**E**

EAR DISORDERS

Ear disorders are common but of little significance to the underwriter.
Newer diagnostic techniques and treatments have greatly diminished the
occurrence of chronic otitis media, the development of cholesteatomas
and the threat of mastoiditis and its complications.

  -------------------------------------------------------- --------------
  Deafness                                                 

  Partial or total with/without hearing aid                0

  Mutism                                                   0

                                                           

  Otitis                                                   

  Otitis Externa, Otitis Media, Otomycosis                 0

                                                           

  Mastoiditis and other chronic disorders                  

  Mastoiditis, Chronic Otitis Media, Cholesteatoma         

  After treatment and recovery                             0

  With continuing or recurrent discharge or treatment      55
  -------------------------------------------------------- --------------

[**Meniere's Syndrome**]{.underline}

This is a condition characterized by fluctuating unilateral hearing
loss, tinnitus (ringing in the ears) and recurrent episodes of vertigo.
It may cause considerable morbidity and can be confused with tumor,
vascular or neurological disease. The basic disease, adequately
investigated and diagnosed, has little mortality significance.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required.

  -------------------------------------------------------- --------------
  Adequately investigated                                  0

  Others                                                   

  Within 1 year of last attack                             55

  2^nd^ year                                               30

  After 2 years                                            0
  -------------------------------------------------------- --------------

**EDEMA**

This is a collection of fluid in the tissue with consequent swelling of
the parts affected.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required.

  ------------------------------------------------ ----------------------
  Localized, due to infection, phlebitis of        RFC
  varicose veins                                   

  General, dropsy, due to heart or kidney disease  Refer to Section Chief

  Edema of lungs, cause not determined             400

  Angioneurotic throat and larynx                  

  Present -- severe                                400

  Within 1 year                                    100

  Within 2 years                                   50

  Within 3 years                                   30

  Others -- see under Urticaria                    

  Mild, eyelids and ankles, late in day, past      20
  mid-life                                         
  ------------------------------------------------ ----------------------

### **ELECTROCARDIOGRAM**

##### [Axis Deviation]{.underline}

Right axis deviation is normal in newborns and young children and
occasionally will persist into adulthood as a normal variant. Right
ventricular hypertrophy, bundle branch blocks and dextrocardia can also
produce right axis deviation.

Left axis deviation can be caused by changes in heart position within
the chest (pregnancy, ascites, obesity), left ventricular hypertrophy,
left anterior hemiblock and complete left bundle branch block.

  --------------------------------------------- -------------------------
  Right axis deviation                          

  No other heart disorder                       0

  Otherwise                                     Rate for associated
                                                disorder

  Left axis deviation                           

  Up to --44 degrees                            0

  Minus 45 degrees and over, when discovered    

  Up to age 59                                  0

  Ages 60 and over                              30
  --------------------------------------------- -------------------------

**[Atrioventricular Blocks]{.underline}**

Delays in the conducting system may be congenital, or acquired due to
disorders such as coronary artery disease, rheumatic fever, medications
and cardiac surgery.

In first degree block, the PR interval on the ECG is prolonged beyond
the normal 0.20 seconds.

Second degree block results from abnormalities in conduction through the
AV node with consequent failure of some of the impulses to reach the
ventricles. There are two types:

Mobitz I (Wenckebach): PR interval lengthens progressively in successive
beats until an impulse fails to conduct to the ventricles, resulting in
a ventricular pause. Generally benign and does not progress to complete
heart block.

Mobitz II: PR interval remains constant with successive beats. AV node
fails to conduct impulses at intervals. This is the more serious of the
two forms and may progress to complete heart block.

Third degree (complete) block occurs when all impulses originating in
the atrium are blocked from the ventricles. In this instance, the atria
and ventricles contract independently of each other.

Second and third degree heart blocks may be associated with a slow
pulse. This may be tolerated well by some individuals but an electronic
pacemaker is needed for most cases of complete heart block. The slow
heart beat may result in episodes of syncope, termed Stokes-Adams
attacks.

#### **Underwriting Requirements**

An APS (VA Form 29-8158) is required.

