S

SACROILIAC DISORDERS or LUMBOSACRAL SPRAIN

The sacroiliac joint is at the junction of the lower end of the spine
(sacrum) with the pelvis. Acute strain, exertion, or injury, faulty
posture, flat feet, arthritis, etc., may produce dislocations, sprains,
relaxation, or inflammation usually resulting in severe pain and
rigidity in this area. A dislocated disc frequently manifests itself as
a sciatic syndrome.

**Underwriting Requirements**

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

  ---------------------------------------------------- ------------------
  Single attack                                        

  Present                                              

  Mild                                                 0

  Moderate                                             20

  Severe                                               100-30

  History (recovered)                                  

  Mild                                                 0

  Moderate                                             0

  Severe                                               0

  Recurrent attacks (chronic)                          

  Mild                                                 15

  Moderate                                             30

  Severe                                               100-40
  ---------------------------------------------------- ------------------

SALIVARY GLAND

The salivary glands consist of the sublingual, submaxillary and the
parotid glands. Simple inflammatory conditions, such as mumps, are
acceptable after recovery.

Salivary stones are a formation of salts in the salivary glands and
consist of calcium salts. These concentration of salt form stones.

**Underwriting Requirements**

APS (VA Form 29-8158) within 2 years

  --------------------------------------------------- -------------------
  Cyst                                                

  Present                                             0

  After removal                                       0

                                                      

  Stone, Calculus                                     

  Present                                             30

  After removal                                       0
  --------------------------------------------------- -------------------

SARCOIDOSIS

Sarcoidosis or Boeck\'s Sarcoid is a chronic benign disease of unknown
cause effecting mainly the skin, lymph nodes, lungs, and bones of the
hands and feet. A special type may be limited to the parotid gland and
eyes (uveoparotid fever); \"disseminated\" sarcoidosis can involve any
organ or tissue. It is insidious in onset, proceeds slowly and unevenly
to a maximum often without much disablement. Spontaneous recovery may be
anticipated in a majority of cases. The lesions heal by scar formation.
Pulmonary changes may lead to congestive failure. The condition during
its progression may remit and recur. The mediastinal nodes may become
massive and may suffer bilateral widespread nodular and streaky
infiltration. It is insidious in onset, proceeds slowly and unevenly to
a maximum, often without much disablement, then recedes, also slowly.
The whole sequence covers an average period of about 22 months and a
maximum of 6 to 8 years. It may recur.

**Underwriting Requirements**

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

Stage 1 -- disease has hilar adenopathy (enlarged lymph nodes) but no
lung involvement by x-ray or other symptoms.

Stage 2 -- disease has hilar adenopathy (enlarged lymph nodes) with
pulmonary infiltrates seen on chest x-ray.

Stage 3 -- disease has extensive lung disease seen on x-ray but no hilar
adenopathy.

Stage 4 -- severe lung disease shown on x-ray and the PFTs show severe
COPD.

+-----------------------+-----------------------+-----------------------+
| [                     | [6 months -- 2        | [After 2              |
| Resolved]{.underline} | years]{.underline}    | years]{.underline}    |
+-----------------------+-----------------------+-----------------------+
| Stage 1               | 0                     | 0                     |
+-----------------------+-----------------------+-----------------------+
| Stage 2               | 75                    | 0                     |
+-----------------------+-----------------------+-----------------------+
| Stage 3               | 200                   | Rate per COPD         |
|                       |                       | schedule              |
+-----------------------+-----------------------+-----------------------+
| Stage 4               | R                     | Rate per COPD         |
|                       |                       | schedule              |
|                       |                       |                       |
|                       |                       | (if extreme, decline) |
+-----------------------+-----------------------+-----------------------+

  ----------------------------------------------- -----------------------
  Currently using steroid medication              Add 55

  Sarcoid other than lung or hilar lymph nodes    Refer to Section Chief

  Cardio involvement including Bundle Branch      R
  Block on EKG                                    

  Progressive pulmonary disease                   R

  Currently using steroid meds                    Add 55

  Eye involvement, skin or liver involvement      Rate per severity of
                                                  lung involvement above

  Sarcoid in locations not covered above, i.e.,   Refer to Section Chief
  nervous system                                  
  ----------------------------------------------- -----------------------

SCALENUS ANTICUS SYNDROME

(Cervical Rib)

There are three scalenus muscles that lie deeply on either side of the
neck. The attachments of the scalenus muscles vary, particularly the
antererior scalenus. In some individuals the variation is capable of
producing a mild single neurovascular symptom or a combination of
symptoms and findings. These may involve any or both sides of the neck.
They may manifest themselves in numbness, tingling, swelling of the
shoulder(s) arm(s) or neck, and even paralysis and marked edema.

