L

# **LARYNGITIS**

Laryngitis is an inflammation of the mucous membrane of the larynx
accompanied by dryness and soreness of the throat, cough and hoarseness
or loss of voice. Acute laryngitis is quite common, usually caused by
overuse of the voice, or local infection. Chronic or recurrent
laryngitis may result from diphtheria, syphilis, aortic disease, tumors,
or tuberculosis.

  ------------------------------------------------------- ---------------
  Acute -- after recovery                                 0

  Chronic -- cause known                                  RFC

  Otherwise -- if present                                 50

  With favorable laryngoscopic                            25

  After recovery                                          0
  ------------------------------------------------------- ---------------

#### **LEAD POISONING**

Lead poisoning is an occupational disease resulting from absorption of
metallic lead or its salts. It is also known as plumbism, painter\'s
colic and lead colic. It occurs most among painters, storage battery
workers, and those exposed to fumes of ethyl gasoline. Often anemia
(pale complexion) or acute metal symptoms may be the first signs or
symptoms noticed.

Characteristic symptoms are fatigue, insomnia, nausea, loss of appetite,
a rigid retracted abdomen with colicky attacks of pain, constipation,
muscle or joint pains, and weakness. In more advanced stages paralysis
of the wrists, referred to as \"wrist drop\" may occur. An examination
often shows evidence of a blue line along the gums, rapid decay of the
teeth, slow pulse, elevated blood pressure, anemia, and failing
nutrition.

**Underwriting Requirements**

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

  ---------------------------------------------------- ------------------
  If present at time of application                    300

  History -- no cerebral involvement                   

  Exposure ended -- full recovery                      

  Within 1 year of recovery                            50

  Within 2 years                                       25

  After 2 years                                        

  Exposure continued -- full recovery                  

  Within 1 year of recovery                            75

  Within 2 through 3 years                             35

  After 3 years                                        0

  With cerebral involvement                            300

  With wrist and/or foot drop -- add to ratings above  

  Exposure ended 1 year or more ago                    20

  Others                                               100

  Spray or other poisoning -- present or within 1 year 100

  Recovered or more than 1 year                        25
  ---------------------------------------------------- ------------------

# **LEGIONELLOSIS**

# **(Legionnaire's Disease)**

Legionnaire's Disease is an acute febrile illness with pneumonia which
may become a fatal multisystem disease. This disease often occurs in
epidemic form since it is spread by airborne infection.

  ---------------------------------------------------- ------------------
  Recovered                                            0

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

**LEPROSY**

**(Hansen's Disease)**

Leprosy is a chronic, infectious and communicable disease in which the
principle lesions occur in the skin, superficial nerves, nose, ears,
pharynx, larynx and lymph nodes. The distal portion of the eye, liver,
spleen, and testicles may be damaged. There are two main contrasting
types, the malignant lepromatous and the usually benign tuberculoid.
With the lepromatous, also known as the tuberous, tubercular, nodular,
malignant or cutaneous type, there is little body resistance and it is
more infectious. With the tuberculoid, also referred to as neutral,
macular, anesthetic, maculoanesthetic or benign type, there is vigorous
body resistance and it is only slightly infectious. There are various
subtypes.

The lepromin (mitsuda) test is a highly valuable prognostic aid and when
positive, there is almost complete correlation with the tuberculoid type
and when negative, with the lepromatous. Communicability is feeble and
the disease is not easily acquired except in certain endemic areas where
there is an increased susceptibility in the individual. The
disfigurement and deformity may be produced by the disease process
itself or by the consequences of the loss of sensation (heat, cold or
pain) or motor or trophic innervations in an affected area or part.

The lepromatous type, when untreated, usually progresses fatally within
10-20 years after disease is recognized. The tuberculoid type, when
untreated, usually recovers spontaneously within l to 3 years.

