Ratings for Special Purposes

3.350 Special monthly compensation ratings 3.350-1

3.351 Special monthly dependency and indemnity compensation, death

compensation, pension and spouse's compensation ratings 3.351-1

3.352 Criteria for determining need for aid and attendance and

"permanently bedridden" 3.352-1

3.353 Determinations of incompetency and competency 3.353-1

3.354 Determinations of insanity 3.354-1

3.355 Testamentary capacity for insurance purposes 3.355-1

3.356 Conditions which determine permanent incapacity for self-support
3.356-1

3.357 Civil service preference ratings 3.357-1

3.358 Compensation for disability or death from hospitalization, medical

or surgical treatment, examinations or vocational rehabilitation

training (§3.800) 3.358-1

3.359 Determination of service connection for former members of the

Armed Forces of Czechoslovakia or Poland 3.359-1

3.360 Service-connected health-care eligibility of certain persons

administratively discharged under other than honorable condition 3.360-1

3.361 Benefits under 38 U.S.C. 1151(a) for additional disability or
death due to

hospital care, medical or surgical treatment, examination, training and

rehabilitation services, or compensated work therapy program 3.361-1

3.362 Offsets under 38 U.S.C. 1151(b) of benefits awarded under 38
U.S.C. 1151(a) 3.362-1

3.363 Bar to benefits under 38 U.S.C. 1151 3.363-1

**§3.350 Special monthly compensation ratings.**

The rates of special monthly compensation stated in this section are
those provided under 38 U.S.C. 1114.

\(a\) *Ratings under 38 U.S.C. 1114(k).* Special monthly compensation
under 38 U.S.C. 1114(k) is payable for each anatomical loss or loss of
use of one hand, one foot, both buttocks, one or more creative organs,
blindness of one eye having only light perception, deafness of both
ears, having absence of air and bone conduction, complete organic
aphonia with constant inability to communicate by speech or, in the case
of a woman veteran, loss of 25% or more of tissue from a single breast
or both breasts in combination (including loss by mastectomy or partial
mastectomy), or following receipt of radiation treatment of breast
tissue. This special compensation is payable in addition to the basic
rate of compensation otherwise payable on the basis of degree of
disability, provided that the combined rate of compensation does not
exceed the monthly rate set forth in 38 U.S.C. 1114(l) when authorized
in conjunction with any of the provisions of 38 U.S.C. 1114(a) through
(j) or (s). When there is entitlement under 38 U.S.C. 1114 (l) through
(n) or an intermediate rate under (p) such additional allowance is
payable for each such anatomical loss or loss of use existing in
addition to the requirements for the basic rates, provided the total
does not exceed the monthly rate set forth in 38 U.S.C. 1114(o). The
limitations on the maximum compensation payable under this paragraph are
independent of and do not preclude payment of additional compensation
for dependents under 38 U.S.C. 1115, or the special allowance for aid
and attendance provided by 38 U.S.C. 1114(r).

\(1\) *Creative organ.*

\(i\) Loss of a creative organ will be shown by acquired absence of one
or both testicles (other than undescended testicles) or ovaries or other
creative organ. Loss of use of one testicle will be established when
examination by a board finds that:

\(a\) The diameters of the affected testicle are reduced to one-third of
the corresponding diameters of the paired normal testicle, or

\(b\) The diameters of the affected testicle are reduced to one-half or
less of the corresponding normal testicle and there is alteration of
consistency so that the affected testicle is considerably harder or
softer than the corresponding normal testicle; or

\(c\) If neither of the conditions (a) or (b) is met, when a biopsy,
recommended by a board including a genitourologist and accepted by the
veteran, establishes the absence of spermatozoa.

\(ii\) When loss or loss of use of a creative organ resulted from wounds
or other trauma sustained in service, or resulted from operations in
service for the relief of other conditions, the creative organ becoming
incidentally involved, the benefit may be granted.

\(iii\) Loss or loss of use traceable to an elective operation performed
subsequent to service, will not establish entitlement to the benefit.
If, however the operation after discharge was required for the
correction of a specific injury caused by a preceding operation in
service. it will support authorization of the benefit. When the
existence of disability is established meeting the above requirements
for nonfunctioning testicle due to operation after service, resulting in
loss of use, the benefit may be granted even though the operation is one
of election. An operation is not considered to be one of election where
it is advised on sound medical judgment for the relief of a pathological
condition or to prevent possible future pathological consequences.