  ------------------------------------ ----------------- -------------------- -------------------
                                       [Under            [Age                 [50 and
                                       40]{.underline}   40-49]{.underline}   Over]{.underline}

  Condition stable, less than 5 years                                         

  1^st^ degree block                                                          

  PR .25 - .30                         30                55                   80

  PR over .30                          55                80                   125

  2^nd^ degree block                                                          

  Mobitz I (Wenckebach)                0                 55                   80

  Mobitz II                            125               225                  275

  3^rd^ degree (complete) block        125               225                  275

  Condition stable 5-10 years          Reduce ratings by                      
                                       one class                              

  Condition stable over 10 years       Reduce ratings by                      
                                       two classes                            

  Stokes-Adams attacks, no pacemaker   R                                      

  Treated with pacemaker               See Pacemaker                          
  ------------------------------------ ----------------- -------------------- -------------------

##### [Bundle Branch Block]{.underline}

Complete right bundle branch block is usually of little significance. It
may be normal variant or associated with heart disease or cardiac
surgery.

Complete left bundle branch block (LBBB) is frequently associated with
heart disease, usually coronary artery disease.

Left anterior or left posterior hemiblock (LAH, LPH) occurs when a
portion of the left bundle (see LBBB) is blocked. Causes are similar to
LBBB.

Bifascicular block occurs when there is right bundle branch block and
either left anterior or posterior hemiblock.

Complete bundle branch blocks that develop with acute myocardial
infarction are presumed secondary to the infarction. Debits are assessed
as for the underlying coronary disease. Complete bundle branch blocks
that develop in the absence of the acute cardiac events may represent a
deterioration in cardiac status. Debits should be assigned as below.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required.

  ------------------------------------ --------------------- --------------------
  Incomplete right or left bundle      0                     
  branch block                                               

  Complete bundle branch block                               

  Age when discovered                  [Right]{.underline}   [Left]{.underline}

  Under 40                             0                     75

  40 and over                          55                    100

  Bifascicular block                   Rate as LBBB          

  Left anterior or posterior hemiblock See LAD               
  ------------------------------------ --------------------- --------------------

##### [Pacemaker]{.underline}

Pacemakers are surgically implanted electronic devices that stimulate
heart beats. These devices may be used temporarily, as for acute
myocardial infarctions, or permanently. The usual indications for a
pacemaker are symptomatic heart block (whether congenital or acquired)
and arrhythmias such as sick sinus syndrome (bradycardia -- tachycardia
syndrome). The prognosis in conditions treated with a pacemaker is
related to the nature of any underlying heart disease. It is poorer in
the elderly and those with a history of CAD or congestive heart failure.
Complications may include perforation, arrhythmia, infection,
thrombosis, emboli, lead fracture, displacement, malfunction, etc.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required.

  -------------------------------------------- --------------------------
  Congenital heart block                       

  No complications or other congenital heart   55
  disorder                                     

  Others                                       Rate for complications or
                                               underlying heart disease
                                               +55

  Acquired heart block                         

  Stokes-Adams attacks, Sick Sinus Syndrome    100

  Coronary or other heart disease              Rate for underlying heart
                                               disease +55

  History of CHF or other complications        R
  -------------------------------------------- --------------------------

**[ST Segment Changes]{.underline}**

Changes in the ST segment, straightening and depression, may indicate
myocardial ischemia. They should be underwritten according to the table,
unless additional information is available which will allow a
modification to the rating.

#### **Underwriting Requirements**

An APS (VA Form 29-8158) is required.

+-----------------------------------+----------------+-----------------+
|                                   | Females Ages   | Females Ages 60 |
|                                   | 0-59           | up              |
|                                   |                |                 |
|                                   | ## M           | ## M            |
|                                   | ales Ages 0-39 | ales Ages 40 up |
+-----------------------------------+----------------+-----------------+
| ST segment changes, no CV history | 55             | 100             |
| or findings                       |                |                 |
+-----------------------------------+----------------+-----------------+

**Modifying factors:**

Where there is report of a well done, normal, exercise test with or
without thallium scan, arteriogram, exercise echocardiogram or other
significant test to help rule out ischemia, debits may be reduced by 50%
or to 0, depending on the circumstances of the case.

##### [T Wave Changes]{.underline}

T wave changes are one of the most common abnormalities noted on
electrocardiograms. Major T wave changes -- clearly inverted T waves in
leads where they should be upright -- usually imply some past or present
cardiac abnormality. Minor T wave changes are very common and are due to
a variety of factors. Minor T waves may be low (less than 1 mm.) in a
lead that should clearly have an upright T wave, flat or even slightly
inverted.