When treated with one of the sulfone groups of drugs (chemotherapy),
virtually all patients experience immediate arrest of the disease and
steady improvement. Bacteriologic negativity may occur more slowly in
some depending on one\'s ability to tolerate intensive treatment and how
early the treatment was started. In the lepromatous type, recovery takes
place usually in 3 to 8 years, while in the tuberculoid type, it is in l
or 2 years. Maintenance therapy is required. This disease is associated
with or accompanied by tuberculosis.

These patients usually die of tuberculosis, amyloid nephrosis,
intercurrent infection or leprosy. In this country, the amyloidosis of
the kidney is the leading cause of death. It is not limited to advanced
or extensive disease. Persistent proteinuria is usually the first sign.

**Underwriting Requirements**

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

+--------------------------------------+---------------+---------------+
| ### Present or Treated               | Little or no  | ## [Others    |
|                                      | [deformity    | ]{.underline} |
|                                      | ]{.underline} |               |
+--------------------------------------+---------------+---------------+
| Less than 3 years                    | 500           | 2000          |
+--------------------------------------+---------------+---------------+
| Within 3 through 8 years             | 300           | 1500          |
+--------------------------------------+---------------+---------------+
| After 8 years                        | 200           | 1000          |
+--------------------------------------+---------------+---------------+

# **LEUKEMIA**

Leukemia is a disease of the blood in which there is a great increase in
the number of white blood cells (leukocytes), and it is associated with
increased growth of all the body tissues involved in the origination of
these cells, particularly the spleen and lymphatic glands. Hemorrhage is
a prominent symptom.

Leukemias are divided into acute and chronic forms based on whether the
cell type is immature or mature. They are further described as
lymphocytic (manifested by increased lymphocytes) or myelocytic
(manifested by an increase in cells arising from the bone marrow).

Acute Lymphocytic Leukemia (ALL) is the common leukemia of childhood. A
cure is expected in 60% to 70% of childhood cases, but the outlook is
less favorable for adults. Acute Myelocytic Leukemia (AML), particularly
in adults, also has a less favorable prognosis. Chronic leukemias are
considered incurable, although Chronic Lymphocytic Leukemia (CLL) may
run an indolent, prolonged course.

In appropriate cases, the use of newer forms of treatment such as
experimental, combination chemotherapy, biological response modifiers
and bone marrow transplants may give prolonged disease-free remissions
or even cure.

**Underwriting Requirements**

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

  -------------------------------------------------- --------------------
  Acute Lymphocytic Leukemia (ALL)                   

  Within 5 years of the end of treatment and         R
  apparent cure                                      

  5-10 years                                         300

  Thereafter, disease-free                           55

                                                     

  Chronic lymphocytic leukemia (CLL)                 

  Best cases, manifested only by lymphocytosis       
  greater than 15,000/cmm (Stage 0)                  

  Under age 50                                       R

  Age 50-59                                          300

  Age 60 and up                                      150

  Manifested only by lumphocytosis greater than      
  15,000/cu mm and lymphadenopathy (Stage 1)         

  Under age 60                                       R

  Age 60 and up                                      R-200

  Others                                             R

                                                     

  Acute and chronic myelocytic leukemia              R

                                                     

  Leukemia treated by bone marrow transplant         

  Within 5 years of transplant and apparent cure     R

  6-10 years                                         300

  Thereafter, disease-free                           55

                                                     

  Other leukemias -- there are a variety of sub      Refer to Section
  types of leukemias. One in particular, hairy cell  Chief
  leukemia, may respond favorably to spelnectomy or  
  to biological response modifiers such as           
  interferon                                         
  -------------------------------------------------- --------------------

**[Myeloproliferative Disorders]{.underline}**

These include chronic myelogenous leukemia, "essential" thrombocythemia
and polycythemia vera. Another disorder known as agnogenic myeloid
metaplasia, is characterized by replacement of marrow by fibrosis
(myelofibrosis) and blood cell production in organs such as liver,
spleen and lymph nodes. Myelofibrosis may also result when a
proliferative phase of one of the myeloproliferative disorders burns
out.

