**M**

MACROGLOBULINEMIA

(Waldenstrom\'s Disease)

This is a clinical term characterized by symptoms of weakness, dyspnea,
weight loss, bleeding tendency and less commonly, visual acuity. There
are personality changes, myelitis, radiculitis and increased
cerebrospinal fluid protein as well as increased distention and
tortuosity of the retinal veins with multiple retinal hemorrhages,
lymphadenopathy and hepatosplenomegaly. The blood shows elevated
sedimentation rate, hyperglobulinemia and increased serum viscosity. The
diagnosis can only be established by ultracentrifugation or
immunoelectrophoresis of the serum and the demonstration of globulins.
It may be impossible to differentiate from malignant lymphomas and
chronic lymphatic leukemia.

**Underwriting Requirements**

An APS (VA Form 29-8158) required at all times.

  --------------------------------------------- -------------------------
  Present                                       R

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

MALARIA

Malaria, also known as blackwater fever, is a disease transmitted by the
anopheles mosquito, which is characterized by recurrent paroxysms of
chills, fever, and sweating. The symptoms may recur daily (quotidian),
every other day (tertian) (this is most common), or with a 3-day
interval (quartan). In the most severe type (estivoautumnal),
enlargement of the liver and spleen may be present, the paroxysm may
last from 20 to 36 hours with more prostration, fever of 104 degrees,
and if untreated, the mortality rate is high.

**Underwriting Requirements**

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

  ---------------------------------------------------------- ------------
  Single mild attack (not more than 1 week duration) -       
  complications                                              

  Within 6 months of last attack                             20

  After 6 months                                             0

  Repeated mild attacks, or 1 severe attack -- no            
  complications                                              

  Within 6 months of last attack                             30

  Within 7-12 months                                         20

  After 1 year                                               0

  With repeated severe attacks                               Add 25

  Chronic form or severe recurrent attacks with unfavorable  300
  appearance or enlarged liver and/or spleen                 
  ---------------------------------------------------------- ------------

**MALIGNANT HYPERTHERMIA**

This muscle metabolism disorder is hereditary and can result in marked
elevation of body temperature and death on exposure to certain
anesthetic agents.

**Underwriting Requirements**

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

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

  No other apparent disease                     

  Recovered                                     0

  Otherwise                                     Refer to Section Chief
  --------------------------------------------- -------------------------

**MEASLES**

Measles generally is a benign self-limited disease, but it may be
associated with a number of potentially serious complications, such as
pneumonia or encephalomyelitis.

  --------------------------------------------- -------------------------
  After recovery, no complications              0

  Complications                                 See specific disorder
  --------------------------------------------- -------------------------

**MELIOIDOSIS**

**(Stanton\' s Disease, Pneumoenteritis**

**Pseudoglanders, Pseudocholera)**

This is a rare disease observed mostly in the Far East. It is a disease
of wild rodents, though some domestic animals become infected.
Mosquitoes and fleas may harbor the disease, and man becomes infected by
direct contact with infected animals (Zoonosis). There may be an acute
or chronic illness. In the acute type, it resembles pneumonia, with
fever, abdominal pain, chills, diarrhea, cough, blood or purulent
sputum, convulsions, rapidly wasting and death commonly within 10 days
of onset, often before serological tests have become helpful. In the
subacute or chronic type, which may follow the acute type or develop in
the absence of an acute illness, the symptoms are abscesses of lungs,
kidney, liver, and spleen. With this septicemia, which resembles typhoid
fever, glanders, cholera, malaria, mycotic infection, tuberculosis,
actinomycosis and staphylococcal infection, some of the patients may
live for 3 to 8 months and recover. This type of infection may lie
dormant for some time (possibly years) and then crop up when least
expected. The diagnosis is made by sputum examination, culture,
serological agglutination, hemagglutination and complemen-fixation
tests. Antibiotics and sulfa drugs are used with varying degrees of
success when continued over a long time. Treatment as a whole is usually
unsatisfactory.