\(iv\) Atrophy resulting from mumps followed by orchitis in service is
service connected. Since atrophy is usually perceptible within 1 to 6
months after infection subsides, an examination more than 6 months after
the subsidence of orchitis demonstrating a normal genitourinary system
will be considered in determining rebuttal of service incurrence of
atrophy later demonstrated. Mumps not followed by orchitis in service
will not suffice as the antecedent cause of subsequent atrophy for the
purpose of authorizing the benefit.

\(2\) *Foot and hand.*

\(i\) Loss of use of a hand or a foot will be held to exist when no
effective function remains other than that which would be equally well
served by an amputation stump at the site of election below elbow or
knee with use of a suitable prosthetic appliance. The determination will
be made on the basis of the actual remaining function, whether the acts
of grasping, manipulation, etc., in the case of the hand, or of balance,
propulsion, etc., in the case of the foot, could be accomplished equally
well by an amputation stump with prosthesis; for example:

\(a\) Extremely unfavorable complete ankylosis of the knee, or complete
ankylosis of two major joints of an extremity, or shortening of the
lower extremity of 3 1/2 inches or more, will constitute loss of use of
the hand or foot involved.

\(b\) Complete paralysis of the external popliteal nerve (common
peroneal) and consequent footdrop, accompanied by characteristic organic
changes including trophic and circulatory disturbances and other
concomitants confirmatory of complete paralysis of this nerve, will be
taken as loss of use of the foot.

\(3\) *Both buttocks.*

\(i\) Loss of use of both buttocks shall be deemed to exist when there
is severe damage by disease or injury to muscle group XVII, bilateral,
(diagnostic code 5317) and additional disability making it impossible
for the disabled person, without assistance, to rise from a seated
position and from a stooped position (fingers to toes position) and to
maintain postural stability (the pelvis upon head of femur). The
assistance may be done by the person's own hands or arms, and, in the
matter of postural stability, by a special appliance. (Authority: 38
U.S.C. 1114(k))

\(ii\) Special monthly compensation for loss or loss of use of both
lower extremities (38 U.S.C. 1114(l) through (n)) will not preclude
additional compensation under 38 U.S.C. 1114(k) for loss of use of both
buttocks where appropriate tests clearly substantiate that there is such
additional loss.

\(4\) *Eye.* Loss of use or blindness of one eye, having only light
perception, will be held to exist when there is inability to recognize
test letters at 1 foot and when further examination of the eye reveals
that perception of objects, hand movements, or counting fingers cannot
be accomplished at 3 feet. Lesser extents of vision, particularly
perception of objects, hand movements, or counting fingers at distances
less than 3 feet is considered of negligible utility.

\(5\) *Deafness.* Deafness of both ears, having absence of air and bone
conduction will be held to exist where examination in a Department of
Veterans Affairs authorized audiology clinic under current testing
criteria shows bilateral hearing loss is equal to or greater than the
minimum bilateral hearing loss required for a maximum rating evaluation
under the rating schedule. (Authority: Pub. L. 88-20)

\(6\) *Aphonia.* Complete organic aphonia will be held to exist where
there is a disability of the organs of speech which constantly precludes
communication by speech. (Authority: Pub. L. 88-22)

\(b\) *Ratings under 38 U.S.C. 1114(l).* The special monthly
compensation provided by 38 U.S.C. 1114(l) is payable for anatomical
loss or loss of use of both feet, one hand and one foot, blindness in
both eyes with visual acuity of 5/200 or less or being permanently
bedridden or so helpless as to be in need of regular aid and attendance.

\(1\) *Extremities.* The criteria for loss and loss of use of an
extremity contained in paragraph (a)(2) of this section are applicable.

\(2\) *Eyes, bilateral.* 5/200 visual acuity or less bilaterally
qualifies for entitlement under 38 U.S.C. 1114(l). However, evaluation
of 5/200 based on acuity in excess of that degree but less than 10/200
(§4.83 of this chapter) does not qualify. Concentric contraction of the
field of vision beyond 5 degrees in both eyes is the equivalent of 5/200
visual acuity.

\(3\) *Need for aid and attendance.* The criteria for determining that a
veteran is so helpless as to be in need of regular aid and attendance
are contained in §3.352(a).

\(4\) *Permanently bedridden.* The criteria for rating are contained in
§3.352(a). Where possible, determinations should be on the basis of
permanently bedridden rather than for need of aid and attendance (except
where 38 U.S.C. 1114(r) is involved) to avoid reduction during
hospitalization where aid and attendance is provided in kind.

