The Schedule for Rating Disabilities

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

This page contains 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. 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 of the Respiratory System, the Cardiovascular System, the Digestive System, the Genitourinary System, and all Gynecological Conditions, see page 2.

Subpart B—Disability Ratings Con't
The Hemic and Lymphatic Systems
The Skin
The Endocrine System
Neurological Conditions and Convulsive Disorders
Mental Disorders
Dental and Oral

Subpart B—Disability Ratings Con't

The Hemic and Lymphatic Systems

4.117 Schedule of ratings—hemic and lymphatic systems

The Skin

4.118 Schedule of ratings—skin

The Endocrine System

4.119 Schedule of ratings-endocrine system

Neurological Conditions and Convulsive Disorders

4.120 Evaluations by comparison
4.121 Identification of epilepsy
4.122 Psychomotor epilepsy
4.123 Neuritis, cranial or peripheral
4.124 Neuralgia, cranial or peripheral
4.124a Schedule of ratings—neurological conditions and convulsive disorders
Organic Diseases of the Central Nervous System
Miscellaneous Diseases
Diseases of the Cranial Nerves
Diseases of the Peripheral Nerves
The Epilepsies

Mental Disorders

4.125 Diagnosis of mental disorders
4.126 Evaluation of disability from mental disorders
4.127 Mental retardation and personality disorders
4.128 Convalescence ratings following extended hospitalization
4.129 Mental disorders due to traumatic stress
4.130 Schedule of ratings-mental disorders
General Rating Formula for Mental Disorders
Eating Disorders

Dental and Oral

§4.150 Schedule of ratings—Dental and oral conditions


Subpart B—Disability Ratings

The Hemic and Lymphatic Systems

§4.117 Schedule of ratings—hemic and lymphatic systems.

7700 Anemia, hypochromic-microcytic and megaloblastic, such as
iron-deficiency and pernicious anemia:

Hemoglobin 5gm/100ml or less, with findings such as high
output congestive heart failure or dyspnea at rest ................................................ 100

Hemoglobin 7gm/100ml or less, with findings such as dyspnea
on mild exertion, cardiomegaly, tachycardia (100 to 120 beats
per minute) or syncope (three episodes in the last six months) ............................... 70

Hemoglobin 8gm/100ml or less, with findings such as weakness,
easy fatigability, headaches, lightheadedness, or shortness of
breath ............................................................................................................... 30

Hemoglobin 10gm/100ml or less with findings such as weakness,
easy fatigability or headaches .............................................................................. 10

Hemoglobin 10gm/100ml or less, asymptomatic...................................................... 0

Note: Evaluate complications of pernicious anemia, such as dementia or peripheral neuropathy, separately.

7702 Agranulocytosis, acute:

Requiring bone marrow transplant, or; requiring transfusion of
platelets or red cells at least once every six weeks, or; infections
recurring at least once every six weeks ............................................................... 100

Requiring transfusion of platelets or red cells at least once
every three months, or; infections recurring at least once
every three months ............................................................................................. 60

Requiring transfusion of platelets or red cells at least once per year
but less than once every three months, or; infections recurring
at least once per year but less than once every three months ................................... 30

Requiring continuous medication for control........................................................... 10

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

7703 Leukemia:

With active disease or during a treatment phase....................................................... 100
Otherwise rate as anemia (code 7700) or aplastic anemia (code 7716),
whichever would result in the greater benefit.

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

7704 Polycythemia vera:

During periods of treatment with myelosuppressants and for three
months following cessation of myelosuppressant therapy ...................................... 100

Requiring phlebotomy .......................................................................................... 40

Stable, with or without continuous medication......................................................... 10

Note: Rate complications such as hypertension, gout, stroke or thrombotic disease separately.

7705 Thrombocytopenia, primary, idiopathic (ITP) or immune:

Platelet count of less than 20,000, with active bleeding, requiring
treatment with medication and transfusions .......................................................... 100

Platelet count between 20,000 and 70,000, not requiring treatment,
without bleeding .................................................................................................. 70

Stable platelet count between 70,000 and 100,000, without bleeding ........................ 30

Stable platelet count of 100,000 or more, without bleeding ....................................... 0

7706 Splenectomy .................................................................................................... 20
Note: Rate complications such as systemic infections with encapsulated bacteria separately.

7707 Spleen, injury of, healed.
Rate for any residuals.

7709 Hodgkin’s disease:

With active disease or during a treatment phase .................................................... 100

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


7710 Adenitis, tuberculous, active or inactive.
Rate under §§4.88c or 4.89 of this part, whichever is appropriate.

7714 Sickle cell anemia:

With repeated painful crises, occurring in skin, joints, bones or
any major organs caused by hemolysis and sickling of red blood cells,
with anemia, thrombosis and infarction, with symptoms precluding
even light manual labor .................................................................................... 100

With painful crises several times a year or with symptoms precluding
other than light manual labor .............................................................................. 60

Following repeated hemolytic sickling crises with continuing
impairment of health .......................................................................................... 30

Asymptomatic, established case in remission, but with identifiable
organ impairment ............................................................................................... 10

Note: Sickle cell trait alone, without a history of directly attributable pathological findings, is not a ratable disability. Cases of symptomatic sickle cell trait will be forwarded to the Director, Compensation and Pension Service, for consideration under §3.321(b)(1) of this chapter.


7715 Non-Hodgkin’s lymphoma:

With active disease or during a treatment phase ................................................. 100

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

7716 Aplastic anemia:

Requiring bone marrow transplant, or; requiring transfusion of
platelets or red cells at least once every six weeks, or; infections
recurring at least once every six weeks ............................................................... 100

Requiring transfusion of platelets or red cells at least once every
three months, or; infections recurring at least once every
three months ..................................................................................................... 60

Requiring transfusion of platelets or red cells at least once per year
but less than once every three months, or; infections recurring
at least once per year but less than once every three months .................................. 30

Requiring continuous medication for control ......................................................... 10

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

7717 AL amyloidosis (primary amyloidosis):
Minimum rating........................................................................................................100

[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; 55 FR 43124, Oct. 26, 1990; 60 FR 49227, Sept. 22, 1995]

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The Skin


§4.118 Schedule of ratings—skin.

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

7800 Burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other
causes; or other disfigurement of the head, face, or neck:

With visible or palpable tissue loss and either gross distortion or
asymmetry of three or more features or paired sets of features
(nose, chin, forehead, eyes (including eyelids), ears (auricles),
cheeks, lips), or; with six or more characteristics of disfigurement................................. 80

With visible or palpable tissue loss and either gross distortion or
asymmetry of two features or paired sets of features (nose, chin,
forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or;
with four or five characteristics of disfigurement.......................................................... 50

With visible or palpable tissue loss and either gross distortion or
asymmetry of one feature or paired set of features (nose, chin,
forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or;
with two or three characteristics of disfigurement......................................................... 30

With one characteristic of disfigurement...................................................................... 10

Note (1): The 8 characteristics of disfigurement, for purposes of evaluation under §4.118, are:

– Scar 5 or more inches (13 or more cm.) in length.
– Scar at least one-quarter inch (0.6 cm.) wide at widest part.
– Surface contour of scar elevated or depressed on palpation.
– Scar adherent to underlying tissue.
– Skin hypo-or hyper-pigmented in an area exceeding six square inches (39 sq. cm.).
– Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in
an area exceeding six square inches (39 sq. cm.).
– Underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.)
– Skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.).

Note (2): Rate tissue loss of the auricle under DC 6207 (loss of auricle) and anatomical loss of the eye under DC 6061 (anatomical loss of both eyes) or DC 6063 (anatomical loss of one eye), as appropriate.

Note (3): Take into consideration unretouched color photographs when evaluating under these criteria.

Note (4): Separately evaluate disabling effects other than disfigurement that are associated with individual scar(s) of the head, face, or neck, such as pain, instability, and residuals of associated muscle or nerve injury, under the appropriate diagnostic code(s) and apply § 4.25 to combine the evaluation(s) with the evaluation assigned under this diagnostic code.

Note (5): The characteristic(s) of disfigurement may be caused by one scar or by multiple scars; the characteristic(s) required to assign a particular evaluation need not be caused by a single scar in order to assign that evaluation.

With visible or palpable tissue loss and either gross distortion or
asymmetry of three or more features or paired sets of features
(nose, chin, forehead, eyes (including eyelids), ears (auricles),
cheeks, lips), or; with six or more characteristics of disfigurement.............................. 80

7801 Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and
nonlinear:

Area or areas of 144 square inches (929 sq. cm.) or greater........................................ 40

Area or areas of at least 72 square inches (465 sq. cm.) but less than
144 square inches (929 sq. cm.).............................................................................. 30

Area or areas of at least 12 square inches (77 sq. cm.) but less than
72 square inches (465 sq. cm.)................................................................................ 20

Area or areas of at least 6 square inches (39 sq. cm.) but less than
12 square inches (77 sq. cm.).................................................................................. 10


Note (1): A deep scar is one associated with underlying soft tissue damage.

Note (2): If multiple qualifying scars are present, or if a single qualifying scar affects more than one extremity, or a single qualifying scar affects one or more extremities and either the anterior portion or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity, assign a separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assign a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. The midaxillary line on each side separates the anterior and posterior portions of the trunk. Combine the separate evaluations under § 4.25. Qualifying scars are scars that are nonlinear, deep, and are not located on the head, face, or neck.

7802 Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck,
that are superficial and nonlinear:

Area or areas of 144 square inches (929 sq. cm.) or greater........................................ 10

Note (1): A superficial scar is one not associated with underlying soft tissue damage.

Note (2): If multiple qualifying scars are present, or if a single qualifying scar affects more than one extremity, or a single qualifying scar affects one or more extremities and either the anterior portion or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity, assign a separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assign a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. The midaxillary line on each side separates the anterior and posterior portions of the trunk. Combine the separate evaluations under § 4.25. Qualifying scars are scars that are nonlinear, superficial, and are not located on the head, face, or neck.