**Underwriting Requirements**

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

  ------------------------------------------------------ ----------------
  Present                                                R

                                                         

  History -- in addition to debits for impaired function 
  of viscera                                             

  Within 6 months of recovery, add                       500

  Within 6 months through 1 year                         300

  Within 2 years                                         200

  Within 2 through 5 years                               50

  After 6 years                                          0

                                                         

  With any recurrence, treat as an original infection    
  ------------------------------------------------------ ----------------

**MENINGITIS**

Meningitis is an acute inflammation of the membranes covering the brain
and spinal cord (nerves). It may be due to bacteria, viruses,
lymphcystic, aseptic, fungi or tuberculosis. In most cases recovery will
be complete.

**Underwriting Requirements**

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

  ----------------------------------------- -----------------------------
  No complications or residual symptoms --  0
  bacterial, viral, or fungal               

  Tuberculosis                              Apple rules for Non-pulmonary
                                            Tuberculosis

  Within 6 months of acute illness          Refer to Section Chief

  Thereafter                                Rate for extent and severity
                                            of complete or residual
                                            symptoms
  ----------------------------------------- -----------------------------

MENOPAUSE

The menopause, climacteric, or change of life, is the period when
menstruation normally ceases. This usually occurs from the middle to
late forties, but may take place as early as 40 or as late as age 55.
Several months to several years may be required for the completion of
the process. Bleeding or hemorrhage after the menopause is highly
suggestive of cancer.

Menopause may take place without significant discomfort, but it
frequently produces such symptoms as irritability, depression, fatigue,
hot flashes or recurrent flushes, emotional disturbances, and/or
occasional mental disorders. Artificial menopause may be produced at any
time by complete hysterectomy, removal of the ovaries, or by the use of
radiation.

**Underwriting Requirements**

APS(VA Form 29-8158) required if bleeding or hemorrhage occurs after the
menopause.

  ---------------------------------------------------------- ---------------
  Present -- with or without injection (hormone treatment)   

  Mild to moderate symptoms                                  0

  Severe symptoms or disabling                               100

  Associated with menorrhagia                                50

  History -- after recovery, no complications                0

  With mental imbalance                                      0

  Artificial menopause                                       RFC

  With hypertension, mental depression, instability, or      Rate for
  other complications                                        complications
  ---------------------------------------------------------- ---------------

**METABOLIC DISORDERS**

**[Hemochromatosis]{.underline}**

Hemochromatosis is an inherited disorder in which excess iron is
absorbed and deposited in body organs, such as the liver, pancreas and
heart. This eventually results in cirrhosis, diabetes and other organ
failure. If the diagnosis is made early, excess iron can be removed by
repeated phlebotomy before any organ damage results, and the prognosis
is excellent. If the diagnosis is made after signs or symptoms develop,
phlebotomy is useful to prevent further damage, but cannot reverse that
which has already been done. A liver biopsy is frequently performed to
assess the amount of iron stores and the extent of any cirrhosis.

**Underwriting Requirements**

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

  -------------------------------------------------- --------------------
  Treated, stabilized, normal blood studies, no      0
  complications                                      

  Others, complicated, cardiac or liver involvement, Refer to Section
  diabetes                                           Chief
  -------------------------------------------------- --------------------

[**Porphyria**]{.underline}

The porphyries are a group of related disorders, usually inherited,
which are manifested by skin, neurologic and liver disorders.
Protoporphyria is a relatively common condition manifested by
sensitivity of the skin to sunlight and occasionally by liver
involvement. Porphyria cutanea tarda is also relatively common and is
manifested by photosensitivity and an association of alcohol abuse.
Hepatic porphyria is of several types and is characterized by abdominal
pain and neurologic and psychiatric dysfunctions. This latter disorder
formerly carried a substantial mortality, but with modern treatments,
the outlook is much improved.

**Underwriting Requirements**

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

  --------------------------------------------- -------------------------
  Protoporphyria, porphyria cutaneous tarda     55-0

  Hepatic porphyrias                            

  With alcohol abuse, liver abnormalities or    Refer to Section Chief
  other complications                           

  Others                                        100-55
  --------------------------------------------- -------------------------

**MORTON\'S TOE**

**(Morton\'s Foot, Morton\'s Disease,**

**Morton\'s Neuralgia or Metatarsalgia)**

Morton\'s Toe is a condition characterized by cramp-like pain, burning,
numbness and tingling of the fore part of the foot. It usually affects
the second, third, or fourth toe. It is presumably due to compression of
a nerve between the heads of adjacent metatarsal bones. It is frequently
disabling and may require surgery.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required if severe or disabling within 3
years.