The cervical rib is an additional rib, usually an incomplete formation
lying above the first rib, which connects with the last cervical
vertebra. If the rib presses on the spinal nerve roots it can cause a
similar chain of symptoms as scalenus anticus syndrome. It may be any
size, however, from rudimentary projection to a complete rib. The
treatment for the alleviation of the distressing signs and symptoms can
be conservative physical therapy or operative, or both.

**Underwriting Requirements**

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

+-------------------------------------------------------+--------------+
| Unilateral                                            |              |
+-------------------------------------------------------+--------------+
| Symptoms and findings are:                            |              |
+-------------------------------------------------------+--------------+
| Moderate or less, not constant, and good functional   | 0            |
| capacity                                              |              |
+-------------------------------------------------------+--------------+
| Moderate or more, with some impaired functional       | 15           |
| capacity                                              |              |
+-------------------------------------------------------+--------------+
| > Marked, constant, and materially impaired           | 75           |
| > functional capacity                                 |              |
+-------------------------------------------------------+--------------+
| > With vasomotor disturbances and/or functional       | Refer to     |
|                                                       | Section      |
|                                                       | Chief        |
+-------------------------------------------------------+--------------+
| Bilateral                                             |              |
+-------------------------------------------------------+--------------+
| Symptoms and findings are:                            |              |
+-------------------------------------------------------+--------------+
| Moderate or less, not constant, and good functional   | 15           |
| capacity                                              |              |
+-------------------------------------------------------+--------------+
| Moderate or more, with some impaired functional       | 25           |
| capacity                                              |              |
+-------------------------------------------------------+--------------+
| > Marked, constant, and materially impaired           | 100          |
| > functional capacity                                 |              |
+-------------------------------------------------------+--------------+
| > With vasomotor disturbances and/or functional       | Refer to     |
|                                                       | Section      |
|                                                       | Chief        |
+-------------------------------------------------------+--------------+

SCARLET FEVER

Scarlet fever, or scarletina, is an acute contagious disease,
characterized by sudden onset with nausea, vomiting, high fever, sore
throat, and scarlet rash. It often leads to such complications as acute
nephritis, ear disorders, and arthritis,

**Underwriting Requirements**

An APS (VA Form 29-8158) is required within 1 year of recovery.

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

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

**SCHISTOSOMIASIS**

**(Be Lharziasis)**

Schistosomiasis is a chronic disease caused by the blood flukes
Mansonia, Japonicum and Haematobium. These flukes, trematodes or worms
are prevalent in Africa, South America, Southern Europe, West Indies and
Eastern Asia. Various species of snails are the intermediate hosts. The
infected larvae enter the body by penetrating the human skin or mucous
membranes that come in contact with contaminated water. Symptoms may not
develop for years in light infestations but with heavy infestations may
develop within a month. The adult flukes many live for 25 years and they
may be asymptomatic for some time. Most cases are diagnosed only when
fairly well advanced. Schistosomiasis (Mansoni and Japonicum) should be
considered in all unresponsive gastrointestinal disorders in persons who
have been in endemic areas. Early schistosomiasis may be mistaken for
amebiasis and various forms of dysentery. At first there may be only a
rash at the site of penetration; this is followed by fever, allergy,
i.e., urticaria, asthma and temporary enlargement of liver and spleen.
Abdominal pain and dysentery are common early in the intestinal
infections; later ulceration, polypoid intestinal tumors, anemia,
cirrhosis, portal and pulmonary hypertension and ascites may occur. The
brain and spinal cord may be affected. With the Haematobium, the urinary
bladder and pelvis are mainly involved. Painless hematuria, with bladder
and kidney damage and possibly uremia may occur.

Prognosis with treatment is good in early and light to moderate
infections if reinfection does not occur. With heavy infestations, and
extensive involvement the outlook is poor even with treatment. Death
commonly results from incurrent disease, often within a few years after
the infestation.