+-----------------------------------+----------------+-----------------+
|                                   | Females Ages   | Females Ages 60 |
|                                   | 0-59           | up              |
|                                   |                |                 |
|                                   | ## M           | ## M            |
|                                   | ales Ages 0-39 | ales Ages 40 up |
+-----------------------------------+----------------+-----------------+
| Major T wave changes              | 55             | 100             |
+-----------------------------------+----------------+-----------------+
| Minor T wave changes              | 0              | 55              |
+-----------------------------------+----------------+-----------------+

**[Wolff-Parkinson-White Syndrome (WPW)]{.underline}**

In this syndrome, impulses originating in the right atrium bypass normal
conducting pathways and may cause episodes of tachycardia. Medications,
and in rare instances surgery, may be needed to control arrhythmias.

#### **Underwriting Requirements**

An APS (VA Form 29-8158) is required.

  ----------------------------------- --------------------------- ---------------------------
  Age when discovered                 Without history of          With history of
                                      T[achycardia]{.underline}   T[achycardia]{.underline}

  Under 30                            0                           30

  30-39                               0                           55

  40 and over                         0                           80
  ----------------------------------- --------------------------- ---------------------------

**EMBOLISM (Pulmonary)**

Blood clots which lodge in the blood vessels of the lungs usually
originate from veins in the pelvis or legs. Obesity, trauma, inactivity
and surgery increase the likelihood of occurrence. Treatment may include
anticoagulant (blood thinners) which carries the additional risk of
hemorrhagic events.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required.

  ------------------------------------------------ ----------------------
  Within 6 months                                  RFC

  Thereafter                                       RFC
  ------------------------------------------------ ----------------------

**EMBOLUS**

An embolus is a blood clot circulating in blood vessels. It may lodge in
any artery, inducing ischemia and infarction distal to the site of
obstruction. Arterial emboli usually originate from the heart, either
from damaged valves or thrombi which cause atrial fibrillation and
myocardial infarctions. Rarely, emboli occur with intracardiac tumors
(atrial myxoma) or with endocarditis, when portions of tumor or infected
material break free into the blood stream.

  --------------------------------------------------------- -------------
  History                                                   RFC

  --------------------------------------------------------- -------------

EMPHYSEMA

Emphysema is air in the lung tissues that causes the air sacs to become
abnormally enlarged. It may be caused by frequent violent coughing from
chronic bronchitis, the cough and respiratory effort with asthma, or in
occupations, like glass blowing. Usually it is diagnosed after the
ailment is far advanced. Physical signs usually found are barrel- shaped
chest and dyspnea (difficult breathing).

**Underwriting Requirements**

An APS (VA Form 29-8158) is required.

  --------------------------------------------------------- -------------
  Slight -- no complications (rales may or may not be       25
  present)                                                  

  Moderate                                                  

  May or may not show signs of bronchitis, with moderate    50
  dyspnea or exertions. No rales, no asthma or bronchitis.  

  With asthma or bronchitis                                 100

  Severe -- marked "barrel chest," asthmatic breathing,     300
  definite dyspnea, chronic bronchitis, etc.                

  Extreme -- in addition to severe, unable to walk any      600
  distance without requiring frequent oxygen                
  --------------------------------------------------------- -------------

EMPYEMA

Empyema is the accumulation of pus in the pleural space (the space
between the lung and the chest wall).

Underwriting Requirements

An APS (VA Form 29-8158) is required.

  ------------------------------------------------- ---------------------
  Present                                           Refer to Section
                                                    Chief

  History                                           0
  ------------------------------------------------- ---------------------

ENCEPHAHALITIS

Encephalitis (sleeping sickness) is an inflammation of the brain that
may result from many causes, including infectious diseases and head
injuries. Encephalitis lethargica, is a virus infection. The onset may
be gradual, or sudden, mild or severe, with headache, weakness,
drowsiness, lethargy (coma) and progressive muscular weakness. Recovery
is slow, death not unusual. Sequelae in the form of personality changes
and paralysis are common, or may develop later. AIDS-related
encephalitis is probably the most common form seen today.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required.

