Custom Federal Regulations Service™

**This is supplemental material**

**for Book C of your set of**

**Federal Regulations**

Title 38, Part 4

*Schedule for Rating Disabilities*

**Veterans Benefits Administration**

Supplement No. 40

Covering period of *Federal Register* issues

through May 22, 2006

Copyright © 2006 Jonathan Publishing

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> **GENERAL INSTRUCTIONS**

Custom Federal Regulations Service™

**Supplemental Materials for *Book C***

**Code of Federal Regulations**

**Title 38, Part 4**

***Schedule for Rating Disabilities***

**Veterans Benefits Administration**

**Supplement No. 40**

25 May 2006

Covering the period of Federal Register issues

through May 22, 2006

When **Book C** was originally prepared, it was current through final
regulations published in the *Federal Register* of 24 March 1992. These
supple­mental materials are designed to keep your regulations up to date.
You should file the attached pages immediately, and record the fact that
you did so on the *Supplement Filing Record* which is at page C-8 of
Book C, *Schedule for Rating Disabilities*.

**To ensure accuracy and timeliness of your materials,**

**it is important that you follow these simple procedures:**

1\. Always file your supplemental materials immediately upon receipt.

2\. Before filing, always check the Supplement Filing Record (page C-8)
to be sure that all prior supplements have been filed. If you are
missing any supple­ments, contact the Veterans Benefits Administration at
the address listed on page C-2.

3\. After filing, enter the relevant information on the Supplement
Filing Record sheet (page C-8)---the date filed, name/initials of filer,
and date through which the *Federal Register* is covered.

4\. If as a result of a failure to file, or an undelivered supplement,
you have more than one supplement to file at a time, be certain to file
them in chronological order, lower number first.

5\. Always retain the filing instructions (simply insert them at the
back of the book) as a backup record of filing and for reference in case
of a filing error.

6\. Be certain that you *permanently discard* any pages indicated for
removal in the filing instructions in order to avoid confusion later.

To execute the filing instructions, simply remove *and throw away* the
pages listed under *Remove These Old Pages,* and replace them in each
case with the corres­pond­ing pages from this supplement listed under *Add
These New Pages*. Occasionally new pages will be added without removal
of any old material (reflecting new regulations), and occasionally old
pages will be removed with­out addition of any new material (reflecting
rescinded regulations)---in these cases the word *None* will appear in
the appropriate column.

> **FILING INSTRUCTIONS**

**Book C, Supplement No. 40**

**May 25, 2006**

**Do not file this supplement until you confirm that**

**all prior supplements have been filed**

*Remove these Add these Section(s)*

*[old pages]{.underline} [new pages]{.underline} [Affected]{.underline}*

4.17-1 to 4.18-1 4.17-1 to 4.18-1 §4.17

4.28-1 to 4.30-1 4.28-1 to 4.30-1 §§4.29--4.30

**4.97-7 to 4.97-14 4.97-7 to 4.97-14 §4.97**

4.124a-4 to 4.124a-5 4.124a-4 to 4.124a-5 §4.124a (tech. corr.)

**Be sure to complete the**

***Supplement Filing Record* (page C-8)**

**when you have finished filing this material.**

> **HIGHLIGHTS**

**Book C, Supplement No. 40**

**May 25, 2006**

***Supplement* Highlights *references***: Where substantive changes are
made in the text of regulations, the paragraphs of *Highlights* sections
are cited at the end of the relevant section of text. Thus, if you are
reading §3.263, you will see a note at the end of that section which
reads: "Supplement *Highlights* references---6(2)." This means that
paragraph 2 of the *Highlights* section in Supplement No. 6 contains
information about the changes made in §3.263. By keeping and filing the
*Highlights* sections, you will have a reference source explaining all
substantive changes in the text of the regulations.

***Supplement frequency***: This Book C (*Schedule for Rating
Disabilities*) was originally supplemented four times a year, in
February, May, August, and November. Beginning 1 August 1995,
supplements will be issued *every month* during which a final rule
addition or modification is made to the parts of Title 38 covered by
this book. Supplements will be numbered consecutively as issued.

