Custom Federal Regulations Service™

**This is supplemental material**

**for Book C of your set of**

**Federal Regulations**

Title 38, Part 4

*Schedule for Rating Disabilities*

**Veterans Benefits Administration**

Supplement No. 28

Covering period of *Federal Register* issues

from June 25, 2001, through February 24, 2002

Copyright © 2002 Jonathan Publishing

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> **GENERAL INSTRUCTIONS**

Custom Federal Regulations Service™

**Supplemental Materials for *Book C***

**Code of Federal Regulations**

**Title 38, Part 4**

***Schedule for Rating Disabilities***

**Veterans Benefits Administration**

**Supplement No. 28**

25 February 2002

Covering the period of Federal Register issues

from June 25, 2001, through February 24, 2002

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. 28**

**February 25, 2002**

*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**

4.116-1 to 4.116-4 4.116-1 to 4.116-4 §4.116

**Be sure to complete the**

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

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

> **HIGHLIGHTS**

**Book C, Supplement No. 28**

**February 25, 2002**

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

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

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

1\. On 14 February 2002, the VA published a final rule, effective 18
March 2002, to amend the adjudication regulations to provide for payment
of special monthly compensation for a woman veteran who loses one or
both breasts as a result of service-connected disability. Change in this
Book C:

• In §4.116, revised Note 2 at the beginning of the section, and added
footnote references in diagnostic code 7626 indicating ratings that are
to be reviewed for entitlement to special monthly compensation under
§3.350.

• See also new §3.350(a)(7) in Book B (*Adjudication*).

**Gynecological Conditions and Disorders of the Breast**

4.116 Schedule of ratings--gynecological conditions and disorders of the
breast 4.116-1

**§4.116 Schedule of ratings---gynecological conditions and disorders of
the breast.**

Note 1: Natural menopause, primary amenorrhea, and pregnancy and
childbirth are not disabilities for rating purposes. Chronic residuals
of medical or surgical complications of pregnancy may be disabilities
for rating purposes.

Note 2: When evaluating any claim involving loss or loss of use of one
or more creative organs or anatomical loss of one or both breasts, refer
to §3.350 of this chapter to determine whether the veteran may be
entitled to special monthly compensation. Footnotes in the schedule
indicate conditions which potentially establish entitlement to special
monthly compensation; however, almost any condition in this section
might, under certain circumstances, establish entitlement to special
monthly compensation.

Rating

**7610** Vulva, disease or injury of (including vulvovaginitis).

**7611** Vagina, disease or injury of.

**7612** Cervix, disease or injury of.

**7613** Uterus, disease, injury, or adhesions of.

**7614** Fallopian tube, disease, injury, or adhesions of (including
pelvic inflammatory disease (PID)).

**7615** Ovary, disease, injury, or adhesions of.

General Rating Formula for Disease, Injury, or Adhesions of Female
Reproductive Organs (diagnostic codes 7610 through 7615):

Symptoms not controlled by continuous treatment 30

Symptoms that require continuous treatment 10

Symptoms that do not require continuous treatment 0

**7617** Uterus and both ovaries, removal of, complete:

For three months after removal 1001

Thereafter 501

**7618** Uterus, removal of, including corpus:

For three months after removal 1001

Thereafter............................................................................................301

**7619** Ovary, removal of:

For three months after removal 1001

Thereafter:

Complete removal of both ovaries 301

Removal of one with or without partial removal of the other 01

**7620** Ovaries, atrophy of both, complete 201

**7621** Uterus, prolapse:

Complete, through vagina and introitus 50

Incomplete 30

**7622** Uterus, displacement of:

With marked displacement and frequent or continuous

menstrual disturbances 30

With adhesions and irregular menstruation 10

**7623** Pregnancy, surgical complications of:

With rectocele or cystocele 50

With relaxation of perineum 10

**7624** Fistula, rectovaginal:

Vaginal fecal leakage at least once a day requiring wearing of pad 100

Vaginal fecal leakage four or more times per week, but less than

daily, requiring wearing of pad 60

Vaginal fecal leakage one to three times per week requiring

wearing of pad 30

Vaginal fecal leakage less than once a week 10

Without leakage 0

**7625** Fistula, urethrovaginal:

Multiple urethrovaginal fistulae 100

Requiring the use of an appliance or the wearing of absorbent

materials which must be changed more than four times per day 60

Requiring the wearing of absorbent materials which must be

changed two to four times per day 40

Requiring the wearing of absorbent materials which must be

changed less than two times per day 20

**7626** Breast, surgery of:

Following radical mastectomy:

Both 801

One 501

Following modified radical mastectomy:

Both 601

One 401

Following simple mastectomy or wide local excision

with significant alteration of size or form:

Both 501

One 301

Following wide local excision without significant

alteration of size or form:

Both or one 0

**Note:** For VA purposes:

> \(1\) *Radical mastectomy* means removal of the entire breast,
> underlying pectoral muscles, and regional lymph nodes up to the
> coracoclavicular ligament.
>
> \(2\) *Modified radical mastectomy* means removal of the entire breast
> and axillary lymph nodes (in continuity with the breast). Pectoral
> muscles are left intact.
>
> \(3\) *Simple (or total) mastectomy* means removal of all of the
> breast tissue, nipple, and a small portion of the overlying skin, but
> lymph nodes and muscles are left intact.
>
> \(4\) *Wide local excision* (including partial mastectomy, lumpectomy,
> tylectomy, segmentectomy, and quadrantectomy) means removal of a
> portion of the breast tissue.

**7627** Malignant neoplasms of gynecological system or breast 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.

**7628** Benign neoplasms of the gynecological system or breast. Rate
according to impairment in function of the urinary or gynecological
systems, or skin.

**7629** Endometriosis:

Lesions involving bowel or bladder confirmed by laparoscopy, pelvic

pain or heavy or irregular bleeding not controlled by treatment,

and bowel or bladder symptoms 50

Pelvic pain or heavy or irregular bleeding not controlled

by treatment 30

Pelvic pain or heavy or irregular bleeding requiring

continuous treatment for control 10

Note: Diagnosis of endometriosis must be substantiated by laparoscopy.

1Review for entitlement to special monthly compensation under §3.350 of
this chapter.

\[29 FR 6718, May 22, 1964, as amended at 41 FR 11301, Mar. 18, 1976; 41
FR 34258, Aug. 13, 1976; redesignated and revised, 60 FR 19855, Apr. 21,
1995; 67 FR 6874, Feb. 14, 2002\]

**Supplement *Highlights* references**: 12(1), 28(1).