The Schedule for Rating Disabilities

(original, current text with links to our interpretations)
Page 2 of 3

This page contains the original VASRD text for the Respiratory System, the Cardiovascular System, the Digestive System, the Genitourinary System, and all Gynecological Conditions. For the original VASRD text of the VASRD Principles, conditions of the Musculoskeletal System, the Sensory Organs, Infectious Diseases, Immune Disorders, and Nutritional Deficiencies, see page 1. For the original VASRD text for the Hemic and Lymphatic Systems, the Skin, the Endocrine System, Neurological Conditions, Convulsive Disorders, Mental Disorders, and Dental and Oral conditions, see page 3.

Subpart B—Disability Ratings Con't
The Respiratory System
The Cardiovascular System
The Digestive System
The Genitourinary System
Gynecological Conditions and Disorders of the Breast

Subpart B—Disability Ratings Con't

The Respiratory System

4.96 Special provisions regarding evaluation of respiratory conditions
4.97 Schedule of ratings—respiratory system
Diseases of the Nose and Throat
Diseases of the Trachea and Bronchi
Diseases of the Lungs and Pleura—Tuberculosis
Nontuberculous Diseases
Bacterial Infections of the Lungs
Interstitial Lung Diseases
Mycotic Lung Diseases
Restrictive Lung Diseases

The Cardiovascular System

4.100 Application of the evaluation criteria for diagnostic codes 7000–7007, 7011, and 7015–7020
4.104 Schedule of ratings—cardiovascular system
Diseases of the Heart
Diseases of the Arteries and Veins

The Digestive System

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

The Genitourinary System

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

Gynecological Conditions and Disorders of the Breast

4.116 Schedule of ratings–gynecological conditions and disorders of the breast

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Subpart B—Disability Ratings

The Respiratory System

§4.96 Special provisions regarding evaluation of respiratory conditions.

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

(b) Rating “protected” tuberculosis cases. Public Law 90-493 repealed section 1156 of title 38, United States Code which had provided graduated ratings for inactive tuberculosis. The repealed section, however, still applies to the case of any veteran who on August 19, 1968, was receiving or entitled to receive compensation for tuberculosis. The use of the protective provisions of Pub. L. 90-493 should be mentioned in the discussion portion of all ratings in which these provisions are applied. For application in rating cases in which the protective provisions of Pub. L. 90-493 apply the former evaluations pertaining to pulmonary tuberculosis are retained in §4.97.

(c) Special monthly compensation. When evaluating any claim involving complete organic aphonia, refer to §3.350 of this chapter to determine whether the veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation. (Authority: 38 U.S.C. 1155)

(d) Special provisions for the application of evaluation criteria for diagnostic codes 6600, 6603, 6604, 6825–6833, and 6840–6845.

(1) Pulmonary function tests (PFT’s) are required to evaluate these conditions except:

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

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

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

(iv) When outpatient oxygen therapy is required.

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

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

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

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

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

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

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

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§4.97 Schedule of ratings—respiratory system.

Diseases of the Nose and Throat

6502 Septum, nasal, deviation of:
Traumatic only,

With 50-percent obstruction of the nasal passage on both sides
or complete obstruction on one side....................................................................... 10

6504 Nose, loss of part of, or scars:

Exposing both nasal passages ............................................................................... 30
Loss of part of one ala, or other obvious disfigurement............................................ 10

Note: Or evaluate as DC 7800, scars, disfiguring, head, face, or neck.

6510 Sinusitis, pansinusitis, chronic.

6511 Sinusitis, ethmoid, chronic.

6512 Sinusitis, frontal, chronic.

6513 Sinusitis, maxillary, chronic.

6514 Sinusitis, sphenoid, chronic.


General Rating Formula for Sinusitis (DC’s 6510 through 6514):

Following radical surgery with chronic osteomyelitis, or; near
constant sinusitis characterized by headaches, pain and
tenderness of affected sinus, and purulent discharge or
crusting after repeated surgeries...................................................................... 50

Three or more incapacitating episodes per year of sinusitis requiring
prolonged (lasting four to six weeks) antibiotic treatment, or;
more than six non-incapacitating episodes per year of sinusitis
characterized by headaches, pain, and purulent discharge or
crusting......................................................................................................... 30

One or two incapacitating episodes per year of sinusitis requiring
prolonged (lasting four to six weeks) antibiotic treatment, or; three
to six non-incapacitating episodes per year of sinusitis characterized
by headaches, pain, and purulent discharge or crusting ..................................... 10

Detected by X-ray only.................................................................................... 0

Note: An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician.

6515 Laryngitis, tuberculous, active or inactive.
Rate under §§4.88c or 4.89, whichever is appropriate.

6516 Laryngitis, chronic:

Hoarseness, with thickening or nodules of cords, polyps,
submucous infiltration, or pre-malignant changes on biopsy................................ 30

Hoarseness, with inflammation of cords or mucous membrane........................... 10

6518 Laryngectomy, total. ..................................................................................1100
Rate the residuals of partial laryngectomy as laryngitis (DC 6516),
aphonia (DC 6519), or stenosis of larynx (DC 6520).

6519 Aphonia, complete organic:

Constant inability to communicate by speech ..................................................1100

Constant inability to speak above a whisper ...................................................... 60

Note: Evaluate incomplete aphonia as laryngitis, chronic (DC 6516).

6520 Larynx, stenosis of, including residuals of laryngeal trauma
(unilateral or bilateral):

Forced expiratory volume in one second (FEV-1) less than
40 percent of predicted value, with Flow-Volume Loop
compatible with upper airway obstruction, or; permanent
tracheostomy................................................................................................. 100

FEV-1 of 40- to 55-percent predicted, with Flow-Volume Loop
compatible with upper airway obstruction.......................................................... 60

FEV-1 of 56- to 70-percent predicted, with Flow-Volume Loop
compatible with upper airway obstruction.......................................................... 30

FEV-1 of 71- to 80-percent predicted, with Flow-Volume Loop
compatible with upper airway obstruction.......................................................... 10

Note: Or evaluate as aphonia (DC 6519).

6521 Pharynx, injuries to:

Stricture or obstruction of pharynx or nasopharynx, or; absence of
soft palate secondary to trauma, chemical burn, or granulomatous
disease, or; paralysis of soft palate with swallowing difficulty
(nasal regurgitation) and speech impairment....................................................... 50

6522 Allergic or vasomotor rhinitis:

With polyps .................................................................................................... 30

Without polyps, but with greater than 50-percent obstruction of nasal
passage on both sides or complete obstruction on one side................................... 10

6523 Bacterial rhinitis:

Rhinoscleroma ................................................................................................ 50

With permanent hypertrophy of turbinates and with greater
than 50-percent obstruction of nasal passage on both sides or
complete obstruction on one side ...................................................................... 10

6524 Granulomatous rhinitis:

Wegener’s granulomatosis, lethal midline granuloma .......................................... 100
Other types of granulomatous infection .............................................................. 20

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

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Diseases of the Trachea and Bronchi

 

6600 Bronchitis, chronic:

FEV-1 less than 40 percent of predicted value, or; the ratio of
Forced Expiratory Volume in one second to Forced Vital Capacity
(FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the
Lung for Carbon Monoxide by the Single Breath Method (DLCO
(SB)) less than 40-percent predicted, or; maximum exercise capacity
less than 15 ml/kg/min oxygen consumption (with cardiac or
respiratory limitation), or; cor pulmonale (right heart failure), or;
right ventricular hypertrophy, or; pulmonary hypertension (shown
by Echo or cardiac catheterization), or; episode(s) of acute
respiratory failure, or; requires outpatient oxygen therapy ................................... 100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55
percent, or; DLCO (SB) of 40- to 55-percent predicted, or;
maximum oxygen consumption of 15 to 20 ml/kg/min (with
cardiorespiratory limit) ...................................................................................... 60

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70
percent, or; DLCO (SB) 56- to 65-percent predicted............................................. 30

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80
percent, or; DLCO (SB) 66- to 80-percent predicted............................................. 10

6601 Bronchiectasis:

With incapacitating episodes of infection of at least six weeks total
duration per year............................................................................................... 100

With incapacitating episodes of infection of four to six weeks total
duration per year, or; near constant findings of cough with
purulent sputum associated with anorexia, weight loss, and frank
hemoptysis and requiring antibiotic usage almost continuously.................................. 60

With incapacitating episodes of infection of two to four weeks total
duration per year, or; daily productive cough with sputum that is
at times purulent or blood-tinged and that requires prolonged (lasting
four to six weeks) antibiotic usage more than twice a year........................................ 30

Intermittent productive cough with acute infection requiring a course
of antibiotics at least twice a year........................................................................... 10

Or rate according to pulmonary impairment as for chronic bronchitis (DC 6600).

Note: An incapacitating episode is one that requires bedrest and treatment by a physician.

6602 Asthma, bronchial:

FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than
40 percent, or; more than one attack per week with episodes of
respiratory failure, or; requires daily use of systemic (oral or
parenteral) high dose corticosteroids or immuno-suppressive
medications......................................................................................................... 100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55
percent, or; at least monthly visits to a physician for required
care of exacerbations, or; intermittent (at least three per year)
courses of systemic (oral or parenteral) corticosteroids.............................................. 60

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70
percent, or; daily inhalational or oral bronchodilator therapy,
or; inhalational anti-inflammatory medication............................................................ 30

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80
percent, or; intermittent inhalational or oral bronchodilator therapy.............................. 10

Note: In the absence of clinical findings of asthma at time of examination, a verified history of asthmatic attacks must be of record.