  ------------------------------------------------ ----------------------
  No residuals                                     

  Within 1 year of recovery                        50

  2^nd^ year                                       30

  After 2 years                                    0

  With residuals, such as personality changes or   
  paralysis                                        

  Depending upon extent and severity               Refer to Section Chief

  AIDS related                                     R
  ------------------------------------------------ ----------------------

EPILEPSY

Epilepsy is a chronic disease of the nervous system characterized by
loss of consciousness with or without convulsions, spasms or fits. The
first attack usually occurs before age 20; if the onset is after age 30,
it is usually due to a tumor located in the frontal or temporal lobe.
These tumors are usually benign (non-cancerous) in origin. This may
develop a few years after a fractured skull or severe head injury.

In 1981, the criteria and definitions for classifying seizures changed.
The following terms are roughly synonymous.

  ----------------------------------- -----------------------------------
  **Old**                             **New**

  Grand Mal                           Generalized Tonic-Clonic

  Petit Mal                           Generalized Absence

  Psychomotor                         Complex Partial

  Temporal Lobe                       Complex Partial

  Jacksonian                          Simple Partial
  ----------------------------------- -----------------------------------

**Generalized Absence (Petit Mal)** is a mild form with transitory
unconsciousness. These attacks may be so transitory that associates of
the person affected may not even notice them. Normally, there is only
momentary loss of consciousness and no convulsions.

**Generalized Tonic-Clonic (Grand Mal)** is a severe form with
convulsions and unconsciousness.

**Simple Partial (Jacksonian Epilepsy)** is not true epilepsy because it
results from a brain injury and is usually due to pressure on a part of
the brain. It is characterized by convulsive seizures limited in extent
and confined to a particular part of the body. Surgical correction and
recovery are possible.

**Narcolepsy** is not really a form of epilepsy and is included here for
convenience: it is the inability to stay awake regardless of time,
place, or activity. It may be due to a disturbance of internal
secretions, possibly a variant of encephalitis or a previous head
injury.

**Nocturnal Epilepsy** is a type of epilepsy in which the attack occurs
during sleep.

Epilepsy occurs more often among relatives of epileptics than in the
general population.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required.

The various types of epilepsy may be rated according to the following
schedule.

  ---------------------------------------------------- ------------------
                                                       **Table**

  Complex Partial (Consciousness Impaired)             A

  Generalized Tonic -- Cloric                          A

  Infantile Spasms, Hypsarrhythmia, Nocturnal Epilepsy A

  Generalized Absence                                  B

  Simple Partial (Consciousness Not Impaired)          B

  Nocturnal Epilepsy                                   B

  Metabolic Brain Disease                              C

  Status Epilepticus                                   C
  ---------------------------------------------------- ------------------

  --------------------------------------------------- -------------------
  **Table A**                                         

  Adequately investigated, well controlled, on        
  treatment                                           

  Within 6 months of diagnosis                        Refer to Section
                                                      Chief

  Within 2 years of last seizure                      125

  Within 3 -- 5 years of last seizure                 55

  After 5^th^ year                                    0

  Any mental deterioration or personality changes or  R
  more than 6 seizures a year                         
  --------------------------------------------------- -------------------

  --------------------------------------------------- -------------------
  **Table B**                                         

  Within 2 years of last seizure                      75

  After 2 years.                                      0
  --------------------------------------------------- -------------------

  --------------------------------------------------- -------------------
  **Table C**                                         

  After 5 years                                       R
  --------------------------------------------------- -------------------

**Febrile Seizures**

  --------------------------------------------------- -------------------
  Epilepsy suspected                                  Refer to Table A

  --------------------------------------------------- -------------------

EPITHELIOMA

An epithelioma is the most common of all skin cancers or skin tumors.
There are two types of skin cancers, one composed of basal cells, known
as a rodent ulcer, and the other composed of squamous cells, sometimes
called squamous celled carcinoma. The basal cell is the less serious of
the two since they do not metastasize (spread to other organs) and as a
rule they do not have a tendency to invade more deeply and remain
confined to the skin. Squamous cell on the other hand has a tendency to
grow both outward and inward and may metastasize rapidly and widely.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required.

  --------------------------------------- -------------------------------
  Epithelioma                             Refer to Tumor Rating Chart A

  --------------------------------------- -------------------------------

ESOPHAGUS

The esophagus or gullet is a muscular tube lined by a mucous membrane
extending from the pharynx (a sac between the mouth and esophagus) to
the stomach. Foreign bodies sometimes become lodged in the esophagus and
require removal by esophagoscope.

**Achalasia** **(Megaesophagus)** - a disorder of the nerves of the
esophagus producing obstruction to the passage of food and liquids with
secondary dilation of the esophagus.

