**D**

**DENGUE**

Dengue, also called Dandy fever or breakbone fever. It is an acute virus
disease caused by the bite of an infected mosquito. It starts with
sudden onset of fever, pains in the joints, muscles, head, and eyes and
a Roseola (rose colored) skin eruption. Usually there are 2 or 3 days of
symptoms, a few days remission and then 2 or 3 more days of symptoms.
Recovery may be slow but the mortality rate is low.

  --------------------------------------------- -------------------------
  Present                                       30

  Upon Recovery                                 0
  --------------------------------------------- -------------------------

DEVIATED SEPTUM

A deviated septum is an abnormal dividing wall in the nose, usually
congenital. Disregard.

DIABETES MELLITUS

Diabetes Mellitus is a disorder of carbohydrate metabolism of varying
etiologies, characterized by hyperglycemia.

Any of the following are considered to be diagnostic of diabetes:

1.  Classic symptoms (weight loss, excessive thirst, etc.) of diabetes
    combined with a non-fasting blood glucose level of 200 mg. or more
    and/or a fasting level of 140 mg. or more.

2.  A Fasting Blood Sugar on more than one occasion (different days)
    equal to or greater than 140 mg.

3.  Fasting Glucose less than 140 mg. but the 120 minute sample and one
    other sample exceed 200 mg. after a 75 gm. glucose meal.

Glycosylated Hemoglobin (HbA1c) and Fructosamine tests have not replaced
the Fasting Blood Sugar or Glucose Tolerance Test for making the
diagnosis of diabetes. They are, however, useful for assessing the level
of control of the disease.

Type I, or insulin dependent diabetes (IDDM), requires insulin
replacement therapy for survival. Low insulin levels and other factors
may make these individuals prone to complications and poor control.

Type II, or noninsulin dependent diabetes (NIDDM), is characterized by
abnormalities in insulin metabolism rather than the complete absence of
insulin production. The hyperglycemia in these individuals may be
controlled by diet, but oral hypoglycemic agents or even supplemental
insulin therapy may be required. In some instances weight loss may
result in return of glucose levels to the normal range.

Diabetics are subject to premature arteriosclerosis and the most common
cause of death is cardiovascular disease. Stroke and renal failure are
also common. Up to 50% of insulin dependent diabetics develop renal
disease, initially manifested by albuminuria. Renal failure is likely to
follow the development of kidney disease in these individuals.

Blindness, due to retinopathy, may also contribute to excess morbidity.
Diabetic neuropathy with its combination of decreased sensation,
increased susceptibility to infection, and impaired circulation may lead
to chronic ulceration of the feet and in severe, cases, the need for
amputation.

The prognosis with regard to individuals with diabetes is dependent upon
their willingness to comply with their physician's instructions and to
educate themselves concerning the disease. They must be willing to
accept the limitations of diet, medication and conduct which are
prescribed.

**Underwriting Requirements**

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

The basic rating table shows the debits to be used in the most favorable
cases. Additional debits must be applied when all conditions are not
favorable.

  ---------------------------------- --------------------- -------------------- --------------------
  Basic Rating                       Less than 10          [10-15               15 Years and
                                     [Years]{.underline}   Years]{.underline}   [Over]{.underline}

  Age 39 and under                   150                   175                  225

  Age 40 -- 59                       125                   125                  175

  Age 60 -- 65                       100                   100                  200
  ---------------------------------- --------------------- -------------------- --------------------

Extra ratings are to be added to the basic rating given above as
follows:

  --------------------------------------------------------- -------------
  1\. Under control less than 1 year                        100

  2\. Overweight: Basic build rate 120 to 150 debits        50

  3\. Overweight: Basic build rate over 150 debits          100

  4\. Blood pressure table rate 40-50 debits                100

  5\. Blood pressure table rate over 50 debits              200

  6\. No. 2 and No. 4 above combined                        300

  7\. No. 3 and No. 4 above combined                        300

  8\. Occasional 1% to 3% glycosuria                        50

  9\. Acetone or diacetic                                   100

  10\. Fasting blood sugar 180-200 mg. or Postprandial      100
  180-250 mg.                                               

  11\. Fasting blood sugar over 220 mg. or Postprandial     200
  above 250 mg.                                             

  12\. Albuminuria requiring a debit of 25 and up           100

  13\. Insulin 71-85 units daily                            25

  14\. Insulin over 86 units daily                          75

  15\. Under medical control for over 20 years              50

  16\. Two episodes of diabetic coma                        100

  17\. More than two episodes of diabetic coma              100

  18\. Evidence of other vascular disease, i.e., amputation 200

  19\. Alcoholism, requiring debits of 30 and up            100

  20\. Inadequate medical supervision                       100

  21\. Coronary artery disease                              500

  22\. Family history                                       See Family
                                                            History