7804 Scar(s), unstable or painful:

Five or more scars that are unstable or painful............................................................. 30
Three or four scars that are unstable or painful............................................................ 20
One or two scars that are unstable or painful............................................................... 10

Note (1): An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar.

Note (2): If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars.

Note (3): Scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable.

7805 Scars, other (including linear scars) and other effects of scars evaluated under diagnostic
codes 7800, 7801, 7802, and 7804:

Evaluate any disabling effect(s) not considered in a rating provided under diagnostic
codes 7800-04 under an appropriate diagnostic code.

7806 Dermatitis or eczema.

More than 40 percent of the entire body or more than 40 percent of
exposed areas affected, or; constant or near-constant systemic therapy
such as corticosteroids or other immunosuppressive drugs required
during the past 12-month period............................................................................. 60

20 to 40 percent of the entire body or 20 to 40 percent of exposed areas
affected, or; systemic therapy such as corticosteroids or other
immunosuppressive drugs required for a total duration of six weeks
or more, but not constantly, during the past 12-month period.................................... 30

At least 5 percent, but less than 20 percent, of the entire body, or at
least 5 percent, but less than 20 percent, of exposed areas affected,
or; intermittent systemic therapy such as corticosteroids or other
immunosuppressive drugs required for a total duration of less than
six weeks during the past 12-month period.............................................................. 10

Less than 5 percent of the entire body or less than 5 percent of exposed
areas affected, and; no more than topical therapy required during the
past 12-month period.............................................................................................. 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars
(DC’s 7801, 7802, 7803, 7804, or 7805), depending upon the
predominant disability.

7807 American (New World) leishmaniasis (mucocutaneous, espundia):
Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC’s 7801,
7802, 7803, 7804, or 7805), or dermatitis (DC 7806), depending upon the
predominant disability.

Note: Evaluate non-cutaneous (visceral) leishmaniasis under DC 6301 (visceral
leishmaniasis).

7808 Old World leishmaniasis (cutaneous, Oriental sore):
Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC’s 7801, 7802,
7803, 7804, or 7805), or dermatitis (DC 7806), depending upon the predominant
disability.

Note: Evaluate non-cutaneous (visceral) leishmaniasis under DC 6301 (visceral
leishmaniasis).

7809 Discoid lupus erythematosus or subacute cutaneous lupus erythematosus:
Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC’s 7801, 7802,
7803, 7804, or 7805), or dermatitis (DC 7806), depending upon the
predominant disability. Do not combine with ratings under DC 6350.

7811 Tuberculosis luposa (lupus vulgaris), active or inactive:
Rate under §§4.88c or 4.89, whichever is appropriate.

7813 Dermatophytosis (ringworm: of body, tinea corporis; of head, tinea capitis; of
feet, tinea pedis; of beard area, tinea barbae; of nails, tinea unguium; of
inguinal area (jock itch), tinea cruris):

Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC’s 7801, 7802,
7803, 7804, or 7805), or dermatitis (DC 7806), depending upon the predominant
disability.

7815 Bullous disorders (including pemphigus vulgaris, pemphigus foliaceous, bullous
pemphigoid, dermatitis herpetiformis, epidermolysis bullosa acquisita, benign
chronic familial pemphigus (Hailey-Hailey), and porphyri cutanea tarda):

More than 40 percent of the entire body or more than 40 percent of
exposed areas affected, or; constant or near-constant systemic therapy
such as corticosteroids or other immunosuppressive drugs required
during the past 12-month period......................................................................... 60

20 to 40 percent of the entire body or 20 to 40 percent of exposed
areas affected, or; systemic therapy such as corticosteroids or other
immunosuppressive drugs required for a total duration of six weeks or
more, but not constantly, during the past 12-month period.................................... 30

At least 5 percent, but less than 20 percent, of the entire body, or at
least 5 percent, but less than 20 percent, of exposed areas affected,
or; intermittent systemic therapy such as corticosteroids or other
immunosuppressive drugs required for a total duration of less than
six weeks during the past 12-month period.......................................................... 10

Less than 5 percent of the entire body or exposed areas affected, and;
no more than topical therapy required during the past 12-month
period............................................................................................................... 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars
(DC’s 7801, 7802, 7803, 7804, or 7805), depending upon the predominant
disability.

7816 Psoriasis:

More than 40 percent of the entire body or more than 40 percent
of exposed areas affected, or; constant or near-constant systemic
therapy such as corticosteroids or other immunosuppressive drugs
required during the past 12-month period............................................................ 60

20 to 40 percent of the entire body or 20 to 40 percent of exposed
areas affected, or; systemic therapy such as corticosteroids or other
immunosuppressive drugs required for a total duration of six weeks
or more, but not constantly, during the past 12-month period................................ 30

At least 5 percent, but less than 20 percent, of the entire body, or at
least 5 percent, but less than 20 percent, of exposed areas affected,
or; intermittent systemic therapy such as corticosteroids or other
immunosuppressive drugs required for a total duration of less than
six weeks during the past 12-month period.......................................................... 10

Less than 5 percent of the entire body or exposed areas affected, and;
no more than topical therapy required during the past 12-month
period ............................................................................................................... 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars
(DC’s 7801, 7802, 7803, 7804, or 7805), depending upon the predominant
disability.

7817 Exfoliative dermatitis (erythroderma):

Generalized involvement of the skin, plus systemic manifestations
(such as fever, weight loss, and hypoproteinemia), and; constant or
near-constant systemic therapy such as therapeutic doses of
corticosteroids, immunosuppressive retinoids, PUVA (psoralen
with long-wave ultraviolet-A light) or UVB (ultraviolet-B light)
treatments, or electron beam therapy required during the past
12-month period............................................................................................... 100

Generalized involvement of the skin without systemic manifestations,
and; constant or near-constant systemic therapy such as therapeutic
doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen
with long-wave ultraviolet-A light) or UVB (ultraviolet-B light)
treatments, or electron beam therapy required during the past
12-month period................................................................................................. 60

Any extent of involvement of the skin, and; systemic therapy such
as therapeutic doses of corticosteroids, immunosuppressive retinoids,
PUVA (psoralen with long-wave ultraviolet-A light) or UVB
(ultraviolet-B light) treatments, or electron beam therapy required
for a total duration of six weeks or more, but not constantly, during
the past 12-month period..................................................................................... 30

Any extent of involvement of the skin, and; systemic therapy such
as therapeutic doses of corticosteroids, immunosuppressive retinoids,
PUVA (psoralen with long-wave ultraviolet-A light) or UVB
(ultraviolet-B light) treatments, or electron beam therapy required
for a total duration of less than six weeks during the past 12-month
period..................................................................................................................10

Any extent of involvement of the skin, and; no more than topical
therapy required during the past 12-month period..................................................... 0

7818 Malignant skin neoplasms (other than malignant melanoma):
Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC’s 7801, 7802,
7803, 7804, or7805), or impairment of function.

Note: If a skin malignancy requires therapy that is comparable to that used for
systemic malignancies, i.e., systemic chemotherapy, X-ray therapy more
extensive than to the skin, or surgery more extensive than wide local excision,
a 100-percent evaluation will be assigned from the date of onset of treatment,
and will continue, with a mandatory VA examination six months following
the completion of such antineoplastic treatment, and any change in evaluation
based upon that or any subsequent examination will be subject to the
provisions of §3.105(e) of this chapter. If there has been no local recurrence
or metastasis, evaluation will then be made on residuals. If treatment is
confined to the skin, the provisions for a 100-percent evaluation do not
apply.

7819 Benign skin neoplasms:
Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC’s 7801, 7802,
7803, 7804, or 7805), or impairment of function.

7820 Infections of the skin not listed elsewhere (including bacterial, fungal, viral,
treponemal and parasitic diseases):

Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC’s 7801, 7802,
7803, 7804, or 7805), or dermatitis (DC 7806), depending upon the predominant
disability.

7821 Cutaneous manifestations of collagen-vascular diseases not listed elsewhere
(including scleroderma, calcinosis cutis, and dermatomyositis):

More than 40 percent of the entire body or more than 40 percent of
exposed areas affected, or; constant or near-constant systemic therapy
such as corticosteroids or other immunosuppressive drugs required
during the past 12-month period....................................................................... 60

20 to 40 percent of the entire body or 20 to 40 percent of exposed
areas affected, or; systemic therapy such as corticosteroids or
other immunosuppressive drugs required for a total duration of six
weeks or more, but not constantly, during the past 12-month period.................... 30

At least 5 percent, but less than 20 percent, of the entire body, or at
least 5 percent, but less than 20 percent, of exposed areas affected,
or; intermittent systemic therapy such as corticosteroids or other
immunosuppressive drugs required for a total duration of less than
six weeks during the past 12-month period......................................................... 10

Less than 5 percent of the entire body or exposed areas affected, and;
no more than topical therapy required during the past 12-month
period............................................................................................................... 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DC’s
7801, 7802, 7803, 7804, or 7805), depending upon the predominant
disability.

7822 Papulosquamous disorders not listed elsewhere (including lichen planus, large or
small plaque parapsoriasis, pityriasis lichenoides et varioliformis acuta
(PLEVA), lymphomatoid papulosus, and pityriasis rubra pilaris (PRP)):

More than 40 percent of the entire body or more than 40 percent of
exposed areas affected, and; constant or near-constant systemic
medications or intensive light therapy required during the past
12-month period........................................................................................... 60

20 to 40 percent of the entire body or 20 to 40 percent of exposed
areas affected, or; systemic therapy or intensive light therapy required
for a total duration of six weeks or more, but not constantly, during
the past 12-month period............................................................................... 30

At least 5 percent, but less than 20 percent, of the entire body, or at
least 5 percent, but less than 20 percent, of exposed areas affected,
or; systemic therapy or intensive light therapy required for a total
duration of less than six weeks during the past 12-month period........................ 10

Less than 5 percent of the entire body or exposed areas affected, and;
no more than topical therapy required during the past 12-month
period............................................................................................................ 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DC’s
7801, 7802, 7803, 7804, or 7805), depending upon the predominant
disability.