**Underwriting Requirements**

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

  --------------------------------------------------- -------------------
  Myelofibrosis                                       Usually R

  Agnogenic myeloid metaplasia                        R

  Others                                              See specific
                                                      disorder
  --------------------------------------------------- -------------------

[**Plasma Cell Disorders**]{.underline}

Plasma cell disorders are a special form of lymphocyte which are
involved in immune functions. They may cause a variety of related
neoplastic disorders, including multiple myeloma, Waldenstrom's
macroglublinemia, heavy chain disease, primary amyloidosis and
plasmacytoma. These disorders are usually uninsurable, though
plasmacytomas, a localized form, may be treated successfully.

Monoclonal gammopathies of undetermined significance is a label used for
individuals having abnormal blood tests resembling myeloma but no other
findings resembling a plasma cell neoplasm. Only prolonged observations
separate a benign aberration from a malignant form.

**Underwriting Requirements**

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

  --------------------------------------------------- -------------------
  Multiple myeloma and related disorders              R

  Monoclonal gammopathy                               

  Within 1 year of discovery                          R

  2-5 years                                           55

  After 5 years                                       0

  Plasmacytoma                                        Refer to Section
                                                      Chief

  Other plasma cell disorders                         R
  --------------------------------------------------- -------------------

**LEUKOPLAKIA**

Leukoplakia, or smoker\'s patch (keratosis labialis) occurs as a white,
thickened patch on the tongue and mucous membranes of the mouth. It is
commonly caused by chronic irritation due to excessive smoking or rough
teeth edges. There is a tendency toward malignancy. Sometimes there is
earlier history of syphilis.

**Underwriting Requirements**

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

  ----------------------------------------------- -----------------------
  Leukoplakia                                     See Tumor Rating Chart
                                                  C

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

**LEUKORRHEA (Leucorrhoea)**

Leucorrhoea is a whitish, sticky discharge from the vagina and uterine
cavity. It is usually associated with congestion and inflammation of
these parts. It is seldom disabling.

# **Underwriting Requirements**

An APS (VA Form 29-8158) is not required unless underlying causes are
indicated.

  ----------------------------------------------- -----------------------
  Mild to moderate, short duration, improved or   0
  recovered                                       

  Others                                          RFC
  ----------------------------------------------- -----------------------

### **LIPIDS**

Cholesterol and triglycerides are fatty substances (lipids) found
normally in the blood. Hyperlipidemias are disease states in which there
are abnormal elevations of these lipids.

Total serum cholesterol is comprised of several fractions termed high
density lipids (HDL), low density lipids (LDL) and very low density
lipids (VLDL). Elevated total cholesterol and LDL's or low HDL's
increase the risk of premature atherosclerosis.

Elevated triglycerides do not appear to increase the risk of premature
atherosclerosis to a significant degree. However, extremely high
elevations may contribute slightly to atherosclerosis and do predispose
to pancreatitis.

Determine the average cholesterol/triglyceride level for rating purposes
by averaging all available blood cholesterol/triglyceride readings for
the past two years. If the most recent reading is higher than the
average, use the recent reading only. If only a single high reading is
available, consider securing a current reading. Cholesterol levels are
not affected by fasting whereas triglycerides can be notably elevated
temporarily after meals.

Both cholesterol and triglycerides can be elevated because of other
diseases including diabetes, kidney disease, liver impairments and
endocrine disorders.

##### Underwriting Requirements

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

  ----------------------------------------------- -----------------------
  Total cholesterol (mg/ml)                       

  Up to 299                                       0

  300 and over                                    55\*

  HDL cholesterol (mg/ml)                         

  Up to 20                                        55\*

  21 and over                                     0

  Triglycerides (mg/ml) -- assume a fasting       
  specimen                                        

  Up to 499                                       0

  500 and over                                    55\*
  ----------------------------------------------- -----------------------

\*Maximum combined debit for lipids is 55.

Credits for lipids:

For normal resting ECG or HDL less than 50, allow 20 credits.