  23\. Retinitis                                            50

  24\. Neuropathy                                           50

  25\. Phlebitis -- unilateral -- no previous attack        50

  26\. Bilateral or recurrent attack                        100
  --------------------------------------------------------- -------------

**DIAPHRAGMATIC HERNIA**

Diaphragmatic hernias are protrusions of abdominal contents through the
diaphragm into the chest. About 50 percent exist from birth. Small
congenital diaphragmatic hernias discovered accidentally by x-ray taken
for other reasons may be disregarded if they are not causing symptoms.
Diaphragmatic hernias caused by injury (traumatic) may require surgical
correction.

**Underwriting Requirements**

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

  -------------------------------------------- --------------------------
  Present                                      

  Small, symptomless, no other GI complaints   0

  Small with symptoms                          20

  Cured by operation                           

  Within 1 year                                10

  After 1 year                                 0

  Others                                       

  Depending upon size, symptoms and degree of  Refer to Section Chief
  disability                                   
  -------------------------------------------- --------------------------

**DIARRHEA-DYSENTERY**

**Diarrhea** is an abnormal frequent bowel movement of fluid fecal
(bowel waste) matter. It is usually caused by contaminated food or minor
infections of the intestinal tract usually referred to as \"acute
enteritis,\" \"gastroenteritis," or "intestinal grippe.\" It may result
from numerous other causes, i.e. liver and pancreatic disorders,
parasite infections, emotional upset and virus infection.

**Dysentery** is a term similar in meaning to diarrhea but is a much
more severe and prolonged condition. It is characterized by pain in the
abdomen, diarrhea and cramps. Blood or mucous may appear in the stools.
The two specific varieties are amebic and bacillary.

**Bacillary dysentery** is an acute infection of the bowel usually
caused by bacteria. Prognosis is good if treatment is prompt and
adequate.

**Amebic dysentery**, also called amebiasis, is an infectious disease
caused by the invasion of the intestinal tract by ameba. Typical
symptoms include frequent stools accompanied by cramps, blood and
ulceration in the bowel. Recurrences are common. If recognized in the
early stages and thoroughly treated, early recovery can be expected. If
chronic or neglected, complications of the liver or colon may develop.
When symptoms cease and repeated stool examinations are found to be
negative, the risk may be regarded as cured, Diagnosis is by examination
of the stool in which may be found the specific ameba (amoeba
histolytica).

**Salmonella --** There are many serological types of this infection
which usually occur in otherwise healthy subjects following the
ingestion of contaminated food or drink, Following an incubation period
of from 8 to 48 hours there is a sudden onset of colicky, abdominal pain
and loose watery diarrhea. Symptoms usually subside within 2 to 5 days
and recovery is uneventful. Sometimes symptoms last 10 to 14 days. It
may occur as a focal infection of various organs, may complicate
malaria, relapsing fever, sickle cell anemia, bartonellosis (Carrion\'s
disease) liver and neoplastic diseases. An individual\'s resistance to
this disease may be reduced following major gastric surgery, use of
corticosteroids, alkylating agents, or irradiation. Diagnosis depends
upon a history of exposure or ingestion, and isolation of causative
organism. Fatalities are rare and are usually limited to infants and
debilitated individuals. The carrier state usually will spontaneously
cease in l to 3 months.

**Underwriting Requirements**

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

  ------------------------------------------ ----------------------------
  Diarrhea                                   

  Uncomplicated -- upon recovery             0

  Others                                     RFC

                                             

  Bacillary Dysentery                        

  Present                                    40

  Within 6 months after recovery             0

  Amebic Dysentery                           

  One attack, duration less than 2 months    

  Presently under treatment                  50

  Within 1 year after recovery               20

  After 1 year                               0

  One attack of 2 or more months, or         
  recurrent attacks                          

  Presently under treatment                  100

  Within 1 year after recovery               75

  Within 2 years                             30

  After 2 years                              0

                                             

  Salmonella                                 

  Uncomplicated                              0

  Complications                              Rate for abscess of organ or
                                             accompanied disease
  ------------------------------------------ ----------------------------

DIPHTHERIA

Diphtheria is an acute infectious disease characterized by the formation
of a grayish membrane in the pharynx and nasal passages. It sometimes
shuts off the windpipe completely. Persons affected may appear to have a
mild sore throat but usually fever is high and exhaustion is extreme. In
extreme cases it can cause paralysis of the palate and pharynx.
Myocarditis is always a hazard.