**Underwriting Requirements**

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

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

  Light to moderate infestation with little or no       300-100
  treatment                                             

  Light to moderate infestation adequately treated      200-50

  Severe -- heavy infestation or with extensive         1000-500
  involvement                                           

  History                                               

  Within 3 years -- light to moderate infestation with  300-100
  little or no treatment                                

  Within 3 years -- light to moderate infestation with  100-25
  adequate treatment                                    

  After 3 years -- light to moderate infestation with   50-25
  little or no treatment                                

  After 3 years -- light to moderate infestation with   0
  adequate treatment                                    

  Severe -- heavy infestation or extensive involvement, 800-300
  regardless of treatment                               
  ----------------------------------------------------- -----------------

SCIATICA, LOW BACK PAIN

Low back pain is a common complaint. It is a frequent cause of
disability, and is difficult to diagnose precisely, and to treat.
Recurrences are usual. Sciatica is a special type of pain radiating into
the buttocks or down the leg. It may accompany low back pain or occur
alone. It is usually due to an intervertebral disk. Less commonly it is
caused by nerve root compression by an intraspinal tumor or by spinal
stenosis, a narrowing of the lumbar spinal canal.

**Underwriting Requirements**

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

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

  Others                                   Rate as Intervertebral Disk
                                           Rupture
  ---------------------------------------- ------------------------------

**SEPTICEMIA**

Septicemia is a severe blood infection due to bacteria in the blood
stream. Wounds, complications following childbirth, or infection
anywhere in the body are the most common causes.

**Underwriting Requirements**

An APS (VA Form 29-8158) may be required if inadequately described.

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

  Uncomplicated -- after recovery    0

  Complicated                        Apply rules for cause or
                                     complications
  ---------------------------------- ------------------------------------

**SEXUALLY TRANSMITTED DISEASES (STDs)**

Sexually transmitted diseases (STDs) are those passed primarily by
sexual and/or intimate contact. Besides sexual contact, the most common
form of spread is from mother to fetus either in utero (e.g. syphilis)
or during the birth process (e.g. gonorrhea, herpes, chlamydia).

In the adult, STDs present a very low mortality risk. But their presence
or history raises the concern that other diseases passed by intimate
contact may also be present or contracted in the future, namely AIDS
(see AIDS).

**Underwriting Requirements**

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

  ------------------------------------------------------ ----------------
  Gonorrhea, syphilis, other sexually transmitted        
  diseases                                               

  Acute, single episode, no complications, adequate      0
  treatment                                              

  Chronic or repeated episodes                           R
  ------------------------------------------------------ ----------------

**SEZARY'S SYNDROME**

**(Special Types of Lymphomas)**

Mycosis Fungoides is a cutaneous lymphoma that may pursue a prolonged
indolent course. Sezary's Syndrome is a leukemic variant of mycosis
fungoides and has a poor prognosis.

  ------------------------------------------------------ ----------------
  Mycosis Fungoides and Sezary's Syndrome                R

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

**SINUSITIS**

The nasal sinuses are cavities lined with mucous membranes. They consist
of the frontals, maxillaries, ethmoids and sphenoids. Inflammation of a
sinus is known as sinusitis. Acute colds, allergy, and injury are common
causes of sinusitis. Sinusitis has a tendency to become chronic and/or
recurrent.

**Underwriting Requirements**

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

  ---------------------------------------------------- ------------------
  Repeated, severe attacks within 1 year               30

  Otherwise, rating will depend on cause or            Disregard
  complication                                         
  ---------------------------------------------------- ------------------

**SKIN AFFECTIONS**

Skin affections of any type are frequently described by the general term
dermatitis. Many systemic or generalized disorders produce
characteristic rashes or lesions on the skin. Their appearance and
subjective symptoms are extremely varied.