7823 Vitiligo:

With exposed areas affected........................................................................... 10
With no exposed areas affected........................................................................ 0

7824 Diseases of keratinization (including icthyoses, Darier’s disease, and palmoplantar
keratoderma):

With either generalized cutaneous involvement or systemic
manifestations, and; constant or near-constant systemic medication,
such as immunosuppressive retinoids, required during the past
12-month period............................................................................................ 60

With either generalized cutaneous involvement or systemic
manifestations, and; intermittent systemic medication, such as
immunosuppressive retinoids, required for a total duration of six
weeks or more, but not constantly, during the past 12-month period.................... 30

With localized or episodic cutaneous involvement and intermittent
systemic medication, such as immunosuppressive retinoids, required
for a total duration of less than six weeks during the past 12-month
period............................................................................................................ 10

No more than topical therapy required during the past 12-month period................ 0

7825 Urticaria:

Recurrent debilitating episodes occurring at least four times during the
past 12-month period despite continuous immunosuppressive therapy.................. 60

Recurrent debilitating episodes occurring at least four times during the
past 12-month period, and; requiring intermittent systemic
immunosuppressive therapy for control.............................................................. 30

Recurrent episodes occurring at least four times during the past
12-month period, and; responding to treatment with antihistamines or
sympathomimetics............................................................................................. 10

7826 Vasculitis, primary cutaneous:

Recurrent debilitating episodes occurring at least four times during the
past 12-month period despite continuous immunosuppressive therapy..................... 60

Recurrent debilitating episodes occurring at least four times during the
past 12-month period, and; requiring intermittent systemic
immunosuppressive therapy for control................................................................. 30

Recurrent episodes occurring one to three times during the past
12-month period, and; requiring intermittent systemic
immunosuppressive therapy for control................................................................. 10

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DC’s
7801, 7802, 7803, 7804, or 7805), depending upon the predominant disability.


7827 Erythema multiforme; Toxic epidermal necrolysis:

Recurrent debilitating episodes occurring at least four times during the
past 12-month period despite ongoing immunosuppressive therapy........................... 60

Recurrent episodes occurring at least four times during the past
12-month period, and; requiring intermittent systemic
immunosuppressive therapy................................................................................... 30

Recurrent episodes occurring during the past 12-month period that
respond to treatment with antihistamines or sympathomimetics, or;
one to three episodes occurring during the past 12-month period
requiring intermittent systemic immunosuppressive therapy........................................ 10

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DC’s
7801, 7802, 7803, 7804, or 7805), depending upon the predominant disability.

7828 Acne:

Deep acne (deep inflamed nodules and pus-filled cysts) affecting 40
percent or more of the face and neck........................................................................ 30

Deep acne (deep inflamed nodules and pus-filled cysts) affecting less
than 40 percent of the face and neck, or; deep acne other than on the
face and neck.......................................................................................................... 10

Superficial acne (comedones, papules, pustules, superficial cysts) of
any extent................................................................................................................ 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DC’s
7801, 7802, 7803, 7804, or 7805), depending upon the predominant disability.

7829 Chloracne:

Deep acne (deep inflamed nodules and pus-filled cysts) affecting 40
percent or more of the face and neck......................................................................... 30

Deep acne (deep inflamed nodules and pus-filled cysts) affecting less
than 40 percent of the face and neck, or; deep acne other than on the
face and neck........................................................................................................... 10

Superficial acne (comedones, papules, pustules, superficial cysts) of
any extent................................................................................................................. 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DC’s
7801, 7802, 7803, 7804, or 7805), depending upon the predominant disability.

7830 Scarring alopecia:

Affecting more than 40 percent of the scalp............................................................... 20
Affecting 20 to 40 percent of the scalp...................................................................... 10
Affecting less than 20 percent of the scalp................................................................... 0

7831 Alopecia areata:

With loss of all body hair.......................................................................................... 10
With loss of hair limited to scalp and face.................................................................... 0

7832 Hyperhidrosis:

Unable to handle paper or tools because of moisture, and
unresponsive to therapy........................................................................................... 30

Able to handle paper or tools after therapy.................................................................. 0

7833 Malignant melanoma:
Rate as scars (DC’s 7801, 7802, 7803, 7804, or 7805), disfigurement of the head, face,
or neck (DC 7800), or impairment of function (under the appropriate body system).

Note: If a skin malignancy requires therapy that is comparable to that used for
systemic malignancies, i.e., systemic chemotherapy, X-ray therapy more
extensive than to the skin, or surgery more extensive than wide local excision,
a 100-percent evaluation will be assigned from the date of onset of treatment,
and will continue, with a mandatory VA examination six months following
the completion of such antineoplastic treatment, and any change in evaluation
based upon that or any subsequent examination will be subject to the
provisions of §3.105(e). If there has been no local recurrence or metastasis,
evaluation will then be made on residuals. If treatment is confined to the
skin, the provisions for a 100-percent evaluation do not apply.

[29 FR 6718, May 22, 1964, as amended at 34 FR 5063, Mar. 11, 1969; 40 FR 42540, Sept. 15, 1975; 43 FR 45262, Oct. 2, 1978; 67 FR 49596, July 31, 2002; 67 FR 58448, Sept. 16, 2002; 68 FR 62889, Oct. 9, 2002; 73 FR 54710, Sept. 23, 2008]

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The Endocrine System


§4.119 Schedule of ratings-endocrine system.

7900 Hyperthyroidism

Thyroid enlargement, tachycardia (more than 100 beats per
minute), eye involvement, muscular weakness, loss of
weight, and sympathetic nervous system, cardiovascular,
or gastrointestinal symptoms ......................................................................... .100

Emotional instability, tachycardia, fatigability, and increased
pulse pressure or blood pressure ...................................................................... 60

Tachycardia, tremor, and increased pulse pressure or blood pressure .................. 30

Tachycardia, which may be intermittent, and tremor, or;
continuous medication required for control ...................................................... 10

Note 1: If disease of the heart is the predominant finding, evaluate as hyperthyroid heart disease (DC 7008) if doing so would result in a higher evaluation than using the criteria above.
Note 2: If ophthalmopathy is the sole finding, evaluate as field vision, impairment of (DC 6080); diplopia (DC 6090); or impairment of central visual acuity (DC 6061-6079).


7901 Thyroid gland, toxic adenoma of

Thyroid enlargement, tachycardia (more than 100 beats per minute),
eye involvement, muscular weakness, loss of weight, and
sympathetic nervous system, cardiovascular, or gastrointestinal
symptoms ..................................................................................................... 100

Emotional instability, tachycardia, fatigability, and increased pulse
pressure or blood pressure ............................................................................... 60

Tachycardia, tremor, and increased pulse pressure or blood pressure ................... 30

Tachycardia, which may be intermittent, and tremor, or;
continuous medication required for control ........................................................ 10

Note (1): If disease of the heart is the predominant finding, evaluate as hyperthyroid heart disease (DC 7008) if doing so would result in a higher evaluation than using the criteria above.
Note (2): If ophthalmopathy is the sole finding, evaluate as field vision, impairment of (DC 6080); diplopia (DC 6090); or impairment of central visual acuity (DC 6061-6079).


7902 Thyroid gland, nontoxic adenoma of

With disfigurement of the head or neck ................................................................... 20
Without disfigurement of the head or neck ................................................................ 0

Note: If there are symptoms due to pressure on adjacent organs such as the trachea, larynx, or esophagus, evaluate under the diagnostic code for disability of that organ, if doing so would result in a higher evaluation than using this diagnostic code.

7903 Hypothyroidism

Cold intolerance, muscular weakness, cardiovascular involvement,
mental disturbance (dementia, slowing of thought, depression),
bradycardia (less than 60 beats per minute), and sleepiness ................................ 100

Muscular weakness, mental disturbance, and weight gain ..................................... 60

Fatigability, constipation, and mental sluggishness ................................................ 30

Fatigability, or; continuous medication required for control ................................... 10

7904 Hyperparathyroidism

Generalized decalcification of bones, kidney stones, gastrointestinal
symptoms (nausea, vomiting, anorexia, constipation, weight loss, or
peptic ulcer), and weakness ................................................................................ 100

Gastrointestinal symptoms and weakness ............................................................... 60

Continuous medication required for control ............................................................ 10

Note: Following surgery or treatment, evaluate as digestive, skeletal, renal, or cardiovascular residuals or as endocrine dysfunction.


7905 Hypoparathyroidism

Marked neuromuscular excitability (such as convulsions, muscular
spasms (tetany), or laryngeal stridor) plus either cataract or
evidence of increased intracranial pressure (such as papilledema) ....................... 100

Marked neuromuscular excitability, or; paresthesias (of arms, legs,
or circumoral area) plus either cataract or evidence of
increased intracranial pressure ........................................................................... 60

Continuous medication required for control ........................................................ 10

7907 Cushing’s syndrome

As active, progressive disease including loss of muscle strength, areas
of osteoporosis, hypertension, weakness, and enlargement of
pituitary or adrenal gland ................................................................................. 100

Loss of muscle strength and enlargement of pituitary or adrenal gland ................... 60

With striae, obesity, moon face, glucose intolerance, and
vascular fragility ............................................................................................... 30

Note: With recovery or control, evaluate as residuals of adrenal insufficiency or cardiovascular, psychiatric, skin, or skeletal complications under appropriate diagnostic code.