**Underwriting Requirements**

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

  --------------------------------------- -------------------------------
  Present                                 200

  After recovery                          

  Without complications                   0

  With complications                      Rate for complication or
                                          residual impairments
  --------------------------------------- -------------------------------

**DISLOCATIONS**

A dislocation is the displacement of the bones that form a joint. Loss
of use of the joint occurs and continues until the dislocation is
corrected. Injury to ligaments and soft tissue in and about the joint is
common. Recurrent dislocations of the shoulder, elbow, and knee (trick
knee) often require surgical repair to stabilize the joint.

The ratings below are for dislocations only. If accompanied by ankylosis
or fracture, consider under appropriate rules.

**Underwriting Requirements**

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

  ------------------------------------------------------ ----------------
  Recurrent dislocation of hip                           

  Present                                                15

  Corrected by surgery                                   0

  Congenital dislocation of hip                          

  Present                                                

  One side with or without aids                          15

  Both sides with or without aids                        30

  Corrected by surgery                                   0

  Recurrent dislocation of elbow, shoulder, or knee      

  Present                                                10

  Corrected by surgery                                   0

  Other dislocations                                     

  Singe -- after recovery                                0

  Recurrent                                              15
  ------------------------------------------------------ ----------------

DIVERTICULUM-DIVERTICULOSIS-DIVERTICULITIS

A diverticulum is a closed pouch or saccular opening extending out from
a hollow organ.

**Diverticulosis** is the presence of multiple pouches or sacs usually
found in the large (sigmoid or descending) intestine (colon). This
condition can exist without showing any signs and in this state is of no
underwriting consequence. It does exist in a large percentage of persons
over 45 and they are not even aware of its presence. Usually it is found
on routine x-ray taken for some other reason.

**Diverticulitis** is the inflammation of one or more diverticulum. This
inflammation is usually the first evidence that diverticulosis is
present. The inflammation may subside within a few days or may spread
and cause abscess, spasm or swelling (edema). These complications may
lead to peritonitis, fistula formation with the urinary bladder or
erosion into an artery or vein, etc.; surgical correction is often
required.

**Meckel\'s diverticulum** is a congenital pouch or sac located near the
appendix. Usually it creates no symptoms. When it does surgery is
normally required. Following a successful operation it becomes a
standard risk.

**Underwriting Requirements**

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

  ----------------------------------------------------- -----------------
  Diverticulum of duodenum -- rate for size             

  Present                                               35

  Corrected by surgery                                  

  Within 1 year                                         10

  After 1 year                                          0

                                                        

  Diverticulum of esophagus                             See Esophagus

                                                        

  Meckel's Diverticulum                                 

  Without symptoms                                      0

  With symptoms                                         35

  Operated -- upon recovery                             0

                                                        

  Diverticulosis                                        

  Present -- no history of diverticulitis               

  Unoperated or single operation, asymptomatic          0

  Others                                                15

                                                        

  Diverticulitis                                        

  Unoperated, one or more attacks                       

  Within 1 year of last attack                          20

  2^nd^ year                                            10

  After 2 years                                         0

  Operated                                              

  Within 1 year of operation                            20

  2^nd^ year                                            10

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

**DIVERTICULUM OF BLADDER**

Diverticulum of the bladder results from a congenital deformity of the
bladder wall; they may be singular or multiple, with or without symptoms
and large or small. They are frequently the cause of recurrent
infection. (See Diverticulosis).

**Underwriting Requirements**

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

  --------------------------------------------------------- -------------
  Present -- Urine normal                                   

  Small to medium                                           25

  Others                                                    50

  With abnormal urine, add debits under urine               

                                                            

  Operated -- Urine normal                                  

  Within 1 year                                             20

  Within 2 years                                            10

  After 2 years                                             0

  With abnormal urine, add debits under urine               
  --------------------------------------------------------- -------------

DRUG ADDICTION

Amphetamines (Benzedrine, Dexedrine, Methedrine, etc.) are also known as
pep pills, bennies, dexies, speed, ice, etc. They are used medically for
weight reduction, narcolepsy, depression and some behavioral disorders.
They are a stimulant and can result in restlessness, dryness of mouth,
tachycardia and tremor. Abuse, particularly by injections, can produce a
psychosis or even death.

Barbiturates (Phenobarbital, Luminal, Amytal, Nembutal, Seconal, etc.)
are also known as goofballs, blue heavens, yellow jackets, red devils,
phennies, etc. They are used medically to sedate or calm patients and to
induce sleep. They are depressants acting in much the same way as
alcohol and, in combination with alcohol, may produce death. They are
habit forming and may produce a physical dependence. Abrupt withdrawal
after heavy use often causes convulsions and even death.