Per DoDI 1332.39, para. E2.A1.2.12. 6600-6630. Disease of the Trachea and Bronchi. Unless contraindicated, pulmonary function tests, performed both with and without medication, must confirm the clinical diagnosis and severity (See Table 2). If the Service member's condition is subject to significant variation over time, a single clinical and pulmonary function evaluation may not be adequate. Response to therapy is to be considered in all cases. The following pulmonary function test values serve as guidelines in determining ratings (See Table 2).

TABLE 2

PULMONARY FUNCTION TEST VALUES 1

                                    (FEV-1)
                                    Forced Expiratory Volume (FEV-1)                                     Rating
                                     (Percentage of predicted)___________________________________
                                    Chronic Obstructive Pulmonary Disease
                                    (Before Bronchodilators)
                                    50 or less                                                                           Severe
                                     55-65                                                               Moderate, moderately severe
                                     65-70                                                                                  Mild
                                    70 or better                                                                        Normal
                                     Vital Capacity (VC)

                                    (Percentage of predicted)                                                       Rating

                                    Chronic Restrictive Pulmonary Disease

                                    50 or less                                                                              Severe
                                    55-65                                                                    Moderate, moderately severe
                                    65-80                                                                                     Mild
                                    80 or better                                                                           Normal
                                    1The AMA "Guides to the Evaluation of Permanent Impairment," while
                                    differing slightly from the above values, is otherwise helpful in
                                    interpreting clinical and functional values. There are no FEV-1
                                    Percentage or VC Percentage between 51 and 54.

 

6603 Emphysema, pulmonary:

FEV-1 less than 40 percent of predicted value, or; the ratio of Forced
Expiratory Volume in one second to Forced Vital Capacity
(FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the
Lung for Carbon Monoxide by the Single Breath Method (DLCO
(SB)) less than 40-percent predicted, or; maximum exercise capacity
less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory
limitation), or; cor pulmonale (right heart failure), or; right
ventricular hypertrophy, or; pulmonary hypertension (shown by
Echo or cardiac catheterization), or; episode(s) of acute respiratory
failure, or; requires outpatient oxygen therapy................................................... 100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55
percent, or; DLCO (SB) of 40- to 55-percent predicted, or;
maximum oxygen consumption of 15 to 20 ml/kg/min (with
cardiorespiratory limit)...................................................................................... 60

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70
percent, or; DLCO (SB) 56- to 65-percent predicted............................................ 30

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80
percent, or; DLCO (SB) 66- to 80-percent predicted............................................ 10

6604 Chronic obstructive pulmonary disease (COPD):

FEV-1 less than 40 percent of predicted value, or; the ratio of
Forced Expiratory Volume in one second to Forced Vital Capacity
(FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the
Lung for Carbon Monoxide by the Single Breath Method (DLCO
(SB)) less than 40-percent predicted, or; maximum exercise capacity
less than 15 ml/kg/min oxygen consumption (with cardiac or
respiratory limitation), or; cor pulmonale (right heart failure), or;
right ventricular hypertrophy, or; pulmonary hypertension (shown
by Echo or cardiac catheterization), or; episode(s) of acute
respiratory failure, or; requires outpatient oxygen therapy..................................... 100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55
percent, or; DLCO (SB) of 40- to 55-percent predicted, or;
maximum oxygen consumption of 15 to 20 ml/kg/min (with
cardiorespiratory limit) ....................................................................................... 60

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70
percent, or; DLCO (SB) 56- to 65-percent predicted.............................................. 30

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80
percent, or; DLCO (SB) 66- to 80-percent predicted.............................................. 10

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Diseases of the Lungs and Pleura—Tuberculosis

Ratings for Pulmonary Tuberculosis Initially Evaluated After August 19, 1968

6730 Tuberculosis, pulmonary, chronic, active.............................................................. 100

Note: Active pulmonary tuberculosis will be considered permanently and totally disabling for non-service-connected pension purposes in the following circumstances:

(a) Associated with active tuberculosis involving other than the respiratory system.
(b) With severe associated symptoms or with extensive cavity formation.
(c) Reactivated cases, generally.
(d) With advancement of lesions on successive examinations or while under
treatment.
(e) Without retrogression of lesions or other evidence of material
improvement at the end of six months hospitalization or without
change of diagnosis from “active” at the end of 12 months hospitalization.
Material improvement means lessening or absence of clinical symptoms,
and X-ray findings of a stationary or retrogressive lesion.

6731 Tuberculosis, pulmonary, chronic, inactive:
Depending on the specific findings, rate residuals as interstitial lung
disease, restrictive lung disease, or, when obstructive lung disease is
the major residual, as chronic bronchitis (DC 6600). Rate thoracoplasty
as removal of ribs under DC 5297.

Note: A mandatory examination will be requested immediately following notification that active tuberculosis evaluated under DC 6730 has become inactive. Any change in evaluation will be carried out under the provisions of §3.105(e).

6732 Pleurisy, tuberculous, active or inactive:

Rate under §§4.88c or 4.89, whichever is appropriate.

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Nontuberculous Diseases

6817 Pulmonary Vascular Disease:

Primary pulmonary hypertension, or; chronic pulmonary thrombo-
embolism with evidence of pulmonary hypertension, right
ventricular hypertrophy, or cor pulmonale, or; pulmonary
hypertension secondary to other obstructive disease of pulmonary
arteries or veins with evidence of right ventricular hypertrophy or
cor pulmonale....................................................................................................... 100

Chronic pulmonary thromboembolism requiring anticoagulant therapy,
or; following inferior vena cava surgery without evidence of
pulmonary hypertension or right ventricular dysfunction............................................. 60

Symptomatic, following resolution of acute pulmonary embolism................................ 30

Asymptomatic, following resolution of pulmonary thromboembolism............................ 0

Note: Evaluate other residuals following pulmonary embolism under the most appropriate diagnostic code, such as chronic bronchitis (DC 6600) or chronic pleural effusion or fibrosis (DC 6844), but do not combine that evaluation with any of the above evaluations.

6819 Neoplasms, malignant, any specified part of respiratory system exclusive
of skin growths....................................................................................................... 100

Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.

6820 Neoplasms, benign, any specified part of respiratory system. Evaluate using an
appropriate respiratory analogy.

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Bacterial Infections of the Lung

6822 Actinomycosis.

6823 Nocardiosis.

6824 Chronic lung abscess.
General Rating Formula for Bacterial Infections of the Lung (diagnostic codes
6822 through 6824):
Active infection with systemic symptoms such as fever, night sweats,
weight loss, or hemoptysis............................................................................... 100
Depending on the specific findings, rate residuals as interstitial lung
disease, restrictive lung disease, or, when obstructive lung disease is
the major residual, as chronic bronchitis (DC 6600).
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Interstitial Lung Disease

6825 Diffuse interstitial fibrosis (interstitial pneumonitis, fibrosing alveolitis).

6826 Desquamative interstitial pneumonitis.

6827 Pulmonary alveolar proteinosis.

6828 Eosinophilic granuloma of lung.

6829 Drug-induced pulmonary pneumonitis and fibrosis.

6830 Radiation-induced pulmonary pneumonitis and fibrosis.

6831 Hypersensitivity pneumonitis (extrinsic allergic alveolitis).

6832 Pneumoconiosis (silicosis, anthracosis, etc.).

6833 Asbestosis.

General Rating Formula for Interstitial Lung Disease (diagnostic
codes 6825 through 6833):

Forced Vital Capacity (FVC) less than 50-percent predicted,
or; Diffusion Capacity of the Lung for Carbon Monoxide by the
Single Breath Method (DLCO (SB)) less than 40-percent predicted,
or; maximum exercise capacity less than 15 ml/kg/min oxygen
consumption with cardiorespiratory limitation, or; cor pulmonale
or pulmonary hypertension, or; requires outpatient oxygen
therapy ........................................................................................................ 100

FVC of 50- to 64-percent predicted, or; DLCO (SB) of 40- to
55-percent predicted, or; maximum exercise capacity of 15 to
20 ml/kg/min oxygen consumption with cardiorespiratory
limitation ....................................................................................................... 60

FVC of 65- to 74-percent predicted, or; DLCO (SB) of 56- to
65-percent predicted........................................................................................ 30

FVC of 75- to 80-percent predicted, or; DLCO (SB) of 66- to
80-percent predicted........................................................................................ 10

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Mycotic Lung Disease

6834 Histoplasmosis of lung.

6835 Coccidioidomycosis.

6836 Blastomycosis.

6837 Cryptococcosis.

6838 Aspergillosis.

6839 Mucormycosis.

General Rating Formula for Mycotic Lung Disease (diagnostic codes
6834 through 6839):

Chronic pulmonary mycosis with persistent fever, weight loss,
night sweats, or massive hemoptysis .............................................................. 100

Chronic pulmonary mycosis requiring suppressive therapy with
no more than minimal symptoms such as occasional minor
hemoptysis or productive cough...................................................................... 50

Chronic pulmonary mycosis with minimal symptoms such as
occasional minor hemoptysis or productive cough............................................. 30

Healed and inactive mycotic lesions, asymptomatic ............................................ 0

Note: Coccidioidomycosis has an incubation period up to 21 days, and the disseminated phase is ordinarily manifest within six months of the primary phase. However, there are instances of dissemination delayed up to many years after the initial infection which may have been unrecognized. Accordingly, when service connection is under consideration in the absence of record or other evidence of the disease in service, service in southwestern United States where the disease is endemic and absence of prolonged residence in this locality before or after service will be the deciding factor.

