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**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. 36

Covering period of *Federal Register* issues

through April 24, 2005

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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. 36**

25 April 2005

Covering the period of Federal Register issues

through April 24, 2005

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. 36**

**April 25, 2005**

*Remove these Add these Section(s)*

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

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

**all prior supplements have been filed**

4.114-1 to 4.114-10 4.114-1 to 4.114-10 §4.114

**Be sure to complete the**

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

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

> **HIGHLIGHTS**

**Book C, Supplement No. 36**

**April 25, 2005**

***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\. This supplement contains a non-substantive modification to §4.114
(*Schedule of Ratings---Digestive System*) to add a citation pursuant to
70 Fed. Reg. 34585, June 22, 2004, and to reformat the section.

\-

**§4.114 Schedule of ratings---digestive system.**

Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and
7345 to 7348 inclusive will not be combined with each other. A single
evaluation will be assigned under the diagnostic code which reflects the
predominant disability picture, with elevation to the next higher
evaluation where the severity of the overall disability warrants such
elevation.

# Digestive System

Rating

**7200** Mouth, injuries of.

Rate as for disfigurement and impairment of function of mastication.

**7201** Lips, injuries of.

Rate as for disfigurement of face.

**7202** Tongue, loss of whole or part:

With inability to communicate by speech 100

One-half or more 60

With marked speech impairment 30

**7203** Esophagus, stricture of:

Permitting passage of liquids only, with marked impairment of general

health 80

Severe, permitting liquids only 50

Moderate 30

**7204** Esophagus, spasm of (cardiospasm).

If not amenable to dilation, rate as for the degree of obstruction
(stricture).

**7205** Esophagus, diverticulum of, acquired.

Rate as for obstruction (stricture).

**7301** Peritoneum, adhesions of:

Severe; definite partial obstruction shown by X-ray, with frequent

and prolonged episodes of severe colic distension, nausea or vomiting,

following severe peritonitis, ruptured appendix, perforated ulcer,

or operation with drainage 50

Moderately severe; partial obstruction manifested by delayed motility

of barium meal and less frequent and less prolonged episodes of pain 30

Moderate; pulling pain on attempting work or aggravated by movements

of the body, or occasional episodes of colic pain, nausea,

constipation (perhaps alternating with diarrhea) or abdominal

distension 10

**7301** Peritoneum, adhesions of: (cont.)

Mild 0

**Note**: Ratings for adhesions will be considered when there is history
of operative or other traumatic or infectious (intraabdominal) process,
and at least two of the following: disturbance of motility, actual
partial obstruction, reflex disturbances, presence of pain.

**7304** Ulcer, gastric.

**7305** Ulcer, duodenal:

Severe; pain only partially relieved by standard ulcer therapy,

periodic vomiting, recurrent hematemesis or melena, with

manifestations of anemia and weight loss productive of

definite impairment of health 60

Moderately severe; less than severe but with impairment of health

manifested by anemia and weight loss; or recurrent incapacitating

episodes averaging 10 days or more in duration at least four or more

times a year 40

Moderate; recurring episodes of severe symptoms two or three times a

year averaging 10 days in duration; or with continuous moderate

manifestations 20

Mild; with recurring symptoms once or twice yearly 10

**7306** Ulcer, marginal (gastrojejunal):

Pronounced; periodic or continuous pain unrelieved by standard ulcer

therapy with periodic vomiting, recurring melena or hematemesis,

and weight loss. Totally incapacitating 100

Severe; same as pronounced with less pronounced and less continuous

symptoms with definite impairment of health 60

Moderately severe; intercurrent episodes of abdominal pain at least once

a month partially or completely relieved by ulcer therapy, mild and

transient episodes of vomiting or melena 40

Moderate; with episodes of recurring symptoms several times a year 20

Mild; with brief episodes of recurring symptoms once or twice yearly 10

**7307** Gastritis, hypertrophic (identified by gastroscope):

Chronic; with severe hemorrhages, or large ulcerated or eroded areas 60

Chronic; with multiple small eroded or ulcerated areas, and symptoms 30

Chronic; with small nodular lesions, and symptoms 10

Gastritis, atrophic.

A complication of a number of diseases, including pernicious anemia.

Rate the underlying condition.

**7308** Postgastrectomy syndromes:

Severe; associated with nausea, sweating, circulatory disturbance after

meals, diarrhea, hypoglycemic symptoms, and weight loss with

malnutrition and anemia 60

Moderate; less frequent episodes of epigastric disorders with

characteristic mild circulatory symptoms after meals but with

diarrhea and weight loss 40

Mild; infrequent episodes of epigastric distress with characteristic

mild circulatory symptoms or continuous mild manifestations 20

**7309** Stomach, stenosis of.

Rate as for gastric ulcer.