  --------------------------------------------- -------------------------
  Mild to moderate, not disabling               0

  Severe or disabling                           

  Within 1 year                                 25

  After 1 year                                  10
  --------------------------------------------- -------------------------

**MULTIPLE ENDOCRINE NEOPLASIA**

Multiple endocrine neoplasia (multiple endocrine adenomatosis, MEN1;
MEN2A; MEN2B) are uncommon disorders which simultaneously involve two or
more endocrine glands. The resulting adenomas may be either benign or
malignant. These conditions are genetic. MEN1 almost always involves the
parathyroid glands producing hypercalcemia and kidney stones. It may
also involve the pancreatic gastrin secreting cells (Zollinger-Ellison
Syndrome), and is often associated with pituitary adenomas. MEN2A
commonly involves the parathyroids and almost always involves the
calcitonin producing cells of the thyroid. Pehochromocytomas are also
frequently present. MEN2B is a variant of the former disorder which
rarely involves the parathyroid glands.

**Underwriting Requirements**

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

  --------------------------------------------- -------------------------
  Present and history                           Refer to Section Chief

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

**MUMPS**

Mumps is an acute viral infectious disease, characterized by painful
swelling of one and sometimes both parotid glands at the angle of the
jaw. It is highly contagious; however, recovery occurs in almost all
cases. Complication may occur in the form of epididymitis and orchitis
in the male, and mammary and ovarian disturbances in the female.

**Underwriting Requirements**

APS (VA Form 29-8158) required within 3 months, if complicated.

  -------------------------------------------- --------------------------
  Uncomplicated -- after recovery              0

  Complicated                                  Apply rules for
                                               complication
  -------------------------------------------- --------------------------

**MUSCULAR DYSTROPHY**

The muscular dystrophies are a group of inherited usually progressive
muscular disorders of unknown cause. The age of onset, rate of
progression, and cause of outcome are highly variable and depend on the
type.

**Underwriting Requirements**

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

  ----------------------------------------------------------- -----------
  Pseudohypertrophic (Duchenne's Muscular Dystrophy)          R

  Limb Girdle Dystrophy                                       R

  Myotonia Dystrophy                                          R
  ----------------------------------------------------------- -----------

**[Becker's Dystrophy]{.underline}**

Becker's Dystrophy is diagnosed later in life than Duchenne's and
progresses less rapidly. Elevation of muscle enzymes (CPK) and cardiac
involvement may be associated.

**Underwriting Requirements**

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

  ----------------------------------------------------------- -----------
  Stable or very slowly progressive, mobile, ECG normal, no   200
  other apparent disease                                      

  Others                                                      R
  ----------------------------------------------------------- -----------

**[Facioscapulohumeral Dystrophy]{.underline}**

This is diagnosed in childhood, and even though many patients are
disabled with arm weakness, they survive into late adult life and have
the best prognosis of all the dystrophies.

**Underwriting Requirements**

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

  ----------------------------------------------------------- -----------
  Stable, no disability                                       50

  Stable, with minor disability, but carrying out normal      100
  activities                                                  

  Others                                                      R
  ----------------------------------------------------------- -----------

**[Myotonia Congenita (Thomsen's Disease)]{.underline}**

This is a benign congenital disorder which usually begins early in life
and is characterized by difficulty relaxing muscles and muscular
hypertrophy. The latter persists throughout life though the myotonia
tends to improve.

  ---------------------------------------------------- ------------------
  Myotonia Congenita                                   Generally
                                                       disregard

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

MYOSITIS

(Fibromyositis, Myaglia, Pleurodynia)

These terms denote an inflammatory condition of muscle and related
fibrous tissue and muscle pain.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required within 2 years.

  --------------------------------------------------------- -------------
  Single attack -- after recovery                           0

  Recurrent attack                                          

  Two or more attacks with less than 1 year intervening     30
  between attacks and less than 1 years since last attack   

  One year or more after recurrent attack                   0

  Heart or other involvement                                RFC
  --------------------------------------------------------- -------------