7908 Acromegaly

Evidence of increased intracranial pressure (such as visual field
defect), arthropathy, glucose intolerance, and either hypertension
or cardiomegaly ................................................................................................ 100

Arthropathy, glucose intolerance, and hypertension ................................................ 60

Enlargement of acral parts or overgrowth of long bones, and
enlarged sella turcica ............................................................................................ 30

7909 Diabetes insipidus

Polyuria with near-continuous thirst, and more than two documented
episodes of dehydration requiring parenteral hydration in the
past year ............................................................................................................ 100

Polyuria with near-continuous thirst, and one or two documented
episodes of dehydration requiring parenteral hydration in the
past year .............................................................................................................. 60

Polyuria with near-continuous thirst, and one or more episodes
of dehydration in the past year not requiring parenteral hydration .............................. 40

Polyuria with near-continuous thirst ........................................................................ 20

7911 Addison’s disease (adrenal cortical hypofunction)

Four or more crises during the past year .................................................................. 60

Three crises during the past year, or; five or more episodes during
the past year ......................................................................................................... 40

One or two crises during the past year, or; two to four episodes during
the past year, or; weakness and fatigability, or; corticosteroid
therapy required for control .................................................................................... 20

Note (1): An Addisonian “crisis” consists of the rapid onset of peripheral vascular collapse (with acute hypotension and shock), with findings that may include: anorexia; nausea; vomiting; dehydration; profound weakness; pain in abdomen, legs, and back; fever; apathy, and depressed mentation with possible progression to coma, renal shutdown, and death.
Note (2): An Addisonian “episode,” for VA purposes, is a less acute and less severe event than an Addisonian crisis and may consist of anorexia, nausea, vomiting, diarrhea, dehydration, weakness, malaise, orthostatic hypotension, or hypoglycemia, but no peripheral vascular collapse.
Note (3): Tuberculous Addison’s disease will be evaluated as active or inactive tuberculosis. If inactive, these evaluations are not to be combined with the graduated ratings of 50 percent or 30 percent for non-pulmonary tuberculosis specified under §4.89. Assign the higher rating.

7912 Pluriglandular syndrome
Evaluate according to major manifestations.


7913 Diabetes mellitus

Requiring more than one daily injection of insulin, restricted diet,
and regulation of activities (avoidance of strenuous occupational
and recreational activities) with episodes of ketoacidosis or
hypoglycemic reactions requiring at least three hospitalizations per
year or weekly visits to a diabetic care provider, plus either
progressive loss of weight and strength or complications that
would be compensable if separately evaluated ....................................................... 100

Requiring insulin, restricted diet, and regulation of activities with
episodes of ketoacidosis or hypoglycemic reactions requiring one
or two hospitalizations per year or twice a month visits to a diabetic
care provider, plus complications that would not be compensable
if separately evaluated ........................................................................................... 60

Requiring insulin, restricted diet, and regulation of activities ...................................... 40

Requiring insulin and restricted diet, or; oral hypoglycemic agent
and restricted diet ............................................................................................... ...20

Manageable by restricted diet only .......................................................................... 10

Note (1): Evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of the diabetic process under diagnostic code 7913.

Note (2): When diabetes mellitus has been conclusively diagnosed, do not request a glucose tolerance test solely for rating purposes.

7914 Neoplasm, malignant, any specified part of the endocrine system ............................. 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.

7915 Neoplasm, benign, any specified part of the endocrine system
Rate as residuals of endocrine dysfunction.

7916 Hyperpituitarism (prolactin secreting pituitary dysfunction)

7917 Hyperaldosteronism (benign or malignant)

7918 Pheochromocytoma (benign or malignant)
Note: Evaluate diagnostic codes 7916, 7917, and 7918 as malignant or benign neoplasm as appropriate.

7919 C-cell hyperplasia of the thyroid ................................................................................ 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.

[46 FR 43666, Aug. 31, 1981, as amended at 61 FR 20446, May 7, 1996]

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§4.120 Neurological Conditions and Convulsive Disorders Evaluations by comparison. Disability in this field is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, injury to the skull, etc. In rating disability from the conditions in the preceding sentence refer to the appropriate schedule. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances.

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§4.121 Identification of epilepsy.

When there is doubt as to the true nature of epileptiform attacks, neurological observation in a hospital adequate to make such a study is necessary. To warrant a rating for epilepsy, the seizures must be witnessed or verified at some time by a physician. As to frequency, competent, consistent lay testimony emphasizing convulsive and immediate post-convulsive characteristics may be accepted. The frequency of seizures should be ascertained under the ordinary conditions of life (while not hospitalized).

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§4.122 Psychomotor epilepsy.

The term psychomotor epilepsy refers to a condition that is characterized by seizures and not uncommonly by a chronic psychiatric disturbance as well.

a) Psychomotor seizures consist of episodic alterations in conscious control that may be associated with automatic states, generalized convulsions, random motor movements (chewing, lip smacking, fumbling), hallucinatory phenomena (involving taste, smell, sound, vision), perceptual illusions (deja vu, feelings of loneliness, strangeness, macropsia, micropsia, dreamy states), alterations in thinking (not open to reason), alterations in memory, abnormalities of mood or affect (fear, alarm, terror, anger, dread, well-being), and autonomic disturbances (sweating, pallor, flushing of the face, visceral phenomena such as nausea, vomiting, defecation, a rising feeling of warmth in the abdomen). Automatic states or automatisms are characterized by episodes of irrational, irrelevant, disjointed, unconventional, asocial, purposeless though seemingly coordinated and purposeful, confused or inappropriate activity of one to several minutes (or, infrequently, hours) duration with subsequent amnesia for the seizure. Examples: A person of high social standing remained seated, muttered angrily, and rubbed the arms of his chair while the National Anthem was being played; an apparently normal person suddenly disrobed in public; a man traded an expensive automobile for an antiquated automobile in poor mechanical condition and after regaining conscious control, discovered that he had signed an agreement to pay an additional sum of money in the trade. The seizure manifestations of psychomotor epilepsy vary from patient to patient and in the same patient from seizure to seizure.

(b) A chronic mental disorder is not uncommon as an interseizure manifestation of psychomotor epilepsy and may include psychiatric disturbances extending from minimal anxiety to severe personality disorder (as distinguished from developmental) or almost complete personality disintegration (psychosis). The manifestations of a chronic mental disorder associated with psychomotor epilepsy, like those of the seizures, are protean in character.

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§4.123 Neuritis, cranial or peripheral.

Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. See nerve involved for diagnostic code number and rating. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis.

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§4.124 Neuralgia, cranial or peripheral.

Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. See nerve involved for diagnostic code number and rating. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve.

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§4.124a Schedule of ratings—neurological conditions and convulsive disorders.

With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves.

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Organic Diseases of the Central Nervous System

8000 Encephalitis, epidemic, chronic:

As active febrile disease.................................................................................... 100
Rate residuals, minimum..................................................................................... 10

Brain, new growth of:

8002 Malignant ..................................................................................................... 100

Note: The rating in code 8002 will be continued for 2 years following cessation of surgical, chemotherapeutic or other treatment modality. At this point, if the residuals have stabilized, the rating will be made on neurological residuals according to symptomatology.

Minimum rating................................................................................................. 30

8003 Benign, minimum............................................................................................. 60
Rate residuals, minimum........................................................................................... 10

8004 Paralysis agitans: (Parkinson’s disease)

Minimum rating.................................................................................................. 30

8005 Bulbar palsy .................................................................................................. 100

8007 Brain, vessels, embolism of.

8008 Brain, vessels, thrombosis of.

8009 Brain, vessels, hemorrhage from:

Rate the vascular conditions under Codes 8007 through 8009,
for 6 months.................................................................................................... 100
Rate residuals, thereafter, minimum..................................................................... 10

8010 Myelitis:
Minimum rating....................................................................................................... 10

8011 Poliomyelitis, anterior:

As active febrile disease..................................................................................... 100
Rate residuals, minimum..................................................................................... 10

8012 Hematomyelia:

For 6 months.................................................................................................... 100
Rate residuals, minimum...................................................................................... 10

8013 Syphilis, cerebrospinal.

8014 Syphilis, meningovascular.

8015 Tabes dorsalis.
Note: Rate upon the severity of convulsions, paralysis, visual impair­ment or psychotic involvement, etc.

8017 Amyotrophic lateral sclerosis:
Minimum rating........................................................................................................ 100
(The Rating for ALS was raised from 30% to 100% January 19, 2012)

8018 Multiple sclerosis:
Minimum rating......................................................................................................... 30

8019 Meningitis, cerebrospinal, epidemic:
As active febrile disease............................................................................................ 100
Rate residuals, minimum............................................................................................ 10

8020 Brain, abscess of:
As active disease..................................................................................................... 100
Rate residuals, minimum............................................................................................ 10

Spinal cord, new growths of:

8021 Malignant........................................................................................................ 100

Note: The rating in code 8021 will be continued for 2 years following cessation of surgical, chemotherapeutic or other treatment modality. At this point, if the residuals have stabilized, the rating will be made on neurological residuals according to symptomatology.

Minimum rating................................................................................................... 30

8022 Benign, minimum rating..................................................................................... 60
Rate residuals, minimum............................................................................................ 10

8023 Progressive muscular atrophy:
Minimum rating.......................................................................................................... 30

8024 Syringomyelia:
Minimum rating.......................................................................................................... 30

8025 Myasthenia gravis:
Minimum rating........................................................................................................... 30

Note: It is required for the minimum ratings for residuals under diagnostic codes 8000-8025, that there be ascertainable residuals. Determinations as to the presence of residuals not capable of objective verification, i.e., headaches, dizziness, fatigability, must be approached on the basis of the diagnosis recorded; subjective residuals will be accepted when consistent with the disease and not more likely attributable to other disease or no disease. It is of exceptional importance that when ratings in excess of the prescribed minimum ratings are assigned, the diagnostic codes utilized as bases of evaluation be cited, in addition to the codes identifying the diagnoses.

