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INDEX TO TRANSMITTAL AND EXTENSION SHEETS

CFR # Transmittal or Extension Sheet # and Diagnostic Code

4.1 17

4.2 12; 17

4.3 12; 16

4.6 12

4.7 12

4.9 12; 17

4.10 17

4.13 12

4.16 6; 11; 16; 26; 4-90-1; 4-96-5

4.17 Ext 5; Ext 9; 6; 11; 16; 19; 4-91-2

4.18 6; 11

4.19 7; 19

4.21 17

4.23 17

4.25 Ext 4; 7; 17; 27

4.26 Ext 4; 7

4.27 Ext 4; 7; 12; 16

4.28 Ext 7; Ext 9; 6; 7; 15

4.29 Ext 2; Ext 2-A; Ext 2-B; Ext 7; 2; 3; 6; 11; 17; 18; 26

4.30 Ext 7; 3; 11; 17; 18; 26

4.31 6; 4-93-1

4.40 11

4.41 11

4.42 11

4.43 11

4.44 10

4.45 10

4.46 10; 17

4.47 10; 4-97-1

4.48 10; 4-97-1

4.49 10; 4-97-1

4.50 10; 4-97-1

4.51 10; 4-97-1

4.52 10; 4-97-1

4.53 10; 19; 4-97-1

4.54 10; 19; 4-97-1

4.55 10; 19; 4-97-1

4.56 10; 19; 4-97-1

4.57 10

4.58 10

4.59 10

4.60 [Reserved]

4.61 10

4.62 10

4.63 Ext 3; 10; 19

4.64 Ext 10; 10

4.66 10

4.67 10

4.68 7; 10

4.69 10; 4-97-1

4.70 10

4.71 4; 10; 17; 19

4.71a 17; 4-99-2

5000 Ext 4; Ext 7; 7

5001 Ext 6-A; 4; 7; 14; 17

5002 10; 17

5003 Ext 7; 7; 10; 17

5004 [No Revision since 1945 Schedule]

5005 [No Revision since 1945 Schedule]

5006 [No Revision since 1945 Schedule]

5007 [No Revision since 1945 Schedule]

5008 [No Revision since 1945 Schedule]

5009 10

5010 10

5011 [No Revision since 1945 Schedule]

5012 17

5013 10

5014 10

5015 [No Revision since 1945 Schedule]

5016 [No Revision since 1945 Schedule]

5017 10

5018 [No Revision since 1945 Schedule]

5019 [No Revision since 1945 Schedule]

5020 [No Revision since 1945 Schedule]

5021 [No Revision since 1945 Schedule]

5022 [No Revision since 1945 Schedule]

5023 [No Revision since 1945 Schedule

5024 10

5025 4-96-1; 4-99-2

5051 19

5052 19

5053 19

5054 19

5055 19

5056 19

5104 17

5105 17

5106 [No Revision since 1945 Schedule]

5107 [No Revision since 1945 Schedule]

5108 [No Revision since 1945 Schedule]

5109 [No Revision since 1945 Schedule]

5110 [No Revision since 1945 Schedule]

5111 [No Revision since 1945 Schedule]

5120 [No Revision since 1945 Schedule]

5121 [No Revision since 1945 Schedule]

5122 [No Revision since 1945 Schedule]

5123 [No Revision since 1945 Schedule]

5124 [No Revision since 1945 Schedule]

5125 [No Revision since 1945 Schedule]

5126 [No Revision since 1945 Schedule]

5127 [No Revision since 1945 Schedule]

5128 [No Revision since 1945 Schedule]

5129 [No Revision since 1945 Schedule]

5130 [No Revision since 1945 Schedule]

5131 [No Revision since 1945 Schedule]

5132 [No Revision since 1945 Schedule]

5133 [No Revision since 1945 Schedule]

5134 [No Revision since 1945 Schedule]

5135 [No Revision since 1945 Schedule]

5136 [No Revision since 1945 Schedule]

5137 [No Revision since 1945 Schedule]

5138 [No Revision since 1945 Schedule]

5139 [No Revision since 1945 Schedule]

5140 [No Revision since 1945 Schedule]

5141 [No Revision since 1945 Schedule]

5142 [No Revision since 1945 Schedule]

5143 [No Revision since 1945 Schedule]

5144 [No Revision since 1945 Schedule]

5145 [No Revision since 1945 Schedule]

5146 [No Revision since 1945 Schedule]

5147 [No Revision since 1945 Schedule]

5148 [No Revision since 1945 Schedule]

5149 [No Revision since 1945 Schedule]

5150 [No Revision since 1945 Schedule]

5151 17

5152 [No Revision since 1945 Schedule]

5153 [No Revision since 1945 Schedule]

5154 [No Revision since 1945 Schedule]

5155 [No Revision since 1945 Schedule]

5156 Ext 7; 7; 17

5160 [No Revision since 1945 Schedule]

5161 [No Revision since 1945 Schedule]

5162 [No Revision since 1945 Schedule]

5163 [No Revision since 1945 Schedule]

5164 Ext 9; 1

5165 [No Revision since 1945 Schedule]

5166 19

5167 [No Revision since 1945 Schedule]

5170 [No Revision since 1945 Schedule]

5171 [No Revision since 1945 Schedule]

5172 Ext 7

5173 Ext 7; Ext 9

5200 [No Revision since 1945 Schedule]

5201 [No Revision since 1945 Schedule]

5202 [No Revision since 1945 Schedule]

5203 [No Revision since 1945 Schedule]

5205 4

5206 4

5207 4

5208 4

5209 [No Revision since 1945 Schedule]

5210 [No Revision since 1945 Schedule]

5211 19

5212 19

5213 4

5214 19

5215 [No Revision since 1945 Schedule]

5216 4-02-2

5217 4-02-2

5218 4-02-2

5219 19; 4-02-2

5220 [No Revision since 1945 Schedule]

5221 4-02-2

5222 4-02-2

5223 1; 17; 19; 4-02-2

5224 4-02-2

5225 4-02-2

5226 4-02-2

5227 19; 4-02-2

5228 4-02-2

5229 4-02-2

5230 4-02-2

5235 4-03-2 (added)

5236 4-03-2 (added)

5237 4-03-2 (added)

5238 4-03-2 (added)

5239 4-03-2 (added)

5240 4-03-2 (added)

5241 4-03-2 (added)

5242 4-03-2 (added)

5243 4-03-2 (added)

5250 4; 10

5251 4

5252 4

5253 4

5254 [No Revision since 1945 Schedule]

5255 Ext 7

5256 4

5257 Ext 7

5258 [No Revision since 1945 Schedule]

5259 [No Revision since 1945 Schedule]

5260 4

5261 4

5262 [No Revision since 1945 Schedule]

5263 [No Revision since 1945 Schedule]

5270 4

5271 [No Revision since 1945 Schedule]

5272 [No Revision since 1945 Schedule]

5273 [No Revision since 1945 Schedule]

5274 [No Revision since 1945 Schedule]

5275 17; 19

5276 5

5277 [No Revision since 1945 Schedule]

5278 [No Revision since 1945 Schedule]

5279 [No Revision since 1945 Schedule]

5280 [No Revision since 1945 Schedule]

5281 [No Revision since 1945 Schedule]

5282 [No Revision since 1945 Schedule]

5283 [No Revision since 1945 Schedule]

5284 [No Revision since 1945 Schedule]

5285 1; 4-03-2 (removed)

5286 4-03-2 (removed)

5287 4-03-2 (removed)

5288 4-03-2 (removed)

5289 4-03-2 (removed)

5290 4-03-2 (removed)

5291 4-03-2 (removed)

5292 1; 4-03-2 (removed)

5293 17; 4-02-4; 4-03-2 (removed)

5294 17

5295 17

5296 17

5297 Ext 4; 7

5298 Ext 4

4.72 Ext 4; 12; 4-97-1

4.73 17; 4-97-1

5301 [No Revision since 1945 Schedule]

5302 [No Revision since 1945 Schedule]

5303 [No Revision since 1945 Schedule]

5304 8

5305 [No Revision since 1945 Schedule]

5306 [No Revision since 1945 Schedule]

5307 [No Revision since 1945 Schedule]

5308 [No Revision since 1945 Schedule]

5309 [No Revision since 1945 Schedule]

5310 4-97-1

5311 4-97-1

5312 4-97-1

5313 [No Revision since 1945 Schedule]

5314 19

5315 [No Revision since 1945 Schedule]

5316 19

5317 Ext 10; 12; 19; 4-97-1(note)

5318 [No Revision since 1945 Schedule]

5319 [No Revision since 1945 Schedule]

5320 [No Revision since 1945 Schedule]

5321 [No Revision since 1945 Schedule]

5322 [No Revision since 1945 Schedule]

5323 [No Revision since 1945 Schedule]

5324 7

5325 4-97-1

5326 [No Revision since 1945 Schedule]

5327 17; 4-91-1; 4-97-1

5328 17; 4-97-1

5329 4-91-1; 4-97-1

4.75 12; 16

4.76 12; 19

4.76a 19

4.77 12; 19

4.78 12; 19

4.79 Ext 4; 12; 19

4.80 12

4.81-2 [Reserved]

4.83 12; 18; 19

4.83a 17; 19

4.84 12; 14

4.84a 16; 17; 25

6000 [No Revision since 1945 Schedule]

6001 [No Revision since 1945 Schedule]

6002 [No Revision since 1945 Schedule]

6003 [No Revision since 1945 Schedule]

6004 [No Revision since 1945 Schedule]

6005 [No Revision since 1945 Schedule]

6006 [No Revision since 1945 Schedule]

6007 6

6008 [No Revision since 1945 Schedule]

6009 [No Revision since 1945 Schedule]

6010 Ext 6-A; 7; 14

6011 [No Revision since 1945 Schedule]

6012 [No Revision since 1945 Schedule]

6013 [No Revision since 1945 Schedule]

6014 [No Revision since 1945 Schedule]

6015 [No Revision since 1945 Schedule]

6016 [No Revision since 1945 Schedule]

6017 [No Revision since 1945 Schedule]

6018 [No Revision since 1945 Schedule]

6019 19

6020 [No Revision since 1945 Schedule]

6021 [No Revision since 1945 Schedule]

6022 [No Revision since 1945 Schedule]

6023 [No Revision since 1945 Schedule]

6024 [No Revision since 1945 Schedule]

6025 [No Revision since 1945 Schedule]

6026 [No Revision since 1945 Schedule]

6027 [No Revision since 1945 Schedule]

6028 [No Revision since 1945 Schedule]

6029 Ext 4; 16; 19

6030 [No Revision since 1945 Schedule]

6031 [No Revision since 1945 Schedule]

6032 12

6033 12

6034 12

6035 16

6061 17

6062 [No Revision since 1945 Schedule]

6063 19

6064 17; 19

6065 19

6066 19

6067 19

6068 19

6069 19

6070 19

6071 17, 19

6072 19

6073 19

6074 19

6075 19

6076 Ext 4; 19

6077 19

6078 16; 19

6079 16; 19

6080 Ext 7; 12; 16; 19

6081 17

6090 19; 25

6091 12

6092 12

4.85 Ext 8; Ext 8-A; Ext 8-B; Ext 8-C; 12; 19; 23; 4-99-1

4.86 Ext 4; Ext 8; Ext 8-B; Ext 8-C; 12; 19; 20; 4-99-1

4.86a Ext 8; Ext 8-B; 12; 17; 19; 23

4.87 17; 4-99-1

6100 23

6101 23; 4-99-1

6102 23; 4-99-1

6103 23; 4-99-1

6104 23; 4-99-1

6105 23; 4-99-1

6106 23; 4-99-1

6107 23; 4-99-1

6108 23; 4-99-1

6109 23; 4-99-1

6110 23; 4-99-1

4.87a 16; 23; 4-99-1

6200 4-99-1

6201 4-99-1

6202 [No Revision since 1945 Schedule]

6203 12; 4-99-1

6204 4-99-1

6205 1; 12; 4-99-1

6206 4-99-1

6207 4-99-1

6208 4-99-1

6209 4-99-1

6210 4-99-1

6211 12

6260 1; 6; 17; 4-99-1; 4-03-1

4.87b 16; 4-99-1

6275 4-99-1

6276 4-99-1

4.88 12; 19; 4-96-3

4.88a 16; 4-94-4

6300 4-96-3

6301 4-96-3

6302 Ext 4; 19; 4-96-3

6304 Ext 4; Ext 7; 4-96-3

6305 26; 4-96-3

6306 4-96-3

6307 4-96-3

6308 4-96-3

6309 10; 26; 4-96-3

6310 4-96-3

6311 4-96-3

6313 4-96-3

6314 26; 4-96-3

6315 4-96-3

6316 26; 4-96-3

6317 4-96-3

6318 26; 4-96-3

6319 4-96-3

6320 4-96-3

6350 10; 17; 4-96-3

6351 26; 4-92-1

6354 4-94-4

4.88b 14; 17; 4-94-4; 4-96-3

4.88c 4-94-4

4.89 Ext 6-A; Ext 9; 7; 11; 14; 17; 19

4.90-5 [Reserved]