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Restrictive Lung Disease

6840 Diaphragm paralysis or paresis.

6841 Spinal cord injury with respiratory insufficiency.

6842 Kyphoscoliosis, pectus excavatum, pectus carinatum.

6843 Traumatic chest wall defect, pneumothorax, hernia, etc.

6844 Post-surgical residual (lobectomy, pneumonectomy, etc.).

6845 Chronic pleural effusion or fibrosis.

General Rating Formula for Restrictive Lung Disease
(diagnostic codes 6840 through 6845):

FEV-1 less than 40 percent of predicted value, or; the ratio of
Forced Expiratory Volume in one second to Forced Vital
Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity
of the Lung for Carbon Monoxide by the Single Breath Method
(DLCO (SB)) less than 40-percent predicted, or; maximum
exercise capacity less than 15 ml/kg/min oxygen consumption
(with cardiac or respiratory limitation), or; cor pulmonale (right
heart failure), or; right ventricular hypertrophy, or; pulmonary
hypertension (shown by Echo or cardiac catheterization), or;
episode(s) of acute respiratory failure, or; requires outpatient
oxygen therapy............................................................................................ 100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55
percent, or; DLCO (SB) of 40- to 55-percent predicted, or;
maximum oxygen consumption of 15 to 20 ml/kg/min (with
cardiorespiratory limit).................................................................................. 60

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70
percent, or; DLCO (SB) 56- to 65-percent predicted........................................ 30

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80
percent, or; DLCO (SB) 66- to 80-percent predicted........................................ 10

Or rate primary disorder.

Note (1): A 100-percent rating shall be assigned for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved.

Note (2): Following episodes of total spontaneous pneumothorax, a rating of 100 percent shall be assigned as of the date of hospital admission and shall continue for three months from the first day of the month after hospital discharge.

Note (3): Gunshot wounds of the pleural cavity with bullet or missile retained in lung, pain or discomfort on exertion, or with scattered rales or some limitation of excursion of diaphragm or of lower chest expansion shall be rated at least 20-percent disabling. Disabling injuries of shoulder girdle muscles (Groups I to IV) shall be separately rated and combined with ratings for respiratory involvement. Involvement of Muscle Group XXI (DC 5321), however, will not be separately rated.

6846 Sarcoidosis:

Cor pulmonale, or; cardiac involvement with congestive heart failure,
or; progressive pulmonary disease with fever, night sweats, and
weight loss despite treatment ........................................................................... 100

Pulmonary involvement requiring systemic high dose (therapeutic)
corticosteroids for control.................................................................................. 60

Pulmonary involvement with persistent symptoms requiring chronic
low dose (maintenance) or intermittent corticosteroids ......................................... 30

Chronic hilar adenopathy or stable lung infiltrates without symptoms
or physiologic impairment.................................................................................... 0

Or rate active disease or residuals as chronic bronchitis (DC 6600) and extra-
pulmonary involvement under specific body system involved

6847 Sleep Apnea Syndromes (Obstructive, Central, Mixed) (OSA):

Chronic respiratory failure with carbon dioxide retention or cor
pulmonale, or; requires tracheostomy................................................................. 100

Requires use of breathing assistance device such as continuous
airway pressure (CPAP) machine........................................................................ 50

Persistent day-time hypersomnolence ................................................................. 30

Asymptomatic but with documented sleep disorder breathing.................................. 0

[29 FR 6718, May 22, 1964, as amended at 34 FR 5062, Mar. 11, 1969; 40 FR 42539, Sept. 15, 1975; 41 FR 11300, Mar. 18, 1976; 43 FR 45361, Oct. 2, 1978; 46 FR 43666, Aug. 31, 1981; 61 FR 46728, Sept. 5, 1996; 71 FR 28586, May 17, 2006]

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The Cardiovascular System

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

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

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

(1) When there is a medical contraindication.

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

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

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

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

[71 FR 52460, Sept. 6, 2006]

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§4.104 Schedule of ratings—cardiovascular system.

Diseases of the Heart

Note 1: Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it.

Note 2: One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used.

7000 Valvular heart disease (including rheumatic heart disease):

During active infection with valvular heart damage and for three
months following cessation of therapy for the active infection ................................... 100

Thereafter, with valvular heart disease (documented by findings on
physical examination and either echocardiogram, Doppler
echocardiogram, or cardiac catheterization) resulting in:

Chronic congestive heart failure, or; workload of 3 METs or less
results in dyspnea, fatigue, angina, dizziness, or syncope,
or; left ventricular dysfunction with an ejection fraction of
less than 30 percent.......................................................................................... 100

More than one episode of acute congestive heart failure in the past
year, or; workload of greater than 3 METs but not greater than
5 METs results in dyspnea, fatigue, angina, dizziness, or syncope,
or; left ventricular dysfunction with an ejection fraction of
30 to 50 percent................................................................................................. 60

Workload of greater than 5 METs but not greater than 7 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electro-cardiogram,
echocardiogram, or X-ray.................................................................................... 30

Workload of greater than 7 METs but not greater than 10 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous
medication required............................................................................................ 10

7001 Endocarditis:

For three months following cessation of therapy for active infection
with cardiac involvement.......................................................................................... 100

Thereafter, with endocarditis (documented by findings on physical
examination and either echocardiogram, Doppler echocardiogram,
or cardiac catheterization) resulting in:

Chronic congestive heart failure, or; workload of 3 METs or less
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
left ventricular dysfunction with an ejection fraction of less than
30 percent......................................................................................................... 100

More than one episode of acute congestive heart failure in the past year,
or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
left ventricular dysfunction with an ejection fraction of 30 to
50 percent.......................................................................................................... 60

Workload of greater than 5 METs but not greater than 7 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electrocardiogram,
echocardiogram, or X-ray.................................................................................... 30

Workload of greater than 7 METs but not greater than 10 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
continuous medication required............................................................................ 10

7002 Pericarditis:

For three months following cessation of therapy for active infection
with cardiac involvement.......................................................................................... 100

Thereafter, with documented pericarditis resulting in:

Chronic congestive heart failure, or; workload of 3 METs or less
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
left ventricular dysfunction with an ejection fraction of less
than 30 percent................................................................................................. 100

More than one episode of acute congestive heart failure in the past year,
or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
left ventricular dysfunction with an ejection fraction of 30 to
50 percent.......................................................................................................... 60

Workload of greater than 5 METs but not greater than 7 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electro-cardiogram,
echocardiogram, or X-ray.................................................................................... 30

Workload of greater than 7 METs but not greater than 10 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous
medication required............................................................................................ 10

7003 Pericardial adhesions:

Chronic congestive heart failure, or; workload of 3 METs or less results
in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular
dysfunction with an ejection fraction of less than 30 percent................................ 100

More than one episode of acute congestive heart failure in the past
year, or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or; left
ventricular dysfunction with an ejection fraction of 30 to 50 percent..................... 60

Workload of greater than 5 METs but not greater than 7 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electro-cardiogram,
echocardiogram, or X-ray.................................................................................. 30

Workload of greater than 7 METs but not greater than 10 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous
medication required........................................................................................... 10

7004 Syphilitic heart disease:

Chronic congestive heart failure, or; workload of 3 METs or less
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
left ventricular dysfunction with an ejection fraction of less
than 30 percent................................................................................................ 100

More than one episode of acute congestive heart failure in the past year,
or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
left ventricular dysfunction with an ejection fraction of 30 to
50 percent......................................................................................................... 60

Workload of greater than 5 METs but not greater than 7 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electrocardiogram,
echocardiogram, or X-ray................................................................................... 30

Workload of greater than 7 METs but not greater than 10 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous
medication required............................................................................................ 10

Note: Evaluate syphilitic aortic aneurysms under DC 7110 (aortic aneurysm).


7005 Arteriosclerotic (atherosclerotic) heart disease (Coronary artery disease, CAD):
With documented coronary artery disease resulting in:

Chronic congestive heart failure, or; workload of 3 METs or less results
in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular
dysfunction with an ejection fraction of less than 30 percent....................................... 100

More than one episode of acute congestive heart failure in the past year,
or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or; left
ventricular dysfunction with an ejection fraction of 30 to 50 percent.............................. 60

Workload of greater than 5 METs but not greater than 7 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electrocardiogram,
echocardiogram, or X-ray........................................................................................... 30

Workload of greater than 7 METs but not greater than 10 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous
medication required................................................................................................... 10

Note: If nonservice-connected arteriosclerotic heart disease is superimposed on service-connected valvular or other non-arteriosclerotic heart disease, request a medical opinion as to which condition is causing the current signs and symptoms.

7006 Myocardial infarction:

During and for three months following myocardial infarction,.
documented by laboratory tests................................................................................ 100

Thereafter:

With history of documented myocardial infarction, resulting in:
Chronic congestive heart failure, or; workload of 3 METs or less
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
left ventricular dysfunction with an ejection fraction of less
than 30 percent................................................................................................ 100

More than one episode of acute congestive heart failure in the past year,
or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
left ventricular dysfunction with an ejection fraction of 30 to
50 percent......................................................................................................... 60

Workload of greater than 5 METs but not greater than 7 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electrocardiogram,
echocardiogram, or X-ray................................................................................... 30

Workload of greater than 7 METs but not greater than 10 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
continuous medication required........................................................................... 10

7007 Hypertensive heart disease:

Chronic congestive heart failure, or; workload of 3 METs or less
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
left ventricular dysfunction with an ejection fraction of less
than 30 percent................................................................................................ 100

More than one episode of acute congestive heart failure in the past year,
or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
left ventricular dysfunction with an ejection fraction of 30 to
50 percent......................................................................................................... 60

Workload of greater than 5 METs but not greater than 7 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electrocardiogram,
echocardiogram, or X-ray................................................................................... 30

Workload of greater than 7 METs but not greater than 10 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous
medication required............................................................................................ 10

7008 Hyperthyroid heart disease:
Include as part of the overall evaluation for hyperthyroidism under
DC 7900. However, when atrial fibrillation is present, hyperthyroidism
may be evaluated either under DC 7900 or under DC 7010
(supraventricular arrhythmia), whichever results in a higher evaluation.

