§ 4.115 38 CFR Ch. I (7–1–04 Edition)

Rat- Rat- ing ing

Moderately severe; with at least 4–7 typical at- Intermittent , malaise, and , or; tacks of abdominal per year with good re- incapacitating episodes (with symptoms such mission between attacks ...... 30 as fatigue, malaise, nausea, vomiting, ano- With at least one recurring attack of typical se- rexia, arthralgia, and right upper quadrant vere abdominal pain in the past year ...... 10 pain) having a total duration of at least one NOTE 1: Abdominal pain in this condition must week, but less than two weeks, during the be confirmed as resulting from pancreatitis by past 12-month period ...... 10 appropriate laboratory and clinical studies. Nonsymptomatic ...... 0 NOTE 2: Following total or partial pancrea- NOTE (1): Evaluate sequelae, such as cirrhosis tectomy, rate under above, symptoms, min- or malignancy of the liver, under an appro- imum rating 30 percent. priate diagnostic code, but do not use the 7348 Vagotomy with pyloroplasty or gastro- same as the basis for enterostomy: evaluation under DC 7354 and under a diag- Followed by demonstrably confirmative post- nostic code for sequelae. (See § 4.14.). operative complications of stricture or con- NOTE (2): For purposes of evaluating conditions tinuing gastric retention ...... 40 under diagnostic code 7354, ‘‘incapacitating With symptoms and confirmed diagnosis of alka- episode’’ means a period of acute signs and line gastritis, or of confirmed persisting diar- symptoms severe enough to require bed rest rhea ...... 30 and treatment by a physician. Recurrent ulcer with incomplete vagotomy ...... 20 NOTE: Rate recurrent ulcer following complete (Authority: 38 U.S.C. 1155) vagotomy under diagnostic code 7305, min- imum rating 20 percent; and rate dumping [29 FR 6718, May 22, 1964, as amended at 34 syndrome under diagnostic code 7308. FR 5063, Mar. 11, 1969; 40 FR 42540, Sept. 15, 7351 Liver transplant: 1975; 41 FR 11301, Mar. 18, 1976; 66 FR 29488, For an indefinite period from the date of hospital admission for transplant surgery ...... 100 May 31, 2001] Minimum ...... 30 NOTE: A rating of 100 percent shall be assigned THE GENITOURINARY SYSTEM as of the date of hospital admission for trans- plant surgery and shall continue. One year fol- § 4.115 Nephritis. lowing discharge, the appropriate disability rat- ing shall be determined by mandatory VA ex- Albuminuria alone is not nephritis, amination. Any change in evaluation based nor will the presence of transient albu- upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of min and casts following acute febrile this chapter. illness be taken as nephritis. The glo- 7354 Hepatitis C (or non-A, non-B hepatitis): merular type of nephritis is usually With serologic evidence of hepatitis C preceded by or associated with severe and the following signs and symptoms due to hepatitis C infection: infectious disease; the onset is sudden, Near-constant debilitating symptoms (such as and the course marked by red blood fatigue, malaise, nausea, vomiting, anorexia, cells, salt retention, and edema; it may arthralgia, and right upper quadrant pain) ...... 100 Daily fatigue, malaise, and anorexia, with sub- clear up entirely or progress to a stantial weight loss (or other indication of mal- chronic condition. The nephrosclerotic nutrition), and hepatomegaly, or; incapacitating type, originating in hypertension or ar- episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, teriosclerosis, develops slowly, with arthralgia, and right upper quadrant pain) hav- minimum laboratory findings, and is ing a total duration of at least six weeks during associated with natural progress. Sepa- the past 12-month period, but not occurring constantly ...... 60 rate ratings are not to be assigned for Daily fatigue, malaise, and anorexia, with minor disability from disease of the heart and weight loss and hepatomegaly, or; incapaci- any form of nephritis, on account of tating episodes (with symptoms such as fa- tigue, malaise, nausea, vomiting, anorexia, the close interrelationships of cardio- arthralgia, and right upper quadrant pain) hav- vascular disabilities. If, however, ab- ing a total duration of at least four weeks, but sence of a kidney is the sole renal dis- less than six weeks, during the past 12-month period ...... 40 ability, even if removal was required Daily fatigue, malaise, and anorexia (without because of nephritis, the absent kidney weight loss or hepatomegaly), requiring dietary and any hypertension or heart disease restriction or continuous medication, or; inca- pacitating episodes (with symptoms such as will be separately rated. Also, in the fatigue, malaise, nausea, vomiting, anorexia, event that chronic renal disease has arthralgia, and right upper quadrant pain) hav- progressed to the point where regular ing a total duration of at least two weeks, but less than four weeks, during the past 12- month period ...... 20