4.96 11; 14; 4-96-4

4.97 17; 4-96-4

6501 4-96-4

6502 4-96-4

6504 4-96-4

6510 4-96-4

6511 4-96-4

6512 4-96-4

6513 4-96-4

6514 4-96-4

6515 7; 4-96-4

6516 4-96-4

6517 4-96-4

6518 4-96-4

6519 4-96-4

6520 4-96-4

6521 4-96-4

6522 4-96-4

6523 4-96-4

6524 4-96-4

6600 16; 4-96-4

6601 4-96-4

6602 16; 4-96-4

6603 16; 4-96-4

6604 4-96-4

6701 Ext 4; Ext 6

6702 Ext 4; Ext 6

6703 Ext 4; Ext 6

6704 Ext 1; Ext 4; Ext 6; Ext 7; Ext 9; 14

6721 Ext 6

6722 Ext 6

6723 Ext 6

6724 Ext 1 (Instr 4); Ext 1 (Instr 4-A); Ext 6; 7; 11

6730 19; 4-96-4

6731 14; 19; 4-96-4

6732 7; 19; 4-96-4

6800 4-96-4

6801 4-96-4

6802 16; 4-96-4

6803 4-96-4

6804 4-96-4

6805 4-96-4

6806 4-96-4

6807 4-96-4

6808 4-96-4

6809 4-96-4

6810 4-96-4

6811 11; 4-96-4

6812 4-96-4

6813 11; 4-96-4

6814 17; 4-96-4

6815 4-96-4

6816 11; 4-96-4

6817 4-96-4

6818 4-96-4

6819 17; 4-96-4

6820 4-96-4

6821 Ext 4

6822 4-96-4

6823 4-96-4

6824 4-96-4

6825 4-96-4

6826 4-96-4

6827 4-96-4

6828 4-96-4

6829 4-96-4

6830 4-96-4

6831 4-96-4

6832 4-96-4

6833 4-96-4

6834 4-96-4

6835 4-96-4

6836 4-96-4

6837 4-96-4

6838 4-96-4

6839 4-96-4

6840 4-96-4

6841 4-96-4

6842 4-96-4

6843 4-96-4

6844 4-96-4

6845 4-96-4

6846 4-96-4

6847 4-96-4

4.98-9 [Reserved]

4.100 12; 4-97-2

4.101 12; 4-97-2

4.102 12; 4-97-2

4.103 [Reserved]

4.104 19; 4-97-2; 4-98-1

7000 Ext 7; 19; 4-97-2

7001 4-97-2

7002 4-97-2

7003 4-97-2

7004 19; 4-97-2

7005 16; 19; 4-97-2

7006 4-97-2

7007 19; 4-97-2

7008 4-97-2

7010 4-97-2

7011 4-97-2

7012 4-97-2

7013 4-97-2

7014 4-97-2

7015 16; 4-97-2

7016 16; 4-97-2

7017 19; 4-97-2

7018 4-97-2

7019 4-97-2

7020 4-97-2

7100 Ext 7; 4-97-2

7101 5; 16; 4-97-2

7110 16; 17; 4-97-2

7111 16; 4-97-2

7112 4-97-2

7113 4-97-2

7114 Ext 9; 4-97-2

7115 Ext 7; Ext 9; 4-97-2

7116 Ext 7; Ext 9; 17; 4-97-2

7117 Ext 9; 4-97-2

7118 4-97-2

7119 4-97-2

7120 Ext 7; 4-97-2

7121 Ext 7; 17; 4-97-2

7122 Ext 7; 4-97-2; 4-98-1

7123 4-91-1; 4-97-2

4.105-9 [Reserved]

4.110 2; 9; 12

4.111 2; 9; 12

4.112 2; 9; 12; 4-01-1

4.113 2; 9; 12

4.114 9; 17; 4-01-1

7200 [No Revision since 1945 Schedule]

7201 [No Revision since 1945 Schedule]

7202 [No Revision since 1945 Schedule]

7203 [No Revision since 1945 Schedule]

7204 [No Revision since 1945 Schedule]

7205 [No Revision since 1945 Schedule]

7301 [No Revision since 1945 Schedule]

7304 [No Revision since 1945 Schedule]

7305 9

7306 2; 9; 12

7307 12

7308 2

7309 9

7310 [No Revision since 1945 Schedule]

7311 4-01-1

7312 17; 4-01-1

7313 17; 4-01-1

7314 [No Revision since 1945 Schedule]

7315 [No Revision since 1945 Schedule]

7316 [No Revision since 1945 Schedule]

7317 [No Revision since 1945 Schedule]

7318 Ext 4

7319 9

7321 Ext 7

7322 [No Revision since 1945 Schedule]

7323 [No Revision since 1945 Schedule]

7324 [No Revision since 1945 Schedule]

7325 9

7326 9

7327 9

7328 9; 10

7329 9; 10

7330 9; 10

7331 7; 14

7332 9

7333 [No Revision since 1945 Schedule]

7334 Ext 7; 9

7335 7

7336 Ext 4; 7; 9

7337 [No Revision since 1945 Schedule]

7338 Ext 9

7339 17

7340 [No Revision since 1945 Schedule]

7342 [No Revision since 1945 Schedule]

7343 17; 4-01-1

7344 4-01-1

7345 Ext 4; Ext 4-B; 7; 12; 4-01-1

7346 7

7347 16; 17

7348 17

7351 4-01-1

7354 4-01-1

4.115 12; 18; 4-94-1

4.115a 4-94-1

4.115b 17; 4-94-1; 4-94-3(NOTE)

7500 Ext 7; 7; 4-94-1

7501 [No Revision since 1945 Schedule]

7502 4-94-1

7503 4-94-1

7504 [No Revision since 1945 Schedule]

7505 Ext 7; Ext 6-A; Ext 9; 7; 14; 17

7507 [No Revision since 1945 Schedule]

7508 4-94-1

7509 4-94-1

7510 4-94-1

7511 4-94-1

7512 [No Revision since 1945 Schedule]

7513 4-94-1

7514 Ext 6-A; 7; 14; 17; 4-94-1

7515 [No Revision since 1945 Schedule]

7516 [No Revision since 1945 Schedule]

7517 [No Revision since 1945 Schedule]

7518 [No Revision since 1945 Schedule]

7519 12; 17

7520 [No Revision since 1945 Schedule]

7521 [No Revision since 1945 Schedule]

7522 [No Revision since 1945 Schedule]

7523 12

7524 Ext 7; 12; 4-94-1

7525 Ext 7; Ext 6-A; 7; 14; 17; 4-94-1

7526 4-94-1

7527 4-94-1

7528 17; 4-94-1

7529 [No Revision since 1945 Schedule]

7530 16; 4-94-1

7531 16; 4-94-1

7532 4-94-1

7533 4-94-1

7534 4-94-1

7535 4-94-1

7536 4-94-1

7537 4-94-1

7538 4-94-1

7539 4-94-1

7540 4-94-1

7541 4-94-1

7542 4-94-1

4.116 12; 18; 4-95-1

7610 4-95-1

7611 4-95-1

7612 4-95-1

7613 4-95-1

7614 4-95-1

7615 4-95-1

7617 4-95-1

7618 4-95-1

7619 4-95-1

7620 4-95-1

7621 4-95-1

7622 4-95-1

7623 4-95-1

7624 4-95-1

7625 4-95-1

7626 4-95-1; 4-02-1

7627 17; 4-95-1

7628 4-95-1

7629 4-95-1

4.116a 17; 4-95-1

4.117 16; 4-95-2

7700 4-95-2

7701 4-95-2

7702 4-95-2

7703 Ext 4; 4-95-2

7704 4-95-2

7705 4-95-2

7706 4-95-2

7707 4-95-2

7709 Ext 4; Ext 9; 17; 4-95-2

7710 Ext 4; Ext 6-A; 7; 14; 17; 4-95-2

7711 Ext 6-A; 7; 14; 17; 4-95-2

7712 Ext 6-A; 7; 14; 17; 4-95-2

7713 4-95-2

7714 16; 4-95-2

7715 4-90-2; 4-95-2

7716 4-95-2

4.118 16

7800 4-02-3

7801 Ext 7; 19; 4-02-3

7802 Ext 7; 19; 4-02-3

7803 4-02-3

7804 Ext 7; 7; 4-02-3

7805 [No Revision since 1945 Schedule]

7806 16; 4-02-3

7807 4-02-3

7808 4-02-3

7809 10; 4-02-3

7810 4-02-3(removed)

7811 Ext 6-A; 7; 14; 17; 19; 4-02-3

7812 4-02-3(removed)

7813 4-02-3

7814 4-02-3(removed)

7815 4-02-3

7816 4-02-3

7817 4-02-3

7818 4-02-3

7819 4-02-3

7820 4-02-3

7821 4-02-3

7822 4-02-3

7823 4-02-3

7824 4-02-3

7825 4-02-3

7826 4-02-3

7827 4-02-3

7828 4-02-3

7829 4-02-3

7830 4-02-3

7831 4-02-3

7832 4-02-3

7833 4-02-3

4.119 12; 21

7900 21; 4-96-2

7901 21; 4-96-2

7902 21; 4-96-2

7903 21; 4-96-2

7904 21; 4-96-2

7905 21; 4-96-2

7907 21; 4-96-2

7908 21; 4-96-2

7909 21; 4-96-2

7910 4-96-2

7911 7; 10; 14; 17; 21; 4-96-2

7912 4-96-2

7913 16; 17; 21; 4-96-2

7914 17; 4-96-2

7915 4-96-2

7916 4-96-2

7917 4-96-2

7918 4-96-2

7919 4-96-2

4.120 12

4.121 6; 12

4.122 6; 12

4.123 12

4.124 12

4.124a 26

8000 [No Revision since 1945 Schedule]

8002 19

8003 [No Revision since 1945 Schedule]

8004 [No Revision since 1945 Schedule]

8005 [No Revision since 1945 Schedule]

8007 [No Revision since 1945 Schedule]

8008 [No Revision since 1945 Schedule]

8009 [No Revision since 1945 Schedule]

8010 [No Revision since 1945 Schedule]

8011 [No Revision since 1945 Schedule]

8012 [No Revision since 1945 Schedule]

8013 [No Revision since 1945 Schedule]

8014 [No Revision since 1945 Schedule]

8015 [No Revision since 1945 Schedule]

8017 [No Revision since 1945 Schedule]

8018 [No Revision since 1945 Schedule]

8019 [No Revision since 1945 Schedule]

8020 [No Revision since 1945 Schedule]

8021 19

8022 [No Revision since 1945 Schedule]

8023 [No Revision since 1945 Schedule]

8024 [No Revision since 1945 Schedule]

8025 Ext 7; 6

8045 6; 17; 26

8046 6; 26

8100 Ext 9

8103 6; 7

8104 [No Revision since 1945 Schedule]

8105 [No Revision since 1945 Schedule]

8106 [No Revision since 1945 Schedule]

8107 [No Revision since 1945 Schedule]

8108 6

8205 [No Revision since 1945 Schedule]

8305 [No Revision since 1945 Schedule]

8405 [No Revision since 1945 Schedule]

8207 [No Revision since 1945 Schedule]

8307 [No Revision since 1945 Schedule]

8407 [No Revision since 1945 Schedule]

8209 [No Revision since 1945 Schedule]

8309 [No Revision since 1945 Schedule]

8409 [No Revision since 1945 Schedule]

8210 [No Revision since 1945 Schedule]

8310 [No Revision since 1945 Schedule]

8410 [No Revision since 1945 Schedule]

8211 [No Revision since 1945 Schedule]

8311 [No Revision since 1945 Schedule]

8411 [No Revision since 1945 Schedule]

8212 [No Revision since 1945 Schedule]

8312 [No Revision since 1945 Schedule]

8412 [No Revision since 1945 Schedule]

8510 [No Revision since 1945 Schedule]

8610 [No Revision since 1945 Schedule]

8710 [No Revision since 1945 Schedule]

8511 [No Revision since 1945 Schedule]

8611 [No Revision since 1945 Schedule]

8711 [No Revision since 1945 Schedule]

8512 [No Revision since 1945 Schedule]

8612 [No Revision since 1945 Schedule]

8712 [No Revision since 1945 Schedule]

8513 [No Revision since 1945 Schedule]

8613 [No Revision since 1945 Schedule]