**Barrett's Esophagus** - an abnormal lining of the lower esophagus that
may result from peptic esophagitis.

**Cardiospasm** -- spasm of the lower part of the esophagus. It may be
congenital or acquired. Occasionally it is associated with severe
neurosis, gastric or duodenal ulcer, or organic lesions of the
esophagus.

**Diffuse Esophageal Spasm** -- the peristaltic wave proceeds normally
from the upper esophagus until it reaches the lower third of the
esophagus where "spastic" or simultaneous contractions intervene and
cause pain that can mimic angina pectoris.

**Esophagitis, Gastro-Esophageal Reflux, Heartburn** -- inflammations of
the lower esophagus caused by reflux of gastric juice from the stomach
up into the esophagus.

**Esophageal Tear (Mallory Weiss Syndrome)** -- laceration of the
esophagus or stomach lining during intense vomiting, frequently with
hemorrhage. This is sometimes associated with ratable conditions such as
alcoholism, bulimia, migraine, etc.

**Varices** -- deflated veins in the lower esophagus often secondary to
cirrhosis. Rupture of a varix results in hemorrhage that is frequently
massive and often leads rapidly to death. Despite treatment, prognosis
is poor.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required.

  ---------------------------------------------------- ------------------
  Achalasia, megaesophagus                             

  Present or history, adequate work up and symptoms    0
  limited to mild dysphagia                            

  Others                                               55

                                                       

  Barrett's Esophagus                                  

  Present without dysplasia                            55

  Present with history of dysplasia                    R

  History, resolution documented by endoscopy          0

                                                       

  Cardiospasm                                          

  Emotional or nervous origin -- organic disease       
  excluded                                             

  Single or occasional attack (not more than 1 per     0
  year) with mild symptoms, after recovery             

  Severe, recurrent or uncertain diagnosis             Rate as Duodenal
                                                       Ulcer

  If known to be secondary to other disease            RFC

                                                       

  Diffuse Esophageal Spasm                             

  Present or history                                   

  Well worked up, cardiovascular disease included      0

  Otherwise                                            Rate as suspicious
                                                       Chest Pain

                                                       

  Diverticulum -- an abnormal sac in the wall of the   
  esophagus, usually congenital but may be acquired    

  Present, small -- mild symptoms                      0

  Others                                               0

  Operated                                             

  Within 1 year                                        0

  After 1 year                                         0

                                                       

  Esophageal Tear (Malloy Weiss Syndrome)              

  Treated and recovered, ratable cause ruled out       0

  Others                                               RFC

                                                       

  Esophagitis, Gastro-Esophageal Reflux, Heartburn     

  Present or history                                   0

  Others                                               55

                                                       

  Foreign bodies -- after removal and return of        0
  swallowing                                           

                                                       

  Hemorrhage                                           

  Cause known                                          RFC

  Others                                               

  1 attack                                             

  Within 1 year                                        50

  Within 2 years                                       25

  After 2 years                                        0

  Multiple attacks                                     

  Within 1 year                                        200

  Within 2 years                                       50

  Within 3 years                                       25

  After 3 years                                        0

                                                       

  Spasm                                                

  Functional                                           See Cardiospasm

  Others                                               RFC

                                                       

  Stricture                                            

  Present -- mild                                      0

  More than 2 dilations per year or complications      75

  History                                              0

                                                       

  Ulcer                                                

  Mild -- after recovery and within 1 year             10

  Others -- no suspicion of cancer, no complications   

  Within 1 year                                        50

  Within 2 years                                       30

  Within 3 years                                       20

  After 3 years                                        0

                                                       

  Varices                                              

  Present or history                                   R
  ---------------------------------------------------- ------------------

### **EXERCISE TESTS**

Exercise testing to detect coronary artery disease continues to be a
developing field. Treadmills, stationary bicycles and pharmacologic
stress may be used. Different protocols have been recommended, though
the Bruce protocol is probably the most popular. Numerous criteria have
been proposed for evaluating the results but none is entirely
satisfactory. In the final analysis, the likelihood that a positive
(abnormal) ECG exercise test represents ischemia will depend on the
degree of suspicion before the test, the factors surrounding the test,
all modified by the results of any additional studies done afterwards.

> **Pretest:** These are factors that either raise or lower ones
> expectation that a treadmill will be normal or abnormal. Presence or
> absence of chest pain, age and sex of examinee, presence of risk
> factors such as smoking, diabetes, hypertension, and abnormal lipids.