**Modifications in this supplement include the following:**

1\. On 17 May 2006, the VA published a final rule, effective that same
date, to correct regulations published in the *Federal Register* on 17
July 2002 (67 FR 46868) that amended its adjudication and fiduciary
regulations in Parts 3 and 13 by replacing the titles of *Adjudication
Division*, *Adjudication Officer*, and *Veterans Services Officer*, with
*Veterans Service Center* and *Veterans Service Center Manager*. Those
changes---all non-substantive---are now extended to Parts 1, 4, 6, 14,
and 21. Changes in this Book C:

Corrections made in §§4.17, 4.29, 4.30, and 4.97.

**§4.17 Total disability ratings for pension based on unemployability
and age of the individual.**

All veterans who are basically eligible and who are unable to secure and
follow a substantially gainful occupation by reason of disabilities
which are likely to be permanent shall be rated as permanently and
totally disabled. For the purpose of pension, the permanence of the
percentage requirements of §4.16 is a requisite. When the percentage
requirements are met, and the disabilities involved are of a permanent
nature, a rating of permanent and total disability will be assigned if
the veteran is found to be unable to secure and follow substantially
gainful employment by reason of such disability. Prior employment or
unemployment status is immaterial if in the judgment of the rating board
the veteran's disabilities render him or her unemployable. In making
such determinations, the following guidelines will be used:

\(a\) Marginal employment, for example, as a self-employed farmer or
other person, while employed in his or her own business, or at odd jobs
or while employed at less than half the usual remuneration will not be
considered incompatible with a determination of unemployability, if the
restriction, as to securing or retaining better employment, is due to
disability.

\(b\) Claims of all veterans who fail to meet the percentage standards
but who meet the basic entitlement criteria and are unemployable, will
be referred by the rating board to the Veterans Service Center Manager
under §3.321(b)(2) of this chapter. (Authority: 38 U.S.C. 1502)

\[43 FR 45348, Oct. 2, 1978; as amended at 56 FR 57985, Nov. 15, 1991;
71 FR 28586, May 17, 2006\]

*Next Section is 4.17a*

**§4.17a Misconduct etiology.**

A permanent and total disability rating under the provisions of §§4.15,
4.16 and 4.17 will not be precluded by reason of the coexistence of
misconduct disability when:

\(a\) A veteran, regardless of employment status, also has innocently
acquired 100 percent disability, or

\(b\) Where unemployable, the veteran has other disabilities innocently
acquired which meet the percentage requirements of §§4.16 and 4.17 and
would render, in the judgment of the rating agency, the average person
unable to secure or follow a substantially gainful occupation.

\[40 FR 42536, Sept. 15 1975, as amended at 43 FR 45349, Oct. 2, 1978\]

**§4.18 Unemployability.**

A veteran may be considered as unemployable upon termination of
employment which was provided on account of disability, or in which
special consideration was given on account of the same, when it is
satisfactorily shown that he or she is unable to secure further
employment. With amputations, sequelae of fractures and other residuals
of traumatism shown to be of static character, a showing of continuous
unemployability from date of incurrence, or the date the condition
reached the stabilized level, is a general requirement in order to
establish the fact that present unemployability is the result of the
disability. However, consideration is to be given to the circumstances
of employment in individual claims, and, if the employment was only
occasional, intermittent, tryout or unsuccessful, or eventually
terminated on account of the disability, present unemployability may be
attributed to the static disability. Where unemployability for pension
previously has been established on the basis of combined
service-connected and nonservice-connected disabilities and the
service-connected disability or disabilities have increased in severity,
§4.16 is for consideration.

\[40 FR 42536, Sept. 15, 1975, as amended at 43 FR 45349, Oct. 2, 1978\]

**§4.28 Prestabilization rating from date of discharge from service.**

The following ratings may be assigned, in lieu of ratings prescribed
elsewhere, under the conditions stated for disability from any disease
or injury. The prestabilization rating is not to be assigned in any case
in which a total rating is immediately assignable under the regular
provisions of the schedule or on the basis of individual
unemployability. The prestabilization 50-percent rating is not to be
used in any case in which a rating of 50-percent or more is immediately
assignable under the regular provisions.