8713 [No Revision since 1945 Schedule]

8514 [No Revision since 1945 Schedule]

8614 [No Revision since 1945 Schedule]

8714 [No Revision since 1945 Schedule]

8515 [No Revision since 1945 Schedule]

8615 [No Revision since 1945 Schedule]

8715 [No Revision since 1945 Schedule]

8516 [No Revision since 1945 Schedule]

8616 [No Revision since 1945 Schedule]

8716 [No Revision since 1945 Schedule]

8517 [No Revision since 1945 Schedule]

8617 [No Revision since 1945 Schedule]

8717 [No Revision since 1945 Schedule]

8518 [No Revision since 1945 Schedule]

8618 [No Revision since 1945 Schedule]

8718 [No Revision since 1945 Schedule]

8519 [No Revision since 1945 Schedule]

8619 [No Revision since 1945 Schedule]

8719 [No Revision since 1945 Schedule]

8520 [No Revision since 1945 Schedule]

8620 [No Revision since 1945 Schedule]

8720 [No Revision since 1945 Schedule]

8521 [No Revision since 1945 Schedule]

8621 [No Revision since 1945 Schedule]

8721 [No Revision since 1945 Schedule]

8522 [No Revision since 1945 Schedule]

8622 [No Revision since 1945 Schedule]

8722 [No Revision since 1945 Schedule]

8523 [No Revision since 1945 Schedule]

8623 [No Revision since 1945 Schedule]

8723 [No Revision since 1945 Schedule]

8524 [No Revision since 1945 Schedule]

8624 [No Revision since 1945 Schedule]

8724 [No Revision since 1945 Schedule]

8525 [No Revision since 1945 Schedule]

8625 [No Revision since 1945 Schedule]

8725 [No Revision since 1945 Schedule]

8526 [No Revision since 1945 Schedule]

8626 [No Revision since 1945 Schedule]

8726 [No Revision since 1945 Schedule]

8527 [No Revision since 1945 Schedule]

8627 [No Revision since 1945 Schedule]

8727 [No Revision since 1945 Schedule]

8528 [No Revision since 1945 Schedule]

8628 [No Revision since 1945 Schedule]

8728 [No Revision since 1945 Schedule]

8529 [No Revision since 1945 Schedule]

8629 [No Revision since 1945 Schedule]

8729 [No Revision since 1945 Schedule]

8530 [No Revision since 1945 Schedule]

8630 [No Revision since 1945 Schedule]

8730 [No Revision since 1945 Schedule]

8540 4-91-1

8910 Ext 7; 6

8911 6; 16

8912 6

8913 6

8914 6; 7; 17; 26

4.125 6; 12; 18; 24; 4-96-5

4.126 6; 12; 24; 4-96-5

4.127 6; 12; 18; 24; 4-96-5

4.128 6; 12; 4-96-5

4.129 6; 12; 4-96-5

4.130 6; 12; 18; 24; 4-96-5

4.131 6; 12; 24; 4-96-5

4.132 Ext 4; Ext 7; 6; 17; 24; 4-96-5

9201 6; 17; 24

9202 6; 17

9203 6; 17

9204 6; 17; 24

9205 6; 17; 24; 4-96-5

9206 6; 17; 24; 4-96-5

9207 6; 24; 4-96-5

9208 6; 17; 24; 4-96-5

9209 6; 17; 24; 4-96-5

9210 6; 12, 17; 24; 4-96-5

9211 4-96-5

9300 6; 17; 24; 4-96-5

9301 6; 17; 24; 4-96-5

9302 6; 17; 24; 4-96-5

9303 6; 17; 24; 4-96-5

9304 6; 17; 24; 4-96-5

9305 6; 17; 24; 4-96-5

9306 6; 17; 24; 4-96-5

9307 6; 17; 24; 4-96-5

9308 6; 17; 24; 4-96-5

9309 6; 17; 24; 4-96-5

9310 6; 17; 24; 4-96-5

9311 6; 17; 24; 4-96-5

9312 17; 24; 4-96-5

9315 17; 24; 4-96-5

9322 17; 24; 4-96-5

9324 17; 24; 4-96-5

9325 17; 24; 4-96-5

9326 4-96-5

9327 4-96-5

9400 6; 17; 24

9401 6; 17; 24; 4-96-5

9402 6; 17; 24; 4-96-5

9403 6; 17; 24; 4-96-5

9404 6; 17; 24

9405 6; 17; 24; 4-96-5

9408 17; 24; 4-96-5

9409 17; 24; 4-96-5

9410 17

9411 20; 24

9412 4-96-5

9413 4-96-5

9416 4-96-5

9417 4-96-5

9421 4-96-5

9422 4-96-5

9423 4-96-5

9424 4-96-5

9425 4-96-5

9431 4-96-5

9432 4-96-5

9433 4-96-5

9434 4-96-5

9435 4-96-5

9440 4-96-5

9500 6; 17; 24; 4-96-5

9501 6; 17; 24; 4-96-5

9502 6; 17; 24; 4-96-5

9505 17; 24; 4-96-5

9506 17; 24; 4-96-5

9507 17; 24; 4-96-5

9508 17; 24; 4-96-5

9509 17; 24; 4-96-5

9510 17; 24; 4-96-5

9511 17; 24; 4-96-5

9520 4-96-5

9521 4-96-5

4.133-48 [Reserved]

4.149 4-94-2; 3-99-2

4.150 16; 4-94-2

9900 Ext 7; 19; 4-94-2

9901 [No Revision since 1945 Schedule]

9903 [No Revision since 1945 Schedule]

9904 [No Revision since 1945 Schedule]

9905 19; 4-94-2

9906 [No Revision since 1945 Schedule]

9907 [No Revision since 1945 Schedule]

9908 [No Revision since 1945 Schedule]

9909 19; 21

9910 [No Revision since 1945 Schedule]

9911 [No Revision since 1945 Schedule]

9912 4-94-2

9913 4-94-2

9914 4-94-2

9915 4-94-2

9916 4-94-2

Program Guide 21-2

APPENDIX B

38 CFR Part 4 -- Rating Schedule

Regulatory Amendment Explanations

4-90-1 Through 4-03-2

REGULATORY AMENDMENT

4-90-1

Regulation Affected: 38 CFR 4.16(a)

EFFECTIVE DATE OF REGULATION: September 4, 1990.

Date Secretary Approved Regulation: July 10, 1990

Federal Register Citation: 55 FR 31579-80

The purpose of the following comment on the change included in this amendment of VA regulations is to inform all concerned why this change is being made. This comment is not regulatory.

Section 4.16. In a report entitled "Veterans Benefits: Improving the Integrity of VA's Unemployability Compensation Program", the GAO recommended that VA define marginal employment so that the criteria used in making determinations of marginal employment in claims for unemployability are consistent between rating boards. 38 CFR 4.16(a) has been amended to provide that marginal employment is not considered substantially gainful employment. Generally, marginal employment is deemed to exist when a veteran's earned annual income does not exceed the amount established by the Bureau of the Census as the poverty threshold for one person. This should not preclude a finding of marginal employment in some cases when earned annual income exceeds the poverty threshold. Consideration will be given in all claims to the nature of the employment and the reasons for termination.

REGULATORY AMENDMENT

4-90-2

Regulation Affected: 38 CFR 4.117

EFFECTIVE DATE OF REGULATION: October 26, 1990

Date Secretary Approved Regulation: October 2, 1990

Federal Register Citation: 55 FR 43123-5 (October 26, 1990)

The purpose of the following comment on the change included in this amendment of VA regulations is to inform all concerned why this change is being made. This comment is not regulatory.

Section 4.117. On March 29, 1990, the Centers for Disease Control released a study entitled "The Association of Selected Cancers with Service in the U.S. Military in Vietnam". That study found that Vietnam veterans have a roughly 50 percent increased risk of developing non-Hodgkin's lymphoma (NHL) after service in Vietnam. The Secretary has determined that there is a relationship between Vietnam service and the subsequent development of NHL. 38 CFR Part 3 has been amended to add section 3.313 to provide the criteria to be used in considering claims for service connection for NHL by Vietnam veterans.

38 CFR 4.117 has been amended to add a diagnostic code and evaluation criteria for NHL.

REGULATORY AMENDMENT

4-91-1

Regulation Affected: 38 CFR 4.73, 4.104 and 4.124a

EFFECTIVE DATE OF REGULATION: October 15, 1991

Date Secretary Approved Regulation: September 16, 1991

Federal Register Citation: 56 FR 51651-3 (October 15, 1991)

The purpose of the following comment on the changes included in this amendment of VA regulations is to inform all concerned why these changes are being made. This comment is not regulatory.

Under 38 CFR 1.17(c), when VA determines that a significant statistical association exists between exposure to a herbicide containing dioxin and any disease, 38 CFR 3.311a shall be amended to provide guidelines for the establishment of service connection for the disease. These determinations are to be made after receiving the advice of the Veterans Advisory Committee on Environmental Hazards (VACEH) based on its evaluation of scientific or medical studies.

In a public meeting on May 16-17, 1990, the VACEH met in Washington, DC. At that meeting, the VACEH considered more than 80 scientific and medical documents relating to the connection, if any, between exposure to a herbicide containing dioxin and the subsequent development of soft-tissue sarcoma (STS). The VACEH found that the relative weights of valid positive and valid negative studies permitted the conclusion that it is at least as likely as not that there is a significant statistical association between exposure to a herbicide containing dioxin and STS. The Secretary has accepted that recommendation.

There is disagreement even among pathologists as to what tumors the term "soft-tissue sarcoma" encompasses. With the assistance of VHA and the VACEH, we compiled a list of those tumors which we consider to be soft-tissue sarcomas and included it in the regulation. For compensation purposes, such tumors must be malignant and arise from tissue of mesenchymal origin, including muscle, fat, blood or lymph vessels, or connective tissue (but not cartilage or bone). Tumors of infancy or childhood, and those having a strong, known causal association with a specific etiology have been excluded because it is unlikely that there is a reasonable probability of a significant statistical association between such tumors and exposure to a herbicide containing dioxin.

STS is currently rated by analogy because there are no specific diagnostic codes in the rating schedule. 38 CFR Part 4 has been amended to add specific diagnostic codes for STS as well as evaluation criteria. In addition, diagnostic code 5327 has been amended to exclude STS and to revise the point at which evaluations are based on residual disability from 1 year to 6 months following cessation of treatment. The revision has been made because medical advances have reduced the recovery time needed following surgery, chemotherapy, etc.

Section 4.73. Diagnostic code 5327 has been revised to exclude STS, and new diagnostic code 5329 has been added.

Section 4.104. New diagnostic code 7123 has been added.

Section 4.124a. New diagnostic code 8540 has been added.

REGULATORY AMENDMENT

4-91-2

Regulation Affected: 38 CFR 4.17

EFFECTIVE DATE OF REGULATION: December 16, 1991

Date Secretary Approved Regulation: October 10, 1991

Federal Register Citation: 56 FR 57985 (November 15, 1991)

The purpose of the following comment on the changes included in this amendment of VA regulations is to inform all concerned why these changes are being made. This comment is not regulatory.

Section 8002 of the Omnibus Budget Reconciliation Act of 1990, Pub. L. 101-508, amended 38 U.S.C. 1502(a) to eliminate the presumption of total disability at age 65 for pension purposes.

Section 4.17. 38 CFR 4.17 has been amended to delete the presumption of permanent and total disability at age 65. 38 CFR 4.17 has also been amended to require for all veterans, regardless of age, a single disability rated as 60 percent or a combined evaluation of 70 percent, with one disability ratable at 40 percent or higher (see § 4.16(a)). Claims of any veterans who fail to meet the required percentages but are otherwise entitled and unemployable will continue to be referred to the Adjudication Officer under § 3.321(b)(2).

REGULATORY AMENDMENT

4-92-1

Regulations Affected: 38 CFR 4.88a, diagnostic codes 6351, 6352, and 6353

EFFECTIVE DATE OF REGULATION: March 24, 1992

Date Secretary Approved Regulation: February 7, 1992

Federal Register Citation: 57 FR 10134-6 (March 24, 1992)

The purpose of the following comment on the changes included in this amendment of VA regulations is to inform all concerned why these changes are being made. This comment is not regulatory.

Three diagnostic codes were previously used for rating HIV-related illnesses: diagnostic code 6351, Acquired immunodeficiency syndrome (AIDS); diagnostic code 6352, AIDS related complex (ARC); and diagnostic code 6353, HIV antibody positive. Diagnostic codes 6351 and 6352 were rated by reference to the underlying disease, and diagnostic code 6353 was assigned a 0 percent evaluation. The need for more specific rating criteria became clear when the multitude and complexity of symptoms associated with HIV infection were considered. Constitutional and neurological diseases can be rated under a variety of diagnostic codes, and since many analogies are possible, inconsistent evaluations often resulted. Opportunistic infections may resolve with minimal chronic impairment of the affected body system, but the average person's employment potential is markedly compromised. Although the HIV infection may not have progressed to the stage of AIDS or ARC, an individual may nevertheless be symptomatic and partially disabled.