**7310** Stomach, injury of, residuals.

Rate as peritoneal adhesions.

**7311** Residuals of injury of the liver:

Depending on the specific residuals, separately evaluate as adhesions

of peritoneum (diagnostic code 7301), cirrhosis of liver (diagnostic

code 7312), and chronic liver disease without cirrhosis (diagnostic

code 7345).

**7312** Cirrhosis of the liver, primary biliary cirrhosis, or cirrhotic
phase

of sclerosing cholangitis:

Generalized weakness, substantial weight loss, and persistent jaundice,

or; with one of the following refractory to treatment: ascites, hepatic

encephalopathy, hemorrhage from varices or portal gastropathy

(erosive gastritis) 100

History of two or more episodes of ascites, hepatic encephalopathy,

or hemorrhage from varices or portal gastropathy (erosive gastritis),

but with periods of remission between attacks 70

History of one episode of ascites, hepatic encephalopathy, or hemorrhage

from varices or portal gastropathy (erosive gastritis) 50

Portal hypertension and splenomegaly, with weakness, anorexia,

abdominal pain, malaise, and at least minor weight loss 30

Symptoms such as weakness, anorexia, abdominal pain, and malaise 10

**Note**: For evaluation under diagnostic code 7312, documentation of
cirrhosis

(by biopsy or imaging) and abnormal liver function tests must be
present.

**7314** Cholecystitis, chronic:

Severe; frequent attacks of gall bladder colic 30

Moderate; gall bladder dyspepsia, confirmed by X-ray technique, and

with infrequent attacks (not over two or three a year) of gall bladder

colic, with or without jaundice 10

Mild 0

**7315** Cholelithiasis, chronic.

Rate as for chronic cholecystitis.

**7316** Cholangitis, chronic.

Rate as for chronic cholecystitis.

**7317** Gall bladder, injury of.

Rate as for peritoneal adhesions.

**7318** Gall bladder, removal of:

With severe symptoms 30

With mild symptoms 10

Nonsymptomatic 0

Spleen, disease or injury of.

See Hemic and Lymphatic Systems.

**7319** Irritable colon syndrome (spastic colitis, mucous colitis,
etc.):

Severe; diarrhea, or alternating diarrhea and constipation, with more

or less constant abdominal distress 30

Moderate; frequent episodes of bowel disturbance with abdominal

distress 10

Mild, disturbances of bowel function with occasional episodes of

abdominal distress 0

**7321** Amebiasis:

Mild gastrointestinal disturbances, lower abdominal cramps, nausea,

gaseous distention, chronic constipation interrupted by diarrhea 10

Asymptomatic 0

**Note**: Amebiasis with or without liver abscess is parallel in
symptomatology with ulcerative colitis and should be rated on the scale
provided for the latter. Similarly, lung abscess due to amebiasis will
be rated under the respiratory system schedule, diagnostic code 6809.

**7322** Dysentery, bacillary.

Rate as for ulcerative colitis

**7323** Colitis, ulcerative:

Pronounced; resulting in marked malnutrition, anemia, and general

debility, or with serious complication as liver abscess 100

Severe; with numerous attacks a year and malnutrition, the health

only fair during remissions. 60

Moderately severe; with frequent exacerbations 30

Moderate; with infrequent exacerbations 10

**7324** Distomiasis, intestinal or hepatic:

Severe symptoms 30

Moderate symptoms 10

Mild or no symptoms 0

**7325** Enteritis, chronic.

Rate as for irritable colon syndrome.

**7326** Enterocolitis, chronic.

Rate as for irritable colon syndrome.

**7327** Diverticulitis.

Rate as for irritable colon syndrome, peritoneal adhesions, or colitis,

ulcerative, depending upon the predominant disability picture.

**7328** Intestine, small, resection of:

With marked interference with absorption and nutrition, manifested

by severe impairment of health objectively supported by

examination findings including material weight loss 60

With definite interference with absorption and nutrition, manifested

by impairment of health objectively supported by examination

findings including definite weight loss 40

Symptomatic with diarrhea, anemia and inability to gain weight 20

**Note**: Where residual adhesions constitute the predominant
disability, rate under diagnostic code 7301.

**7329** Intestine, large, resection of:

With severe symptoms, objectively supported by examination findings 40

With moderate symptoms 20

With slight symptoms 10

**Note**: Where residual adhesions constitute the predominant
disability, rate under diagnostic code 7301.

**7330** Intestine, fistula of, persistent, or after attempt at
operative closure:

Copious and frequent, fecal discharge 100

Constant or frequent, fecal discharge 60

Slight infrequent, fecal discharge 30

Healed; rate for peritoneal adhesions.