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dialysis is required, any coexisting hy- Rat- pertension or heart disease will be sep- ing arately rated. Urinary frequency: Daytime voiding interval less than one hour, or; [41 FR 34258, Aug. 13, 1976, as amended at 59 awakening to void five or more times per night 40 FR 2527, Jan. 18, 1994] Daytime voiding interval between one and two hours, or; awakening to void three to four § 4.115a Ratings of the genitourinary times per night ...... 20 system—dysfunctions. Daytime voiding interval between two and three hours, or; awakening to void two times per Diseases of the genitourinary system night ...... 10 generally result in disabilities related Obstructed voiding: Urinary retention requiring intermittent or contin- to renal or voiding dysfunctions, infec- uous catheterization ...... 30 tions, or a combination of these. The Marked obstructive symptomatology (hesitancy, following section provides descriptions slow or weak stream, decreased force of stream) with any one or combination of the fol- of various levels of disability in each of lowing: these symptom areas. Where diagnostic 1. Post void residuals greater than 150 cc. codes refer the decisionmaker to these 2. Uroflowmetry; markedly diminished peak specific areas dysfunction, only the flow rate (less than 10 cc/sec). 3. Recurrent urinary tract sec- predominant area of dysfunction shall ondary to obstruction. be considered for rating purposes. 4. Stricture disease requiring periodic dilata- Since the areas of dysfunction de- tion every 2 to 3 months ...... 10 scribed below do not cover all symp- Obstructive symptomatology with or without stric- ture disease requiring dilatation 1 to 2 times toms resulting from genitourinary dis- per year ...... 0 eases, specific diagnoses may include a Urninary tract infection: description of symptoms assigned to Poor renal function: Rate as renal dysfunction. Recurrent symptomatic infection requiring drain- that diagnosis. age/frequent hospitalization (greater than two times/year), and/or requiring continuous inten- Rat- sive management ...... 30 ing Long-term drug therapy, 1–2 hospitalizations per year and/or requiring intermittent intensive Renal dysfunction: management ...... 10 Requiring regular dialysis, or precluding more than sedentary activity from one of the fol- lowing: persistent edema and albuminuria; or, [59 FR 2527, Jan. 18, 1994; 59 FR 10676, Mar. 7, BUN more than 80mg%; or, creatinine more 1994] than 8mg%; or, markedly decreased function of kidney or other organ systems, estpecially cardiovascular ...... 100 § 4.115b Ratings of the genitourinary Persistent edema and albuminuria with BUN 40 system—diagnoses. to 80mg%; or, creatinine 4 to 8mg%; or, gen- eralized poor health characterized by lethargy, Rat- , anorexia, weight loss, or limitation ing of exertion ...... 80 Constant albuminuria with some edema; or, defi- Note: When evaluating any claim in- nite decrease in kidney function; or, hyper- volving loss or loss of use of one or tension at least 40 percent disabling under di- more creative organs, refer to agnostic code 7101 ...... 60 Albumin constant or recurring with hyaline and § 3.350 of this chapter to determine granular casts or red blood cells; or, transient whether the veteran may be enti- or slight edema or hypertension at least 10 tled to special monthly compensa- percent disabling under diagnostic code 7101 30 tion. Footnotes in the schedule indi- Albumin and casts with history of acute nephritis; cate conditions which potentially or, hypertension non-compensable under diag- establish entitlement to special nostic code 7101 ...... 0 monthly compensation; however, Voiding dysfunction: there are other conditions in this Rate particular condition as urine leakage, fre- section which under certain cir- quency, or obstructed voiding cumstances also establish entitle- Continual Urine Leakage, Post Surgical Urinary Diversion, Urinary Incontinence, or Stress In- ment to special monthly compensa- continence: tion. Requiring the use of an appliance or the wearing 7500 Kidney, removal of one: of absorbent materials which must be changed Minimum evaluation ...... 30 more than 4 times per day ...... 60 Or rate as renal dysfunction if there is Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day .. 40 nephritis, infection, or pathology of Requiring the wearing of absorbent materials the other. which must be changed less than 2 times per 7501 Kidney, abscess of: day ...... 20 Rate as urinary tract infection ......

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