Ignore these conditions unless they are associated with more serious
impairments:

+-----------------------------------+-----------------------------------+
| Acne rosacea                      | > Keloids                         |
+-----------------------------------+-----------------------------------+
| Acne vulgaris                     | > Keratoacanthoma                 |
+-----------------------------------+-----------------------------------+
| Atopic dermatitis                 | > Molluscum contagiosum           |
+-----------------------------------+-----------------------------------+
| Blue nevus                        | > Morphea                         |
+-----------------------------------+-----------------------------------+
| Cellulites                        | > Nevus -- moles (simple)         |
+-----------------------------------+-----------------------------------+
| Chloasma                          | > Parapsoriasis                   |
+-----------------------------------+-----------------------------------+
| Contact dermatitis                | > Pediculosis                     |
+-----------------------------------+-----------------------------------+
| Dermatophytosis                   | > Pityriasis rosea                |
+-----------------------------------+-----------------------------------+
| Ecthyma                           | > Pseudoxanthoma elasticum        |
+-----------------------------------+-----------------------------------+
| Eczema                            | > Seborrheic dermatitis           |
+-----------------------------------+-----------------------------------+
| Erysipelas                        | > Serum sickness                  |
+-----------------------------------+-----------------------------------+
| Erythema Nodosum                  | > Sporotrichosis                  |
+-----------------------------------+-----------------------------------+
| Fixed drug reaction               | > Tinea                           |
+-----------------------------------+-----------------------------------+
| Folliculitis                      | > Urticaria (hives)               |
+-----------------------------------+-----------------------------------+
| Furunculosis                      | > Verruca vulgaris                |
+-----------------------------------+-----------------------------------+
| Hidradenitis suppuritiva          | > Vitiligo                        |
+-----------------------------------+-----------------------------------+
| Hirsutism                         | > Xanthoma                        |
+-----------------------------------+-----------------------------------+
| Impetigo                          | > Xerosis                         |
+-----------------------------------+-----------------------------------+
| Kawasaki disease (mucocutaneous   |                                   |
| lymph node syndrome)              |                                   |
+-----------------------------------+-----------------------------------+

**[Malignancies]{.underline}**

+-----------------------------------+-----------------------------------+
| Basal Cell Carcinoma              | > Kaposi's Sarcoma                |
+-----------------------------------+-----------------------------------+
| Cutaneous Lymphoma                | > Melanoma                        |
+-----------------------------------+-----------------------------------+

  ----------------------------------- -----------------------------------
  Malignancies                        See Tumor Section

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

**[Premalignant Conditions]{.underline}**

+-----------------------------------+-----------------------------------+
| Bowen's Disease (including        | > Keratosis (Actinic, Senile,     |
| Erythroplasia of Queyrat)         | > Solar, Luekoplakia)             |
+-----------------------------------+-----------------------------------+
| Nevi -- Giant Hairy, Dysplastic,  |                                   |
| Junctional, or with recent change |                                   |
+-----------------------------------+-----------------------------------+

  -------------------------------------------- --------------------------
  Present                                      25

  After surgical excision                      0
  -------------------------------------------- --------------------------

**[Other Significant Skin Disorders]{.underline}**

  -------------------------------------------- --------------------------
  Condyloma acuminata (venereal warts)         See Sexually Transmitted
                                               Diseases

  Discoid lupus                                

  Systemic lupus unlikely                      0

  Others                                       

  Within 1 year of diagnosis                   55

  After 1^st^ year                             0

  Genital herpes                               See Sexually Transmitted
                                               Diseases

  Psoriasis                                    

  Present -- slight or moderate                0

  Others, extensive                            30

  History -- upon recovery                     0

  With arthritis                               See Rheumatoid Arthritis
  -------------------------------------------- --------------------------

**[Skin Disorder Indicative of Underlying Disease]{.underline}**

**Acanthosis Nigricans** -- this type appears in childhood is usually
benign but can be associated with Cushing's disease or diabetes. Adult
form has about 50% incidence of associated malignancy.

**Underwriting Requirements**

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

  --------------------------------------------- -------------------------
  Present                                       Rate for complications

  History                                       0
  --------------------------------------------- -------------------------

**Café Au Lait Spots** -- these are light brown or tan spots associated
with Neurofibromatosis or with Albright's Disease

+---------------------------------------------+------------------------+
| Café Au Lait spots                          | See Tumor Rating Chart |
|                                             | C                      |
|                                             |                        |
|                                             | Under Birthmark, etc.  |
+---------------------------------------------+------------------------+

**Ehlers-Danlos Syndrome --** hyperextensible joints, increased
elasticity of skin, and ecchymoses are the classic signs. Severe forms
may be associated with increased tendency for rupture of large arteries
and bowel.