*Rating*

Unstabilized condition with severe disability:

Substantially gainful employment

is not feasible or advisable 100

Unhealed or incompletely healed wounds or injuries:

Material impairment of employability likely 50

Note (1): Department of Veterans Affairs examination is not required
prior to assignment of prestabilization ratings; however, the fact that
examination was accomplished will not preclude assignment of these
benefits. Prestabilization ratings are for assignment in the immediate
postdischarge period. They will continue for a 12-month period following
discharge from service. However, prestabilization ratings may be changed
to a regular schedular total rating or one authorizing a greater benefit
at any time. In each prestabilization rating an examination will be
requested to be accomplished not earlier than 6 months nor more than 12
months following discharge. In those prestabilization ratings in which
following examination reduction in evaluation is found to be warranted,
the higher evaluation will be continued to the end of the 12th month
following discharge or to the end of the period provided under §3.105(e)
of this chapter, whichever is later. Special monthly compensation should
be assigned concurrently in these cases whenever records are adequate to
establish entitlement.

Note (2): Diagnosis of disease, injury, or residuals will be cited, with
diagnostic code number assigned from this rating schedule for conditions
listed therein.

\[35 FR 11906, July 24, 1970\]

**§4.29 Ratings for service-connected disabilities requiring hospital
treatment or observation.**

A total disability rating (100 percent) will be assigned without regard
to other provisions of the rating schedule when it is established that a
service-connected disability has required hospital treatment in a
Department of Veterans Affairs or an approved hospital for a period in
excess of 21 days or *hospital observation at Department of Veterans
Affairs expense* for a service-connected disability for a period in
excess of 21 days.

\(a\) Subject to the provisions of paragraphs (d), (e), and (f) of this
section this increased rating will be effective the first day of
continuous hospitalization and will be terminated effective the last day
of the month of hospital discharge (regular discharge or release to
non-bed care) or effective the last day of the month of termination of
treatment or observation for the service-connected disability. A
temporary release which is approved by an attending Department of
Veterans Affairs physician as part of the treatment plan will not be
considered an absence.

\(1\) An authorized absence in excess of 4 days which begins during the
first 21 days of hospitalization will be regarded as the equivalent of
hospital discharge effective the first day of such authorized absence.
An authorized absence of 4 days or less which results in a total of more
than 8 days of authorized absence during the first 21 days of
hospitalization will be regarded as the equivalent of hospital discharge
effective the ninth day of authorized absence.

\(2\) Following a period of hospitalization in excess of 21 days, an
authorized absence in excess of 14 days or a third consecutive
authorized absence of 14 days will be regarded as the equivalent of
hospital discharge and will interrupt hospitalization effective on the
last day of the month in which either the authorized absence in excess
of 14 days or the third 14 day period begins, except where there is a
finding that convalescence is required as provided by paragraph (e) or
(f) of this section. The termination of these total ratings will not be
subject to §3.105(e) of this chapter.

\(b\) Notwithstanding that hospital admission was for disability not
connected with service, if during such hospitalization, hospital
treatment for a service-connected disability is instituted and continued
for a period in excess of 21 days, the increase to a total rating will
be granted from the first day of such treatment. If service connection
for the disability under treatment is granted after hospital admission,
the rating will be from the first day of hospitalization if otherwise in
order.

\(c\) The assignment of a total disability rating on the basis of
hospital treatment or observation will not preclude the assignment of a
total disability rating otherwise in order under other provisions of the
rating schedule, and consideration will be given to the propriety of
such a rating in all instances and to the propriety of its continuance
after discharge. Particular attention, with a view to proper rating
under the rating schedule, is to be given to the claims of veterans
discharged from hospital, regardless of length of hospitalization, with
indications on the final summary of expected confinement to bed or
house, or to inability to work with requirement of frequent care of
physician or nurse at home.

\(d\) On these total ratings Department of Veterans Affairs regulations
governing effective dates for increased benefits will control.

\(e\) The total hospital rating if convalescence is required may be
continued for periods of 1, 2, or 3 months in addition to the period
provided in paragraph (a) of this section.

\(f\) Extension of periods of 1, 2, or 3 months beyond the initial 3
months may be made upon approval of the Veterans Service Center Manager.