For normal exercise test, reduce to 0.

# **LIPOMA AND LIPOMATOSIS**

A lipoma is a tumor made up of fatty cells. They may appear on almost
any part of the body and are often found in multiples. Lipomas are
ordinarily painless and benign but may become tender if subject to
constant irritation because of their location.

Lipomatosis is a condition in which there are abnormal, tumor-like
deposits of fat in the tissues of various parts of the body. Lipomatosis
should not be confused with simple obesity in which the distribution of
fat is fairly even throughout the body.

Dercum\'s disease (Adiposis dolorosa) is an ailment in which irregular
fat deposits appear spontaneously with considerable tenderness and pain
for no apparent reason.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required within 2 years if not adequately
described on the application.

  ------------------------------------------------ ----------------------
  Lipoma                                           0

  Lipomatosis, present or history                  55-0

  Dercum's disease (Adiposis dolorosa)             Rate for Lipoma
  ------------------------------------------------ ----------------------

#### **LIVER**

The liver is the largest and probably most important gland in the body.
Among its major functions are the formation of bile, the metabolism of
food, the destruction and inactivation of toxic materials, the storage
of nutrient materials, blood formation and coagulation.

The normal liver is not usually palpable (felt) in the abdomen. Any
evidence of enlargement by palpation of the liver below the right costal
border (lower rib margin) is to be considered evidence of disease until
proven otherwise. If palpable liver is attributable solely to the
applicant\'s slim build or relaxed abdomen there should be no evidence
of any increase in size.

The terms \"sluggish liver,\" \"biliousness\", etc., referring to a
tendency to dizziness, vague indigestion, gas, constipation, etc., are
sometimes used. These conditions are not to be considered as liver
disorders until more specific information is obtained.

**Underwriting Requirements**

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

  --------------------------------------------------------- -------------
  Abscess                                                   

  Present                                                   100

  History                                                   

  No residuals, treated medically or surgically             

  Within 1^st^ year                                         30

  2^nd^ year                                                20

  3^rd^ year                                                10

  After 3 years                                             0

                                                            

  Cirrhosis                                                 

  Alcohol induced                                           

  Continuing to drink or with ascites, jaundice, or         R
  abnormal liver function tests                             

  With abstinence, no ascites, liver function tests normal  

  Within 1 year                                             900

  Within 2 -- 3 years                                       400

  Within 4 years                                            200

  Within 5 -- 6 years                                       100 -- 30

  Within 7 --10 years                                       50

  Within 11 years                                           25

  After 11 years                                            0

  Non-alcoholic                                             RFC

  Primary biliary cirrhosis                                 

  Present, asymptomatic                                     Refer to
                                                            Section Chief

  Present, symptomatic                                      R

                                                            

  Cysts of liver                                            

  Present                                                   

  Simple, not enlarging                                     0

  Others                                                    R-55

  History (treated medically, aspirated or surgically       0
  removed)                                                  
  --------------------------------------------------------- -------------

**Dubin-Johnson Syndrome** -- This is a familial form of chronic
non-hemolytic jaundice, characterized by brown pigment in the liver
cells.

**Enlargement (hepatomegaly) --** The liver size is usually less than 12
-- 15 cm by 15 -- 20 cm. Enlargement is greater than 4 cm (1.5") or more
than two finger breadths reported on the exam. Hepatomegaly exists if
the liver measures repeatedly outside the upper range of normal.

**Fatty liver** -- Fat deposition in liver cells may be related to
alcohol consumption. It is reversible with abstinence.

**Gilbert's Syndrome** -- This is a benign congenital condition causing
slight elevation of bilirubin.

**Hepatitis** -- Hepatitis may be infectious (see Viral Hepatitis) or
toxic. The latter is a reaction of the liver to drugs of numerous types,
anesthetic agents and alcohol. Toxic hepatitis may be an asymptomatic
inconsequential process or it may be rapidly fatal.

**Portal Hypertension** -- This is increased pressure in the portal vein
usually due to cirrhosis of the liver. It may result in esophageal
varices, hemorrhoids, or ascites.