**Underwriting Requirements**

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

  --------------------------------------------- -------------------------
  No internal or arterial involvement           125-75

  With mitral value prolapse                    Rate as Mitral Valve
                                                Prolapse

  History of spontaneous rupture of artery or   R
  aneurysm                                      
  --------------------------------------------- -------------------------

**Epidermolysis bullosum --** characterized by blisters and ulceration
at sites of minor skin trauma. Growth retardation, squamous cell
carcinoma and esophageal strictures are complications.

  --------------------------------------------- -------------------------
  Epidermolysis bullosum                        R

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

**Erythema multiforme (Stevens-Johnson Syndrome)** -- characterized by
the "iris" or "target" lesion -- concentric circles of different colors.
May be caused by hypersensitivity to drugs, herpes, collagen vascular
disease, or by radiotherapy.

  --------------------------------------------- -------------------------
  Erythema multiforma                           RFC

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

**Lichen planus** -- itchy inflammatory condition of the skin with
typical lesions on ankles, wrists, mouth and genitalia.

  --------------------------------------------- -------------------------
  No evidence of other system involvement       0

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

**Bullous pemphigoid** -- blistering skin disease.

**Underwriting Requirements**

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

  --------------------------------------------- -------------------------
  Currently on treatment                        100

  Disease cured, treatment ended                

  Within 1 year                                 55

  Thereafter                                    0
  --------------------------------------------- -------------------------

**Pemphigas (vulgaris, erythematosus, foliaceus, and vegetans)** -- skin
disorder manifested by blisters and ulceration of the skin and mucous
membranes.

  --------------------------------------------- -------------------------
  Currently on treatment                        55

  Disease cured, treatment ended                

  Within 1 year                                 55

  2^nd^ year                                    30

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

**Port wine stain** -- a cutaneous hemangioma that follows a division of
the trigeminal nerve.

  --------------------------------------------- -------------------------
  No complications                              0

  Others                                        30
  --------------------------------------------- -------------------------

**Pyoderma gangrenosum** -- ulcerative skin lesions often associated
with ulcerative colitis or other diseases.

  --------------------------------------------- -------------------------
  Pyoderma gangrenosum                          RFC

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

**SLEEP APNEA**

Sleep apnea includes excessive daytime somnolence and nocturnal sleep
abnormality including frequent disruption of sleep, heavy snoring, and
observed periods of apnea (cessation of breathing for over 10 seconds)
during sleep. Diagnosis is made by overnight sleep study.

Complications include: obesity, hypertension, psychiatric disturbances,
dangerous arrhythmias, pulmonary hypertension, cor pulmonale,
polycythemia, and congestive heart failure.

**Underwriting Requirements**

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

  ------------------------------------------------- ---------------------
  Sleep study available for review, no              
  complications, no BP debits, and no surgical      
  treatment such as UPPP or tracheostomy            

  Mild with or without treatment                    0

  Moderate, compliant with use of CPAP (continuous  0
  positive airway pressure mask)                    

  Moderate, untreated, non-compliant, or compliance 55
  unknown                                           

  Moderately severe, compliant with nightly use of  75
  CPAP                                              

  Moderately severe, untreated, non-compliant or    100
  unknown compliance                                

  Severe                                            

  Success of CPAP documented by follow-up sleep     0
  study                                             

  No follow-up sleep study, non-compliant or        R
  unknown                                           

  Sleep study done by not available for review, no  
  complications, no surgical treatment like UPPP or 
  tracheostomy and no BP debits                     

  With complications                                

  Obesity, systemic hypertension, or psychiatric    Sum debits
  impairment                                        

  Arrhythmias, polycythemia                         R

  With surgical treatment                           Follow-up sleep study
                                                    needed then rate as
                                                    above

  For those with history of possible sleep apnea    
  but no work-up                                    

  No driving problems, normal BP, no arrhythmias,   0
  no heart disease, non-ratable build               
  ------------------------------------------------- ---------------------

**SPINA BIFIDA, SPINA BIFIDA OCCULTA**

Spina bifida is a congenital disorder manifested by defective closure of
the vertebral column. In its mildest form, spina bifida occulta, it is
usually discovered on x-rays done for some other purpose and is
asymptomatic. In its more severe form there may be complete paralysis
below the level of the defect as well as other associated abnormalities.
Surgery may be required to prevent complications but has little effect
on established paralysis.