**Test:** Stage reached, percent of age-predicted pulse rate achieved,
degree and duration of any abnormalities noted.

**Post-Test:** Results of tests such as thallium scan or
catheterization.

Criteria for Test Interpretation:

####### **Normal**

1.  Absence of ST segment change at 85% maximal predicted heart rate.

2.  Junctional depression with rapidly rising ST segment

3.  Isolated T wave inversion, infrequent ectopic ventricular beats,
    atrial arrhythmias, and development of RBBB.

####### **Positive**

Development of 0.10 mv (1 mm.) or more, flat or downsloping ST segment
displacement, or junctional depression with slow rising ST slope that
remains 2.0 mm or more depressed 90 msec after J point. Borderline
changes that occur at maximum stress in a technically satisfactory test
may be ignored if shown not to persist a minute or more after exercise.

####### **Mildly Positive**

1.  ST depression between 1-1.5 mm.

2.  J junction depression with ST depressed 2.0 mm. or more at 80 msec.

####### **Moderately Positive**

1.  ST depression between 1.5 and 2.5 mm.

2.  Upsloping ST depression with ST segment more than 2.5 mm. depressed
    at 80 msec.

3.  Frequent ventricular ectopic activity at heart rates under 130 when
    associated with milder ST segment abnormalities.

####### **Strongly Positive**

1.  Downsloping ST segment depression with J point 2 mm. or more
    depressed.

2.  ST segment depression more than 2.5 mm.

3.  ST segment depression appearing in first stage or persisting more
    than 8 minutes into recovery.

4.  Complex ventricular ectopic activity, runs of ventricular
    tachycardia or ventricular fibrillation.

####### **Inconclusive Tests**

1.  Failure to attain 85% of age-predicted maximal heart rate, otherwise
    normal test.

2.  Baseline ECG abnormalities such as LVH, RBBB, LBBB, WPW, ST or T
    wave changes with hyperventilation, use of digitalis or presence of
    other medications such as B-blockers.

####### 

####### **Abnormal Exercise Test**

  ----------------------------------------------------- -----------------
  Mild                                                  75

  Moderate                                              100

  Strong                                                150
  ----------------------------------------------------- -----------------

##### Modifications to Exercise Test Ratings:

If any of the following clinical changes are noted on a test report,
additional debits should be given.

1.  Hypotension or significant BP drop during moderate level of
    exercise.

2.  History or development of typical angina coincident with ischemic
    ECG changes.

3.  Unusual or severe shortness of breath.

+-----------------------------------+-----------------------------------+
| Any of above                      | # A                               |
|                                   | dd +50 to mild or moderate rating |
+-----------------------------------+-----------------------------------+

Other factors may indicate that a mild or moderately positive test is a
false positive.

1.  Young, asymptomatic subjects or pre-menopausal women.

2.  Presence of LVH, digitalis or MVP with resting or hyperventilation
    induced ST-T changes.

  ----------------------------------- -----------------------------------
  Any of above                        Apply 50 credits to exercise test
                                      rating RFC any underlying disorder

  ----------------------------------- -----------------------------------

Following an abnormal treadmill test it is common practice to do
additional studies to confirm the finding. When these tests, such as
thallium scan, exercise echo or catheterization are confirmatory the
likelihood of coronary artery disease is high. Not infrequently,
however, they provide contradictory information (a positive treadmill
followed by a negative scan) and the likelihood of coronary artery
disease is reduced.

  ------------------------------------ ----------------------------------
  Confirmatory studies                 Rate as abnormal exercise test
                                       above, as appropriate

  Contradictory studies                

  Normal scan or exercise echo         Apply up to 50 credits to
  cardiogram                           treadmill rating

  Normal coronary catheterization      Apply up to 75 credits to
                                       treadmill rating
  ------------------------------------ ----------------------------------

**EXOSTOSIS**

An exostosis is an abnormal non-malignant outgrowth (spur) from the
surface of a bone.

  ---------------------------------------------------- ------------------
  Present -- moderate to mild symptoms                 0

  Cured by operation                                   0
  ---------------------------------------------------- ------------------

EYE DISORDERS

Because of its importance as a sensory organ, its exposed position and
its sensitivity, eye complaints are common. Most complaints are of
little concern to the underwriter, some may lead to impaired vision or
blindness, others may be associated with underlying disease or
neurological disorders.

