis, tendinitis, tendinosis or tendinopathy.
5025Fibromyalgia.
Prosthetic Implants
5051Shoulder replacement (prosthesis).
5052Elbow replacement (prosthesis).
5053Wrist replacement (prosthesis).
5054Hip, resurfacing or replacement (prosthesis).
5055Knee, resurfacing or 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:
5120Complete amputation, upper extremity.
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:
5160Complete amputation, lower extremity.
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, amputation of, without metatarsal loss or transmetatarsal, amputation of, with up to half of 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, degenerative disc disease other than intervertebral disc syndrome (also, see either DC 5003 or 5010).
5243Intervertebral disc syndrome.
5244Traumatic paralysis, complete.
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
5269Plantar fasciitis.
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.
5330Rhabdomyolysis, residuals of.
5331Compartment syndrome.
THE EYE
Diseases of the Eye
6000Choroidopathy, including uveitis, iritis, cyclitis, or choroiditis.
6001Keratopathy.
6002Scleritis.
6003Iritis.
6004Cyclitis.
6005Choroiditis.
6006Retinopathy or maculopathy not otherwise specified.
6007Intraocular hemorrhage.
6008Detachment of retina.
6009Unhealed eye injury.
6010Tuberculosis of eye.
6011Retinal scars, atrophy, or irregularities.
6012Angle-closure glaucoma.
6013Open-angle glaucoma.
6014Malignant neoplasms of the eye, orbit, and adnexa (excluding skin).
6015Benign neoplasms of the eye, orbit, and adnexa (excluding skin).
6016Nystagmus, central.
6017Conjunctivitis, trachomatous, chronic.
6018Conjunctivitis, other, chronic.
6019Ptosis unilateral or bilateral.
6020Ectropion.
6021Entropion.
6022Lagophthalmos.
6023Eyebrows, loss.
6024Eyelashes, loss.
6025Disorders of the lacrimal apparatus (epiphora, dacrocystitis, etc.).
6026Optic neuropathy.
6027Cataract.
6028Cataract, senile, and others.
6029Aphakia.
6030Accommodation, paralysis.
6031Dacryocystitis.
6032Eyelids, loss of portion.
6033Lens, crystalline, dislocation.
6034Pterygium.
6035Keratoconus.
6036Status post corneal transplant.
6040Diabetic retinopathy.
6042Retinal dystrophy (including retinitis pigmentosa, wet or dry macular degeneration, early-onset macular degeneration, rod and/or cone dystrophy).
6046Post-chiasmal disorders.
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
6300Vibriosis (Cholera, Non-cholera).
6301Visceral Leishmaniasis.
6302Leprosy (Hansen's Disease).
6304Malaria.
6305Lymphatic filariasis, to include elephantiasis.
6306Bartonellosis.
6307Plague.
6308Relapsing fever.
6309Rheumatic fever.
6310Syphilis.
6311Tuberculosis, miliary.
6312Nontuberculosis mycobacterium infection.
6313Avitaminosis.
6314Beriberi.
6315Pellagra.
6316Brucellosis.
6317Rickettsial, ehrlichia, and anaplasma infections.
6318Melioidosis.
6319Lyme disease.
6320Parasitic diseases.
6325Hyperinfection syndrome or disseminated strongyloidiasis.
6326Schistosomiasis.
6329Hemorrhagic fevers, including dengue, yellow fever, and others.
6330Campylobacter jejuni infection.
6331Coxiella burnetii infection (Q Fever).
6333Nontyphoid salmonella infections.
6334Shigella infections.
6335West Nile virus infection.
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 or clitoris, disease or injury of (including vulvovaginitis).
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.
7621Complete or incomplete pelvic organ prolapse due to injury or disease or surgical complications of pregnancy.
7624Fistula, rectovaginal.
7625Fistula, urethrovaginal.
7626Breast, surgery.
7627Malignant neoplasms of gynecological system.
7628Benign neoplasms of gynecological system.
7629Endometriosis.
7630Malignant neoplasms of the breast.
7631Benign neoplasms of the breast and other injuries of the breast.
7632Female sexual arousal disorder (FSAD).
The Hematologic and Lymphatic Systems
7700[Removed]
7702Agranulocytosis, acquired.
7703Leukemia.
7704Polycythemia vera.
7705Immune thrombocytopenia.
7706Splenectomy.