7010 Supraventricular arrhythmias (SVT, tachycardia):

Paroxysmal atrial fibrillation or other supraventricular tachycardia, with
more than four episodes per year documented by ECG or Holter
monitor............................................................................................................... 30

Permanent atrial fibrillation (lone atrial fibrillation), or; one to four episodes
per year of paroxysmal atrial fibrillation or other supraventricular
tachycardia documented by ECG or Holter monitor................................................ 10

7011 Ventricular arrhythmias (sustained):

For indefinite period from date of hospital admission for initial evaluation
and medical therapy for a sustained ventricular arrhythmia, or; for
indefinite period from date of hospital admission for ventricular
aneurysmectomy, or; with an automatic implantable Cardioverter-
Defibrillator (AICD) in place............................................................................. 100

Chronic congestive heart failure, or; workload of 3 METs or less results
in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular
dysfunction with an ejection fraction of less than 30 percent................................ 100

More than one episode of acute congestive heart failure in the past year,
or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or; left
ventricular dysfunction with an ejection fraction of 30 to 50 percent...................... 60

Workload of greater than 5 METs but not greater than 7 METs results in
dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electrocardiogram,
echocardiogram, or X-ray................................................................................... 30

Workload of greater than 7 METs but not greater than 10 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or;
continuous medication required........................................................................... 10

Note: A rating of 100 percent shall be assigned from the date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia or for ventricular aneurysmectomy. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.

7015 Atrioventricular block:

Chronic congestive heart failure, or; workload of 3 METs or less results
in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular
dysfunction with an ejection fraction of less than 30 percent....................................... 100

More than one episode of acute congestive heart failure in the past year,
or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or; left
ventricular dysfunction with an ejection fraction of 30 to 50 percent............................. 60

Workload of greater than 5 METs but not greater than 7 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electrocardiogram,
echocardiogram, or X-ray.......................................................................................... 30

Workload of greater than 7 METs but not greater than 10 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous
medication or a pacemaker required........................................................................... 10

Note: Unusual cases of arrhythmia such as atrioventricular block associated with a supraventricular arrhythmia or pathological bradycardia should be submitted to the Director, Compensation and Pension Service. Simple delayed P-R conduction time, in the absence of other evidence of cardiac disease, is not a disability.

7016 Heart valve replacement (prosthesis):

For indefinite period following date of hospital admission for valve
replacement............................................................................................................. 100

Thereafter:

Chronic congestive heart failure, or; workload of 3 METs or less results
in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular
dysfunction with an ejection fraction of less than 30 percent.................................. 100

More than one episode of acute congestive heart failure in the past year,
or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
left ventricular dysfunction with an ejection fraction of 30 to
50 percent.......................................................................................................... 60

Workload of greater than 5 METs but not greater than 7 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electrocardiogram,
echocardiogram, or X-ray.................................................................................... 30

Workload of greater than 7 METs but not greater than 10 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous
medication required............................................................................................ 10

Note: A rating of 100 percent shall be assigned as of the date of hospital admission for valve replacement. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.

7017 Coronary bypass surgery:

For three months following hospital admission for surgery.......................................... 100

Thereafter:

Chronic congestive heart failure, or; workload of 3 METs or less results
in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular
dysfunction with an ejection fraction of less than 30 percent ............................... 100

More than one episode of acute congestive heart failure in the past year,
or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or; left
ventricular dysfunction with an ejection fraction of 30 to 50 percent...................... 60

Workload of greater than 5 METs but not greater than 7 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electrocardiogram,
echocardiogram, or X-ray................................................................................... 30

Workload greater than 7 METs but not greater than 10 METs results in
dyspnea, fatigue, angina, dizziness, or syncope, or; continuous
medication required........................................................................................... 10

7018 Implantable cardiac pacemakers:

For two months following hospital admission for implantation or
reimplantation........................................................................................................ 100

Thereafter:

Evaluate as supraventricular arrhythmias (DC 7010), ventricular
arrhythmias (DC 7011), or atrioventricular block (DC 7015).

Minimum......................................................................................................... 10

Note: Evaluate implantable Cardioverter-Defibrillators (AICD’s) under DC 7011.

7019 Cardiac transplantation:

For an indefinite period from date of hospital admission for cardiac
transplantation....................................................................................................... 100

Thereafter:

Chronic congestive heart failure, or; workload of 3 METs or less results
in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular
dysfunction with an ejection fraction of less than 30 percent .............................. 100

More than one episode of acute congestive heart failure in the past year,
or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
left ventricular dysfunction with an ejection fraction of 30 to
50 percent....................................................................................................... 60

Minimum ....................................................................................................... 30

Note: A rating of 100 percent shall be assigned as of the date of hospital admission for cardiac transplantation. One year following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.

7020 Cardiomyopathy:

Chronic congestive heart failure, or; workload of 3 METs or less results
in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular
dysfunction with an ejection fraction of less than 30 percent............................... 100

More than one episode of acute congestive heart failure in the past year,
or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or;
left ventricular dysfunction with an ejection fraction of 30 to
50 percent........................................................................................................ 60

Workload of greater than 5 METs but not greater than 7 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electrocardiogram,
echocardiogram, or X-ray................................................................................... 30

Workload of greater than 7 METs but not greater than 10 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous
medication required............................................................................................ 10

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Diseases of the Arteries and Veins

7101 Hypertensive vascular disease (hypertension and isolated systolic hypertension):

Diastolic pressure predominantly 130 or more........................................................ 60

Diastolic pressure predominantly 120 or more........................................................ 40

Diastolic pressure predominantly 110 or more, or; systolic pressure
predominantly 200 or more................................................................................... 20

Diastolic pressure predominantly 100 or more, or; systolic pressure
predominantly 160 or more, or; minimum evaluation for an
individual with a history of diastolic pressure predominantly 100
or more who requires continuous medication for control........................................... 10

Note 1: Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm.

Note 2: Evaluate hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, as part of the condition causing it rather than by a separate evaluation.

Note 3: Evaluate hypertension separately from hypertensive heart disease and other types of heart disease.

7110 Aortic aneurysm:

If five centimeters or larger in diameter, or; if symptomatic, or; for
indefinite period from date of hospital admission for surgical
correction (including any type of graft insertion)................................................ 100

Precluding exertion .......................................................................................... 60

Evaluate residuals of surgical correction according to organ systems affected.

Note: A rating of 100 percent shall be assigned as of the date of admission for surgical correction. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.

7111 Aneurysm, any large artery:

If symptomatic, or; for indefinite period from date of hospital admission
for surgical correction................................................................................................ 100

Following surgery:

Ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/
brachial index of 0.4 or less............................................................................. 100

Claudication on walking less than 25 yards on a level grade at 2 miles per
hour, and; persistent coldness of the extremity, one or more deep
ischemic ulcers, or ankle/brachial index of 0.5 or less.......................................... 60

Claudication on walking between 25 and 100 yards on a level grade at
2 miles per hour, and; trophic changes (thin skin, absence of hair,
dystrophic nails) or ankle/brachial index of 0.7 or less.......................................... 40

Claudication on walking more than 100 yards, and; diminished peripheral
pulses or ankle/brachial index of 0.9 or less......................................................... 20

Note 1: The ankle/brachial index is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater.

Note 2: These evaluations are for involvement of a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine (under §4.25), using the bilateral factor, if applicable.

Note 3: A rating of 100 percent shall be assigned as of the date of hospital admission for surgical correction. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.

7112 Aneurysm, any small artery:

Asymptomatic .................................................................................................... 0

Note: If symptomatic, evaluate according to body system affected. Following surgery, evaluate residuals under the body system affected.

7113 Arteriovenous fistula, traumatic:

With high output heart failure ........................................................................... 100

Without heart failure but with enlarged heart, wide pulse pressure,
and tachycardia................................................................................................. 60

Without cardiac involvement but with edema, stasis dermatitis, and either
ulceration or cellulitis:

Lower extremity ......................................................................................... 50
Upper extremity ......................................................................................... 40

With edema or stasis dermatitis:

Lower extremity .......................................................................................... 30
Upper extremity ............................................................................................20

7114 Arteriosclerosis obliterans:

Ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/
brachial index of 0.4 or less................................................................................ 100

Claudication on walking less than 25 yards on a level grade at 2 miles
per hour, and; either persistent coldness of the extremity or ankle/
brachial index of 0.5 or less................................................................................. 60

Claudication on walking between 25 and 100 yards on a level grade at
2 miles per hour, and; trophic changes (thin skin, absence of hair,
dystrophic nails) or ankle/brachial index of 0.7 or less............................................ 40

Claudication on walking more than 100 yards, and; diminished peripheral
pulses or ankle/brachial index of 0.9 or less........................................................... 20

Note 1: The ankle/brachial index is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater.

Note 2: Evaluate residuals of aortic and large arterial bypass surgery or arterial graft as arteriosclerosis obliterans.

Note 3: These evaluations are for involvement of a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine (under §4.25), using the bilateral factor (§4.26), if applicable.

7115 Thrombo-angiitis obliterans (Buerger’s Disease):

Ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/
brachial index of 0.4 or less............................................................................. 100

Claudication on walking less than 25 yards on a level grade at 2 miles
per hour, and; either persistent coldness of the extremity or ankle/
brachial index of 0.5 or less.............................................................................. 60

Claudication on walking between 25 and 100 yards on a level grade at
2 miles per hour, and; trophic changes (thin skin, absence of hair,
dystrophic nails) or ankle/brachial index of 0.7 or less......................................... 40

Claudication on walking more than 100 yards, and; diminished peripheral
pulses or ankle/brachial index of 0.9 or less........................................................ 20

Note 1: The ankle/brachial index is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater.