**Primary Sclerosis Cholingitis** -- This chronic inflammatory condition
causes narrowing of the bile ducts and results in jaundice and eventual
cirrhosis. Many cases are associated with ulcerative colitis or regional
enteritis.

**Rotor Syndrome --** Similar to Dubin-Johnson Syndrome but the liver is
not pigmented.

**Trauma** -- Rupture.

**Underwriting Requirements**

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

  ----------------------------------------------------- -----------------
  Dubin-Johnson Syndrome                                

  Present or history                                    0

                                                        

  Enlargement (hepatomegaly)                            

  Cause known (e.g. heart failure, tumor)               RFC

  Cause unknown                                         

  Palpated up to 4 cm (1.5") or 2 fingerbreadths on     0
  examination, normal liver function tests              

  Enlargement greater than 4 cm (1.5") or more than 2   Refer to Section
  fingerbreadths reported on examination                Chief

                                                        

  Fatty liver                                           

  Present or history                                    

  Cause known (e.g. alcohol, diabetes, hyperlipidemia)  RFC

  Cause unknown                                         Refer to Section
                                                        Chief

                                                        

  Gilbert's Syndrome                                    

  Present or history                                    0

                                                        

  Hepatitis                                             

  Toxic, other than alcoholic                           RFC

  Alcoholic                                             Rate as Alcoholic
                                                        Cirrhosis

  Portal hypertension                                   

  Present                                               R

  History                                               RFC

                                                        

  Primary Sclerosis Cholingitis                         

  Present                                               R

  History                                               RFC

                                                        

  Rotor Syndrome                                        

  Present or history                                    0

                                                        

  Trauma - rupture                                      

  After recovery                                        0
  ----------------------------------------------------- -----------------

**LUMBAGO**

Lumbago is an inflammation of the muscles in the lumbar region of the
back. In popular use, the term lumbago more widely describes any pain in
the back. With prolonged or recurrent attacks suspect intervertebral
disc, vertebral arthritis or sacro-iliac disorder.

**Underwriting Requirements**

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

  ----------------------------------- -------------------- ------------------------ ----------------------
                                      [Mild]{.underline}   [Moderate]{.underline}   [Severe]{.underline}

  Present                             0                    20                       100 - 30

  History (recovered)                 0                    0                        0

  Recurrent attacks or chronic        15                   30                       100 - 40
  ----------------------------------- -------------------- ------------------------ ----------------------

**LYME DISEASE**

Lyme disease is transmitted to humans via a tick bite. It is most
commonly seen in the Northeast, the Upper Midwest, and the Northwest
United States.

Neurologic, cardiac or joint abnormalities may occur weeks to months
after infection if not properly treated.

**Underwriting Requirements**

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

  --------------------------------------------------- -------------------
  Present, continuing treatment                       Refer to Section
                                                      Chief

  History                                             

  Full recovery, no complications                     0

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

**LYMPHADENITIS**

Lymphadenitis is the name given to an inflammation of the lymph glands
or nodes. These are a part of the lymphatic system and are found
throughout the body - in the neck, armpit, elbow, and groin and behind
the knee. Usually the swelling and tenderness subsides after an acute
infection, but occasionally the infection may become chronic and this or
scar tissue may leave the glands enlarged. Adenitis is the inflammation
of a gland.

A generalized enlargement of the lymph glands may indicate tuberculosis,
syphilis, leukemia, malignancy, or Hodgkin\'s disease. Such serious
conditions are to be suspected when surgery, x-ray, or radium treatment
is admitted.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required within 5 years if treated by
surgery, x-ray, or radium; otherwise within 1 year.

  ---------------------------------------------------- ------------------
  Lymphadentis recovered                               0

  Lymphadenophathy, enlarged nodes, history unknown,   0
  stable in size and in number for at least one year   

  Others                                               R

  History unknown                                      RFC
  ---------------------------------------------------- ------------------