**7331** Peritonitis, tuberculous, active or inactive:

Active 100

Inactive: See §§4.88b and 4.89.

**7332** Rectum and anus, impairment of sphincter control:

Complete loss of sphincter control 100

Extensive leakage and fairly frequent involuntary bowel movements 60

Occasional involuntary bowel movements, necessitating wearing of pad 30

Constant slight, or occasional moderate leakage. 10

Healed or slight, without leakage 0

**7333** Rectum and anus, stricture of:

Requiring colostomy 100

Great reduction of lumen, or extensive leakage 50

Moderate reduction of lumen, or moderate constant leakage 30

**7334** Rectum, prolapse of:

Severe (or complete), persistent 50

Moderate, persistent or frequently recurring 30

Mild with constant slight or occasional moderate leakage 10

**7335** Ano, fistula in.

Rate as for impairment of sphincter control.

**7336** Hemorrhoids, external or internal:

With persistent bleeding and with secondary anemia, or with fissures 20

Large or thrombotic, irreducible, with excessive redundant tissue,

evidencing frequent recurrences 10

Mild or moderate 0

**7337** Pnuritus ani.

Rate for the underlying condition.

**7338** Hernia, inguinal:

Large, postoperative, recurrent, not well supported under ordinary

conditions and not readily reducible, when considered inoperable 60

Small, postoperative recurrent, or unoperated irremediable, not well

supported by truss, or not readily reducible 30

Postoperative recurrent, readily reducible and well supported by

truss or belt 10

Not operated, but remediable 0

Small, reducible, or without true hernia protrusion 0

**Note**: Add 10 percent for bilateral involvement, provided the second
hernia is compensable. This means that the more severely disabling
hernia is to be evaluated, and 10 percent, only, added for the second
hernia, if the latter is of compensable degree.

**7339** Hernia, ventral, postoperative:

Massive, persistent, severe diastasis of recti muscles or extensive

diffuse destruction or weakening of muscular and fascial support

of abdominal wall so as to be inoperable 100

Large, not well supported by belt under ordinary conditions 40

Small, not well supported by belt under ordinary conditions, or healed

ventral hernia or postoperative wounds with weakening of abdominal

wall and indication for a supporting belt 20

Wounds, postoperative, healed, no disability, belt not indicated 0

**7340** Hernia, femoral.

Rate as for inguinal hernia.

**7342** Visceroptosis, symptomatic, marked 10

**7343** Malignant neoplasms of the digestive 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.

**7344** Benign neoplasms, exclusive of skin growths:

Evaluate under an appropriate diagnostic code, depending on the

predominant disability or the specific residuals after treatment.

**7345** Chronic liver disease without cirrhosis (including hepatitis B,
chronic

active hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced

hepatitis, etc., but excluding bile duct disorders and hepatitis C):

Near-constant debilitating symptoms (such as fatigue, malaise, nausea,

vomiting, anorexia, arthralgia, and right upper quadrant pain) 100

Daily fatigue, malaise, and anorexia, with substantial weight loss (or

other indication of malnutrition), and hepatomegaly, or; incapacitating

episodes (with symptoms such as fatigue, malaise, nausea, vomiting,

anorexia, arthralgia, and right upper quadrant pain) having a total
duration

of at least six weeks during the past 12- month period, but not

occurring constantly 60

Daily fatigue, malaise, and anorexia, with minor weight loss and

hepatomegaly, or; incapacitating episodes (with symptoms such as

fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right

upper quadrant pain) having a total duration of at least four weeks,

but less than six weeks, during the past 12-month period 40

Daily fatigue, malaise, and anorexia (without weight loss or
hepatomegaly),

requiring dietary restriction or continuous medication, or;

incapacitating episodes (with symptoms such as fatigue, malaise,

nausea, vomiting, anorexia, arthralgia, and right upper quadrant

pain) having a total duration of at least two weeks, but less than four

weeks, during the past 12-month period 20

Intermittent fatigue, malaise, and anorexia, or; incapacitating episodes

(with symptoms such as fatigue, malaise, nausea, vomiting, anorexia,

arthralgia, and right upper quadrant pain) having a total duration of at

least one week, but less than two weeks, during the past 12-month

period 10

Nonsymptomatic 0

**Note (1)**: Evaluate sequelae, such as cirrhosis or malignancy of the
liver, under an appropriate diagnostic code, but do not use the same
signs and symptoms as the basis for evaluation under DC 7354 and under a
diagnostic code for sequelae. (See §4.14.).