Note 2: These evaluations are for involvement of a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine (under §4.25), using the bilateral factor (§4.26), if applicable.

7117 Raynaud’s syndrome:

With two or more digital ulcers plus autoamputation of one or more
digits and history of characteristic attacks.......................................................... 100

With two or more digital ulcers and history of characteristic attacks....................... 60

Characteristic attacks occurring at least daily........................................................ 40

Characteristic attacks occurring four to six times a week....................................... 20

Characteristic attacks occurring one to three times a week.................................... 10

Note: For purposes of this section, characteristic attacks consist of sequential color changes of the digits of one or more extremities lasting minutes to hours, sometimes with pain and paresthesias, and precipitated by exposure to cold or by emotional upsets. These evaluations are for the disease as a whole, regardless of the number of extremities involved or whether the nose and ears are involved.


7118 Angioneurotic edema: (angioedema, anaphylaxis)

Attacks without laryngeal involvement lasting one to seven days or
longer and occurring more than eight times a year, or; attacks with
laryngeal involvement of any duration occurring more than twice
a year ............................................................................................................ 40

Attacks without laryngeal involvement lasting one to seven days and
occurring five to eight times a year, or; attacks with laryngeal
involvement of any duration occurring once or twice a year................................. 20

Attacks without laryngeal involvement lasting one to seven days and
occurring two to four times a year...................................................................... 10

7119 Erythromelalgia:

Characteristic attacks that occur more than once a day, last an average
of more than two hours each, respond poorly to treatment, and that
restrict most routine daily activities................................................................... 100

Characteristic attacks that occur more than once a day, last an average of
more than two hours each, and respond poorly to treatment, but that
do not restrict most routine daily activities........................................................... 60

Characteristic attacks that occur daily or more often but that respond to
treatment......................................................................................................... 30

Characteristic attacks that occur less than daily but at least three times
a week and that respond to treatment.................................................................. 10

Note: For purposes of this section, a characteristic attack of erythromelalgia consists of burning pain in the hands, feet, or both, usually bilateral and symmetrical, with increased skin temperature and redness, occurring at warm ambient temperatures. These evaluations are for the disease as a whole, regardless of the number of extremities involved.

7120 Varicose veins:
With the following findings attributed to the effects of varicose veins:

Massive board-like edema with constant pain at rest.......................................... 100

Persistent edema or subcutaneous induration, stasis pigmentation or
eczema, and persistent ulceration....................................................................... 60

Persistent edema and stasis pigmentation or eczema, with or without
intermittent ulceration........................................................................................ 40

Persistent edema, incompletely relieved by elevation of extremity,
with or without beginning stasis pigmentation or eczema................................... ....20

Intermittent edema of extremity or aching and fatigue in leg after
prolonged standing or walking, with symptoms relieved by elevation of
extremity or compression hosiery......................................................................... 10

Asymptomatic palpable or visible varicose veins...................................................... 0

Note: These evaluations are for involvement of a single extremity. If more than one extremity is involved, evaluate each extremity separately and combine (under §4.25), using the bilateral factor (§4.26), if applicable.

7121 Post-phlebitic syndrome of any etiology (DVT):
With the following findings attributed to venous disease:

Massive board-like edema with constant pain at rest.................................... 100

Persistent edema or subcutaneous induration, stasis pigmentation or
eczema, and persistent ulceration................................................................. 60

Persistent edema and stasis pigmentation or eczema, with or without
intermittent ulceration.................................................................................. 40

Persistent edema, incompletely relieved by elevation of extremity,
with or without beginning stasis pigmentation or eczema.................................. 20

Intermittent edema of extremity or aching and fatigue in leg after
prolonged standing or walking, with symptoms relieved by
elevation of extremity or compression hosiery.................................................. 10

Asymptomatic palpable or visible varicose veins................................................. 0

Note: These evaluations are for involvement of a single extremity. If more than one extremity is involved, evaluate each extremity separately and combine (under §4.25), using the bilateral factor (§4.26), if applicable.

7122 Cold injury residuals:

With the following in affected parts:

Arthralgia or other pain, numbness, or cold sensitivity plus two
or more of the following: tissue loss, nail abnormalities, color
changes, locally impaired sensation, hyperhidrosis, X-ray
abnormalities (osteoporosis, subarticular punched out lesions,
or osteoarthritis) ....................................................................................... 30

Arthralgia or other pain, numbness, or cold sensitivity plus tissue
loss, nail abnormalities, color changes, locally impaired sensation,
hyperhidrosis, or X-ray abnormalities (osteoporosis, subarticular
punched out lesions, or osteoarthritis) ......................................................... 20

Arthralgia or other pain, numbness, or cold sensitivity.....................................10

Note 1: Separately evaluate amputations of fingers or toes, and complications such as squamous cell carcinoma at the site of a cold injury scar or peripheral neuropathy, under other diagnostic codes. Separately evaluate other disabilities that have been diagnosed as the residual effects of cold injury, such as Raynaud’s phenomenon, muscle atrophy, etc., unless they are used to support an evaluation under diagnostic code 7122.

Note 2: Evaluate each affected part (e.g., hand, foot, ear, nose) separately and combine the ratings in accordance with §§4.25 and 4.26.

7123 Soft tissue sarcoma (of vascular origin).................................................... 100

Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.

[29 FR 6718, May 22, 1964, as amended at 40 FR 42539, Sept. 15, 1975; 41 FR 11300, Mar. 18, 1976; 43 FR 45361, Oct. 2, 1978; 56 FR 51653, Oct. 15, 1991; 62 FR 65219, Dec. 11, 1997; 63 FR 37779, July 14, 1998; 71 FR 52460, Sept. 6, 2006]

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The Digestive System

§4.110 Ulcers.

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

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§4.111 Postgastrectomy syndromes.

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

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§4.112 Weight loss.

For purposes of evaluating conditions in §4.114, the term “substantial weight loss” means a loss of greater than 20 percent of the individual’s baseline weight, sustained for three months or longer; and the term “minor weight loss” means a weight loss of 10 to 20 percent of the individual’s baseline weight, sustained for three months or longer. The term “inability to gain weight” means that there has been substantial weight loss with inability to regain it despite appropriate therapy. “Baseline weight” means the average weight for the two-year-period preceding onset of the disease. (Authority: 38 U.S.C. 1155)

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§4.113 Coexisting abdominal conditions.

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

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§4.114 Schedule of ratings—digestive system.

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

Digestive System

7200 Mouth, injuries of.
Rate as for disfigurement and impairment of function of mastication.

7201 Lips, injuries of.
Rate as for disfigurement of face.

7202 Tongue, loss of whole or part:

With inability to communicate by speech................................................................... 100

One-half or more...................................................................................................... 60

With marked speech impairment................................................................................. 30

7203 Esophagus, stricture of:

Permitting passage of liquids only, with marked impairment of general
health ................................................................................................................... 80

Severe, permitting liquids only................................................................................. 50

Moderate .............................................................................................................. 30

7204 Esophagus, spasm of (cardiospasm).
If not amenable to dilation, rate as for the degree of obstruction (stricture).

7205 Esophagus, diverticulum of, acquired.
Rate as for obstruction (stricture).

7301 Peritoneum, adhesions of:

Severe; definite partial obstruction shown by X-ray, with frequent
and prolonged episodes of severe colic distension, nausea or vomiting,
following severe peritonitis, ruptured appendix, perforated ulcer,
or operation with drainage................................................................................... 50

Moderately severe; partial obstruction manifested by delayed motility
of barium meal and less frequent and less prolonged episodes of pain...................... 30

Moderate; pulling pain on attempting work or aggravated by movements
of the body, or occasional episodes of colic pain, nausea, constipation
(perhaps alternating with diarrhea) or abdominal distension..................................... 10

Mild.................................................................................................................... 0

Note: Ratings for adhesions will be considered when there is history of operative or other traumatic or infectious (intraabdominal) process, and at least two of the following: disturbance of motility, actual partial obstruction, reflex disturbances, presence of pain.


7304 Ulcer, gastric.

7305 Ulcer, duodenal:

Severe; pain only partially relieved by standard ulcer therapy,
periodic vomiting, recurrent hematemesis or melena, with
manifestations of anemia and weight loss productive of
definite impairment of health................................................................................. 60

Moderately severe; less than severe but with impairment of health
manifested by anemia and weight loss; or recurrent incapacitating
episodes averaging 10 days or more in duration at least four or more
times a year.......................................................................................................... 40

Moderate; recurring episodes of severe symptoms two or three times a
year averaging 10 days in duration; or with continuous moderate
manifestations....................................................................................................... 20

Mild; with recurring symptoms once or twice yearly ................................................ 10

7306 Ulcer, marginal (gastrojejunal):

Pronounced; periodic or continuous pain unrelieved by standard ulcer
therapy with periodic vomiting, recurring melena or hematemesis,
and weight loss. Totally incapacitating.................................................................... 100

Severe; same as pronounced with less pronounced and less continuous
symptoms with definite impairment of health........................................................... 60

Moderately severe; intercurrent episodes of abdominal pain at least once
a month partially or completely relieved by ulcer therapy, mild and
transient episodes of vomiting or melena ................................................................. 40

Moderate; with episodes of recurring symptoms several times a year.......................... 20

Mild; with brief episodes of recurring symptoms once or twice yearly ........................ 10

7307 Gastritis, hypertrophic (identified by gastroscope):

Chronic; with severe hemorrhages, or large ulcerated or eroded areas......................... 60

Chronic; with multiple small eroded or ulcerated areas, and symptoms........................ 30

Chronic; with small nodular lesions, and symptoms .................................................. 10

Gastritis, atrophic.
A complication of a number of diseases, including pernicious anemia.
Rate the underlying condition.