**Underwriting Requirements**

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

  ------------------------------------------ ----------------------------
  Spina bifida occulta                       0

  Spina bifida                               

  Present or history                         Rate for degree of paralysis
                                             and complications
  ------------------------------------------ ----------------------------

**SPINE INJURIES**

Injuries to the spine may be a fracture of the body of a vertebra or the
projections, dislocation, or crushing; torn ligaments or tendons
attached to each vertebra and excessive growths that may or may not
result from an injury. The injury may or may not affect the spinal cord.

**Underwriting Requirements**

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

  ------------------------------------------------------- ---------------
  Unoperated -- no deformity or residuals                 

  Spinal injuries, fractures, contusion, compression,     
  dislocation, G.S.W., cord not injured                   

  Present or within 6 months                              300-100

  6 months after recovery                                 0

  Operated -- fusion or fixation                          

  No cord injury -- cured                                 

  Within 1 year after recovery                            30

  More than 1 year after recovery                         0

  Others                                                  

  Residuals of, symptomatic with muscular weakness,       100-50
  marked restriction of activity                          
  ------------------------------------------------------- ---------------

SPLEEN

The spleen is an oval-shaped organ situated in the upper left quadrant
of the abdomen. Its functions are many and varied. The spleen may become
involved secondarily in any number of diseases, most of which result in
varying degrees of splendic enlargement (splenomegaly), such as Banti\'s
disease, blood disorders, malignancy, portal cirrhosis, tuberculosis,
syphilis, and chronic malaria.

Removal of the spleen (splenectomy) is sometimes required because of
rupture due to injury.

**Underwriting Requirements**

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

  --------------------------------------------------- -------------------
  History or evidence of persistent enlargement       0

  Splenectomy                                         

  Due to injury, fully recovered and returned to      0
  normal duties                                       

  Due to other causes                                 RFC

  Hypersplenism                                       

  Present                                             R

  Cured by splenectomy                                0

  Splenomegaly                                        

  Present                                             

  Cause known                                         RFC

  Cause unknown                                       Refer to Section
                                                      Chief

  History                                             0
  --------------------------------------------------- -------------------

**STRICTURE**

The abnormal narrowing of a canal, duct, or passage is called a
stricture. It may be due to external pressure, inflammation, or other
changes. The term may be applied to narrowing of the ureter, bile duct,
esophagus, etc., and prolonged treatment or surgery may be required

**Underwriting Requirements**

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

  -------------------------------------------- --------------------------
  Chronic histories or those requiring         50
  repeated dilation                            

  Other strictures                             See under respective
                                               headings
  -------------------------------------------- --------------------------

**SUICIDE**

**(Attempted)**

Suicide, the intentional taking of one's own life, is a complex
phenomenon. It is often the end result in a pattern of self-destructive
behavior. Contributing factors include alcoholism, organic brain
disease, personality disorders, schizophrenia and particularly
depression. Social factors, physical illness and alcohol may contribute
to the latter.

Suicide attempts or gestures are much more frequent than completed
suicides, and are often viewed as a "cry for help." In the absence of
successful intervention, attempts may be repeated. Any history of
suicide gestures or suicidal thoughts must be given serious
consideration.

**Underwriting Requirements**

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

  --------------------------------------------- -------------------------
  When related to Psychotic Disorder            Apply rules for the
                                                specific psychoses

  One attempt only                              

  Within 1 year                                 R

  Within 2-3 years                              175

  Within 4-6 years                              125

  Within 7-8 years                              100

  Within 9-10 years                             55

  After 10 years                                0

  Two or more attempts                          

  Within 5 years of last attempt                R

  Within 6 years                                350

  Within 7 years                                275

  Within 8 years                                225

  Within 9 years                                175

  Within 10 years                               125

  Within 11-15 years                            55

  After 15 years                                0
  --------------------------------------------- -------------------------

> **SYNCOPE AND VERTIGO**

Synocope is a term synonymous with loss of consciousness. Vertigo refers
to a spinning sensation or dizziness. While not often due to serious
disease, epilepsy, cardiac disorders, Meniere's disease, stroke, etc.
must be considered.