\(c\) *Ratings under 38 U.S.C. 1114(m).*

\(1\) The special monthly compensation provided by 38 U.S.C. 1114(m) is
payable for any of the following conditions:

\(i\) Anatomical loss or loss of use of both hands;

\(ii\) Anatomical loss or loss of use of both legs at a level, or with
complications, preventing natural knee action with prosthesis in place;

\(iii\) Anatomical loss or loss of use of one arm at a level, or with
complications, preventing natural elbow action with prosthesis in place
with anatomical loss or loss of use of one leg at a level, or with
complications, preventing natural knee action with prosthesis in place;

\(iv\) Blindness in both eyes having only light perception;

\(v\) Blindness in both eyes leaving the veteran so helpless as to be in
need of regular aid and attendance.

\(2\) *Natural elbow or knee action.* In determining whether there is
natural elbow or knee action with prosthesis in place, consideration
will be based on whether use of the proper prosthetic appliance requires
natural use of the joint, or whether necessary motion is otherwise
controlled, so that the muscles affecting joint motion, if not already
atrophied, will become so. If there is no movement in the joint, as in
ankylosis or complete paralysis, use of prosthesis is not to be
expected, and the determination will be as though there were one in
place.

\(3\) *Eyes, bilateral.* With visual acuity 5/200 or less or the vision
field reduced to 5 degree concentric contraction in both eyes,
entitlement on account of need for regular aid and attendance will be
determined on the facts in the individual case.

\(d\) *Ratings under 38 U.S.C. 1114(n).* The special monthly
compensation provided by 38 U.S.C. 1114(n) is payable for any of the
conditions which follow: Amputation is a prerequisite except for loss of
use of both arms and blindness without light perception in both eyes. If
a prosthesis cannot be worn at the present level of amputation but could
be applied if there were a reamputation at a higher level, the
requirements of this paragraph are not met; instead, consideration will
be given to loss of natural elbow or knee action.

\(1\) Anatomical loss or loss of use of both arms at a level or with
complications, preventing natural elbow action with prosthesis in place;

\(2\) Anatomical loss of both legs so near the hip as to prevent use of
a prosthetic appliance;

\(3\) Anatomical loss of one arm so near the shoulder as to prevent use
of a prosthetic appliance with anatomical loss of one leg so near the
hip as to prevent use of a prosthetic appliance;

\(4\) Anatomical loss of both eyes or blindness without light perception
in both eyes.

\(e\) *Ratings under 38 U.S.C. 1114 (o).*

\(1\) The special monthly compensation provided by 38 U.S.C. 1114(o) is
payable for any of the following conditions:

\(i\) Anatomical loss of both arms so near the shoulder as to prevent
use of a prosthetic appliance;

\(ii\) Conditions entitling to two or more of the rates (no condition
being considered twice) provided in 38 U.S.C. 1114(l) through (n);

\(iii\) Bilateral deafness rated at 60 percent or more disabling (and
the hearing impairment in either one or both ears is service connected)
in combination with service-connected blindness with bilateral visual
acuity 5/200 or less.

\(iv\) Service-connected total deafness in one ear or bilateral deafness
rated at 40 percent or more disabling (and the hearing impairment in
either one of both ears is service-connected) in combination with
service-connected blindness of both eyes having only light perception or
less.

\(2\) *Paraplegia.* Paralysis of both lower extremities together with
loss of anal and bladder sphincter control will entitle to the maximum
rate under 38 U.S.C. 1114(o), through the combination of loss of use of
both legs and helplessness. The requirement of loss of anal and bladder
sphincter control is met even though incontinence has been overcome
under a strict regimen of rehabilitation of bowel and bladder training
and other auxiliary measures.

\(3\) *Combinations.* Determinations must be based upon separate and
distinct disabilities. This requires, for example, that where a veteran
who had suffered the loss or loss of use of two extremities is being
considered for the maximum rate on account of helplessness requiring
regular aid and attendance, the latter must be based on need resulting
from pathology other than that of the extremities. If the loss or loss
of use of two extremities or being permanently bedridden leaves the
person helpless, increase is not in order on account of this
helplessness. Under no circumstances will the combination of "being
permanently bedridden" and "being so helpless as to require regular aid
and attendance" without separate and distinct anatomical loss, or loss
of use, of two extremities, or blindness, be taken as entitling to the
maximum benefit. The fact, however, that two separate and distinct
entitling disabilities, such as anatomical loss, or loss of use of both
hands and both feet, result from a common etiological agent, for
example, one injury or rheumatoid arthritis, will not preclude maximum
entitlement.