8045 Residuals of traumatic brain injury (TBI):

There are three main areas of dysfunction that may result from TBI and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation.

Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Evaluate cognitive impairment under the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.”

Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Evaluate subjective symptoms that are residuals of TBI, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.” However, separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere’s disease, even if that diagnosis is based on subjective symptoms, rather than under the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table.

Evaluate emotional/behavioral dysfunction under §4.130 (Schedule of ratings–mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified.”

Evaluate physical (including neurological) dysfunction based on the following list, under an appropriate diagnostic code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions.

The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, evaluate under the most appropriate diagnostic code. Evaluate each condition separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine under §4.25 the evaluations for each separately rated condition. The evaluation assigned based on the “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations.

Consider the need for special monthly compensation for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc.

Evaluation of Cognitive Impairment and Subjective Symptoms

The table titled “Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified” contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled “total.” However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than “total,” since any level of impaired consciousness would be totally disabling. Assign a 100-percent evaluation if “total” is the level of evaluation for one or more facets. If no facet is evaluated as “total,” assign the overall percentage evaluation based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet.

Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled “Evaluation Of Cognitive Impairment And Other Residuals Of TBI Not Otherwise Classified” with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition.

Note (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation.

Note (3): “Instrumental activities of daily living” refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one’s own medications, and using a telephone. These activities are distinguished from “Activities of daily living,” which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet.

Note (4): The terms “mild,” “moderate,” and “severe” TBI, which may appear in medical records, refer to a classification of TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under diagnostic code 8045.

Note (5): A veteran whose residuals of TBI are rated under a version of § 4.124a, diagnostic code 8045, in effect before October 23, 2008 may request review under diagnostic code 8045, irrespective of whether his or her disability has worsened since the last review. VA will review that veteran’s disability rating to determine whether the veteran may be entitled to a higher disability rating under diagnostic code 8045. A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating awarded as a result of such review, VA will apply 38 CFR 3.114, if applicable.

 

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

Facets of cognitive impairment and other residuals of TBI not otherwise classified

Level of Impairment

Criteria

Memory, attention, concentration, executive functions.

0

No complaints of impairment of member, attention, concentration, or executive functions.

 

1

A complaint of mild loss of memory (such as having difficulty following a conversation, recalling recent conversations, remembering names of new acquaintances, or finding words, or often misplacing items), attention, concentration, or executive functions, but without objective evidence on testing.

 

2

Objective evidence on testing of mild impairment of memory, attention, concentration, or executive functions resulting in mild functional impairment.

 

3

Objective evidence on testing of moderate impairment of memory, attention, concentration, or executive functions resulting in moderate functional impairment.

 

Total

Objective evidence on testing of severe impairment of memory, attention, concentration, or executive functions resulting in severe functional impairment.

Judgment

0

Normal

 

1

Mildly impaired judgment. For complex or unfamiliar decisions, occasionally unable to indentify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision.

 

2

Moderately impaired judgment. For complex or unfamiliar decisions, usually unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision, although has little difficulty with simple decisions.

 

3

Moderately severely impaired judgment. For even routine and familiar decisions, occasionally unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision.

 

Total

Severely impaired judgment. For even routine and familiar decisions, usually unable to identify, understand, and weigh the alternatives, understand the consequences of choices, and make a reasonable decision. For example, unable to determine appropriate clothing for current weather conditions or judge when to avoid dangerous situations or activities.

Social Interaction

0

Social interaction is routinely appropriate.

 

1

Social interaction is occasionally inappropriate.

 

2

Social interaction is frequently inappropriate.

 

3

Social interaction is inappropriate most or all of the time.

Orientation

0

Always oriented to person, time, place, and situation.

 

1

Occasionally disoriented to one of the four aspects (person, time, place, situation) of orientation.

 

2

Occasionally disoriented to two of the four aspects (person, time, place, situation) of orientation or often disoriented to one aspect of orientation.

 

3

Often disoriented to two or more of the four aspects (person, time, place, situation) of orientation.

 

Total

Consistently disoriented to two or more of the four aspects (person, time, place, situation) of orientation.

Motor Activity (with intact motor and sensory system.)

0

Motor activity normal

 

1

Motor activity normal most of the time, but mildly slowed at times due to apraxia (inability to perform previously learned motor activities, despite normal motor function.)

 

2

Motor activity mildly decreased or with moderate slowing due to apraxia.

 

3

Motor activity moderately decreased due to apraxia.

 

Total

Motor activity severely decreased due to apraxia.

Visual Spatial Orientation

0

Normal.

 

1

Mildly impaired. Occasionally gets lost in unfamiliar surroundings, has difficulty reading maps or following directions. Is able to use assistive devices such as GPS.

 

2

Moderately impaired. Usually gets lost in unfamiliar surroundings, has difficulty reading maps following directions, and judging distance. Has difficulty using assistive devices such as GPS.

 

3

Moderately severely impaired. Gets lost even in familiar surroundings, unable to use assistive devices such as GPS.

 

Total

Severely impaired. May be unable to touch or name own body parts when asked by the examiner, identify the relative position in space of two different objects, or find the way from one room to another in a familiar environment.

Subjective Symptoms

0

Subjective symptoms that do not interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples are: mild or occasional headaches, mild anxiety.

 

1

Three or more subjective symptoms that mildly interfere with work; instrumental activities of daily living; or work, family, or other close, relationships. Examples of findings that might be seen at this level of impairment are: intermittent dizziness, daily mild to moderate headaches, tinnitus, frequent insomnia, hypersensitivity to sound, hypersensitivity to light.

 

2

Three or more subjective symptoms that moderately interfere with work; instrumental activities of daily living; or work, family, and other close relationships. Examples of findings that might be seen at this level of impairment are: marked fatigability, blurred or double vision, headaches requiring rest periods during most days.

Neurobehavioral effects

0

One or more neurobehavioral effects that do not interfere with workplace interaction or social interaction. Examples of neurobehavioral effects are: Irritability, impulsivity, unpredictability, lack of motivation, verbal aggression, physical aggression, belligerence, apathy, lack of empathy, moodiness, lack of cooperation, inflexibility, and impaired awareness of disability. Any of these effects may range from slight to severe, although verbal and physical aggression are likely to have a more serious impact on workplace interaction and social interaction than some of the other effects.

 

1

One or more neurobehavioral effects that occasionally interfere with workplace interaction, social interaction, or both but do not preclude them.

 

2

One or more neurobehavioral effects that frequently interfere with workplace interaction, social interaction, or both but do not preclude them.

 

3

One or more neurobehavioral effects that interfere with or preclude workplace interaction, social interaction, or both on most days or that occasionally require supervision for safety of self or others.

Communication

0

Able to communicate by spoken and written language (expressive communication), and to comprehend spoken and written language.

 

1

Comprehension or expression, or both, of either spoken language or written language is only occasionally impaired. Can communicate complex ideas.

 

2

Inability to communicate either by spoken language, written language, or both, more than occasionally but less than half of the time, or to comprehend spoken language, written language, or both, more than occasionally but less than half of the time. Can generally communicate complex ideas.

 

3

Inability to communicate either by spoken language, written language, or both, at least half of the time but not all of the time, or to comprehend spoken language, written language, or both, at least half of the time but not all of the time. May rely on gestures or other alternative modes of communication. Able to communicate basic needs.

 

Total

Complete inability to communicate either by spoken language, written language, or both, or to comprehend spoken language, written language, or both. Unable to communicate basic needs.

Consciousness

0

None

 

Total

Persistently altered state of consciousness, such as vegetative state, minimally responsive state, coma.



8046 Cerebral arteriosclerosis:
Purely neurological disabilities, such as hemiplegia, cranial nerve paralysis, etc., due to cerebral arteriosclerosis will be rated under the diagnostic codes dealing with such specific disabilities, with citation of a hyphenated diagnostic code (e.g., 8046-8207).

Purely subjective complaints such as headache, dizziness, tinnitus, insomnia and irritability, recognized as symptomatic of a properly diagnosed cerebral arteriosclerosis, will be rated 10 percent and no more under diagnostic code 9305. This 10 percent rating will not be combined with any other rating for a disability due to cerebral or generalized arteriosclerosis. Ratings in excess of 10 percent for cerebral arteriosclerosis under diagnostic code 9305 are not assignable in the absence of a diagnosis of multi-infarct dementia with cerebral arteriosclerosis.

Note: The ratings under code 8046 apply only when the diagnosis of cerebral arteriosclerosis is substantiated by the entire clinical picture and not solely on findings of retinal arteriosclerosis.

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Miscellaneous Diseases


8100 Migraine (headaches):

With very frequent completely prostrating and prolonged attacks
productive of severe economic inadaptability........................................................... 50

With characteristic prostrating attacks occurring on an average once
a month over last several months........................................................................... 30

With characteristic prostrating attacks averaging one in 2 months over
last several months............................................................................................... 10

With less frequent attacks....................................................................................... 0

Per DoDI 1332.39, para. E2.A1.4.1.4, "Prostrating" means that the Service member must stop what he or she is doing and seek medical attention. The number of prostrating attacks per time period (day, week, month) should be recorded by a neurologist for diagnostic confirmation. Estimation of the social and industrial impairment due to migranious attacks should be made.


8103 Tic, convulsive:

Severe .............................................................................................................. 30
Moderate .......................................................................................................... 10
Mild ................................................................................................................... 0

Note: Depending upon frequency, severity, muscle groups involved.


8104 Paramyoclonus multiplex (convulsive state, myoclonic type):
Rate as tic; convulsive; severe cases............................................................................ 60

8105 Chorea, Sydenham’s:

Pronounced, progressive grave types.................................................................... 100
Severe ................................................................................................................ 80
Moderately severe................................................................................................ 50
Moderate ............................................................................................................ 30
Mild ................................................................................................................... 10

Note: Consider rheumatic etiology and complications.