Diagnostic codes 6352 and 6353 have been removed, and HIV-related illnesses are now rated under a single diagnostic code, 6351. This code contains evaluation criteria at the levels of 0, 10, 30, 60, and 100 percent which allow for rating by staging or symptomatology, whichever permits a higher evaluation. Separate evaluations under other diagnostic codes for manifestations of the disease are also permitted if a higher overall evaluation would thereby result.

Section 4.88a. Diagnostic codes 6351 (Acquired Immunodeficiency Syndrome), 6352 (Aids Related Complex), and 6353 (HIV Antibody positive) have been replaced by a single diagnostic code 6351 for HIV-related illnesses with evaluation criteria at the 0, 10, 30, 60, and 100 percentage levels.

REGULATORY AMENDMENT

4-93-1

Regulation affected: 38 CFR 4.31

EFFECTIVE DATE OF REGULATION: October 6, 1993

Date Secretary Approved Regulation: August 26, 1993

Federal Register Citation: 58 FR 52017-18 (October 6, 1993)

The purpose of the following comment on the change included in this amendment of VA regulations is to inform all concerned why this change is being made. This comment is not regulatory.

A majority of the disabilities addressed in the VA's Schedule for Rating Disabilities (38 CFR part 4) do not specify criteria for a zero percent level. Once it has been determined that a disability is service-connected, it has been VA's consistent practice to assign a zero percent evaluation whenever the condition does not meet the stated minimum requirements for compensable evaluation. In recent decisions, however, the U.S. Court of Veterans Appeals (COVA) pointed out that unless an individual diagnostic code requires residual disability for a compensable evaluation, a zero percent evaluation is not authorized under §§ 3.357(a) and 4.31. See Rabideu v. Derwinski, U.S. Vet. App. No. 90-1296 and Conley v. Derwinski, U.S. Vet. App. No. 91-527. From the Court's analysis it is apparent that VA regulations are seen as being inconsistent with VA's longstanding practice of assigning a zero percent evaluation for any disability which does not meet the minimum requirements for a compensable evaluation.

We have amended § 4.31 to eliminate this perceived discrepancy between VA practice and regulations. We have changed the heading of § 4.31 from "A no-percent rating" to "Zero percent evaluations" to more accurately represent the issue addressed in the regulation.

We have deleted § 3.357(a) because it is a duplicate of § 4.31 and because the issue is more appropriately addressed in the rating schedule.

Section 4.31: Section 4.31 has been revised to provide that, in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met.

REGULATORY AMENDMENT

4-94-1

Regulation affected: 38 CFR 4.115, 4.115a.

EFFECTIVE DATE OF REGULATION: February 17, 1994

Date Secretary Approved Regulation: March 5, 1993

Federal Register Citation: 59 FR 2523-2529, January 19, 1994

The purpose of the following comment on the change included in this amendment of VA regulations is to inform all concerned why this change is being made. This comment is not regulatory.

In December 1988, the General Accounting Office (GAO) recommended that VA prepare a plan for a comprehensive review of the rating schedule and, based on the results, revise the medical criteria accordingly. Based in part on this recommendation, the Compensation and Pension Service initiated a systematic review of the Schedule for Rating Disabilities (38 CFR Part 4) in order to remove outdated medical terminology and ambiguous rating criteria and to introduce recent medical advances.

We have made a number of editorial changes, primarily of syntax and punctuation, throughout these section, intended to clarify the rating criteria and represent no substantive amendment. We have deleted generic terms such as "severe", "moderate", and "mild" from various evaluation criteria and replaced them, whereever possible, with more objective, unambiguous descriptions of the levels of disability. We have also changed a number of terms to reflect current medical terminology and to clarify various anatomical aspects or treatment procedures.

We added two sentences to § 4.115 to clarify that hypertension or heart disease will be separately rated if absence of a kidney is the sole renal disability and that hypertension or heart disease will be separately rated if renal disease has progressed to the point where regular dialysis is required. This makes regulatory the long-established policy which is included in the Department of Veterans Benefits Manual of Adjudication Procedures, M21-1.

We have redesignated § 4.115a as § 4.115b and replaced the existing § 4.115a with an explanation of the three new dysfuntion formulas which follow.

In order to allow a broader range of possible evaluations for many disabilities and a more accurate level of compensation for each, we have provided three general dysfunction formulas for disabilities of the genitourinary system. Diagnostic codes throughout the section refer to these criteria for evaluation of the predominant dysfunction. The evaluations prescribed for each catagory of dysfunction are generally consistent with percentages and criteria currently specified under the following diagnostic codes: 7502, nephritis, corresponding to renal dysfunction; 7512, cystitis with criteria relating to frequency of urination, corresponding to voiding dysfunction; 7518, stricture of urethra with criteria relating to dialtion treatments, corresponding to urinary tract infection, and also relating to obstructed voiding as a catagory of voiding dysfunction; and, 7519, fistula of urethra with criteria relating to frequency of drainage, corresponding to continual urinary leakage as a catagory of voiding dysfunction.

Under renal dysfunction and diagnostic code 7530, chronic renal disease requiring regular hemodialysis, the word dialysis has been used instead of hemodialysis in order to include consideration of continuous ambulatory peritoneal dialysis, as well as hemodialysis, in the assignment of a total evaluation. Specific measurements of creatinine and blood urea nitrogen (BUN) are provided for the 100 and 80 percent evaluations under renal dysfunction. The term "nonprotein nitrogen" shown under diagnostic code 7502, chronic nephritis, is obsolete and has been removed as a measure of kidney dysfunction. We have described hypertension requirements in terms of diagnostic code 7101, essential hypertension, under the 60, 30 and 0 percent levels of evaluation for renal dysfunction in order to promote a clear understanding of the rule and for internal consistency within the rating schedule.

We have deleted the one year period of convalescence under diagnostic code 7528, malignancies of the genitourinary system in favor of an indefinite period of convalescence with mandatory examination at the end of six months; any reduction in evaluation based on the findings of the examination will be implimented in accordance with § 3.105(e). This will provide the claimant contemporaneous notification and base any reduction on current medical findings rather than a regulatory assumption that there has been an improvement.

Similarly, we have deleted the two year convalescence period under diagnostic code 7531, kidney transplant. Kidney transplants have become far more common since 1975, when a total evaluation for two years was first specified in the rating schedule, and improved surgical techniques and experience with immuno-suppressive management make it possible to assess residual impairment one year after surgery instead of two. As with malignancies, there will be an indefinite period of convalescence with a mandatory VA examination, in this case one year after hospital discharge following surgery, and any reduction will be based on the findings of this examination, subject to the provisions of 38 CFR 3.105(e). We have retained the 30 percent minimum evaluation. Subsequent to convalescence, the residuals are to be evaluated as renal dysfunction, in order to provide consistent evaluations and objective criteria.

We have eliminated four of the diagnostic categories. Pyelitis, diagnostic code 7503, is not currently used in medical practice and is generally understood to be included under pyelonephritis, which remains as diagnostic code 7504. Intersitial cystitis, diagnostic code 7513 is included under chronic cystitis, diagnostic code 7512, since these are essentially the same disability. Chronic cystitis is amended to include cystitis of all etiologies, infectious and non-infectious. Tuberculosis of the bladder, diagnostic code 7514, is a very uncommon disease and it does not warrant a separate code in this section of the schedule. Ratings for nonpulmonary tuberculosis are prescribed by §§ 4.88b and 4.89. Resection or removal of the prostate gland is included under diagnostic code 7527, prostate gland injuries. Residuals of total prostatectomy are to be evaluated according to the severity of the individual disability instead of assigning a minimum evaluation of 20 percent. A separate diagnostic code is therefore redundant.

Eleven new codes have been added to this section of the rating schedule. Renal tubular dysfunctions, diagnostic code 7532, is given a minimum 20 percent evaluation if symptomatic, with instructions to otherwise rate as renal dysfunction. The following nine conditions are to be rated as renal dysfunction: Cystic disease of the kidneys, code 7533; atherosclerotic renal disease, 7534; toxic neuropathy, 7535; glomerulonephritis, 7536; interstitial nephritis, 7537; papillary necrosis, 7538; renal amyloid disease, 7539; disseminated intravascular coagulation with renal cortical necrosis, 7540; and renal involvement in diabetes mellitus, sickle cell anemia, systemic lupus erythematosus, vasculitis, or other systemic disease processes, 7541. These additional codes have been added in order to reduce reliance on the uncertain practice of rating many kidney disorders by analogy. We have added diagnostic code 7542, neurogenic bladder, with instructions to rate the condition under the criteria for voiding dysfunction. This is a common condition in cases of severe spinal cord injury.

Diagnostic code 7500, removal of one kidney, is changed to instruct the rater to evaluate the condition as renal dysfunction if there is nephritis, infection or pathology of the other kidney. This represents consideration of entire renal dysfunction and is the most consistent means of rating kidney disorders.

Diagnostic code 7508, nephrolithiasis, has been changed to provide a 30 percent evaluation for recurrent stone formation if drug or diet therapy or invasive or non-invasive procedures, more than two times per year are required. If stone formation is not recurrent to this extent, the condition will be evaluated according to the criteria for hydronephrosis, diagnostic code 7509. Ureterolithiasis, code 7510, and stricture of the ureter, code 7511, have been given the same criteria for evaluation. This provides objective criteria and consistency within this section of the schedule.

We have changed the criteria for the "severe" level of hydronephrosis, diagnostic code 7509, to to instruct the rater to use objective evaluation criteria under the general formula for renal dysfunction.

The percentage evaluation for loss of one testicle under diagnostic code 7524 has been reduced from 10 percent to zero percent and the term "other than undecended or congenitally undeveloped" has been deleted from the new zero percent level. No significant employment handicap is anticipated from loss of a single testical, any retrogressive changes in secondary sex characteristics even following removal of both testes after sexual maturity would occur slowly, if at all, and a solitary testis is adequate to sustain normal endocrine function without hormone replacement.

The title of epididymo-orchitis, tuberculous, active or inactive, diagnostic code 7525, has been changed to epididymo-orchitis, chronic only, with instructions to rate as urinary tract infection. The instructions to rate tubercular infections under §§ 4.88b or 4.89 has been retained. These new instructions allow for evaluation of any type of epididymal infection under this code.

The instructions for evaluation of prostate gland injuries, infections, hypertrophy, or postoperative residuals, diagnostic code 7527, have been changed to evaluate the conditions as voiding dysfunction or urinary tract infection, consistent with other codes in this section and to provide the widest, most objective range of criteria.

The title of diagnostic code 7528, new growths, malignant, any specified part of genitourinary system, has been changed to malignant neoplasms of the genitourinary system because the term neoplasm better connotes the pathological abnormality. Following convalescence, as explained above, the condition will be evaluated as voiding dysfunction or renal dysfunction, whichever is predominant, in order to provide consistent evaluations and objective criteria.

Section 4.115: Revised to clarify that hypertension or heart disease will be separately rated if absence of a kidney is the sole renal disability, if it has progressed to the point where regular dialysis is required.

Section 4.115a: Redesignated as section 4.115b, and replaced with the explanation of the three new dysfunction formulas for evaluating a number of genitourinary disabilities.

Section 4.115b: Added as the heading for the section containing the rating codes and diagnoses for genitourinary disabilities.

Diagnostic codes Diagnostic codes Diagnostic codes

Revised Added Removed

7500 7532 7503

7502 7533 7513

7508 7534 7514

7509 7535 7526

7510 7536

7511 7537

7524 7538

7525 7539

7527 7540

7528 7541

7530 7542

7531

REGULATORY AMENDMENT

4-94-2

Regulation affected: 38 CFR 4.150.

EFFECTIVE DATE OF REGULATION: February 17, 1994

Date Secretary Approved Regulation: August 19, 1993

Federal Register Citation: 59 FR 2529-2530, January 18, 1994

The purpose of the following comment on the change included in this amendment of VA regulations is to inform all concerned why this change is being made. This comment is not regulatory.

The schedule of ratings for Dental and Oral Conditions lists five disabilities without diagnostic codes: Carious teeth, treatable; missing teeth, replaceable; dento-alveolar abscess; pyorrhea alveolaris; and Vincent's stomatitis. These conditions are not considered disabling and the issue of service-connection is addressed by raters only for the purpose of determining entitlement to out patient dental treatment under the provisions of 38 CFR 3.382 and 17.123. We have deleted them from § 4.150 and added a new section designated as § 4.149 which states, in more contemporary terms, that these conditions are not compensable conditions, but that they may be considered service-connected solely for the purpose of establishing entitlement to dental examination or outpatient dental treatment.