\(4\) *Helplessness.* The maximum rate, as a result of including
helplessness as one of the entitling multiple disabilities, is intended
to cover, in addition to obvious losses and blindness, conditions such
as the loss of use of two extremities with absolute deafness and nearly
total blindness or with severe multiple injuries producing total
disability outside the useless extremities, these conditions being
construed as loss of use of two extremities and helplessness.

\(f\) *Intermediate or next higher rate.* An intermediate rate
authorized by this paragraph shall be established at the arithmetic
mean, rounded to the nearest dollar, between the two rates concerned.
(Authority: 38 U.S.C. 1114 (p))

\(1\) *Extremities.*

\(i\) Anatomical loss or loss of use of one foot with anatomical loss or
loss of use of one leg at a level, or with complications preventing
natural knee action with prosthesis in place, shall entitle to the rate
between 38 U.S.C. 1114(l) and (m).

\(ii\) Anatomical loss or loss of use of one foot with anatomical loss
of one leg so near the hip as to prevent use of prosthetic appliance
shall entitle to the rate under 38 U.S.C. 1114(m).

\(iii\) Anatomical loss or loss of use of one foot with anatomical loss
or loss of use of one arm at a level, or with complications, preventing
natural elbow action with prosthesis in place, shall entitle to the rate
between 38 U.S.C. 1114(l) and (m).

\(iv\) Anatomical loss or loss of use of one foot with anatomical loss
or loss of use of one arm so near the shoulder as to prevent use of a
prosthetic appliance shall entitle to the rate under 38 U.S.C. 1114(m).

\(v\) Anatomical loss or loss of use of one leg at a level, or with
complications, preventing natural knee action with prosthesis in place
with anatomical loss of one leg so near the hip as to prevent use of a
prosthetic appliance, shall entitle to the rate between 38 U.S.C.
1114(m) and (n).

\(vi\) Anatomical loss or loss of use of one leg at a level, or with
complications, preventing natural knee action with prosthesis in place
with anatomical loss or loss of use of one hand, shall entitle to the
rate between 38 U.S.C. 1114(l) and (m).

\(vii\) Anatomical loss or loss of use of one leg at a level, or with
complications, preventing natural knee action with prosthesis in place
with anatomical loss of one arm so near the shoulder as to prevent use
of a prosthetic appliance, shall entitle to the rate between 38 U.S.C.
1114(m) and (n).

\(viii\) Anatomical loss of one leg so near the hip as to prevent use of
a prosthetic appliance with anatomical loss or loss of use of one hand
shall entitle to the rate under 38 U.S.C. 1114(m).

\(ix\) Anatomical loss of one leg so near the hip as to prevent use of a
prosthetic appliance with anatomical loss or loss of use of one arm at a
level, or with complications, preventing natural elbow action with
prosthesis in place, shall entitle to the rate between 38 U.S.C. 1114(m)
and (n).

\(x\) Anatomical loss or loss of use of one hand with anatomical loss or
loss of use of one arm at a level, or with complications, preventing
natural elbow action with prosthesis in place, shall entitle to the rate
between 38 U.S.C. 1114(m) and (n).

\(xi\) Anatomical loss or loss of use of one hand with anatomical loss
of one arm so near the shoulder as to prevent use of a prosthetic
appliance shall entitle to the rate under 38 U.S.C. 1114(n).

\(xii\) Anatomical loss or loss of use of one arm at a level, or with
complications, preventing natural elbow action with prosthesis in place
with anatomical loss of one arm so near the shoulder as to prevent use
of a prosthetic appliance, shall entitle to the rate between 38 U.S.C.
1114(n) and (o).

\(2\) *Eyes, bilateral, and blindness in connection with deafness and/or
loss or loss of use of a hand or foot*.

\(i\) Blindness of one eye with 5/200 visual acuity or less and
blindness of the other eye having only light perception will entitle to
the rate between 38 U.S.C. 1114(l) and (m).

\(ii\) blindness of one eye with 5/200 visual acuity or less and
anatomical loss of, or blindness having no light perception in the other
eye, will entitle to a rate equal to 38 U.S.C. 1114(m).

\(iii\) Blindness of one eye having only light perception and anatomical
loss of, or blindness having no light perception in the other eye, will
entitle to a rate between 38 U.S.C. 1114(m) and (n).