7308 Postgastrectomy syndromes:

Severe; associated with nausea, sweating, circulatory disturbance after
meals, diarrhea, hypoglycemic symptoms, and weight loss with
malnutrition and anemia......................................................................................... 60

Moderate; less frequent episodes of epigastric disorders with
characteristic mild circulatory symptoms after meals but with
diarrhea and weight loss........................................................................................ 40

Mild; infrequent episodes of epigastric distress with characteristic
mild circulatory symptoms or continuous mild manifestations.................................... 20


7309 Stomach, stenosis of.
Rate as for gastric ulcer.

7310 Stomach, injury of, residuals.
Rate as peritoneal adhesions.

7311 Residuals of injury of the liver:
Depending on the specific residuals, separately evaluate as adhesions
of peritoneum (diagnostic code 7301), cirrhosis of liver (diagnostic
code 7312), and chronic liver disease without cirrhosis (diagnostic
code 7345).

7312 Cirrhosis of the liver, primary biliary cirrhosis, or cirrhotic phase
of sclerosing cholangitis:

Generalized weakness, substantial weight loss, and persistent jaundice,
or; with one of the following refractory to treatment: ascites, hepatic
encephalopathy, hemorrhage from varices or portal gastropathy
(erosive gastritis)............................................................................................ 100

History of two or more episodes of ascites, hepatic encephalopathy,
or hemorrhage from varices or portal gastropathy (erosive gastritis),
but with periods of remission between attacks.................................................... 70

History of one episode of ascites, hepatic encephalopathy, or hemorrhage
from varices or portal gastropathy (erosive gastritis)........................................... 50

Portal hypertension and splenomegaly, with weakness, anorexia,
abdominal pain, malaise, and at least minor weight loss...................................... 30

Symptoms such as weakness, anorexia, abdominal pain, and malaise................... 10

Note: For evaluation under diagnostic code 7312, documentation of cirrhosis (by biopsy or imaging) and abnormal liver function tests must be present.


7314 Cholecystitis, chronic:

Severe; frequent attacks of gall bladder colic....................................................... 30

Moderate; gall bladder dyspepsia, confirmed by X-ray technique, and
with infrequent attacks (not over two or three a year) of gall bladder
colic, with or without jaundice .......................................................................... 10

Mild ................................................................................................................ 0

7315 Cholelithiasis, chronic.
Rate as for chronic cholecystitis.

7316 Cholangitis, chronic.
Rate as for chronic cholecystitis.

7317 Gall bladder, injury of.
Rate as for peritoneal adhesions.

7318 Gall bladder, removal of:

With severe symptoms..................................................................................... 30

With mild symptoms........................................................................................ 10

Nonsymptomatic............................................................................................... 0

7319 Irritable colon syndrome (spastic colitis, mucous colitis, irritable bowel, etc.):

Severe; diarrhea, or alternating diarrhea and constipation, with more
or less constant abdominal distress..................................................................... 30

Moderate; frequent episodes of bowel disturbance with abdominal
distress............................................................................................................ 10

Mild, disturbances of bowel function with occasional episodes of
abdominal distress.............................................................................................. 0

7321 Amebiasis:

Mild gastrointestinal disturbances, lower abdominal cramps, nausea,
gaseous distention, chronic constipation interrupted by diarrhea............................ 10

Asymptomatic................................................................................................... 0

Note: Amebiasis with or without liver abscess is parallel in symptomatology with ulcerative colitis and should be rated on the scale provided for the latter. Similarly, lung abscess due to amebiasis will be rated under the respiratory system schedule, diagnostic code 6809.

7322 Dysentery, bacillary.
Rate as for ulcerative colitis

7323 Colitis, ulcerative:

Pronounced; resulting in marked malnutrition, anemia, and general
debility, or with serious complication as liver abscess............................................ 100

Severe; with numerous attacks a year and malnutrition, the health
only fair during remissions................................................................................... 60

Moderately severe; with frequent exacerbations..................................................... 30

Moderate; with infrequent exacerbations............................................................... 10

7324 Distomiasis, intestinal or hepatic:

Severe symptoms ............................................................................................... 30

Moderate symptoms ........................................................................................... 10

Mild or no symptoms............................................................................................. 0

7325 Enteritis, chronic.
Rate as for irritable colon syndrome.

7326 Enterocolitis, chronic.
Rate as for irritable colon syndrome.

7327 Diverticulitis.
Rate as for irritable colon syndrome, peritoneal adhesions, or colitis,
ulcerative, depending upon the predominant disability picture.

7328 Intestine, small, resection of:

With marked interference with absorption and nutrition, manifested
by severe impairment of health objectively supported by
examination findings including material weight loss................................................ 60

With definite interference with absorption and nutrition, manifested
by impairment of health objectively supported by examination
findings including definite weight loss................................................................... 40

Symptomatic with diarrhea, anemia and inability to gain weight.............................. 20

Note: Where residual adhesions constitute the predominant disability, rate under diagnostic code 7301.

7329 Intestine, large, resection of:

With severe symptoms, objectively supported by examination findings....................... 40

With moderate symptoms....................................................................................... 20

With slight symptoms............................................................................................. 10

Note: Where residual adhesions constitute the predominant disability, rate under diagnostic code 7301.

7330 Intestine, fistula of, persistent, or after attempt at operative closure:

Copious and frequent, fecal discharge.................................................................... 100

Constant or frequent, fecal discharge....................................................................... 60

Slight infrequent, fecal discharge............................................................................. 30

Healed; rate for peritoneal adhesions.

7331 Peritonitis, tuberculous, active or inactive:
Active ...................................................................................................................... 100
Inactive: See §§4.88b and 4.89.

7332 Rectum and anus, impairment of sphincter control: (incontinence)

Complete loss of sphincter control......................................................................... 100

Extensive leakage and fairly frequent involuntary bowel movements.......................... 60

Occasional involuntary bowel movements, necessitating wearing of pad..................... 30

Constant slight, or occasional moderate leakage....................................................... 10

Healed or slight, without leakage.............................................................................. 0

7333 Rectum and anus, stricture of:

Requiring colostomy........................................................................................... 100

Great reduction of lumen, or extensive leakage....................................................... 50

Moderate reduction of lumen, or moderate constant leakage.................................... 30

7334 Rectum, prolapse of:

Severe (or complete), persistent.......................................................................... 50

Moderate, persistent or frequently recurring......................................................... 30

Mild with constant slight or occasional moderate leakage....................................... 10

7335 Ano, fistula in.
Rate as for impairment of sphincter control.

7336 Hemorrhoids, external or internal:

With persistent bleeding and with secondary anemia, or with fissures..................... 20

Large or thrombotic, irreducible, with excessive redundant tissue,
evidencing frequent recurrences.......................................................................... 10

Mild or moderate................................................................................................. 0

7337 Pruritus ani.
Rate for the underlying condition.

7338 Hernia, inguinal:

Large, postoperative, recurrent, not well supported under ordinary
conditions and not readily reducible, when considered inoperable............................. 60

Small, postoperative recurrent, or unoperated irremediable, not well
supported by truss, or not readily reducible............................................................. 30

Postoperative recurrent, readily reducible and well supported by
truss or belt.......................................................................................................... 10

Not operated, but remediable.................................................................................. 0

Small, reducible, or without true hernia protrusion.................................................... 0

Note: Add 10 percent for bilateral involvement, provided the second hernia is compensable. This means that the more severely disabling hernia is to be evaluated, and 10 percent, only, added for the second hernia, if the latter is of compensable degree.

7339 Hernia, ventral, postoperative:

Massive, persistent, severe diastasis of recti muscles or extensive
diffuse destruction or weakening of muscular and fascial support
of abdominal wall so as to be inoperable............................................................... 100

Large, not well supported by belt under ordinary conditions..................................... 40

Small, not well supported by belt under ordinary conditions, or healed
ventral hernia or postoperative wounds with weakening of abdominal
wall and indication for a supporting belt................................................................. 20

Wounds, postoperative, healed, no disability, belt not indicated.................................. 0


7340 Hernia, femoral.
Rate as for inguinal hernia.

7342 Visceroptosis, symptomatic, marked..................................................................... 10

7343 Malignant neoplasms of the digestive system, exclusive of skin growths................. 100

Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.

7344 Benign neoplasms, exclusive of skin growths:
Evaluate under an appropriate diagnostic code, depending on the
predominant disability or the specific residuals after treatment.