\(g\) Meritorious claims of veterans who are discharged from the
hospital with less than the required number of days but need
post-hospital care and a prolonged period of convalescence will be
referred to the Director, Compensation and Pension Service, under
§3.321(b)(1) of this chapter.

\[29 FR 6718, May 22, 1964, as amended at 41 FR 11294, Mar. 18, 1976; 41
FR 34256, Aug. 13, 1976; 54 FR 4281, Jan. 30, 1989; 54 FR 34981, Aug.
23, 1989; 71 FR 28586, May 17, 2006\]

**§4.30 Convalescent ratings.**

A total disability rating (100 percent) will be assigned without regard
to other provisions of the rating schedule when it is established by
report at hospital discharge (regular discharge or release to non-bed
care) or outpatient release that entitlement is warranted under
paragraph (a)(1), (2), or (3) of this section effective the date of
hospital admission or outpatient treatment and continuing for a period
of 1, 2, or 3 months from the first day of the month following such
hospital discharge or outpatient release. The termination of these total
ratings will not be subject to §3.105(e) of this chapter. Such total
rating will be followed by appropriate schedular evaluations. When the
evidence is inadequate to assign a schedular evaluation, a physical
examination will be scheduled and considered prior to the termination of
a total rating under this section.

\(a\) Total ratings will be assigned under this section if treatment of
a service-connected disability resulted in:

\(1\) Surgery necessitating at least one month of convalescence
(Effective as to outpatient surgery March 1, 1989.)

\(2\) Surgery with severe postoperative residuals such as incompletely
healed surgical wounds, stumps of recent amputations, therapeutic
immobilization of one major joint or more, application of a body cast,
or the necessity for house confinement, or the necessity for continued
use of a wheelchair or crutches (regular weight-bearing prohibited).
(Effective as to outpatient surgery March 1, 1989.)

\(3\) Immobilization by cast, without surgery, of one major joint or
more. (Effective as to outpatient treatment March 10, 1976.)

A reduction in the total rating will not be subject to §3.105(e) of this
chapter. The total rating will be followed by an open rating reflecting
the appropriate schedular evaluation; where the evidence is inadequate
to assign the schedular evaluation, a physical examination will be
scheduled prior to the end of the total rating period.

\(b\) A total rating under this section will require full justification
on the rating sheet and may be extended as follows:

\(1\) Extensions of 1, 2, or 3 months beyond the initial 3 months may be
made under paragraph (a)(1), (2), or (3) of this section.

\(2\) Extensions of 1 or more months up to 6 months beyond the initial 6
months period may be made under paragraph (a)(2) or (3) of this section
upon approval of the Veterans Service Center Manager.

\[41 FR 34256, Aug. 13, 1976, as amended at 54 FR 4281, Jan. 30, 1989;
71 FR 28586, May 17, 2006\]

# diseases of the lungs and pleura---tuberculosis

Rating

> **Ratings for Pulmonary Tuberculosis Entitled on August 19, 1968**

**6701** Tuberculosis, pulmonary, chronic, far advanced, active 100

**6702** Tuberculosis, pulmonary, chronic, moderately advanced, active
100

**6703** Tuberculosis, pulmonary, chronic, minimal, active 100

**6704** Tuberculosis, pulmonary, chronic, active, advancement
unspecified 100

**6721** Tuberculosis, pulmonary, chronic, far advanced, inactive

**6722** Tuberculosis, pulmonary, chronic, moderately advanced, inactive

**6723** Tuberculosis, pulmonary, chronic, minimal, inactive

**6724** Tuberculosis, pulmonary, chronic, inactive, advancement
unspecified

General Rating Formula for Inactive Pulmonary Tuberculosis:

For two years after date of inactivity, following active tuberculosis,

which was clinically identified during service or subsequently 100

Thereafter for four years, or in any event, to six years after date

of inactivity 50

Thereafter, for five years, or to eleven years after date of inactivity
30

Following far advanced lesions diagnosed at any time while the

disease process was active, minimum 30

Following moderately advanced lesions, provided there is continued

disability, emphysema, dyspnea on exertion, impairment of

health, etc. 20

Otherwise 0

**Note (1)**: The 100-percent rating under codes 6701 through 6724 is
not subject to a requirement of precedent hospital treatment. It will be
reduced to 50 percent for failure to submit to examination or to follow
prescribed treatment upon report to that effect from the medical
authorities. When a veteran is placed on the 100-percent rating for
inactive tuberculosis, the medical authorities will be appropriately
notified of the fact, and of the necessity, as given in footnote 1 to 38
U.S.C. 1156 (and formerly in 38 U.S.C. 356, which has been repealed by
Public Law 90-493), to notify the Veterans Service Center in the event
of failure to submit to examination or to follow treatment.

**Note (2)**: The graduated 50-percent and 30-percent ratings and the
permanent 30 percent and 20 percent ratings for inactive pulmonary
tuberculosis are not to be combined with ratings for other respiratory
disabilities. Following thoracoplasty the rating will be for removal of
ribs combined with the rating for collapsed lung. Resection of the ribs
incident to thoracoplasty will be rated as removal.

> **Ratings for Pulmonary Tuberculosis Initially Evaluated After August
> 19, 1968**

**6730** Tuberculosis, pulmonary, chronic, active 100

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

\(a\) Associated with active tuberculosis involving other than the
respiratory system.

\(b\) With severe associated symptoms or with extensive cavity
formation.

\(c\) Reactivated cases, generally.

\(d\) With advancement of lesions on successive examinations or while
under

treatment.

\(e\) Without retrogression of lesions or other evidence of material

improvement at the end of six months hospitalization or without

change of diagnosis from "active" at the end of 12 months
hospitalization.

Material improvement means lessening or absence of clinical symptoms,

and X-ray findings of a stationary or retrogressive lesion.

**6731** Tuberculosis, pulmonary, chronic, inactive:

Depending on the specific findings, rate residuals as interstitial lung

disease, restrictive lung disease, or, when obstructive lung disease is

the major residual, as chronic bronchitis (DC 6600). Rate thoracoplasty

as removal of ribs under DC 5297.

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

**6732** Pleurisy, tuberculous, active or inactive:

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

**[nontuberculous diseases]{.smallcaps}**

Rating

**6817** Pulmonary Vascular Disease:

Primary pulmonary hypertension, or; chronic pulmonary thrombo-

embolism with evidence of pulmonary hypertension, right

ventricular hypertrophy, or cor pulmonale, or; pulmonary

hypertension secondary to other obstructive disease of pulmonary

arteries or veins with evidence of right ventricular hypertrophy or

cor pulmonale 100

Chronic pulmonary thromboembolism requiring anticoagulant therapy,

or; following inferior vena cava surgery without evidence of

pulmonary hypertension or right ventricular dysfunction 60

Symptomatic, following resolution of acute pulmonary embolism 30

Asymptomatic, following resolution of pulmonary thromboembolism 0

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

**6819** Neoplasms, malignant, any specified part of respiratory system
exclusive

of skin growths 100

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

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

appropriate respiratory analogy.

> **Bacterial Infections of the Lung**

**6822** Actinomycosis.

**6823** Nocardiosis.

**6824** Chronic lung abscess.

General Rating Formula for Bacterial Infections of the Lung (diagnostic
codes

6822 through 6824):

Active infection with systemic symptoms such as fever, night sweats,

weight loss, or hemoptysis 100

Depending on the specific findings, rate residuals as interstitial lung

disease, restrictive lung disease, or, when obstructive lung disease is

the major residual, as chronic bronchitis (DC 6600).