We have included osteoradionecrosis under diagnostic code 9900, osteomyelitis of the maxilla or mandible, because this condition occurs often enough in the veteran population to warrant inclusion and because its disabling effects are similar to osteomyelitis.

We have denoted categories of both inter-incisal and lateral excursion of the temporomandibular joint, diagnostic code 9905 because this diagnostic code does not specify this type of limitation. We have provided evaluation levels of 10, 20, 30, and 40 percent for precise ranges of inter-incisal motion limitation and a 10 percent evaluation for limited lateral excursion from 0 to 4 millimeters. We have provided a NOTE following the code specifying that ratings for limited inter-incisal movement will not be combined with ratings for limited lateral excursion under this code in accordance with the prohibition against pyramiding (38 CFR 4.14).

We have deleted diagnostic code 9510, maxilla, loss of whole or part of substance of, nonunion of , or malunion of because disabilities of the maxilla are not comparable to those of the mandible, as the instructions to rate the disability imply. We have added three new codes, 9914, 9915 and 9916, each with its own percentage ranges and evaluation criteria in order to provide complete and equitable evaluations for these disabilities.

We have revised the note following diagnostic code 9913, teeth, loss of, due to loss of substance of maxilla or mandible to use the less ambiguous term "periodontal disease" instead of "natural resorption" and to explain why loss of the alveolar process without loss of bone is not compensable.

We have revised the evaluation criteria of diagnostic code 9913 because the current descriptions are confusing and unclear. No substantive change is intended by this revision.

We have substituted the word "prosthesis" for the term "prosthetic appliance under codes 9911 and 9912 for the sake of consistency, since "prosthesis" is used under code 9913 and other diagnostic codes throughout the schedule.

Section 4.149: This section is added to include the non-disabling conditions which are listed for the purpose of determining entitlement to dental examination and dental outpatient treatment and to instruct the rater that these are not compensable conditions.

Section 4.150: This section is amended to:

1) Include osteoradionecrosis under diagnostic code 9900, osteomyelitis of the maxilla or mandible,

2) Provide specific criteria for limitations of ranges of motion of the jaw, diagnostic code 9905, and to add a NOTE cautioning against pyramiding,

3) Add three diagnostic codes: 9914, maxilla, loss of more than half, 9915, maxilla, loss of half or less, and 9916, maxilla, malunion or nonunion, with percentage evaluations for each at levels appropriate to the levels of disability,

4) Amend the note following diagnostic code 9913, tooth loss due to damage of the mandible or maxilla, for clarity and to explain why loss of the alveolar process without bone loss is not compensable,

5) Clarify the descriptions of combinations of loss of teeth in diagnostic code 9913,

6) Substitute the word "prosthesis" for the term "prosthetic appliance" under diagnostic code 9912.

Diagnostic codes Diagnostic codes Diagnostic codes

Revised Added Removed

9900 9914 NONE

9905 9915

9912 9916

9913

REGULATORY AMENDMENT

4-94-3

Regulation Affected: 38 CFR 4.115b

EFFECTIVE DATE OF REGULATION: September 8, 1994

Date Secretary Approved Regulation: July 28, 1994

Federal Register Citation: 59 FR 46338-9 (September 8, 1994)

The purpose of the following comments on the changes included in these amendments of VA regulations is to inform all concerned why the changes are being made. These comments are not regulatory.

The final revision of the section of the Schedule for Rating Disabilities of the Genitourinary System was published in the Federal Register on January 18, 1994. Taking into account a comment we received after publication of the proposed revision of the genitourinary section of the rating schedule that we should add a n note under DC 7522 (Penis deformity, with loss of erectile power) indicating entitlement to SMC, we have reconsidered the issue of providing guidance to rating specialists in the rating schedule on the issue of special monthly compensation (SMC). We concluded that the combination of the two provisions added by this amendment is the best means of assuring that potential entitlement to SMC is considered.

The amendment adds a note at the beginning of 38 CFR 4.115b requiring rating specialists to refer to 38 CFR 3.350 any time they evaluate a claim involving loss or loss of use of a creative organ, and also adds a footnote at diagnostic codes 7522, 7523, and 7524 directing the rater to review for entitlement to special monthly compensation under § 3.350.

REGULATORY AMENDMENT

4-94-4

Regulation affected: 38 CFR 4.88a and 4.88b.

EFFECTIVE DATE OF REGULATION: November 29, 1994

Date Secretary Approved Regulation: August 1, 1994

Federal Register Citation: 59 FR 60901-2, November 29, 1994

The purpose of the following comment on the change included in this amendment of VA regulations is to inform all concerned why this change is being made. This comment is not regulatory.

We have amended 38 CFR 4.88a and 4.88b and added 4.88c by means of an interim rule with request for comments in order to add a diagnostic code and evaluation criteria for chronic fatigue syndrome to the portion of the rating schedule on systemic diseases. We have provided evaluation levels of 10, 20, 40, 60, and 100 percent. Chronic fatigue syndrome is of unknown etiology and is characterized by non-specific symptoms. Because it has been ill-defined and sometimes confused with other conditions, we have also added a section that provides diagnostic criteria for the syndrome.

We have made this an interim rule with request for comments so that it can be effective immediately, but comments will be received for 60 days, and the rule may be amended based on the comments.

Sections 4.88a and 4.88b are redesignated 4.88b and 4.88c respectively.

Section 4.88a is added to provide diagnostic criteria for chronic fatigue syndrome.

Section 4.88b. New diagnostic code 6354 has been added.

REGULATORY AMENDMENT

4-95-1

Regulation affected: 38 CFR 4.116 and 4.116a

EFFECTIVE DATE OF REGULATION: May 22, 1995.

Date Secretary approved regulation: December 22, 1994.

Federal Register Citation: 60 FR 19851-6, April 21, 1995

The purpose of the following comment on the changes included in this amendment of VA regulations is to inform all concerned why this change is being made. This comment is not regulatory.

As part of its ongoing revision of the Schedule for Rating Disabilities, the Department of Veterans Affairs (VA) has amended sections 4.116 and 4.116a of 38 CFR, Part 4, the sections of the rating schedule that deal with gynecological conditions and disorders of the breast. The intended effect of this action is to update the gynecological and breast disorders section of the rating schedule to ensure that it uses current medical terminology, unambiguous criteria, and that it reflects medical advances which have occurred since the last review.

We changed the title of this part of the rating schedule from "gynecological conditions" to "gynecological conditions and disorders of the breast" to reflect more accurately the content. We made language changes consistent with current medical usage, such as changing "mammary glands" to "breasts," "new growths" to "neoplasms," and "extirpation," "resection," and "excision" to "removal."

We deleted the introductory section, 4.116, removing some material and putting the material that remained in the form of a note. We removed from the material the statement that excision of uterus, ovaries, etc., prior to the natural menopause is considered disabling because the implied distinction of the effects of the surgery itself before and after the menopause is not warranted.

We also removed from the material in § 4.116 the statement that surgical complications of pregnancy will not be held the result of service except when additional disability resulted from treatment, or they are otherwise attributable to unusual circumstances of service. These remarks were unclear, seemingly restricting service connection in most cases, and such chronic disabilities, if incurred during service, would be subject to service connection, as with other chronic disabilities. For further clarification, we added the statement that chronic residuals of medical or surgical complications of pregnancy may be disabilities for rating purposes.

We added footnotes at diagnostic codes (DC's) 7617 through 7620 and a note at the beginning of § 4.116 to alert the rater to consider special monthly compensation (SMC) because we believe that the combination of the footnotes and note is the best method of assuring that potential entitlement to SMC is considered.

We removed the criteria of "mild," "moderate," and "severe" that had been used to evaluate disease or injury of vulva, vagina, or cervix, and for disease, injury, or adhesions of uterus, Fallopian tube (including PID), or ovary (DC's 7610 through 7615). In their place, we provided a general rating formula using objective evaluation criteria based on the need for continuous treatment and whether symptoms are controlled by treatment. These changes will assure that comparable medical conditions are assigned comparable evaluations. We also revised the titles of DC's 7610 through 7615 to clarify the proper classification of gynecological conditions.

We changed the convalescent period following the removal of uterus and ovaries, or ovaries alone (DC's 7617 and 7619) from 6 months to 3 months, in accord with current medical practice, and taking into account improved surgical techniques, postoperative care, and the practice of early ambulation. We also changed the title of DC 7619 from "ovaries, removal of both" to "ovary, removal of" so that a three-month period of convalescence will apply to the removal of one or both ovaries. The evaluation for removal of one ovary with or without partial removal of the other (DC 7619) has been changed from 10 percent to 0 percent because the loss of one ovary does not compromise endocrine or reproductive function to such an extent that an impairment of earning capacity ordinarily results.

We provided specific criteria for rectovaginal fistula and urethrovaginal fistula (DC's 7624 and 7625, respectively) rather than referring the rater to diagnostic codes in other systems for evaluation criteria. We also removed subjective terminology such as "extensive leakage" and "fairly frequent" from the criteria for rectovaginal fistula (which we had proposed to be the same as the criteria for rectum and anus, impairment of sphincter control, DC 7332), replacing that language with more precise criteria, although with the same basis of evaluation.

We added definitions of the various types of breast surgery for clarity and also provided a compensable evaluation (30%) for less than a total mastectomy when there is significant alteration of size or form (DC 7626). This is a type of breast surgery that may be done for neoplasms and other conditions that is more conservative than a total mastectomy, but which may still be disabling.

We added a new diagnostic code and evaluation criteria for two common conditions that previously required rating by analogy: endometriosis (DC 7628) and benign neoplasms of the gynecological system or breast (DC 7629). In order to assure more consistent evaluations of endometriosis than rating by analogy, we provided evaluation criteria based on the presence of pelvic pain or heavy or irregular bleeding and whether they are controlled by treatment, and on whether there is symptomatic involvement of bladder or bowel. Benign neoplasms are to be evaluated on the basis of impairment of function

We made a minor revision in the language of the evaluation criteria for prolapse of uterus (DC 7621) to be more precise, changing "complete, through vulva" to "complete, through vagina and introitus."

We made changes in the convalescent period following treatment for malignant neoplasm (DC 7627) similar to changes we have made in other body systems, i.e., requiring a mandatory VA examination 6 months following completion of treatment and implementation of § 3.105(e) before any reduction can be made.

Section 4.116 is removed.

Section 4.116a is redesignated as § 4.116.

Diagnostic codes Diagnostic codes Diagnostic codes

revised added removed

7610 7621 7628 NONE

7611 7622 7629

7612 7623

7613 7624

7614 7625

7615 7626

7617 7627

7618

7619

7620

REGULATORY AMENDMENT

4-95-2

Regulation affected: 38 CFR 4.117

EFFECTIVE DATE OF REGULATION: October 23, 1995.

Date Secretary approved regulation: June 13, 1995.

Federal Register Citation: 60 FR 49225-28, September 22, 1995.

The purpose of the following comment on the changes included in this amendment of VA regulations is to inform all concerned why this change is being made. This comment is not regulatory.

As part of its ongoing revision of the Schedule for Rating Disabilities, the Department of Veterans Affairs (VA) has amended section 4.117 of 38 CFR, Part 4, the section of the rating schedule that deal with the hemic and lymphatic systems. The intended effect of this action is to update this section of the rating schedule to ensure that it uses current medical terminology, unambiguous criteria, and that it reflects medical advances which have occurred since the last review.

We changed the title of DC 7700 from "pernicious anemia" to "hypochromic-microcytic and megaloblastic anemia" because we have expanded this code to include additional anemias that will be evaluated under the same criteria. The schedule formerly had evaluation levels for 30, 60, 70, and 100 percent. We changed the levels to 0, 10, 30, 70, and 100 percent since the difference between the 60 and 70 percent levels would be so slight as to be meaningless for rating purposes. We added a zero percent level to make it clear that those who are asymptomatic despite a hemoglobin level of 10gm/100ml or less warrant only a zero percent evaluation, and we added a ten percent level for those who are anemic and have mild symptoms such as weakness, easy fatigability, or headaches. We changed the criteria for these anemias to make them more objective, basing them on a certain range of hemoglobin levels plus specific signs and symptoms. Finally, we added a note directing that complications of pernicious anemia be rated separately because such complications occur often enough to warrant instructions in order to ensure consistent ratings.

We deleted DC 7701, secondary anemia, because this represents a symptom of another more specific disease and does not warrant its own diagnostic code.