8106 Chorea, Huntington’s.
Rate as Sydenham’s chorea. This, though a familial disease, has its onset in late adult life, and is
considered a ratable disability.

8107 Athetosis, acquired.
Rate as chorea.

8108 Narcolepsy.
Rate as for epilepsy, petit mal.

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Diseases of the Cranial Nerves

Disability from lesions of peripheral portions of first, second, third, fourth, sixth, and eighth nerves will be rated under the Organs of Special Sense. The ratings for the cranial nerves are for unilateral involvement; when bilateral, combine but without the bilateral factor.

Fifth (trigeminal) cranial nerve

8205 Paralysis of:

Complete ................................................................................................................. 50
Incomplete, severe..................................................................................................... 30
Incomplete, moderate................................................................................................. 10

Note: Dependent upon relative degree of sensory manifestation or motor loss.

8305 Neuritis.

8405 Neuralgia.

Note: Tic douloureux may be rated in accordance with severity, up to complete paralysis.

Seventh (facial) cranial nerve

8207 Paralysis of:

Complete ................................................................................................................ 30
Incomplete, severe.................................................................................................... 20
Incomplete, moderate................................................................................................ 10

Note: Dependent upon relative loss of innervation of facial muscles.

8307 Neuritis.

8407 Neuralgia.

Ninth (glossopharyngeal) cranial nerve

8209 Paralysis of:

Complete ........................................................................................... ....................30
Incomplete, severe................................................................................................... 20
Incomplete, moderate............................................................................................... 10

Note: Dependent upon relative loss of ordinary sensation in mucous membrane of the pharynx, fauces, and tonsils.

8309 Neuritis.

8409 Neuralgia.

Tenth (pneumogastric, vagus) cranial nerve

8210 Paralysis of:

Complete ................................................................................................................ 50
Incomplete, severe.................................................................................................... 30
Incomplete, moderate................................................................................................ 10

Note: Dependent upon extent of sensory and motor loss to organs of voice, respiration, pharynx, stomach and heart.

8310 Neuritis.

8410 Neuralgia.

Eleventh (spinal accessory, external branch) cranial nerve.

8211 Paralysis of:

Complete................................................................................................................. 30
Incomplete, severe.................................................................................................... 20
Incomplete, moderate................................................................................................ 10

Note: Dependent upon loss of motor function of sternomastoid and trapezius muscles.

8311 Neuritis.

8411 Neuralgia.

Twelfth (hypoglossal) cranial nerve.

8212 Paralysis of:

Complete ................................................................................................................. 50
Incomplete, severe..................................................................................................... 30
Incomplete, moderate................................................................................................. 10

Note: Dependent upon loss of motor function of tongue.


8312 Neuritis.

8412 Neuralgia.


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Diseases of the Peripheral Nerves

The term “incomplete paralysis” with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The following ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor.
                                                                                                                         Ratings
                                                                                                                  Major          Minor

Upper radicular group (fifth and sixth cervicals)

8510 Paralysis of:

Complete; all shoulder and elbow movements lost or severely
affected, hand and wrist movements not affected .................................... 70.......... 60

Incomplete:

Severe ........................................................................................... 50.......... 40
Moderate ....................................................................................... 40.......... 30
Mild .............................................................................................. 20.......... 20

8610 Neuritis

8710 Neuralgia

Middle radicular group

8511 Paralysis of:

Complete; adduction, abduction, and rotation of arm, flexion of
elbow, and extension of wrist lost or severely affected ................................ 70.......... 60

Incomplete:

Severe .............................................................................................. 50.......... 40
Moderate .......................................................................................... 40.......... 30
Mild ................................................................................................. 20.......... 20

8611 Neuritis

8711 Neuralgia

Lower radicular group

8512 Paralysis of

Complete; all intrinsic muscles of hand, and some or all of flexors
Flexors of wrist and fingers, paralyzed (substantial loss of use
of hand) ................................................................................................. 70.......... 60

Incomplete

Severe................................................................................................50..........40
Moderate .......................................................................................... 40.......... 30
Mild ................................................................................................. 20.......... 20

8612 Neuritis

8712 Neuralgia

All radicular groups

8513 Paralysis of:

Complete .............................................................................................. 90.......... 80

Incomplete:

Severe ............................................................................................. 70.......... 60
Moderate ......................................................................................... 40.......... 30
Mild ................................................................................................ 20.......... 20

8613 Neuritis

8713 Neuralgia

The musculospiral nerve (radial nerve)

8514 Paralysis of:

Complete; drop of hand and fingers, wrist and fingers perpetually
flexed, the thumb adducted falling within the line of the outer
border of the index finger; cannot extend hand at wrist, extend
proximal phalanges of fingers, extend thumb, or make lateral
movement of wrist; supination of hand, extension and flexion
of elbow weakened, the loss of synergic motion of extensors
impairs the hand grip seriously; total paralysis of the triceps
occurs only as the greatest rarity .......................................................... 70.......... 60

Incomplete:

Severe .......................................................................................... 50.......... 40
Moderate ...................................................................................... 30.......... 20
Mild ............................................................................................. 20.......... 20

8614 Neuritis

8714 Neuralgia

Note: Lesions involving only “dissociation of extensor communis digitorum” and “paralysis below the extensor communis digitorum,” will not exceed the moderate rating under code 8514.

The median nerve (carpal tunnel)

8515 Paralysis of:

Complete; the hand inclined to the ulnar side, the index and middle
fingers more extended than normally, considerable atrophy of the
muscles of the thenar eminence, the thumb in the plane of the hand
(ape hand); pronation incomplete and defective, absence of flexion
of index finger and feeble flexion of middle finger, cannot make a fist,
index and middle fingers remain extended; cannot flex distal phalanx
of thumb, defective opposition and abduction of the thumb at right
angles to palm; flexion of wrist weakened; pain with trophic
disturbances .................................................................................... 70.......... 60

Incomplete

Severe ....................................................................................... 50.......... 40
Moderate ................................................................................... 30.......... 20
Mild .......................................................................................... 10.......... 10

8615 Neuritis

8715 Neuralgia

The ulnar nerve (cubital tunnel)

8516 Paralysis of:

Complete; the “griffin claw” deformity, due to flexor contraction of
ring and little fingers, atrophy very marked in dorsal interspace
and thenar and hypothenar eminences; loss of extension of ring
and little fingers, cannot spread the fingers (or reverse), cannot
adduct the thumb; flexion of wrist weakened ......................................... 60.......... 50

Incomplete:

Severe .......................................................................................... 40.......... 30
Moderate ...................................................................................... 30.......... 20
Mild ............................................................................................. 10.......... 10

8616 Neuritis

8716 Neuralgia

Musculocutaneous nerve

8517 Paralysis of:

Complete; weakness but not loss of flexion of elbow and
supination of forearm............................................................................. 30.......... 20

Incomplete:

Severe ........................................................................................... 20.......... 20
Moderate ....................................................................................... 10.......... 10
Mild .................................................................................................0............ 0

8617 Neuritis

8717 Neuralgia

Circumflex nerve

8518 Paralysis of:

Complete; abduction of arm is impossible, outward rotation is
weakened; muscles supplied are deltoid and teres minor .......................... 50.......... 40
Incomplete:

Severe .......................................................................................... 30.......... 20
Moderate ...................................................................................... 10.......... 10
Mild ............................................................................................... 0............ 0

8618 Neuritis

8718 Neuralgia

Long thoracic nerve

8519 Paralysis of:

Complete; inability to raise arm above shoulder level, winged
scapula deformity ................................................................................... 30.......... 20

Incomplete:

Severe ............................................................................................. 20.......... 20
Moderate ......................................................................................... 10.......... 10
Mild .................................................................................................. 0............ 0

Note: Not to be combined with lost motion above shoulder level.

8619 Neuritis

8719 Neuralgia
Note: Combined nerve injuries should be rated by reference to the major involvement, or if sufficient in extent, consider radicular group ratings.

Sciatic nerve.

8520 Paralysis of:

Complete; the foot dangles and drops, no active movement possible
of muscles below the knee, flexion of knee weakened or (very
rarely) lost........................................................................................................ 80

Incomplete:

Severe, with marked muscular atrophy.......................................................... 60
Moderately severe ...................................................................................... 40
Moderate.................................................................................................... 20
Mild .......................................................................................................... 10

8620 Neuritis.

8720 Neuralgia.

External popliteal nerve (common peroneal).

8521 Paralysis of:

Complete; foot drop and slight droop of first phalanges of all toes,
cannot dorsiflex the foot, extension (dorsal flexion) of proximal
phalanges of toes lost; abduction of foot lost, adduction weakened;
anesthesia covers entire dorsum of foot and toes...................................................... 40

Incomplete:

Severe ........................................................................................................... 30
Moderate........................................................................................................ 20
Mild .............................................................................................................. 10

8621 Neuritis

8721 Neuralgia.

Musculocutaneous nerve (superficial peroneal)

8522 Paralysis of:

Complete; eversion of foot weakened................................................................ 30
Incomplete:

Severe ..................................................................................................... 20
Moderate.................................................................................................. 10
Mild........................................................................................................... 0

8622 Neuritis.

8722 Neuralgia.

Anterior tibial nerve (deep peroneal).

8523 Paralysis of:

Complete; dorsal flexion of foot lost........................................................................ 30

Incomplete:

Severe ............................................................................................................ 20
Moderate......................................................................................................... 10
Mild ................................................................................................................. 0

8623 Neuritis.

8723 Neuralgia.

Internal popliteal nerve (tibial).