The following disorders can generally be disregarded:

  ----------------------------------- -----------------------------------
  Amblyopia                           Conjunctivitis

  Arcus Senilis                       Pterygium

  Astigmatism                         Refraction Errors

  Blepharitis                         Strabismus

  Coloboma                            Stye
  ----------------------------------- -----------------------------------

[**Cataracts**]{.underline}

These are opacities occurring in the usually transparent lens. Most
cataracts occur with aging, but they may be congenital, traumatic or
associated with metabolic disease. Newer surgical techniques have
greatly simplified their removal and increased the likelihood of visual
improvement after treatment.

**Underwriting Requirements**

An APS (VA Form 29-8158) may be required if not adequately explained on
application.

  -------------------------------------------------------- --------------
  Senile, traumatic                                        

  Present                                                  0

  Operated                                                 0

  Metabolic                                                RFC

  Congenital                                               

  Present                                                  0

  Operated                                                 0
  -------------------------------------------------------- --------------

**[Choroiditis (Iritis)]{.underline}**

Choroiditis, chorioretinitis, episcleritis, iridocyclitis, keratitis and
uveitis are a variety of inflammatory disorders which may be associated
with localized or systemic conditions, infections or trauma.

**Underwriting Requirements**

An APS (VA Form 29-8158) may be required if not adequately explained on
application.

  ------------------------------------------------- ---------------------
  Due to injury                                     0

  Due to other than injury                          

  Cause known                                       RFC

  Cause unknown                                     

  One attack, recovered                             0

  Recurrent or present                              Refer to Section
                                                    Chief
  ------------------------------------------------- ---------------------

**[Glaucoma]{.underline}**

Glaucoma is due to increased pressure within the eye due to impeded
circulation of the eye fluids. \"Primary\" is without apparent cause,
\"secondary\" follows a previous injury or eye disease and is usually
limited to the affected eye. In severe cases sufficient pressure may be
placed on the optic nerve to cause atrophy (wasting) or blindness.

**Underwriting Requirements**

An APS (VA Form 29-8158) may be required if not adequately explained on
application.

  -------------------------------------------- --------------------------
  Controlled by medication or surgery          0

  Others                                       Refer to Section Chief
  -------------------------------------------- --------------------------

[Impaired Vision]{.underline}

If the corrected vision in both eyes is 20/200 or less, consider as
blind.

**Underwriting Requirements**

An APS (VA Form 29-8158) may be required if not adequately explained on
application.

  ------------------------------------------------------ ----------------
  Corrected vision                                       

  20/100 -- 20/200 in better eye                         0

  Less than 20/200 in better eye or totally blind        

  Congenital or accidental causes                        0

  Other causes                                           Refer to Section
                                                         Chief
  ------------------------------------------------------ ----------------

[**Nystagmus, Optic Neuritis, Ptosis**]{.underline}

Several eye disorders are important because they may be manifestations
of significant disease. Nystagmus is a rapid, involuntary movement of
the eyes which may be congenital or related to acquired neurological
disease. Optic neuritis, retrobulbar neuritis and optic atrophy are
inflammations of the optic nerve and may be caused by underlying
neurological disorders. Ptosis is a drooping of one or both eyelids. It
may be congenital but is also seen with certain tumors and neurological
disorders.

**Underwriting Requirements**

An APS (VA Form 29-8158) may be required if not adequately explained on
application.

  ----------------------------------------------------------- -----------
  Cause known                                                 RFC

  Cause unknown                                               

  Within 1 year of onset                                      125

  2^nd^ and 3^rd^ year                                        50

  After 3 years                                               0
  ----------------------------------------------------------- -----------

[**Retinal Disease**]{.underline}

Retinal diseases are not uncommon and may be related to a variety of
factors. Retinal detachment is frequently a result of trauma or high
degrees of myopia. Hemorrhage may be spontaneous, or due to local eye
conditions. It may also be due to systemic conditions such as diabetes,
hypertension, arteriosclerosis or bleeding disorders. Retinitis
Pigmentosa is a hereditary condition which results in degeneration of
the retina and may cause blindness.

  -------------------------------------------- --------------------------
  Retinal detachment                           

  Due to trauma, myopia                        0

  Other, 1 or both eyes                        55

  Retinal hemorrhage                           

  Isolated finding                             0

  Others                                       RFC

  Retinitis Pigmentosa                         0
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