Cocaine (coke, crack, powder) is widely available in many forms from
powder to crack cocaine. It can be ingested in numerous ways from
inhaling to injections. Thus hepatitis, AIDS, and other infections are
possibilities resulting from unsterile needles.

LSD is a hallucinogenic drug with unpredictable results. The most common
effects are delusions, depression, anxiety and confusion. Even a single
"bad trip" may produce a psychiatric disorder, and hallucinations may
continue to recur even without further use. LSD is commonly called acid,
sugar, big D, or cubes.

Marijuana is also known as pot, grass, tea, weed, Mary Jane, and when
rolled may be referred to as reefers, sticks, joints, good-butts, etc.
Legally it is an opiate and narcotic. Its strength varies considerably,
with a very potent form being known as hashish. In modest doses, the
effects are often similar to that of alcohol. Use of hashish or strong
heavy doses or extensive use of marijuana may produce hallucinations or
psychotic reactions.

Narcotics are opium and opium derivatives such as morphine, codeine,
heroin and paregoric. Demerol and Dolophine are also narcotics. Many
compounds of opium are widely used in medicine as pain killers. Heroin
is the principal illicit drug and is known as big H, horse, junk, smack
and scrag. As is true of cocaine, it may be sniffed, injected beneath
the skin (skin or joy popper) or injected intraveneously (mainliners).
On a long term basis, a high tolerance develops and there is a psychic
and physical dependence. Heroin addicts can be spotted by their pinpoint
pupils, needle marks, "nodding" and slow pulse rate.

**Underwriting Requirements**

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

  -------------------------------------------- --------------------------
  Any drug of abuse                            

  Positive findings in urine, no admissions,   R
  no history                                   

                                               

  Amphetamines, cocaine                        

  Information from the proposed insured or     125
  attending physician confirming intermittent  
  use as a temporary stimulant, no evidence of 
  a ratable behavioral problem                 

  Suspicion of abuse by injection, behavioral  
  problems                                     

  Within 2 years                               R

  3^rd^ -- 5^th^ year                          

  If reverting to abuse improbable             100

  Otherwise                                    R

  After 5 years                                0

                                               

  Barbiturates                                 

  Evidence of physical dependence              

  Within 2 years                               R

  Thereafter -- consider associated problems   Rate accordingly but not
  and permanence of reform                     less than Amphetamine
                                               schedule above

                                               

  LSD                                          

  Use within 3 years                           R

  After 3 years                                

  Single "trip" only, no evidence of           0
  psychiatric problems or maladjustment, good  
  student or employment record                 

  Others                                       

  Within 5 years                               R

  6^th^ -- 10^th^ year                         175

  After 10 years                               0

                                               

  Marijuana and hashish                        

  Occasional use or discontinued 1 year or     0
  more                                         

  Weekend or regular use                       55

                                               

  Opium and its derivatives, Demerol,          
  Dolophine, including those that receive      
  Methadone treatment                          

  Within 2 years                               R

  3^rd^ -- 5^th^ year                          150

  6^th^ -- 10^th^ year                         55

  After 10 years                               0

                                               

  Other drugs                                  

  Mescaline and peyote                         Rate same as Hashish

  Miscellaneous                                Classify under one of the
                                               above guides according to
                                               its effect on the
                                               individual
  -------------------------------------------- --------------------------

**DUODENITIS**

The duodenum is the first division of the small intestine, it is about
11 inches or 12 finger breadths long (duodeni means 12 -- hence the
name). It may become inflamed and produce symptoms of diarrhea
alternating with constipation, rumbling in the high abdomen and may
produce a little jaundice.

The diagnosis is made in patients who have stomach trouble of the ulcer
type when x-rays produce no definite ulcer cavity. The duodenal cap
fills and empties rapidly and appears irritable and fuzzy in outline.

**Underwriting Requirements**

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

  --------------------------------------------------------- -------------
  Mild or moderate -- infrequent brief episodes not         0
  requiring medical attention or prescription medication    

  Severe -- more frequent or prolonged, requiring medical   30
  attention, prescription medication and requiring          
  diagnostic tests                                          
  --------------------------------------------------------- -------------

# **DYSPLASTIC NEVUS SYNDROME**

Dyplastic nevi or atypical moles are larger and more irregular than
typical benign moles. They are both a precursor or melanoma and a marker
for an increased risk of melanoma arising from normal skin.

## Underwriting Requirements

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

  --------------------------------------------------- -------------------
  History of Dyplastic Nevi, no personal or family    0
  history of melanoma                                 

  History of Dyplastic Nevi, plus family history of   55
  melanoma                                            

  History of Dyplastic Nevi, plus personal history of Add 55 to Melanoma
  melanoma                                            schedule
  --------------------------------------------------- -------------------