8524 Paralysis of:

Complete; plantar flexion lost, frank adduction of foot impossible,
flexion and separation of toes abolished; no muscle in sole can
move; in lesions of the nerve high in popliteal fossa, plantar flexion
of foot is lost..................................................................................................... 40

Incomplete:

Severe ........................................................................................................ 30
Moderate..................................................................................................... 20
Mild............................................................................................................ 10

8624 Neuritis.

8724 Neuralgia.

Posterior tibial nerve. (tarsal tunnel)

8525 Paralysis of:

Complete; paralysis of all muscles of sole of foot, frequently with painful
paralysis of a causalgic nature; toes cannot be flexed; adduction
is weakened; plantar flexion is impaired................................................................... 30

Incomplete:

Severe ............................................................................................................ 20
Moderate......................................................................................................... 10
Mild ............................................................................................................... 10

8625 Neuritis.

8725 Neuralgia.

Anterior crural nerve (femoral).

8526 Paralysis of:

Complete; paralysis of quadriceps extensor muscles................................................. 40
Incomplete:

Severe ........................................................................................................... 30
Moderate ....................................................................................................... 20
Mild............................................................................................................... 10

8626 Neuritis.

8726 Neuralgia.

Internal saphenous nerve.

8527 Paralysis of:

Severe to complete.................................................................................................. 10
Mild to moderate....................................................................................................... 0

8627 Neuritis.

8727 Neuralgia.

Obturator nerve.

8528 Paralysis of:

Severe to complete............................................................................................... 10
Mild or moderate....................................................................................................... 0

8628 Neuritis.

8728 Neuralgia.

External cutaneous nerve of thigh.

8529 Paralysis of:

Severe to complete.................................................................................................... 10
Mild or moderate........................................................................................................ 0

8629 Neuritis.

8729 Neuralgia.

Ilio-inguinal nerve. (ilioinguinal)

8530 Paralysis of:

Severe to complete.................................................................................................... 10
Mild or moderate........................................................................................................ 0

8630 Neuritis.

8730 Neuralgia.

8540 Soft-tissue sarcoma (of neurogenic origin)................................................................. 100

Note: The 100 percent rating will be continued for 6 months following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic proce­­dure. At this point, if there has been no local recurrence or metastases, the rating will be made on residuals.

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The Epilepsies

A thorough study of all material in §§4.121 and 4.122 of the preface and under the ratings for epilepsy is necessary prior to any rating action.

8910 Epilepsy, grand mal.
Rate under the general rating formula for major seizures.

8911 Epilepsy, petit mal.
Rate under the general rating formula for minor seizures.

Note (1): A major seizure is characterized by the generalized tonic-clonic convulsion with unconsciousness.

Note (2): A minor seizure consists of a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head (“pure” petit mal), or sudden jerking movements of the arms, trunk, or head (myoclonic type) or sudden loss of postural control (akinetic type).


General Rating Formula for Major and Minor Epileptic Seizures:

Averaging at least 1 major seizure per month over the last year....................... 100
Averaging at least 1 major seizure in 3 months over the last year;
or more than 10 minor seizures weekly........................................................... 80
Averaging at least 1 major seizure in 4 months over the last year;
or 9-10 minor seizures per week.................................................................... 60
At least 1 major seizure in the last 6 months or 2 in the last year;
or averaging at least 5 to 8 minor seizures weekly............................................ 40
At least 1 major seizure in the last 2 years; or at least 2 minor seizures
in the last 6 months....................................................................................... 20
A confirmed diagnosis of epilepsy with a history of seizures ............................ 10

Note (1): When continuous medication is shown necessary for the control of epilepsy, the minimum evaluation will be 10 percent. This rating will not be combined with any other rating for epilepsy.

Note (2): In the presence of major and minor seizures, rate the predominating type.

Note (3): There will be no distinction between diurnal and nocturnal major seizures.


8912 Epilepsy, Jacksonian and focal motor or sensory.

8913 Epilepsy, diencephalic.
Rate as minor seizures, except in the presence of major and minor seizures, rate the predominating type.

8914 Epilepsy, psychomotor.

Major seizures:

Psychomotor seizures will be rated as major seizures under the general
rating formula when characterized by automatic states and/or
generalized convulsions with unconsciousness.

Minor seizures:

Psychomotor seizures will be rated as minor seizures under the general
rating formula when characterized by brief transient episodes of
random motor movements, hallucinations, perceptual illusions,
abnormalities of thinking, memory or mood, or autonomic disturbances.

Mental Disorders in Epilepsies: A nonpsychotic organic brain syndrome will be rated separately under the appropriate diagnostic code (e.g., 9304 or 9326). In the absence of a diagnosis of non-psychotic organic psychiatric disturbance (psychotic, psychoneurotic or personality disorder) if diagnosed and shown to be secondary to or directly associated with epilepsy will be rated separately. The psychotic or psychoneurotic disorder will be rated under the appropriate diagnostic code. The personality disorder will be rated as a dementia (e.g., diagnostic code 9304 or 9326).

Epilepsy and Unemployability:

(1) Rating specialists must bear in mind that the epileptic, although his or her seizures are controlled, may find employment and rehabilitation difficult of attainment due to employer reluctance to the hiring of the epileptic.

(2) Where a case is encountered with a definite history of unemployment, full and complete development should be undertaken to ascertain whether the epilepsy is the determining factor in his or her inability to obtain employment.

(3) The assent of the claimant should first be obtained for permission to conduct this economic and social survey. The purpose of this survey is to secure all the relevant facts and data necessary to permit of a true judgment as to the reason for his or her unemployment and should include information as to:

(a) Education;

(b) Occupations prior and subsequent to service;

(c) Places of employment and reasons for termination;

(d) Wages received;

(e) Number of seizures.

4) Upon completion of this survey and current examination, the case should have rating board consideration. Where in the judgment of the rating board the veteran’s unemployability is due to epilepsy and jurisdiction is not vested in that body by reason of schedular evaluations, the case should be submitted to the Director, Compensation and Pension Service.

[29 FR 6718, May 22, 1964, as amended at 40 FR 42540, Sept. 15, 1975; 41 FR 11302, Mar. 18, 1976; 43 FR 45362, Oct. 2, 1978; 54 FR 4282, Jan. 30, 1989; 54 FR 49755, Dec. 1, 1989; 55 FR 154, Jan. 3, 1990; 56 FR 51653, Oct. 15, 1991; 57 FR 24364, June 9, 1992; 70 FR 75399, Dec. 20, 2005; 73 FR 54705, Sept. 23, 2008]

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Mental Disorders

§4.125 Diagnosis of mental disorders.

(a) If the diagnosis of a mental disorder does not conform to DSM-5 or is not supported by the findings on the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis.

(b) If the diagnosis of a mental disorder is changed, the rating agency shall determine whether the new diagnosis represents progression of the prior diagnosis, correction of an error in the prior diagnosis, or development of a new and separate condition. If it is not clear from the available records what the change of diagnosis represents, the rating agency shall return the report to the examiner for a determination.

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§4.126 Evaluation of disability from mental disorders.

(a) When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination.

(b) When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment.

(c) Neurocognitive disorders shall be evaluated under the general rating formula for mental disorders; neurologic deficits or other impairments stemming from the same etiology (e.g., a head injury) shall be evaluated separately and combined with the evaluation for the neurocognitive disorder (see §4.25).

(d) When a single disability has been diagnosed both as a physical condition and as a mental disorder, the rating agency shall evaluate it using a diagnostic code which represents the dominant (more disabling) aspect of the condition (see §4.14).

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

Intellectual disability (intellectual developmental disorder) and personality disorders are not diseases or injuries for compensation purposes, and, except as provided in §3.310(a) of this chapter, disability resulting from them may not be service-connected. However, disability resulting from a mental disorder that is superimposed upon intellectual disability (intellectual developmental disorder) or a personality disorder may be service-connected.

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§4.128 Convalescence ratings following extended hospitalization.

If a mental disorder has been assigned a total evaluation due to a continuous period of hospitalization lasting six months or more, the rating agency shall continue the total evaluation indefinitely and schedule a mandatory examination six months after the veteran is discharged or released to nonbed care. A change in evaluation based on that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.

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§4.129 Mental disorders due to traumatic stress.

When a mental disorder that develops in service as a result of a highly stressful event is severe enough to bring about the veteran’s release from active military service, the rating agency shall assign an evaluation of not less than 50 percent and schedule an examination within the six month period following the veteran’s discharge to determine whether a change in evaluation is warranted.

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

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§4.130 Schedule of ratings-mental disorders.