**Note (2)**: For purposes of evaluating conditions under diagnostic
code 7345, "incapacitating episode" means a period of acute signs and
symptoms severe enough to require bed rest and treatment by a physician.

**Note (3)**: Hepatitis B infection must be confirmed by serologic
testing in order to evaluate it under diagnostic code 7345.

**7346** Hernia hiatal:

Symptoms of pain, vomiting, material weight loss and hematemesis or

melena with moderate anemia; or other symptom combinations

productive of severe impairment of health 60

Persistently recurrent epigastric distress with dysphagia, pyrosis, and

regurgitation, accompanied by substernal or arm or shoulder pain,

productive of considerable impairment of health 30

With two or more of the symptoms for the 30 percent evaluation of

less severity 10

**7347** Pancreatitis:

With frequently recurrent disabling attacks of abdominal pain with few

pain free intermissions and with steatorrhea, malabsorption, diarrhea

and severe malnutrition 100

With frequent attacks of abdominal pain, loss of normal body weight

and other findings showing continuing pancreatic insufficiency

between acute attacks 60

Moderately severe; with at least 4-7 typical attacks of abdominal pain

per year with good remission between attacks 30

With at least one recurring attack of typical severe abdominal pain

in the past year 10

**Note 1**: Abdominal pain in this condition must be confirmed as
resulting from pancreatitis by appropriate laboratory and clinical
studies.

**Note 2**: Following total or partial pancreatectomy, rate under above,
symptoms, minimum rating 30 percent.

**7348** Vagotomy with pyloroplasty or gastroenterostomy:

Followed by demonstrably confirmative postoperative complications

of stricture or continuing gastric retention 40

With symptoms and confirmed diagnosis of alkaline gastritis, or of

confirmed persisting diarrhea 30

Recurrent ulcer with incomplete vagotomy 20

**Note**: Rate recurrent ulcer following complete vagotomy under
diagnostic code 7305, minimum rating 20 percent; and rate dumping
syndrome under diagnostic code 7308.

**7351** Liver transplant:

For an indefinite period from the date of hospital admission for

transplant surgery 100

Minimum 30

**Note**: A rating of 100 percent shall be assigned as of the date of
hospital admission for transplant surgery and shall continue. One year
following discharge, 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.

**7354** Hepatitis C (or non-A, non-B hepatitis):

With serologic evidence of hepatitis C infection and the following

signs and symptoms due to hepatitis C infection:

Near-constant debilitating symptoms (such as fatigue, malaise,

nausea, vomiting, anorexia, arthralgia, and right upper quadrant

pain) 100

Daily fatigue, malaise, and anorexia, with substantial weight loss (or

other indication of malnutrition), and hepatomegaly, or;

incapacitating episodes (with symptoms such as fatigue,

malaise, nausea, vomiting, anorexia, arthralgia, and right upper

quadrant pain) having a total duration of at least six weeks

during the past 12-month period, but not occurring constantly 60

Daily fatigue, malaise, and anorexia, with minor weight loss and

hepatomegaly, or; incapacitating episodes (with symptoms such as

fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right

upper quadrant pain) having a total duration of at least four weeks,

but less than six weeks, during the past 12-month period 40

Daily fatigue, malaise, and anorexia (without weight loss or

hepatomegaly), requiring dietary restriction or continuous

medication, or; incapacitating episodes (with symptoms such as

fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right

upper quadrant pain) having a total duration of at least two weeks,

but less than four weeks, during the past 12-month period 20

Intermittent fatigue, malaise, and anorexia, or; incapacitating episodes

(with symptoms such as fatigue, malaise, nausea, vomiting, anorexia,

arthralgia, and right upper quadrant pain) having a total duration of

at least one week, but less than two weeks, during the past

12-month period 10

Nonsymptomatic\...\...\...\...\...\...\...\...\...\...\...\...\...\... 0

**Note (1)**: Evaluate sequelae, such as cirrhosis or malignancy of the
liver, under an appropriate diagnostic code, but do not use the same
signs and symptoms as the basis for evaluation under DC 7354 and under a
diagnostic code for sequelae. (See §4.14.).

**Note (2)**: For purposes of evaluating conditions under diagnostic
code 7354, "incapacitating episode" means a period of acute signs and
symptoms severe enough to require bed rest and treatment by a physician.

(Authority: 38 U.S.C. 1155)

\[29 FR 6718, May 22, 1964, as amended at 34 FR 5063, Mar. 11, 1969; 40
FR 42540, Sept. 15, 1975; 41 FR 11301, Mar. 18, 1976; 66 FR 29488, May
31, 2001; 70 FR 34585, June 22, 2004\]