7345 Chronic liver disease without cirrhosis (including hepatitis B, chronic
active hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced
hepatitis, etc., but excluding bile duct disorders and hepatitis C):

Near-constant debilitating symptoms (such as fatigue, malaise, nausea,
vomiting, anorexia, arthralgia, and right upper quadrant pain)................................. 100

Daily fatigue, malaise, and anorexia, with substantial weight loss (or other
indication of malnutrition), and hepatomegaly, or; incapacitating episodes
(with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia,
and right upper quadrant pain) having a total duration of at least six weeks
during the past 12- month period, but not occurring constantly ............................... 60

Daily fatigue, malaise, and anorexia, with minor weight loss and
hepatomegaly, or; incapacitating episodes (with symptoms such as
fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right
upper quadrant pain) having a total duration of at least four weeks,
but less than six weeks, during the past 12-month period.......................................... 40

Daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly),
requiring dietary restriction or continuous medication, or;
incapacitating episodes (with symptoms such as fatigue, malaise,
nausea, vomiting, anorexia, arthralgia, and right upper quadrant
pain) having a total duration of at least two weeks, but less than four
weeks, during the past 12-month period................................................................... 20

Intermittent fatigue, malaise, and anorexia, or; incapacitating episodes
(with symptoms such as fatigue, malaise, nausea, vomiting, anorexia,
arthralgia, and right upper quadrant pain) having a total duration of at
least one week, but less than two weeks, during the past 12-month
period ................................................................................................................... 10

Nonsymptomatic...................................................................................................... 0

Note (1): Evaluate sequelae, such as cirrhosis or malignancy of the liver, under an appropriate diagnostic code, but do not use the same signs and symptoms as the basis for evaluation under DC 7354 and under a diagnostic code for sequelae. (See §4.14.).
Note (2): For purposes of evaluating conditions under diagnostic code 7345, “incapacitating episode” means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician.
Note (3): Hepatitis B infection must be confirmed by serologic testing in order to evaluate it under diagnostic code 7345.


7346 Hernia hiatal: (hiatal hernia)

Symptoms of pain, vomiting, material weight loss and hematemesis or
melena with moderate anemia; or other symptom combinations
productive of severe impairment of health.................................................................. 60

Persistently recurrent epigastric distress with dysphagia, pyrosis, and
regurgitation, accompanied by substernal or arm or shoulder pain,
productive of considerable impairment of health.......................................................... 30

With two or more of the symptoms for the 30 percent evaluation of
less severity.............................................................................................................. 10

7347 Pancreatitis:

With frequently recurrent disabling attacks of abdominal pain with few
pain free intermissions and with steatorrhea, malabsorption, diarrhea
and severe malnutrition........................................................................................... 100

With frequent attacks of abdominal pain, loss of normal body weight
and other findings showing continuing pancreatic insufficiency
between acute attacks............................................................................................... 60

Moderately severe; with at least 4-7 typical attacks of abdominal pain
per year with good remission between attacks............................................................. 30

With at least one recurring attack of typical severe abdominal pain
in the past year......................................................................................................... 10

Note 1: Abdominal pain in this condition must be confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies.
Note 2: Following total or partial pancreatectomy, rate under above, symptoms, minimum rating 30 percent.

7348 Vagotomy with pyloroplasty or gastroenterostomy:

Followed by demonstrably confirmative postoperative complications
of stricture or continuing gastric retention................................................................... 40

With symptoms and confirmed diagnosis of alkaline gastritis, or of
confirmed persisting diarrhea..................................................................................... 30

Recurrent ulcer with incomplete vagotomy.................................................................. 20

Note: Rate recurrent ulcer following complete vagotomy under diagnostic code 7305, minimum rating 20 percent; and rate dumping syndrome under diagnostic code 7308.

7351 Liver transplant:

For an indefinite period from the date of hospital admission for
transplant surgery................................................................................................... 100

Minimum ............................................................................................................... 30

Note: A rating of 100 percent shall be assigned as of the date of hospital admission for transplant surgery and shall continue. One year following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.

7354 Hepatitis C (or non-A, non-B hepatitis):

With serologic evidence of hepatitis C infection and the following
signs and symptoms due to hepatitis C infection:

Near-constant debilitating symptoms (such as fatigue, malaise,
nausea, vomiting, anorexia, arthralgia, and right upper quadrant
pain)................................................................................................................ 100

Daily fatigue, malaise, and anorexia, with substantial weight loss (or
other indication of malnutrition), and hepatomegaly, or;
incapacitating episodes (with symptoms such as fatigue,
malaise, nausea, vomiting, anorexia, arthralgia, and right upper
quadrant pain) having a total duration of at least six weeks
during the past 12-month period, but not occurring constantly................................. 60

Daily fatigue, malaise, and anorexia, with minor weight loss and
hepatomegaly, or; incapacitating episodes (with symptoms such as
fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right
upper quadrant pain) having a total duration of at least four weeks,
but less than six weeks, during the past 12-month period......................................... 40

Daily fatigue, malaise, and anorexia (without weight loss or
hepatomegaly), requiring dietary restriction or continuous
medication, or; incapacitating episodes (with symptoms such as
fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right
upper quadrant pain) having a total duration of at least two weeks,
but less than four weeks, during the past 12-month period........................................ 20

Intermittent fatigue, malaise, and anorexia, or; incapacitating episodes
(with symptoms such as fatigue, malaise, nausea, vomiting, anorexia,
arthralgia, and right upper quadrant pain) having a total duration of
at least one week, but less than two weeks, during the past

12-month period.................................................................................................... 10

Nonsymptomatic..................................................................................................... 0

Note (1): Evaluate sequelae, such as cirrhosis or malignancy of the liver, under an appropriate diagnostic code, but do not use the same signs and symptoms as the basis for evaluation under DC 7354 and under a diagnostic code for sequelae. (See §4.14.).

Note (2): For purposes of evaluating conditions under diagnostic code 7354, “incapacitating episode” means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician.

[29 FR 6718, May 22, 1964, as amended at 34 FR 5063, Mar. 11, 1969; 40 FR 42540, Sept. 15, 1975; 41 FR 11301, Mar. 18, 1976; 66 FR 29488, May 31, 2001; 69 FR 34585, June 22, 2004]

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The Genitourinary System

§4.115 Nephritis.

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

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

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§4.115a Ratings of the genitourinary system—dysfunctions.

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


Renal dysfunction:

Requiring regular dialysis, or precluding more than sedentary activity
from one of the following: persistent edema and albuminuria;
or, BUN more than 80mg%; or, creatinine more than 8mg%; or,
markedly decreased function of kidney or other organ systems,
especially cardiovascular..................................................................................... 100

Persistent edema and albuminuria with BUN 40 to 80mg%; or,
creatinine 4 to 8mg%; or, generalized poor health characterized by
lethargy, weakness, anorexia, weight loss, or limitation of exertion .......................... 80

Constant albuminuria with some edema; or, definite decrease in kidney
function; or, hypertension at least 40 percent disabling under
diagnostic code 7101 ........................................................................................... 60

Albumin constant or recurring with hyaline and granular casts or red
blood cells; or, transient or slight edema or hypertension at least
10 percent disabling under diagnostic code 7101 ................................................. 30

Albumin and casts with history of acute nephritis; or, hypertension
non-compensable under diagnostic code 7101.......................................................... 0


Voiding dysfunction:

Rate particular condition as urine leakage, frequency, or obstructed voiding.

Continual Urine Leakage, Post Surgical Urinary Diversion,
Urinary Incontinence, or Stress Incontinence:

Requiring the use of an appliance or the wearing of absorbent
materials which must be changed more than 4 times per day.......................... 60

Requiring the wearing of absorbent materials which must be
changed 2 to 4 times per day ......................................................................... 40

Requiring the wearing of absorbent materials which must be
changed less than 2 times per day .................................................................. 20

Urinary frequency:

Daytime voiding interval less than one hour, or; awakening to
void five or more times per night ........................................................................ 40

Daytime voiding interval between one and two hours, or;
awakening to void three to four times per night .................................................... 20

Daytime voiding interval between two and three hours, or;
awakening to void two times per night ................................................................. 10

Obstructed voiding:

Urinary retention requiring intermittent or continuous catheterization ...................... 30

Marked obstructive symptomatology (hesitancy, slow or weak stream, decreased
force of stream) with any one or combination of the following:

1. Post void residuals greater than 150 cc
2. Uroflowmetry; markedly diminished peak flow rate
(less than 10 cc/sec)
3. Recurrent urinary tract infections secondary to obstruction
4. Stricture disease requiring periodic dilatation every 2 to 3 months................. 10

Obstructive symptomatology with or without stricture disease requiring
dilatation 1 to 2 times per year ............................................................................. 0

Urninary tract infection:

Poor renal function: Rate as renal dysfunction.

Recurrent symptomatic infection requiring drainage/frequent
hospitalization (greater than two times/year), and/or requiring
continuous intensive management ................................................................... 30

Long-term drug therapy, 1-2 hospitalizations per year and/or
requiring intermittent intensive management......................................................... 10

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

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§4.115b Ratings of the genitourinary system—diagnoses.

Note: When evaluating any claim involving loss or loss of use of one or more creative organs, refer to §3.350 of this chapter to determine whether the veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.

7500 Kidney, removal of one (nephrectomy):

Minimum evaluation............................................................................................. 30
Or rate as renal dysfunction if there is nephritis, infection,
or pathology of the other.

7501 Kidney, abscess of:
Rate as urinary tract infection

7502 Nephritis, chronic:
Rate as renal dysfunction.

7504 Pyelonephritis, chronic:
Rate as renal dysfunction or urinary tract infection, whichever is
predominant.

7505 Kidney, tuberculosis of:
Rate in accordance with §§4.88b or 4.89, whichever is appropriate.

7507 Nephrosclerosis, arteriolar:
Rate according to predominant symptoms as renal dysfunction,
hypertension or heart disease. If rated under the cardiovascular
schedule, however, the percentage rating which would otherwise
be assigned will be elevated to the next higher evaluation.

7508 Nephrolithiasis:
Rate as hydronephrosis, except for recurrent stone formation requiring
one or more of the following:

1. diet therapy
2. drug therapy
3. invasive or non-invasive procedures more than two times/year .......................... 30

7509 Hydronephrosis:
Severe; Rate as renal dysfunction.

Frequent attacks of colic with infection (pyonephrosis), kidney
function impaired................................................................................................ 30

Frequent attacks of colic, requiring catheter drainage.............................................. 20
Only an occasional attack of colic, not infected and not requiring
catheter drainage................................................................................................. 10

7510 Ureterolithiasis:
Rate as hydronephrosis, except for recurrent stone formation requiring one or
more of the following:

1. diet therapy
2. drug therapy
3. invasive or non-invasive procedures more than two times/year ........................... 30

7511 Ureter, stricture of:
Rate as hydronephrosis, except for recurrent stone formation requiring one or
more of the following:

1. diet therapy
2. drug therapy
3. invasive or non-invasive procedures more than two times/year ........................... 30

7512 Cystitis, chronic, includes interstitial and all etiologies, infectious and non-infectious:
Rate as voiding dysfunction.