For acute agranulocytosis, DC 7702, we changed the evaluation levels from 30, 60, 70, and 100 percent to 10, 30, 60, and 100 percent. We removed the 70 percent level because, as stated under DC 7700, the difference between the 60 and 70 percent levels would be so slight as to be meaningless for rating purposes. We added a 10 percent level when the condition requires continuous medication for control. Previously, acute agranulocytosis was rated under the criteria for acute pernicious anemia. However, the course and treatment of agranulocytosis are usually substantially different from those of pernicious anemia, and we have therefore provided new criteria based on the need for a bone marrow transplant or transfusions, the presence of recurrent infections, or the need for continuous medication for control, since these are more appropriate means of evaluating this condition than the criteria we have used for DC 7700. We added a note stating that a 100 percent evaluation will be assigned from the date of hospital admission for a bone marrow transplant, with a mandatory VA examination to be done six months later, and any change in evaluation to be subject to the provisions of § 3.105(e). This will ensure that no evaluation after bone marrow transplant is reduced without current medical evidence, offers veterans prior notice of any proposed action, and provides an opportunity for the veteran to present evidence showing that the action should not be taken.

Under DC 7703, leukemia, we edited the language regarding requirements for a 100 percent evaluation and changed the direction for rating otherwise, directing that it be under either DC 7700 or 7716 (a new code for aplastic anemia), depending on which results in a higher evaluation. This provides a broader range of evaluations, consistent with what may be seen in this condition. For consistency with the method of evaluating malignancies of other body systems, we added a note directing that the total evaluation be continued, with a mandatory VA examination six months following completion of therapy, and any change in evaluation be subject to the provisions of § 3.105(e).

We changed the title of DC 7704, primary polycythemia, to the more current name for this condition, polycythemia vera. This condition was formerly rated as pernicious anemia, but we have provided criteria more specific to this condition, with evaluation levels of 10, 40, and 100 percent, based on the need for phlebotomy or myelosuppressant therapy, and on whether it is stable. We added a note directing that complications be rated separately because they occur often enough that this instruction is needed to assure that veterans are rated consistently.

We changed the title of DC 7705 from purpura hemorrhagica to the more modern term, thrombocytopenia, primary, idiopathic or immune. We made the criteria more objective, basing them primarily on the blood platelet count, requirement for treatment, and whether there is bleeding. As with several other conditions in this section, we changed the evaluation levels from 30, 60, 70, and 100 percent to 0, 30, 70, and 100 percent because the 60 percent level is clinically indistinguishable from the 70 percent level for rating purposes, and we added a zero percent level to indicate that when the platelet count is stable and above 100,000, and there is no bleeding, the condition does not warrant more than a zero percent evaluation.

We changed the evaluation level for splenectomy, DC 7706, from 30 percent to 20 percent because, although antibiotics now available can diminish the consequences of splenectomy (such as increased susceptibility to infection), the spleen also has other functions, and splenectomy is therefore still considered moderately disabling. We added a note under DC 7706 to clarify that complications of splenectomy are to be separately evaluated.

Under DC 7707, spleen, injury of, healed, we changed the direction from "rate as peritoneal adhesions" to "rate for any residuals" to take into account the fact that residuals other than peritoneal adhesions may occur.

We changed the title of DC 7709 from lymphogranulomatosis (Hodgkin's disease) to Hodgkin's disease because this is the modern name for the condition. Rather than continuing evaluation levels of 30, 60, and 100 percent based on specific signs and symptoms, we based the 100 percent evaluation level on the presence of active disease or during a treatment phase and added a note directing the same procedure as for leukemia and other malignancies -- a mandatory VA examination six months following the cessation of treatment, and any change in evaluation to be subject to the provisions of § 3.105(e). In addition to the benefits mentioned above (under the discussion of DC 7702) regarding the use of § 3.105(e), this change will allow the assignment of any level of evaluation based on the findings at examination.

We changed the title of DC 7710 from adenitis, cervical, tuberculous, active or inactive, to adenitis, tuberculous, active or inactive. This consolidates three types of tuberculous adenitis that are now relatively uncommon: cervical, axillary (formerly DC 7711), and inguinal (formerly DC 7712), into a single code. We have deleted DC's 7711 and 7712. We also removed the direction to rate active disease at 100 percent and inactive as §§ 4.88b and 4.89 in favor of a direction to rate as §§ 4.88c or 4.89, which are the sections that direct how to evaluate nonpulmonary tuberculosis.

We have deleted DC 7713, adenitis, secondary, because it is commonly accepted as a symptom of a specific disease and would be included in the evaluation for that disease.

Under DC 7714, sickle cell anemia, we revised the language of the criteria for the sake of more objectivity by removing the subjective terms "mild," "moderately severe," "severe," and "pronounced"; and we made other editorial, non-substantive changes in the criteria and the note under the code.

There was an instruction under non-Hodgkin's lymphoma, DC 7715, to rate as Hodgkin's disease (DC 7709). For the sake of convenience of those using the schedule, we repeated the criteria used to evaluate Hodgkin's disease under DC 7715.

We added a new condition, aplastic anemia, DC 7716, with the same criteria and evaluation levels we have provided for acute agranulocytosis, DC 7702, because the treatment of these conditions is similar.

Diagnostic codes Diagnostic codes Diagnostic codes

revised added removed

7700 7716 7701

7702 7711

7703 7712

7704 7713

7705

7706

7707

7709

7710

7714

7715

REGULATORY AMENDMENT

4-96-1

Regulation affected: 38 CFR 4.71a.

EFFECTIVE DATE OF REGULATION: May 7, 1996

Date Secretary Approved Regulation: December 7, 1995

Federal Register Citation: 61FR 20438-9

The purpose of the following comment on the change included in this amendment of VA regulations is to inform all concerned why this change is being made. This comment is not regulatory.

We have amended 38 CFR 4.71a by means of an interim rule with request for comments in order to add a diagnostic code and evaluation criteria for fibromyalgia to the portion of the rating schedule on musculoskeletal diseases. We have provided evaluation levels of 10, 20, and 40 percent. Fibromyalgia is a syndrome of unknown etiology that is characterized by chronic, widespread musculoskeletal pain associated with multiple tender or "trigger" points, and often with multiple somatic complaints, such as sleep disorders, anxiety, fatigue, headache, and irritable bowel symptoms. Other possible associated complaints include neurologic symptoms such as numbness and weakness without objective neurologic findings, depression, Raynaud's-like syndrome, and weakness.

Classification criteria for fibromyalgia for research and epidemiological purposes were established by the American College of Rheumatology in 1990. The first requirement is a history of widespread pain, which means pain in both the left and right sides of the body, pain both above and below the waist, and pain in both the axial (cervical spine, anterior chest, thoracic spine, or low back) and peripheral (extremity) skeleton. The second requirement is the presence of pain on digital palpation at a minimum of 11 of the following 18 tender point sites: occiput, low cervical, trapezius, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter, knee (there is a left site and a right site at each location). In clinical practice, the diagnosis is often made on less stringent criteria, with fewer tender points required.

We are providing three levels of evaluation: 10, 20, and 40 percent, consistent, in our judgment, with the clinical range of impairment of this condition. While patients may have numerous symptoms that may be chronic, it is a benign disease that does not result in loss of musculoskeletal function. For the 40 percent level, the requirements are that the widespread pain and multiple tender points, with or without certain associated complaints, be constant, or nearly so, and refractory to therapy. For the 20 percent level, the requirements are that the pain and tender points, etc., be episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but present more than one-third of the time. For the 10 percent level, the requirement is that the pain and tender points, etc., require continuous medication for control.

We have made this an interim rule with request for comments so that it can be effective immediately, but comments will be received for 60 days, and the rule may be amended based on the comments.

Section 4.71a. New diagnostic code 5025 has been added.

REGULATORY AMENDMENT

4-96-2

Regulation affected: 38 CFR 4.119.

EFFECTIVE DATE OF REGULATION: June 6, 1996.

Date Secretary approved regulation: December 5, 1995.

Federal Register Citation: 61 FR 20440-47

The purpose of the following comment on the changes included in this amendment of VA regulations is to inform all concerned why this change is being made. This comment is not regulatory.

As part of its ongoing revision of the Schedule for Rating Disabilities, the Department of Veterans Affairs (VA) has amended section 4.119 of 38 CFR, Part 4, the section of the rating schedule that deals with endocrine system disabilities.

We changed the evaluation criteria for hyperthyroidism (DC 7900) to make them more objective, for example, by removing subjective terms such as "pronounced," "severe," "moderately severe," "marked," and "moderate," because they serve no objective function, and by defining tachycardia as more than 100 beats per minute. The former schedule required "severe" tachycardia at the 100-percent level, but since the medical literature does not define severe tachycardia, we have removed "severe." We added eye involvement to the criteria for a 100-percent evaluation because long-standing hyperthyroidism can lead to significant impairment affecting the eyes. We deleted references to surgery because they are of no value in explaining the qualifying symptoms. We specified that the "nervous symptoms" formerly included in the 100-percent criteria are "sympathetic nervous system" symptoms since this is the part of the nervous system affected. We edited the notes under DC7900 for clarity.

We removed the zero-percent levels for DC's 7900 and 7903, which required that the condition be "in remission" because they merely restate the general rule found in §4.32. We deleted the criteria that referred to hormone levels for DC's 7900, 7903, and 7904 because although many endocrine conditions require laboratory confirmation of hormone levels for diagnosis, the hormone levels may not correlate with the severity of the clinical findings, and laboratory findings are therefore more useful for diagnosis than for evaluation.

Rather than directing in a note the assignment of a 10-percent evaluation for hyperthyroidism, hypothyroidism (DC 7903), and hypoparathyroidism (DC 7905) when continuous medication is required for control, we have added "continuous medication required for control" to the evaluation criteria themselves at the 10-percent level. For the sake of consistency, we have made "continuous medication required for control" a criterion for a 10-percent evaluation for hyperparathyroidism (DC 7904) as well.

For the convenience of rating specialists, we repeated the criteria for DC 7900 (hyperthyroidism) under DC 7901 (thyroid gland, toxic adenoma of) rather than directing to rate as DC 7900.

We removed "with pressure symptoms" from the criteria (because they are rarely encountered) in favor of a note directing that if there are symptoms due to pressure on adjacent organs, evaluation is to be made under the diagnostic code for disability of the affected organ, if doing so would result in a higher evaluation. We also removed "marked" as a modifier of disfigurement for a 20-percent evaluation because it is our judgment that any adenoma substantial enough to be disfiguring warrants a 20-percent evaluation.

As under DC 7900, we removed the subjective terms "pronounced," "severe," "moderately severe," and "moderate" from the criteria for DC 7903 (hypothyroidism). We also removed the requirement for slow return of reflexes for a 100-percent evaluation and added criteria of cold intolerance, muscular weakness, and cardiovascular involvement because these symptoms are typical of the disease when it is totally disabling. Also at the 100-percent level, we changed "slow pulse" to the more objective "bradycardia (less than 60 beats per minute)" and removed "sluggish mentality" in favor of "mental disturbance (dementia, slowing of thought, depression)" because these are the common mental disturbances that may be seen in advanced hypothyroidism. We revised the former criteria for the 60-percent level in favor of the more objective criteria: "muscular weakness, mental disturbance, and weight gain". We made "fatigability, constipation, and mental sluggishness," instead of "sluggish mentality and other indications of myxedema," the criteria for the 30-percent level because they are commonly encountered symptoms and are more specific than the former criteria.

We removed "osteitis fibrosa cystica" from the title of DC 7904 (hyperparathyroidism) because that term represents certain bony findings that may be seen in hyperparathyroidism rather than being another term for hyperparathyroidism itself. As under other endocrine criteria, we removed subjective terms such as "pronounced," "severe," and "marked." We removed "high blood and urinary calcium" from the criteria for a 100-percent evaluation and "manifestations of hypercalcemia and urinary calcium" from the 60-percent level for the same reason we deleted criteria related to hormone levels under other endocrine conditions--these laboratory findings are more pertinent to diagnosis than to evaluation of functional impairment. We removed "marked weight loss" in favor of "gastrointestinal symptoms (nausea, vomiting, anorexia, constipation, weight loss, or peptic ulcer) because this is more representative of the variety of gastrointestinal symptoms that may be seen in hyperparathyroidism. We added "kidney stones" as an additional criterion at the 100-percent level because they are indicative of a totally disabling level. For consistency with the 100-percent level criteria, we changed "muscular weakness," one of the former criteria for the 60-percent level, to "weakness." We deleted the indefinite "with symptom combinations less than under 'pronounced' " from the 60-percent level criteria and, as at the 100-percent level, changed "marked weight loss" to "gastrointestinal symptoms. We revised the instructions under DC 7904 regarding post-operative or post-treatment evaluation, deleting the reference to "residual of benign tumor, considering especially bones and kidneys" to a more general direction to evaluate, following surgery or treatment as "digestive, skeletal, renal, or cardiovascular residuals."