+---------------------------------------------+------------------------+
| Cause known                                 | RFC                    |
+---------------------------------------------+------------------------+
| Otherwise, no other impairments             |                        |
+---------------------------------------------+------------------------+
| Mild occasional momentary attack            | 50-0                   |
+---------------------------------------------+------------------------+
| Others (consider age, frequency, duration,  | R-55                   |
| etc.)                                       |                        |
|                                             | Refer to Section Chief |
+---------------------------------------------+------------------------+

SYNOVITIS

Inflammation of the lining of a joint (synovial membrane) is known as
synovitis. It is characterized by redness, swelling, exudation of fluid,
and pain, especially on motion. Synovitis may follow infection or result
from an injury such as sprain, contusion, fracture, or wounds.

**Underwriting Requirements**

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

+---------------------------------------------+------------------------+
| One attack -- duration 3 weeks or less,     | > 0                    |
| after recovery                              |                        |
+---------------------------------------------+------------------------+
| More than one attack or duration over 3     |                        |
| weeks                                       |                        |
+---------------------------------------------+------------------------+
| Last attack within 6 months                 | > 55                   |
+---------------------------------------------+------------------------+
| After 6 months, with good functional result | > 0                    |
+---------------------------------------------+------------------------+

**SYSTEMIC CONNECTIVE TISSUE DISEASE**

**[Mixed Connective Tissue Disease]{.underline}**

Mixed connective tissue disease is characterized by a combination of the
features of systemic lupus, scleroderma, polymyositis, and rheumatoid
arthritis. They may be mild or severe and the prognosis is thought to be
similar to that for systemic lupus erythematosis. Treatment may include
corticosteroids or cytotoxic agents.

  -------------------------------------- --------------------------------
  Mixed connective tissue disease        Rate as Systemic Lupus
                                         Erythematosis

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

**[Scleroderma/Progressive Systemic Sclerosis]{.underline}**

Diffuse scleroderma or progressive systemic sclerosis is characterized
by an increase in the amount of fibrotic connective tissue in the skin
and internal organs accompanied by inflammatory and vascular changes.
The gastrointestinal tract, lungs, heart and kidney are most commonly
involved and may not be progressive.

A variant of the disease known as the "CREST" syndrome (calcinoisis,
Raynaud's phenomenon, esophageal dysfunction, sclerodactyly and
telangiectasia) may have a better prognosis at least in the short term.
Some of these patients will have disease that is primarily limited to
the skin; however, others will go on to develop disease of the internal
organs.

**Underwriting Requirements**

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

  ------------------------------------- ---------------------------------
  Scleroderma/Progressive systemic      Rate as Systemic Lupus
  sclerosis                             Erythematosis

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

**[Sjogren's Syndrome]{.underline}**

Sjogren's Syndrome is a chronic autoimmune inflammatory disorder in
which the salivary and lacrimal glands undergo progressive destruction
resulting in a corresponding decrease in the production of saliva and
tears. It is associated with rheumatoid arthritis, systemic lupus, mixed
connective tissue disease and scleroderma and in some cases with
pulmonary and central nervous system disorders.

**Underwriting Requirements**

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

  ------------------------------------- ---------------------------------
  Sjogren's Syndrome                    Rate as Systemic Lupus
                                        Erythematosis

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

**[Systemic Lupus Erythematosis (SLE)]{.underline}**

SLI is an autoimmune disorder of unknown etiology. Its varied clinical
manifestations are the result of antibodies directed against tissues or
cells, or the deposition of immune complexes in tissues or organs. The
disease ranges in seriousness from mild and transient to severe and life
threatening. It is seen most often in women of childbearing age, but
anyone can be affected. Systemic symptoms (fatigue, malaise, fever,
weight loss), musculoskeletal, cutaneous and hematologic manifestations
are the most common but neurologic, cardiopulmonary, renal,
gastrointestinal, vascular and ocular features are not uncommon. The
clinical course is usually one of exacerbations and remissions. Complete
recovery is uncommon though the prognosis in general seems to be
improving. Treatment depends on the seriousness of the disease and may
include corticosteroids or cytotoxic drugs.

  -------------------------------------------------- --------------------
  Present, current evidence of disease but minimal   
  progression                                        

  Within 1 year of diagnosis                         R

  Within 2-5 years                                   400-200

  After 5 years                                      100

  In remission, no current evidence of disease       

  Within 1 year                                      125

  Within 2-3 years                                   75

  After 3 years                                      0

  Renal, cerebral, or multi-organ disease            Refer to Section
                                                     Chief

  On steroids                                        Add 55 to above
  -------------------------------------------------- --------------------