7707Spleen, injury of, healed.
7709Hodgkin's lymphoma.
7710Adenitis, tuberculous.
7712Multiple myeloma
7714Sickle cell anemia.
7715Non-Hodgkin's lymphoma.
7716Aplastic anemia.
7717AL amyloidosis (primary amyloidosis).
7718Essential thrombocythemia and primary myelofibrosis.
7719Chronic myelogenous leukemia (CML) (chronic myeloid leukemia or chronic granulocytic leukemia).
7720Iron deficiency anemia.
7721Folic acid deficiency.
7722Pernicious anemia and Vitamin B12 deficiency anemia.
7723Acquired hemolytic anemia.
7724Solitary plasmacytoma.
7725Myelodysplastic syndromes.
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 associated with underlying soft tissue damage.
7802Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck that are not associated with underlying soft tissue damage.
7804Scar(s), unstable or painful.
7805Scars, other; and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804.
7806Dermatitis or eczema.
7807Leishmaniasis, American (New World).
7808Leishmaniasis, Old World.
7809Discoid lupus erythematosus.
7811Tuberculosis luposa (lupus vulgaris).
7813Dermatophytosis.
7815Bullous disorders.
7816Psoriasis.
7817Erythroderma.
7818Malignant skin neoplasms.
7819Benign skin neoplasms.
7820Infections of the skin.
7821Cutaneous manifestations of collagen-vascular diseases not listed elsewhere.
7822Papulosquamous disorders not listed elsewhere.
7823Vitiligo.
7824Keratinization, diseases.
7825Chronic urticaria.
7826Vasculitis, primary cutaneous.
7827Erythema multiforme.
7828Acne.
7829Chloracne.
7830Scarring alopecia.
7831Alopecia areata.
7832Hyperhidrosis.
7833Malignant melanoma.
THE ENDOCRINE SYSTEM
7900Hyperthyroidism, including, but not limited to, Graves' disease.
7901Thyroid enlargement, toxic.
7902Thyroid enlargement, nontoxic.
7903Hypothyroidism.
7904Hyperparathyroidism.
7905Hypoparathyroidism.
7906Thyroiditis.
7907Cushing's syndrome.
7908Acromegaly.
7909Diabetes insipidus.
7911Addison's disease (adrenocortical insufficiency).
7912Polyglandular syndrome (multiple endocrine neoplasia, autoimmune polyglandular 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 osteomyelitis, osteonecrosis, or osteoradionecrosis of.
9901Mandible, loss of, complete.
9902Mandible loss of, including ramus, unilaterally or bilaterally.
9903Mandible, nonunion of, confirmed by diagnostic imaging studies.
9904Mandible, malunion.
9905Temporomandibular disorder (TMD).
9908Condyloid process.
9909Coronoid process.
9911Hard palate, loss of.
9913Teeth, loss of.
9914Maxilla, loss of more than half.
9915Maxilla, loss of half or less.
9916Maxilla, malunion or nonunion of.
9917Neoplasm, hard and soft tissue, benign.
9918Neoplasm, hard and soft tissue, malignant.
[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; 82 FR 36085, Aug. 3, 2017; 82 FR 50807, Nov. 2, 2017; 83 FR 15073, Apr. 9, 2018; 83 FR 15323, Apr. 10, 2018; 83 FR 32600, July 13, 2018; 83 FR 54258, Oct. 29, 2018; 84 FR 28234, June 18, 2019; 85 FR 76466, Nov. 30, 2020; 86 FR 8143, Feb. 4, 2021]

Appendix C - Appendix C to Part 4 - Alphabetical Index of Disabilities

Diagnostic code No.