We removed the reference to thyroidectomy in the criteria for a 100-percent level of hypoparathyroidism (DC 7905) because, although hypoparathyroidism may follow thyroidectomy if the parathyroid glands are also removed, there are other causes as well. There was a single 100-percent evaluation level based on painful muscular spasms or marked neuromuscular excitability. We revised the 100-percent criteria to "marked neuromuscular excitability," with examples, "plus either cataract or evidence of increased intracranial pressure," with examples. We added the alternative criteria because they are additional objective findings that may be seen at this level of disability. We clarified "marked neuromuscular excitability" by adding in parentheses "convulsions, muscular spasms (tetany), and laryngeal stridor" and eliminated the redundancy of including both "tetany" and "marked neuromuscular excitability" as separate symptoms. We added a 60-percent level based on either marked neuromuscular excitability or a combination of paresthesias (of arms, legs, or circumoral area) plus cataract or evidence of increased intracranial pressure, and a 10-percent level based on the need for continuous medication.

We changed the title of DC 7907 from "hyperpituitarism (pituitary basophilism, Cushing's syndrome)" to "Cushing's syndrome" since this is the medically accepted term for the condition. We removed the requirements at the 100-percent level for pathological fractures and enlargement of the sella turcica, which are rarely encountered, in favor of the more frequently seen findings of hypertension and weakness, and removed the subjective term "marked" modifying loss of muscle strength. We replaced the indefinite criteria of "severe; with symptom combination less than for the 100-percent rating with only partial control by treatment" at the 60-percent level with the more specific requirements of loss of muscle strength and enlargement of pituitary or adrenal gland. We added a 30-percent level for milder cases, especially those that are secondary to steroid treatment, with criteria of striae, obesity, moon face, glucose intolerance, and vascular fragility, which are indicators of milder disease than those criteria named at the 60- and 100-percent levels. We edited the note directing evaluation after recovery or control by expanding the list of possible residuals.

We changed the title of DC 7908 from "hyperpituitarism (acromegaly or gigantism)" to "acromegaly," since this is the most commonly used term for this disability. We removed the phrase "hypofunctional stage of hyperfunction" from the criteria for the 100-percent level because this description does not assist in the evaluation of the condition. We edited and partially revised the list of symptoms for a 100-percent evaluation to "evidence of increased intra-cranial pressure (such as visual field defect), arthropathy, glucose intolerance, and either hypertension or cardiomegaly because these findings more accurately represent the 100-percent level of severity. We also replaced the former criteria for the 60-percent level with "arthropathy, glucose intolerance, and hypertension" because these are more frequently encountered symptoms. We removed the phrase "X-ray evidence of" modifying enlarged sella turcica at the 30-percent level as unnecessary.

We changed the title of DC 7909 from "hypopituitarism (diabetes insipidus)" to "diabetes insipidus" since this name alone is sufficient to identify this category of disease. We removed the subjective modifiers "pronounced," "severe," "moderately severe," and "moderate" because they did not aid in the evaluation of the condition. As elsewhere in the endocrine system, we removed the laboratory findings, in this case related to serum and urine osmolality from the criteria because they are not necessarily consistent with particular levels of functional impairment. In place of "excessive thirst," "polyuria," and :polydipsia," we added "polyuria with near-continuous thirst" as criteria for all levels. For clarity, we replaced "parenteral replacement therapy" with "episodes of dehydration requiring parenteral hydration" and specified a number of episodes of dehydration per year for the 40-, 60-, and 100-percent level for more objectivity.

Under Addison's disease, DC 7911, the former criteria included references to "episodes" and "crises," but they were not defined. We have added notes under DC 7911 defining them, and specified in the criteria the number of each that warrant each percentage evaluation. We removed the references to laboratory findings of hyponatremia, hyperpotassemia, azotemia, hypoglycemia, and cortisol deficiency for the same reasons as discussed under other endocrine conditions.

We revised the evaluation criteria for diabetes mellitus (DC 7913) to make them more objective and base them on how well the diabetes is controlled. The frequency of insulin injection and medical treatment are valid measures of the severity of diabetes, and we have stipulated a requirement for more than one daily injection of insulin for the 100-percent evaluation level. We also specified the number of hospitalizations per year required because of episodes of ketoacidosis or hypoglycemic reactions and the frequency of visits to a diabetic care provider that warrant a 60- or 100-percent evaluation. We eliminated the requirement for a "large" or "moderate" insulin dosage at the 40- and 20-percent levels respectively because the severity of diabetes is better determined by the degree of control in response to treatment than by the amount of medication required for control.

We deleted from the criteria for the 10- and 20-percent evaluation levels under DC 7913 the requirement "without impairment of health or vigor or limitation of activity" because they do not affirmatively denote required criteria for those evaluation levels. A requirement for regulation of activities was formerly one of the criteria for the 40- and 100-percent levels but not for the 60-percent level. For the sake of consistency, we have made "regulation of activities" one of the required criteria for the 40-. 60-, and 100-percent levels. We clarified the meaning of "severe" complications of diabetes and how to evaluate complications by means of a note and by including a reference to complications that would and would not be separately compensable under the 100- and 60-percent criteria respectively.

Under DC 7914, malignant neoplasms of the endocrine system, we made changes in the convalescent period following treatment that are similar to changes we have made in other body systems, i.e., requiring a mandatory VA examination 6 months following completion of treatment and implementation of § 3.105(e) before any reduction can be made.

We added four commonly occurring endocrine disorders: hyperpituitarism (prolactin secreting pituitary dysfunction) as DC 7916, hyperaldosteronism (benign or malignant) as DC 7917, and pheochromocytoma (benign or malignant) as DC 7918), all to be evaluated as malignant or benign neoplasm as appropriate, and C-cell hyperplasia of the thyroid as DC 7919, to be evaluated as malignant neoplasm.

We removed one condition from this section, hyperadrenia (adrenal genital syndrome), DC 7910, because it is a condition that occurs during infancy and childhood and is rarely encountered in individuals in service.

Diagnostic codes Diagnostic codes Diagnostic codes

revised added removed

7900 7916 7910

7901 7917

7902 7918

7903 7919

7904

7905

7907

7908

7909

7911

7912

7913

7914

7915

REGULATORY AMENDMENT

4-96-3

Regulation affected: 38 CFR 4.88 and 4.88b

EFFECTIVE DATE OF REGULATION: August 30, 1996

Date Secretary approved regulation: March 7, 1996

Federal Register Citation: 61 FR 39873 (July 31, 1996)

The purpose of the following comment on the changes included in this amendment of VA regulations is to inform all concerned why this change is being made. This comment is not regulatory.

As part of its ongoing revision of the Schedule for Rating Disabilities, the Department of Veterans Affairs (VA) has amended sections 4.88 and 4.88b of 38 CFR, Part 4, the sections of the rating schedule that deal with infectious diseases, immune disorders, and nutritional deficiencies. The intended effect of this action is to update these sections to ensure that they use current medical terminology and unambiguous criteria, and that they reflect medical advances which have occurred since the last review.

We changed the title of this portion of the rating schedule from "Systemic diseases" to "Infectious diseases, immune disorders, and nutritional deficiencies" because the former title did not adequately depict the range of conditions that this section addresses.

We changed the convalescent period for Asiatic cholera (DC 6300) from six months to three months because treatment of this condition is now simple, and the condition is ordinarily self-limited to a few days duration. We also added a note under DC 6300 regarding the rating of residuals to assure that they will be evaluated.

We changed the title of DC 6301 from "kala-azar" to the more modern term for this condition, "visceral leishmaniasis." We also changed the convalescent period for this condition from one year to a requirement for a VA examination six months after the date of inactivity and any reduction in the total evaluation to be made under the provisions of § 3.105(e). This convalescence will allow a period for recuperation and also assure that the extent of residual impairment is documented by examination before any change in evaluation is considered. We added a note under DC 6301 regarding the rating of residuals such as liver damage or lymphadenopathy to assure that they will be evaluated.

Similarly, we changed the period of convalescence for leprosy (DC 6302) from one year to a requirement for a VA examination six months after the date of inactivity and any reduction in the total evaluation to be made under the provisions of § 3.105(e). This change was made for the same reason as for leishmaniasis. We edited the note regarding residuals, removing the instructions regarding contagious and noncontagious cases, because all active disease is regarded as 100 percent disabling; and, following the period of convalescence, the condition is to be evaluated on the basis of residuals such as skin lesions or peripheral neuropathy.

We changed the criteria for the evaluation of malaria (DC 6304) from those based on number of relapses and presence of symptoms such as anemia to a direction to rate active disease at 100 percent, since active infection is normally totally disabling, and there is no need to specify the signs and symptoms. We also provided a note explaining the diagnostic requirements for malaria in current medical practice and directing that residuals be rated under the appropriate system. This information replaces the two former notes that discussed diagnosis and evaluation.

We changed the title of DC 6305 from "filariasis" to "lymphatic filariasis" because the criteria formerly used for the evaluation of filariasis applied only to the lymphatic type. Other types of filariasis are included in DC 6320, Parasitic diseases otherwise not specified. We simplified the evaluation by changing the criteria from those based on recurrences and involvement of extremities and genitalia to a direction to rate active disease at 100 percent and to rate residuals under the appropriate system, as we have done for a number of infectious diseases, and for the same reasons as discussed under malaria.

We modernized the title of DC 6306 by changing it from Oroya fever to Bartonellosis. We changed the period of convalescence from six months to three months, which is an adequate period of time for recuperation and stabilization of red blood cells in the average individual, according to our consultants. We also added a note regarding evaluation of residuals.

The only change we made under DC 6307, plague, is the addition of a note regarding residuals, and under DC 6308, relapsing fever, we added specific examples of residuals that might occur—liver or spleen damage or central nervous system involvement. We made only minor editorial changes in DC 6309, rheumatic fever. We also made editorial changes under DC 6310, syphilis, expanded the title to "syphilis, and other treponemal infections" to accommodate additional treponemal conditions that can be rated similarly, and listed specific diagnostic codes where complications might be rated. Under DC 6311, miliary tuberculosis, we referred the rater to §§ 4.88c or 4.89, the specific sections that apply to the evaluation of inactive nonpulmonary disease.

For the convenience of the rater, we repeated the criteria for the evaluation of pellagra, DC 6315, under DC 6313, avitaminosis, rather than referring the rater to DC 6315. We provided more objective criteria for beriberi, DC 6314, providing evaluation levels of 30- 60- and 100-percent. We removed the 10-percent level because it was to be assigned for "moderate residuals." By removing this level and adding a note regarding residuals, we provide more latitude in evaluating residuals at any level of disability and also indicate that active beriberi warrants at least a 30 percent evaluation.

We revised the criteria for the evaluation of pellagra, DC 6315, by removing subjective language and otherwise made only minor changes. We removed "Malta or undulant fever," alternative names that are no longer used, from the title of DC 6316, Brucellosis. We revised the criteria by establishing a 100-percent evaluation for active disease. We removed all other criteria and instead stated that residuals such as liver or spleen damage or meningitis are to be rated under the appropriate system.

We changed the period of convalescence for scrub typhus, DC 6317, from six months to three months because with modern therapy, recovery is prompt and uneventful, and convalescence is short. We also updated the note regarding the evaluation of residuals.

For melioidosis, DC 6318, we changed the requirement for 100 percent to active disease, as we have done for several other infectious diseases, rather than requiring specific signs or symptoms, and we modified the note regarding residuals.

We added two new diagnostic codes: 6319 for Lyme disease, which has been identified as a distinct disease and occurs often enough in the veteran population to warrant a separate code, and 6320, parasitic diseases otherwise not specified, to accommodate all parasitic diseases not otherwise listed without the need to rate by analogy. Active disease under both new codes warrants 100 percent, and residuals are to be rated under the appropriate system.

We changed the evaluation percentage levels and the criteria for lupus erythematosus, DC 6350, because the former three highest levels were indistinguishable clinically, and they are now included in the 100-percent evaluation level. Furthermore, two or three exacerbations per year of a week or more were felt to be more consistent with a 60-percent level of evaluation rather than the current 30 percent. We also added two additional potential residuals, adverse effects of medication, and neurological complications, to the note regarding residuals and also revised the note for clarity.

Section 4.88 is removed and reserved.