7515 Bladder, calculus in, with symptoms interfering with function:
Rate as voiding dysfunction.

7516 Bladder, fistula of:
Rate as voiding dysfunction or urinary tract infection, whichever is
predominant.
Postoperative, superapubic cystotomy ......................................................................... 100

7517 Bladder, injury of:
Rate as voiding dysfunction.

7518 Urethra, stricture of:
Rate as voiding dysfunction.

7519 Urethra, fistula of:
Rate as voiding dysfunction.
Multiple urethroperineal fistulae .................................................................................. 100

7520 Penis, removal of half or more.............................................................................. 30
Or rate as voiding dysfunction.

7521 Penis, removal of glans......................................................................................... 20
Or rate as voiding dysfunction

7522 Penis, deformity, with loss of erectile power........................................................... 201

7523 Testis, atrophy complete:

Both...................................................................................................................... 201
One ........................................................................................................................ 01

7524 Testis, removal:

Both...................................................................................................................... 301
One......................................................................................................................... 01

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

Note: In cases of the removal of one testis as the result of a service-incurred injury or disease, other than an undescended or congenitally undeveloped testis, with the absence or nonfunctioning of the other testis unrelated to service, an evaluation of 30 percent will be assigned for the service-connected testicular loss. Testis, undescended, or congenitally undeveloped is not a ratable disability.


7525 Epididymo-orchitis, chronic only:
Rate as urinary tract infection.
For tubercular infections: Rate in accordance with §§4.88b or 4.89,
whichever is appropriate.

7527 Prostate gland injuries, infections, hypertrophy, post-operative residuals: (including prostatitis)
Rate as voiding dysfunction or urinary tract infection, whichever is
predominant.

7528 Malignant neoplasms of the genitourinary system ..................................................... 100

Note: Following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals as voiding dysfunction or renal dysfunction, whichever is predominant.


7529 Benign neoplasms of the genitourinary system:
Rate as voiding dysfunction or renal dysfunction, whichever is predominant.

7530 Chronic renal disease requiring regular dialysis:
Rate as renal dysfunction.

7531 Kidney transplant:

Following transplant surgery .................................................................................... 100
Thereafter: Rate on residuals as renal dysfunction, minimum rating .............................. 30

Note: The 100 percent evaluation shall be assigned as of the date of hospital admission for transplant surgery and shall continue with a mandatory VA examination one year following hospital discharge. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.


7532 Renal tubular disorders (such as renal glycosurias, aminoacidurias, renal
tubular acidosis, Fanconi’s syndrome, Bartter’s syndrome, related
disorders of Henle’s loop and proximal or distal nephron function, etc.):
Minimum rating for symptomatic condition ....................................................................... 20
Or rate as renal dysfunction.

7533 Cystic diseases of the kidneys (polycystic disease, uremic medullary
cystic disease, Medullary sponge kidney, and similar conditions):
Rate as renal dysfunction.

7534 Atherosclerotic renal disease (renal artery stenosis or atheroembolic renal
disease):
Rate as renal dysfunction.

7535 Toxic nephropathy (antibotics, radiocontrast agents, nonsteroidal
anti-inflammatory agents, heavy metals, and similar agents):
Rate as renal dysfunction.

7536 Glomerulonephritis:
Rate as renal dysfunction.

7537 Interstitial nephritis:
Rate as renal dysfunction.

7538 Papillary necrosis:
Rate as renal dysfunction.

7539 Renal amyloid disease:
Rate as renal dysfunction.

7540 Disseminated intravascular coagulation with renal cortical necrosis:
Rate as renal dysfunction.

7541 Renal involvement in diabetes mellitus, sickle cell anemia, systemic
lupus erythematosus, vasculitis, or other systemic disease processes:
Rate as renal dysfunction.

7542 Neurogenic bladder:
Rate as voiding dysfunction.

[29 FR 6718, May 22, 1964, as amended at 34 FR 5063, Mar. 11, 1969; 40 FR 42540, Sept. 15, 1975; 41 FR 11301, Mar. 18, 1976; 41 FR 34258, Aug. 13, 1976; 59 FR 2527, Jan. 18, 1994; 59 FR 14567, Mar. 29, 1994; 59 FR 46339, Sept. 8, 1994]

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Gynecological Conditions and Disorders of the Breast

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

Note 1: Natural menopause, primary amenorrhea, and pregnancy and childbirth are not disabilities for rating purposes. Chronic residuals of medical or surgical complications of pregnancy may be disabilities for rating purposes.

Note 2: When evaluating any claim involving loss or loss of use of one or more creative organs or anatomical loss of one or both breasts, refer to §3.350 of this chapter to determine whether the veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, almost any condition in this section might, under certain circumstances, establish entitlement to special monthly compensation.

7610 Vulva, disease or injury of (including vulvovaginitis).

7611 Vagina, disease or injury of.

7612 Cervix, disease or injury of.

7613 Uterus, disease, injury, or adhesions of.

7614 Fallopian tube, disease, injury, or adhesions of (including pelvic inflammatory disease (PID)).

7615 Ovary, disease, injury, or adhesions of.


General Rating Formula for Disease, Injury, or Adhesions of Female

Reproductive Organs (diagnostic codes 7610 through 7615):

Symptoms not controlled by continuous treatment............................................. 30
Symptoms that require continuous treatment..................................................... 10
Symptoms that do not require continuous treatment............................................. 0

7617 Uterus and both ovaries, removal of, complete:

For three months after removal............................................................................ 1001
Thereafter .......................................................................................................... 501

7618 Uterus, removal of, including corpus:

For three months after removal............................................................................ 1001
Thereafter ........................................................................................................... 301

7619 Ovary, removal of:

For three months after removal............................................................................ 1001

Thereafter:

Complete removal of both ovaries......................................................................... 301
Removal of one with or without partial removal of the other...................................... 01

7620 Ovaries, atrophy of both, complete...................................................................... 201

7621 Uterus, prolapse:

Complete, through vagina and introitus................................................................... 50
Incomplete........................................................................................................... 30

7622 Uterus, displacement of:

With marked displacement and frequent or continuous
menstrual disturbances......................................................................................... 30
With adhesions and irregular menstruation............................................................. 10

7623 Pregnancy, surgical complications of:

With rectocele or cystocele................................................................................... 50
With relaxation of perineum ................................................................................. 10

7624 Fistula, rectovaginal:

Vaginal fecal leakage at least once a day requiring wearing of pad........................... 100

Vaginal fecal leakage four or more times per week, but less than
daily, requiring wearing of pad.............................................................................. 60

Vaginal fecal leakage one to three times per week requiring
wearing of pad................................................................................................ 30

Vaginal fecal leakage less than once a week........................................................... 10

Without leakage.................................................................................................... 0

7625 Fistula, urethrovaginal:

Multiple urethrovaginal fistulae............................................................................ 100

Requiring the use of an appliance or the wearing of absorbent
materials which must be changed more than four times per day............................... 60

Requiring the wearing of absorbent materials which must be
changed two to four times per day......................................................................... 40

Requiring the wearing of absorbent materials which must be
changed less than two times per day....................................................................... 20

7626 Breast, surgery of:

Following radical mastectomy:

Both.................................................................................................................... 801
One..................................................................................................................... 501

Following modified radical mastectomy:

Both.....................................................................................................................601
One..................................................................................................................... 401

Following simple mastectomy or wide local excision
with significant alteration of size or form:

Both.................................................................................................................... 501
One..................................................................................................................... 301

Following wide local excision without significant
alteration of size or form:

Both or one........................................................................................................... 0

Note: For VA purposes:

(1) Radical mastectomy means removal of the entire breast, underlying pectoral muscles, and regional lymph nodes up to the coracoclavicular ligament.
(2) Modified radical mastectomy means removal of the entire breast and axillary lymph nodes (in continuity with the breast). Pectoral muscles are left intact.
(3) Simple (or total) mastectomy means removal of all of the breast tissue, nipple, and a small portion of the overlying skin, but lymph nodes and muscles are left intact.
(4) Wide local excision (including partial mastectomy, lumpectomy, tylectomy, segmentectomy, and quadrantectomy) means removal of a portion of the breast tissue.

7627 Malignant neoplasms of gynecological system or breast........................................ 100

Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.

7628 Benign neoplasms of the gynecological system or breast. Rate according to
impairment in function of the urinary or gynecological systems, or skin.

7629 Endometriosis:

Lesions involving bowel or bladder confirmed by laparoscopy, pelvic
pain or heavy or irregular bleeding not controlled by treatment,
and bowel or bladder symptoms............................................................................ 50

Pelvic pain or heavy or irregular bleeding not controlled by treatment....................... 30

Pelvic pain or heavy or irregular bleeding requiring
continuous treatment for control............................................................................ 10

Note: Diagnosis of endometriosis must be substantiated by laparoscopy.


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

[29 FR 6718, May 22, 1964, as amended at 41 FR 11301, Mar. 18, 1976; 41 FR 34258, Aug. 13, 1976; redesignated and revised, 60 FR 19855, Apr. 21, 1995; 67 FR 6874, Feb. 14, 2002; 67 FR 37695, May 30, 2002]

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