Abscess:
Brain8020
Kidney7501
Lung6824
Acne7828
Acromegaly7908
Actinomycosis6822
Addison's disease7911
Agranulocytosis, acquired7702
AL amyloidosis7717
Alopecia areata7831
Amebiasis7321
Amputation:
Arm:
Complete amputation, upper extremity5120
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 lower level, permitting prosthesis5165
Forefoot, proximal to metatarsal bones5166
Toes, all, amputation of, without metatarsal loss or transmetatarsal, amputation of, with up to half of metatarsal loss5170
Toe, great5171
Toe, other than great, with removal metatarsal head5172
Toes, three or more, without metatarsal involvement5173
Thigh:
Complete amputation, lower extremity5160
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
Anemia:
Acquired hemolytic anemia7723
Folic acid deficiency7721
Iron deficiency anemia7720
Pernicious anemia and Vitamin B12 deficiency anemia7722
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, other than post-traumatic5003
Gonorrheal5004
Other specified forms (excluding gout)5009
Pneumococcic5005
Post-traumatic5010
Multi-joint (except post-traumatic and gout)5002
Streptococcic5008
Syphilitic5007
Typhoid5006
Arthropathy5009
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:
Neoplasm, benign5015
Neoplasm, malignant, primary or secondary5012
Shortening of the lower extremity5275
Brain:
Abscess8020
Breast surgery7626
Bronchiectasis6601
Bronchitis6600
Brucellosis6316
Buerger's disease7115
Bulbar palsy8005
Bullous disorders7815
Bursitis5019
Campylobacter jejuni infection6330
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
Choroiditis6005
Chronic Fatigue Syndrome (CFS)6354
Chronic lung abscess6824
Chronic obstructive pulmonary disease6604
Coccidioidomycosis6835
Cold injury residuals7122
Colitis, ulcerative7323
Compartment syndrome5331
Complete or incomplete pelvic organ prolapse due to injury or disease or surgical complications of pregnancy, including uterine or vaginal vault prolapse, cystocele, urethrocele, rectocele, enterocele, or combination7621
Conjunctivitis:
Trachomatous6017
Other6018
Coronary bypass surgery7017
Coxiella burnetii infection (Q Fever)6331
Cryptococcosis6837
Cushing's syndrome7907
Cutaneous manifestations of collagen-vascular diseases not listed elsewhere7821
Cyclitis6004
Cystitis, chronic7512
Dacryocystitis6031
Decompression illness5011
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
Erythroderma7817
Erythromelalgia7119
Esophagus:
Diverticulum7205
Spasm7204
Stricture7203
Fallopian tube7614
Female sexual arousal disorder (FSAD)7632
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
Graves' disease7900
Hallux:
Rigidus5281
Valgus5280
Hammer toe5282
Heart valve replacement7016
Hematologic:
Essential thrombocythemia and primary myelofibrosis7718
Immune thrombocytopenia7705
Multiple myeloma7712
Myelodysplastic syndromes7725
Solitary plasmacytoma7724
Hematomyelia8012
Hemorrhage:
Brain8009
Intra-ocular6007
Hemorrhagic fevers, including dengue, yellow fever, and others6329
Hemorrhoids7336
Hepatitis C7354
Hernia:
Femoral7340
Hiatal7346
Inguinal7338
Muscle5326
Ventral7339
Heterotopic ossification5023
Hip:
Flail joint5254
Histoplasmosis6834
HIV-Related Illness6351
Hodgkin's disease7709
Hodgkin's lymphoma7709
Hydronephrosis7509
Hyperaldosteronism7917
Hyperhidrosis7832
Hyperinfection syndrome or disseminated strongyloidiasis6325
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
Breast7631
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
Leukemia:
Chronic myelogenous leukemia (CML) (chronic myeloid leukemia or chronic granulocytic leukemia)7719
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
Temporomandibular9905
Thumb5228
Wrist, limitation of motion5215
Liver:
Disease, chronic, without cirrhosis7345
Transplant7351
Cirrhosis7312
Loss of:
Auricle6207
Condyloid process9908
Coronoid process9909
Eyebrows6023
Eyelashes6024
Eyelids6032
Palate, hard9911
Mandible:
Including ramus, unilaterally or bilaterally9902
Maxilla:
More than half9914
Less than half9915
Nose, part of, or scars6504
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 filariasis, to include elephantiasis6305
Malaria6304
Malignant melanoma7833
Malunion:
Mandible9904
Os calcis or astragalus5273
Maxilla, malunion or nonunion9916
Maxilla or mandible, chronic osteomyelitis, osteonecrosis, or osteoradionecrosis of9900
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
Myositis5021
Narcolepsy8108
Neoplasms:
Benign:
Breast7631
Digestive system7344
Ear6209
Endocrine7915
Genitourinary7529
Gynecological7628
Hard and soft tissue9917
Muscle5328
Respiratory6820
Skin7819
Malignant:
Breast7630
Digestive system7343
Ear6208
Endocrine7914
Genitourinary7528
Gynecological7627
Hard and soft tissue9918
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