\(iv\) Blindness in both eyes with visual acuity of 5/200 or less, or
blindness in both eyes rated under subparagraph (2)(i) or (ii) of this
paragraph, when accompanied by service-connected total deafness in one
ear, will afford entitlement to the next higher intermediate rate of if
the veteran is already entitled to an intermediate rate, to the next
higher statutory rate under 38 U.S.C. 1114, but in no event higher than
the rate for (o).

\(v\) Blindness in both eyes having only light perception or less, or
rated under subparagraph (2)(iii) of this paragraph, when accompanied by
bilateral deafness (and the hearing impairment in either one or both
ears is service-connected) rated at 10 or 20 percent disabling, will
afford entitlement to the next higher intermediate rate, or if the
veteran is already entitled to an intermediate rate, to the next higher
statutory rate under 38 U.S.C. 1114, but in no event higher than the
rate for (o). (Authority: Sec. 112, Pub. L. 98-223)

\(vi\) Blindness in both eyes rated under 38 U.S.C. 1114(l), (m) or (n),
or rated under subparagraphs (2) (i), (ii) or (iii) of this paragraph,
when accompanied by bilateral deafness rated at no less than 30 percent,
and the hearing impairment in one or both ears is service-connected,
will afford entitlement to the next higher statutory rate under 38
U.S.C. 1114, or if the veteran is already entitled to an intermediate
rate, to the next higher intermediate rate, but in no event higher than
the rate for (o). (Authority: 38 U.S.C. 1114(p))

\(vii\) Blindness in both eyes rated under 38 U.S.C. 1114(l), (m), or
(n), or under the intermediate or next higher rate provisions of this
subparagraph, when accompanied by:

\(A\) Service-connected loss or loss of use of one hand, will afford
entitlement to the next higher statutory rate under 38 U.S.C. 1114 or,
if the veteran is already entitled to an intermediate rate, to the next
higher intermediate rate, but in no event higher than the rate for (o);
or

\(B\) Service-connected loss or loss of use of one foot which by itself
or in combination with another compensable disability would be ratable
at 50 percent or more, will afford entitlement to the next higher
statutory rate under 38 U.S.C. 1114 or, if the veteran is already
entitled to an intermediate rate, to the next higher intermediate rate,
but in no event higher than the rate for (o); or

\(C\) Service-connected loss or loss of use of one foot which is ratable
at less than 50 percent and which is the only compensable disability
other than bilateral blindness, will afford entitlement to the next
higher intermediate rate or, if the veteran is already entitled to an
intermediate rate, to the next higher statutory rate under 38 U.S.C.
1114, but in no event higher than the rate for (o). (Authority: 38
U.S.C. 1114(p))

\(3\) *Additional independent 50 percent disabilities.* In addition to
the statutory rates payable under 38 U.S.C. 1114(l) through (n) and the
intermediate or next higher rate provisions outlined above, additional
single permanent disability or combinations of permanent disabilities
independently ratable at 50 percent or more will afford entitlement to
the next higher intermediate rate or if already entitled to an
intermediate rate to the next higher statutory rate under 38 U.S.C.
1114, but not above the (o) rate. In the application of this
subparagraph the disability or disabilities independently ratable at 50
percent or more must be separate and distinct and involve different
anatomical segments or bodily systems from the conditions establishing
entitlement under 38 U.S.C. 1114(l) through (n) or the intermediate rate
provisions outlined above. The graduated ratings for arrested
tuberculosis will not be utilized in this connection, but the permanent
residuals of tuberculosis may be utilized.

\(4\) *Additional independent 100 percent ratings.* In addition to the
statutory rates payable under 38 U.S.C. 1114(l) through (n) and the
intermediate or next higher rate provisions outlined above additional
single permanent disability independently ratable at 100 percent apart
from any consideration of individual unemployability will afford
entitlement to the next higher statutory rate under 38 U.S.C. 1114 or if
already entitled to an intermediate rate to the next higher intermediate
rate, but in no event higher than the rate for (o). In the application
of this subparagraph the single permanent disability independently
ratable at 100 percent must be separate and distinct and involve
different anatomical segments or bodily systems from the conditions
establishing entitlement under 38 U.S.C. 1114(l) through (n) or the
intermediate rate provisions outlined above.

\(i\) Where the multiple loss or loss of use entitlement to a statutory
or intermediate rate between 38 U.S.C. 1114(l) and (o) is caused by the
same etiological disease or injury, that disease or injury may not serve
as the basis for the independent 50 percent or 100 percent unless it is
so rated without regard to the loss or loss of use.