The nomenclature employed in this portion of the rating schedule is based upon the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, of the American Psychiatric Association (DSM-5). Rating agencies must be thoroughly familiar with this manual to properly implement the directives in §4.125 through §4.129 and to apply the general rating formula for mental disorders in §4.130. The schedule for rating for mental disorders is set forth as follows:

9201 Schizophrenia

9208 Delusional disorder

9210 Other specified and unspecified schizophrenia spectrum and other psychotic disorders

9211 Schizoaffective disorder

9300 Delirium

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

9304 Major or mild neurocognitive disorder due to traumatic brain injury

9305 Major or mild vascular neurocognitive disorder

9310 Unspecified neurocognitive disorder

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

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


9400 Generalized anxiety disorder

9403 Specific phobia; social anxiety disorder (social phobia)

9404 Obsessive compulsive disorder

9410 Other specified anxiety disorder

9411 Post-traumatic stress disorder (PTSD)

9412 Panic disorder and/or agoraphobia

9413 Unspecified anxiety disorder


9416 Dissociative amnesia; dissociative identity disorder

9417 Depersonalization/Derealization disorder


9421 Somatic symptom disorder

9422 Other specified somatic symptom and related disorder

9423 Unspecified somatic symptom and related disorder

9424 Conversion disorder (functional neurological symptom disorder)

9425 Illness anxiety disorder

9431 Cyclothymic disorder

9432 Bipolar disorder

9433 Persistent depressive disorder (dysthymia)

9434 Major depressive disorder (MDD)

9435 Unspecified depressive disorder

9440 Chronic adjustment disorder

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General Rating Formula for Mental Disorders:
Total occupational and social impairment, due to such symptoms as:
gross impairment in thought processes or communication;
persistent delusions or hallucinations; grossly inappropriate
behavior; persistent danger of hurting self or others; intermittent
inability to perform activities of daily living (including maintenance
of minimal personal hygiene); disorientation to time or place; memory
loss for names of close relatives, own occupation, or own name ..................... 100
Occupational and social impairment, with deficiencies in most areas,
such as work, school, family relations, judgment, thinking, or mood,
due to such symptoms as: suicidal ideation; obsessional rituals
which interfere with routine activities; speech intermittently illogical,
obscure, or irrelevant; near-continuous panic or depression affecting
the ability to function independently, appropriately and effectively;
impaired impulse control (such as unprovoked irritability with periods
of violence); spatial disorientation; neglect of personal appearance and
hygiene; difficulty in adapting to stressful circumstances (including
work or a worklike setting); inability to establish and maintain
effective relationships .................................................................................... 70
Occupational and social impairment with reduced reliability and
productivity due to such symptoms as: flattened affect; circumstantial,
circumlocutory, or stereotyped speech; panic attacks more than once
a week; difficulty in understanding complex commands; impairment
of short- and long-term memory (e.g., retention of only highly learned
material, forgetting to complete tasks); impaired judgment; impaired
abstract thinking; disturbances of motivation and mood; difficulty in
establishing and maintaining effective work and social relationships .................... 50
Occupational and social impairment with occasional decrease in work
efficiency and intermittent periods of inability to perform occupational
tasks (although generally functioning satisfactorily, with routine
behavior, self-care, and conversation normal), due to such symptoms
as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or
less often), chronic sleep impairment, mild memory loss (such as
forgetting names, directions, recent events) ...................................................... 30
Occupational and social impairment due to mild or transient symptoms
which decrease work efficiency and ability to perform occupational
tasks only during periods of significant stress, or; symptoms controlled
by continuous medication ............................................................................... 10
A mental condition has been formally diagnosed, but symptoms are not
severe enough either to interfere with occupational and social
functioning or to require continuous medication.................................................. 0

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Eating Disorders

9520 Anorexia nervosa

9521 Bulimia nervosa


Rating Formula for Eating Disorders:

Self-induced weight loss to less than 80 percent of expected minimum
weight, with incapacitating episodes of at least six weeks total duration
per year, and requiring hospitalization more than twice a year for
parenteral nutrition or tube feeding................................................................ 100

Self-induced weight loss to less than 85 percent of expected minimum
weight with incapacitating episodes of six or more weeks total
duration per year ........................................................................................... 60

Self-induced weight loss to less than 85 percent of expected minimum
weight with incapacitating episodes of more than two but less than
six weeks total duration per year ...................................................................... 30

Binge eating followed by self-induced vomiting or other measures to
prevent weight gain, or resistance to weight gain even when below
expected minimum weight, with diagnosis of an eating disorder and
incapacitating episodes of up to two weeks total duration per year ...................... 10

Binge eating followed by self-induced vomiting or other measures to
prevent weight gain, or resistance to weight gain even when below
expected minimum weight, with diagnosis of an eating disorder
but without incapacitating episodes..................................................................... 0

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

[53 FR 23, Jan. 4, 1988; 53 FR 1441, Jan. 19, 1988. Redesignated and amended at 61 FR 52700, Oct. 8, 1996]

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Dental and Oral

§4.150 Schedule of ratings—Dental and oral conditions.

Note (1): For VA compensation purposes, diagnostic imaging studies include, but are not limited to, conventional radiography (X-ray), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), radionuclide bone scanning, or ultrasonography.

Note (2): Separately evaluate loss of vocal articulation, loss of smell, loss of taste, neurological impairment, respiratory dysfunc- tion, and other impairments under the appropriate diagnostic code and combine under § 4.25 for each separately rated condi- tion.

9900 Maxilla or mandible, chronic osteomyelitis, osteonecrosis or osteoradionecrosis of:
Rate as osteomyelitis, chronic under diagnostic code 5000.

9901 Mandible, loss of, complete, between angles......................................................... 100

9902 Mandible, loss of, including ramus, unilaterally or bilaterally:

Loss of one-half or more,

Involving temporomandibular articulation.

Not replaceable by prosthesis ................................................................... 70
Replaceable by prosthesis ........................................................................ 50

Not involving temporomandibular articulation.

Not replaceable by prosthesis .................................................................... 40
Replaceable by prosthesis ......................................................................... 30

Loss of less than one-half,

Involving temporomandibular articulation.

Not replaceable by prosthesis .................................................................... 70
Replaceable by prosthesis ......................................................................... 50

Not involving temporomandibular articulation.

Not replaceable by prosthesis ..................................................................... 20
Replaceable by prosthesis .......................................................................... 10

9903 Mandible, nonunion of, confirmed by diagnostic imaging studies:

Severe, with false motion....................................................................................... 30
Moderate, without false motion.............................................................................. 10

9904 Mandible, malunion of:

Displacement, causing severe anterior or posterior open bite...................................... 20
Displacement, causing moderate anterior or posterior open bite.................................. 10
Displacement, not causing anterior or posterior open bite............................................ 0

9905 Temporomandibular disorder (TMD):

Interincisal range:

0 to 10 millimeters (mm) of maximum unassisted vertical opening.

With dietary restrictions to all mechanically altered foods .............................. 50
Without dietary restrictions to mechanically altered foods .............................. 40

11 to 20 mm of maximum unassisted vertical opening.

With dietary restrictions to all mechanically altered foods ............................... 40
Without dietary restrictions to mechanically altered foods ............................... 30

21 to 29 mm of maximum unassisted vertical opening.

With dietary restrictions to full liquid and pureed foods .................................. 40
With dietary restrictions to soft and semi-solid foods ...................................... 30
Without dietary restrictions to mechanically altered foods ............................... 20

30 to 34 mm of maximum unassisted vertical opening.

With dietary restrictions to full liquid and pureed foods ................................... 30
With dietary restrictions to soft and semi-solid foods ....................................... 20
Without dietary restrictions to mechanically altered foods ................................ 10

Lateral excursion range of motion:

0 to 4 mm ................................................................................................... 10

Note (1): Ratings for limited interincisal movement shall not be combined with ratings for limited lateral excursion.
Note (2): For VA compensation purposes, the normal maximum unassisted range of vertical jaw opening is from 35 to 50 mm. Note (3): For VA compensation purposes, mechanically altered foods are defined as alteredby blending, chopping, grinding or mashing so that they are easy to chew and swallow. There are four levels of mechanically altered foods: full liquid, puree, soft, and semisolid foods. To warrant elevation based on mechanically altered foods, the use of texture-modified diets must be recorded or verified by a physician.

9908 Condyloid process, loss of, one or both sides........................................................... 30

9909 Coronoid process, loss of:

Bilateral.................................................................................................................. 20
Unilateral................................................................................................................ 10

9911 Hard palate, loss of:

Loss of half or more, not replaceable by prosthesis ..................................................... 30
Loss of less than half, not replaceable by prosthesis .................................................... 20
Loss of half or more, replaceable by prosthesis ........................................................... 10
Loss of less than half, replaceable by prosthesis ........................................................... 0

9913 Teeth, loss of, due to loss of substance of body of maxilla or mandible without loss of continuity:

Where the lost masticatory surface cannot be restored by suitable prosthesis:

Loss of all teeth........................................................................................... 40
Loss of all upper teeth ................................................................................. 30
Loss of all lower teeth .................................................................................. 30
All upper and lower posterior teeth missing .................................................... 20
All upper and lower anterior teeth missing ...................................................... 20
All upper anterior teeth missing ..................................................................... 10
All lower anterior teeth missing ..................................................................... 10
All upper and lower teeth on one side missing ................................................ 10

Where the loss of masticatory surface can be restored by
suitable prosthesis ............................................................................................... 0

Note: These ratings apply only to bone loss through trauma or disease such as osteomyelitis, and not to the loss of the alveolar process as a result of periodontal disease, since such loss is not considered disabling.

9914 Maxilla, loss of more than half:

Not replaceable by prosthesis ............................................................................... 100
Replaceable by prosthesis ...................................................................................... 50

9915 Maxilla, loss of half or less:

Loss of 25 to 50 percent:

Not replaceable by prosthesis ................................................................................. 40
Replaceable by prosthesis ...................................................................................... 30

Loss of less than 25 percent:

Not replaceable by prosthesis ................................................................................. 20
Replaceable by prosthesis ........................................................................................ 0

9916 Maxilla, malunion or nonunion of:

Nonunion,

With false motion ............................................................................................. 30
Without false motion ......................................................................................... 10

Malunion,

With displacement, causing severe anterior or posterior open bite .......................... 30
With displacement, causing moderate anterior or posterior open bite ...................... 10
With displacement, causing mild anterior or posterior open bite ............................... 0

Note: For VA compensation purposes, the severity of maxillary nonunion is dependent upon the degree of abnormal mobility of maxilla fragments following treatment (i.e., presence or absence of false motion), and maxillary nonunion must be confirmed by diagnostic imaging studies.

9917 Neoplasm, hard and soft tissue, benign:
Rate as loss of supporting structures (bone or teeth) and/or functional impairment due to scarring.

9918 Neoplasm, hard and soft tissue, malignant ................................................................................................. 100

Note: A rating of 100 percent shall continue beyond the cessation of any surgical, radiation, antineoplastic chemotherapy or
other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be de-
termined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be
subject to the provisions of §3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals such as loss of supporting structures (bone or teeth) and/or functional impairment due to scarring.


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