> **Interstitial Lung Disease**

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

**6826** Desquamative interstitial pneumonitis.

**6827** Pulmonary alveolar proteinosis.

**6828** Eosinophilic granuloma of lung.

**6829** Drug-induced pulmonary pneumonitis and fibrosis.

**6830** Radiation-induced pulmonary pneumonitis and fibrosis.

**6831** Hypersensitivity pneumonitis (extrinsic allergic alveolitis).

**6832** Pneumoconiosis (silicosis, anthracosis, etc.).

**6833** Asbestosis.

General Rating Formula for Interstitial Lung Disease (diagnostic

codes 6825 through 6833):

Forced Vital Capacity (FVC) less than 50-percent predicted,

or; Diffusion Capacity of the Lung for Carbon Monoxide by the

Single Breath Method (DLCO (SB)) less than 40-percent predicted,

or; maximum exercise capacity less than 15 ml/kg/min oxygen

consumption with cardiorespiratory limitation, or; cor pulmonale

or pulmonary hypertension, or; requires outpatient oxygen

therapy 100

FVC of 50- to 64-percent predicted, or; DLCO (SB) of 40- to

55-percent predicted, or; maximum exercise capacity of 15 to

20 ml/kg/min oxygen consumption with cardiorespiratory

limitation 60

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

65-percent predicted 30

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

80-percent predicted 10

> **Mycotic Lung Disease**

**6834** Histoplasmosis of lung.

**6835** Coccidioidomycosis.

**6836** Blastomycosis.

**6837** Cryptococcosis.

**6838** Aspergillosis.

**6839** Mucormycosis.

General Rating Formula for Mycotic Lung Disease (diagnostic codes

6834 through 6839):

Chronic pulmonary mycosis with persistent fever, weight loss,

night sweats, or massive hemoptysis 100

Chronic pulmonary mycosis requiring suppressive therapy with

no more than minimal symptoms such as occasional minor

hemoptysis or productive cough 50

Chronic pulmonary mycosis with minimal symptoms such as

occasional minor hemoptysis or productive cough 30

Healed and inactive mycotic lesions, asymptomatic 0

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

> **Restrictive Lung Disease**

**6840** Diaphragm paralysis or paresis.

**6841** Spinal cord injury with respiratory insufficiency.

**6842** Kyphoscoliosis, pectus excavatum, pectus carinatum.

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

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

**6845** Chronic pleural effusion or fibrosis.

General Rating Formula for Restrictive Lung Disease

(diagnostic codes 6840 through 6845):

FEV-1 less than 40 percent of predicted value, or; the ratio of

Forced Expiratory Volume in one second to Forced Vital

Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity

of the Lung for Carbon Monoxide by the Single Breath Method

(DLCO (SB)) less than 40-percent predicted, or; maximum

exercise capacity less than 15 ml/kg/min oxygen consumption

(with cardiac or respiratory limitation), or; cor pulmonale (right

heart failure), or; right ventricular hypertrophy, or; pulmonary

hypertension (shown by Echo or cardiac catheterization), or;

episode(s) of acute respiratory failure, or; requires outpatient

oxygen therapy 100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55

percent, or; DLCO (SB) of 40- to 55-percent predicted, or;

maximum oxygen consumption of 15 to 20 ml/kg/min (with

cardiorespiratory limit) 60

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70

percent, or; DLCO (SB) 56- to 65-percent predicted 30

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80

percent, or; DLCO (SB) 66- to 80-percent predicted 10

Or rate primary disorder.

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

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

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

**6846** Sarcoidosis:

Cor pulmonale, or; cardiac involvement with congestive heart failure,

or; progressive pulmonary disease with fever, night sweats, and

weight loss despite treatment 100

Pulmonary involvement requiring systemic high dose (therapeutic)

corticosteroids for control 60

Pulmonary involvement with persistent symptoms requiring chronic

low dose (maintenance) or intermittent corticosteroids 30

Chronic hilar adenopathy or stable lung infiltrates without symptoms

or physiologic impairment 0

Or rate active disease or residuals as chronic bronchitis (DC 6600) and
extra-

pulmonary involvement under specific body system involved

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

Chronic respiratory failure with carbon dioxide retention or cor

pulmonale, or; requires tracheostomy 100

Requires use of breathing assistance device such as continuous

airway pressure (CPAP) machine 50

Persistent day-time hypersomnolence 30

Asymptomatic but with documented sleep disorder breathing 0

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

**Supplement *Highlights* reference**: 18(1)

*Next Section is §4.100*

Reserved

**[Miscellaneous Diseases]{.smallcaps}**

Rating

**8100** Migraine:

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

**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.

**[Diseases of the Cranial Nerves]{.smallcaps}**

Rating

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.