\(ii\) The graduated ratings for arrested tuberculosis will not be
utilized in this connection, but the permanent residuals of tuberculosis
may be utilized.

\(5\) *Three extremities.* Anatomical loss or loss of use, or a
combination of anatomical loss and loss of use, of three extremities
shall entitle a veteran to the next higher rate without regard to
whether that rate is a statutory rate or an intermediate rate. The
maximum monthly payment under this provision may not exceed the amount
stated in 38 U.S.C. 1114(p).

\(g\) *Inactive tuberculosis (complete arrest).* The rating criteria for
determining inactivity of tuberculosis are set out in §3.375.

\(1\) For a veteran who was receiving or entitled to receive
compensation for tuberculosis on August 19, 1968, the minimum monthly
rate is \$67. This minimum special monthly compensation is not to be
combined with or added to any other disability compensation.

\(2\) For a veteran who was not receiving or entitled to receive
compensation for tuberculosis on August 19, 1968, the special monthly
compensation authorized by paragraph (g)(1) of this section is not
payable.

\(h\) *Special aid and attendance benefit; 38 U.S.C. 1114(r)*:

\(1\) *Maximum compensation cases*. A veteran receiving the maximum rate
under 38 U.S.C. 1114 (o) or (p) who is in need of regular aid and
attendance or a higher level of care is entitled to an additional
allowance during periods he or she is not hospitalized at United States
Government expense. (See §3.552(b)(2) as to continuance following
admission for hospitalization.) Determination of this need is subject to
the criteria of §3.352. The regular or higher level aid and attendance
allowance is payable whether or not the need for regular aid and
attendance or a higher level of care was a partial basis for entitlement
to the maximum rate under 38 U.S.C. 1114(o) or (p), or was based on an
independent factual determination.

\(2\) *Entitlement to compensation at the intermediate rate between 38
U.S.C. 1114(n) and (o) plus special monthly compensation under 38 U.S.C.
1114(k). A* veteran receiving compensation at the intermediate rate
between 38 U.S.C. 1114(n) and (o) plus special monthly compensation
under 38 U.S.C. 1114(k) who establishes a factual need for regular aid
and attendance or a higher level of care, is also entitled to an
additional allowance during periods he or she is not hospitalized at
United States Government expense. (See §3.552(b)(2) as to continuance
following admission for hospitalization.) Determination of the factual
need for aid and attendance is subject to the criteria of §3.352.

\(3\) *Amount of the allowance.* The amount of the additional allowance
payable to a veteran in need of regular aid and attendance is specified
in 38 U.S.C. 1114(r)(1). The amount of the additional allowance payable
to a veteran in need of a higher level of care is specified in 38 U.S.C.
1114(r)(2). The higher level aid and attendance allowance authorized by
38 U.S.C. 1114(r)(2) is payable in lieu of the regular aid and
attendance allowance authorized by 38 U.S.C. 1114(r)(1).

\(i\) *Total plus 60 percent, or housebound; 38 U.S.C. 1114(s).* The
special monthly compensation provided by 38 U.S.C. 1114(s) is payable
where the veteran has a single service-connected disability rated as 100
percent and:

\(1\) Has additional service-connected disability or disabilities
independently ratable at 60 percent, separate and distinct from the 100
percent service-connected disability and involving different anatomical
segments or bodily systems, or

\(2\) Is permanently housebound by reason of service-connected
disability or disabilities. This requirement is met when the veteran is
substantially confined as a direct result of service-connected
disabilities to his or her dwelling and the immediate premises or, if
institutionalized, to the ward or clinical areas, and it is reasonably
certain that the disability or disabilities and resultant confinement
will continue throughout his or her lifetime.

\[26 FR 1587, Feb. 24, 1961, as amended at 27 FR 4739, May 18, 1962; 28
FR 1587, Feb. 20, 1963; 28 FR 5671, June 11, 1963; 40 FR 54245, Nov. 21,
1975; 45 FR 25392, Apr. 15, 1980; 46 FR 47541, Sept. 29, 1981; 48 FR
41161, Sept. 14, 1983; 49 FR 47003, Nov. 30 1984; 54 FR 34981, Aug. 23,
1989; 60 FR 12886, Mar. 9, 1995; 67 FR 6873, Feb. 14, 2002; 68 FR 55467,
Sept. 26, 2003\]

**Supplement *Highlights* references**: 15(1), 50(2), 60(1).