Diagnostic codes Diagnostic codes Diagnostic codes

revised added removed

6300 6319 NONE

6301 6320

6302

6304

6305

6306

6307

6308

6309

6310

6311

6313

6314

6315

6316

6317

6318

6350

REGULATORY AMENDMENT

4-96-4

Regulation affected: 38 CFR 4.96 and 4.97

EFFECTIVE DATE OF REGULATION: October 7, 1996

Date Secretary approved regulation: May 13, 1996

Federal Register Citation: 61FR 46720-31

The purpose of the following comment on the changes included in this amendment of VA regulations is to inform all concerned why this change is being made. This comment is not regulatory.

As part of its ongoing revision of the Schedule for Rating Disabilities, the Department of Veterans Affairs (VA) has amended sections 4.96 and 4.97 of 38 CFR, Part 4, the sections of the rating schedule that deal with the respiratory system. The intended effect of this action is to update this portion of the rating schedule to ensure that it uses current medical terminology and unambiguous criteria, and that it reflects medical advances which have occurred since the last review.

We revised § 4.96 (a) only to reflect changed diagnostic codes in § 4.97. We added paragraph (c), concerning special monthly compensation (SMC), to § 4.96 as an additional reminder to the rating agency to refer to § 3.350 of this chapter to determine whether the veteran may be entitled to SMC. We also retitled § 4.96 to better reflect its content.

We have made one other change to remind the rating agency to consider SMC when there is organic aphonia. We placed footnotes at DC's 6518 (total laryngectomy) and 6519 (complete organic aphonia), conditions that may be associated with complete organic aphonia, directing to review for entitlement to SMC.

We removed chronic atrophic rhinitis (DC 6501) and in its place added three new diagnostic codes for specific types of rhinitis that may result in atrophic rhinitis: DC's 6522, allergic or vasomotor rhinitis, with evaluation levels of 10 and 30 percent; 6523, bacterial rhinitis, with evaluation levels of 10 and 50 percent; and 6524, granulomatous rhinitis, with evaluation levels of 20 and 100 percent. The percentage levels are highest for granulomatous diseases because they are most seriously disabling.

We modernized the title of DC 6502 by changing it from "septum, nasal, deflection of" to "septum, nasal, deviation of" and made the criteria more objective by requiring 50-percent obstruction of the nasal passage on both sides or complete obstruction on one side for a 10-percent evaluation rather than using the indefinite term "marked" for the required degree of interference with the breathing space.

We changed "exposing both nares" to "exposing both nasal passages" under DC 6504 (nose, loss of part of, or scars) for clarity, and added a note regarding alternative evaluation under DC 7800, scars, disfiguring, head, face, or neck.

We provided a general rating formula for sinusitis (DC's 6510 through 6514) based on more objective criteria, including signs, symptoms, and frequency of nonincapacitating episodes, and frequency and duration of antibiotic treatment of incapacitating episodes (defined in a note) that warrant a 10- or 30-percent evaluation, and specific findings following surgery that warrant a 50-percent evaluation.

In order to clarify and distinguish the criteria for the given percentages of DC 6516, chronic laryngitis, we have removed the indefinite terms "severe," "marked," and "moderate" and revised the requirements for a ten-percent evaluation to "hoarseness with inflammation of cords or mucous membrane" and for a thirty-percent evaluation to "hoarseness with thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes on biopsy." We removed DC 6517, healed injuries of larynx, and combined residuals of laryngeal trauma and stenosis of the larynx under DC 6520, larynx, stenosis of, including residuals of laryngeal trauma, with evaluation based on results of pulmonary function testing or on aphonia (under DC 6519). This provides more flexibility by providing alternative methods of evaluation. Under laryngectomy, DC 6518, in addition to adding a footnote regarding SMC, we added a direction on the evaluation of partial laryngectomy under DC's 6516, 6519, or 6520. We added more objective criteria for the evaluation of larynx, stenosis of, including residuals of laryngeal trauma (DC 6520) by basing them on pulmonary function tests (FEV-1) and the pattern of the Flow-Volume Loop instead of on subjective indicators such as whether there is dyspnea on "slight," "moderate," or "heavy" exertion.

We added a new diagnostic code, DC 6521, for injuries to the pharynx, with a single evaluation level of 50-percent based on the presence of stricture or obstruction of the pharynx or nasopharynx or on paralysis or absence of the soft palate.

We made the evaluation criteria for chronic bronchitis (DC 6600) more objective by basing them on the results of pulmonary function tests or, for the 100-percent level, the alternative criteria of cor pulmonale, right ventricular hypertrophy, pulmonary hypertension, episode(s) of acute respiratory failure, or a need for outpatient oxygen therapy. We established the similar criteria for conditions with similar functional impairments: pulmonary emphysema (DC 6603), chronic obstructive pulmonary disease (DC 6604), and the restrictive lung diseases--diaphragm paralysis or paresis (DC 6840), spinal cord injury with respiratory insufficiency (DC 6841), kyphoscoliosis, pectus excavatum, pectus carinatum (DC 6842), traumatic chest wall defect (DC 6843), post-surgical residual (DC 6844), and chronic pleural effusion or fibrosis (DC 6845).

We removed indefinite terms such as "pronounced," "severe," "considerable," "occasional," "moderate," etc., from the criteria under DC 6601, bronchiectasis and instead provided more objective, but flexible, criteria based either on the total duration per year of incapacitating episodes of infection, or on symptoms requiring a certain frequency and duration of antibiotic treatment. Using pulmonary impairment as for chronic bronchitis as an alternative was also added. We removed indefinite terms such as "pronounced," "severe," "frequent," and "several" from the criteria for bronchial asthma (DC 6602) and provided objective evaluation criteria based either on the results of selected pulmonary function tests (FEV-1 or FEV-1/FVC) or on treatment requirements.

We made a technical change in Note (1) under the general rating formula for inactive pulmonary tuberculosis by referring to a footnote under 38 U.S.C. 1156 rather than to 38 U.S.C. 356, as in the former schedule, because 38 U.S.C. has been repealed by Public Law 90-493. Because of modern treatment methods of tuberculosis, we have revised the provision under DC 6731 (tuberculosis, pulmonary, chronic, inactive) for a total evaluation for one year after date of attainment of inactivity of tuberculosis to the requirement for a mandatory examination to be requested immediately following notification that active tuberculosis under DC 6730 has become inactive, and with any change in evaluation to be carried out under the provisions of § 3.105(e). We also removed subjective terms such as "pronounced," "severe," "extensive," and "slight" from the former criteria and replaced them with more objective, but flexible, criteria by directing to rate residuals as interstitial lung disease, restrictive lung disease, or, when obstructive lung disease is the major residual, as chronic bronchitis and to rate thoracoplasty as removal of ribs under DC 5297.

We reorganized the nontuberculous diseases that formerly included DC's 6800 through 6821 by grouping most of them into several categories--bacterial infections of the lung, interstitial lung disease, mycotic lung disease, and restrictive lung disease--and by providing a general rating formula for each of these categories of disease. Many conditions were given new diagnostic codes in order to group conditions in the same category together. Bacterial infections of the lung include actinomycosis, DC 6822 (formerly 6803); nocardiosis, DC 6823 (a new condition added because it is one of the common conditions in this category), and chronic lung abscess, DC 6824 (formerly DC 6809). This group is evaluated under a general rating formula with a total evaluation when there is active infection with systemic symptoms, and residuals are evaluated as interstitial or restrictive lung disease, or as chronic bronchitis when obstructive lung disease is the major residual. We deleted streptotrichosis of lung (DC 6804), because this is a term no longer in use.

We deleted DC's 6800 (anthracosis), 6801 (silicosis), and 6802 (pneumoconiosis, unspecified) and included all of these in the newly added DC 6832, titled "pneumoconiosis (silicosis, anthracosis, etc.)" in the category of interstitial lung disease. We also added under this category: diffuse interstitial fibrosis (DC 6825), desquamative interstitial pneumonitis (DC 6826), pulmonary alveolar proteinosis (DC 6827), eosinophilic granuloma of lung (DC 6828), drug-induced pulmonary pneumonitis and fibrosis (DC 6829), radiation-induced pulmonary pneumonitis and fibrosis (DC 6830), hypersensitivity pneumonitis (DC 6831), and asbestosis (DC 6832). All of these are evaluated under a general rating formula for interstitial lung disease that has 10-, 30-, 60-, and 100-percent evaluation levels based on FVC, DLCO, maximum exercise capacity measured in oxygen consumption, or, at the 100-percent level, alternative criteria of cor pulmonale, pulmonary hypertension, or a requirement for outpatient oxygen therapy.

For mycotic diseases, we removed sporotrichosis (DC 6806) because it usually affects only skin and lymph nodes rather than lung, and mycosis of lung, unspecified (DC 6808), and assigned new diagnostic codes for blastomycosis (changed from DC 6805 to 6836), aspergillosis (changed from DC 6807 to 6838), and coccidioidomycosis (changed from DC 6821 to 6835). We added histoplasmosis of lung (DC 6833), cryptococcosis (DC 6837), and mucormycosis (DC 6838). All of the mycotic diseases are evaluated under a general rating formula with percentage evaluation levels of zero-, 30- 50-, and 100-percent based on symptoms and treatment requirements. We placed the note (edited) about the incubation period of coccidioidomycosis that had been under DC 6821 under the general rating formula.

For restrictive lung diseases, we removed serofibrinous pleurisy (DC 6810), purulent pleurisy (DC 6811), bronchocutaneous or bronchopleural fistula (DC 6812), permanent collapse of the lung (DC 6813), spontaneous pneumothorax (DC 6814), pneumonectomy (DC 6815), lobectomy (DC 6816), and residuals of pleural cavity injuries (DC 6818). We added diaphragm paralysis or paresis (DC 6839); spinal cord injury with respiratory insufficiency (DC 6840); kyphoscoliosis, pectus excavatum, pectus carinatum (DC 6841); traumatic chest wall defect, pneumothorax, hernia, etc. (DC 6842); post-surgical residuals (lobectomy, pneumonectomy, etc.) (DC 6843); and chronic pleural effusion or fibrosis (DC 6844). DC 6813 was removed because collapse therapy for tuberculosis is no longer common. The conditions currently rated as pleurisy will be rated as chronic pleural effusion or fibrosis; fistula, pneumonectomy, and lobectomy will be rated under post-surgical residuals; pleural cavity injuries and pneumothorax will be rated as traumatic chest wall defect. The restrictive lung diseases will be evaluated under a general rating formula with 10-, 30-, 60-, and 100-percent levels based on the same criteria used to evaluate chronic bronchitis, emphysema, etc. Alternatively, the primary disorder may be rated.

We added three notes following the rating formula for restrictive lung diseases. One note stipulates a three-month period of convalescent evaluation from the date of hospital admission for a total spontaneous pneumothorax, a change from the assignment of a 100-percent evaluation for six months for spontaneous pneumothorax under DC 6814. A second note states that pleurisy with empyema will be evaluated at 100 percent until resolved. There was a range of evaluation levels from 10 to 100 percent in the former schedule. The third note discusses the evaluation of gunshot wounds of the pleural cavity, and this represents no substantive change from directions in the former schedule except for an added statement that muscle group XXI (the respiratory muscles) will not be combined with these injuries, a statement added to prevent pyramiding in evaluating these disabilities.

We retitled DC 6817 (lung, chronic passive congestion of) to "pulmonary vascular disease," a more inclusive title to accommodate all types of pulmonary vascular disease. Evaluation under this diagnostic code was formerly done by rating the underlying disease. However, we have provided objective criteria specific to pulmonary vascular disease with evaluation percentage levels of 100-, 60-, 30, and zero-percent.

We changed the method of evaluating respiratory system malignancies in favor of the same system we have used in other revised sections of the rating schedule, namely, a mandatory examination six following cessation of therapy, and implementation of any change in the total evaluation under the provisions of § 3.105(e).

We added a new diagnostic code, 6846, for sarcoidosis, with evaluation levels of zero, 30, 60, and 100 percent based on symptoms, cardiac involvement, treatment requirements, and X-ray findings. Alternatively, sarcoidosis can be evaluated as chronic bronchitis or, with extra-pulmonary involvement, under the specific body system involved. We also added a new diagnostic code, 6847, for sleep apnea, with evaluation levels of zero, 30, 50, and 100 percent based on symptoms, treatment requirements, and the presence of cor pulmonale or respiratory failure.

Diagnostic codes Diagnostic codes Diagnostic codes

revised removed added

6502 6501 6521

6504 6517 6522

6510 6800 6523

6511 6801 6524

6512 6802 6604

6513 6803 6822

6514 6804 6823

6515 6805 6824

6516 6806 6825

6518 6807 6826

6519 6808 6827

6520 6809 6828

6600 6810 6829

6601 6811 6830

6602 6812 6831

6603 6813 6832

6730 6814 6833

6731 6815 6834

6732 6816 6835

6817 6818 6836

6819 6837

6820 6838

6839

6840

6841

6842

6843

6844