U

**UNDULANT FEVER (Brucellosis)**

Undulant Fever, Brucellosis, Malta Fever or Mediterranean Fever, is a
systemic disease with an acute febrile stage and chronic stage
associated with relapse of fevers, weakness, sweats, and vague body
aches and pain. It is caused by Brucella organisms mainly Brucella
Abortus (cattle and hogs). It may be an occupational disease contracted
by direct contact with secretions and excretions and the ingestion of
milk or milk products. The disease may last 2 to 3 months or more, and
may have periods of remissions and exacerbations (recurrence of
symptoms) for years. After apparent recovery acute symptoms may flare up
following such other conditions as acute sinusitis, an injection of
typhoid vaccine, etc. During the disease, in either acute or chronic
phases, any part of the body may become acutely infected. The bacteria
are very prone to settle in any damaged or weakened organ, i.e.,
osteomyelitis, pneumonitis, vegetative endocarditis, involvement of
gastrointestinal or genitourinary systems.

# **Underwriting Requirements**

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

  -------------------------------------------------------- --------------
  Single attack, duration less than 6 months               

  Present or within 6 months of cessation of all symptoms  30

  After 6 months                                           0

  Duration 6 months or more, or recurrent attacks          

  Present or within 6 months of cessation of all symptoms  50

  Within 7 months through 2 years                          25

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

**UREMIA**

Uremia is the toxic clinical condition associated with renal
insufficiency and the retention in the blood of nitrogenous urinary
waste products (azotemia). It may be caused by either bilateral
obstruction to urinary outflow or by nonobstructive bilateral renal
disease. In most obstructive situations, the condition reverses when the
obstruction is removed. The majority of nonobstructive cases are not
reversible.

Symptoms are chiefly nervous headache, vomiting, dyspnea, insomnia,
convulsions and coma. Urinalysis usually shows marked signs of renal
disturbance and blood chemistry is abnormal with high nonprotein
nitrogen (NPN) and other nitrogenous waste products.

**Underwriting Requirements**

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

  -------------------------------------------------- --------------------
  Present or within 2 years, with NPN above 40, urea Refer to Section
  clearance less than 55 or phenolsulfonephthalein   Chief
  (PSP) excretion 50 percent or less in 2 hours      

  Two to 5 years, with normal NPN (40 or less) urea  300
  clearance over 55 and PSP over 50, to the debits   
  for blood pressure and urinalysis add              

  Others                                             Refer to Section
                                                     Chief
  -------------------------------------------------- --------------------

**URETERAL STRICTURE**

A ureteral stricture is a narrowing of the duct between the kidney and
the urinary bladder.

**Underwriting Requirements**

An APS (VA Form 29-815) is required.

  ----------------------------------------------- -----------------------
  Urine normal                                    

  Present                                         

  No complications                                55

  Others                                          Rate for complications

  History -- cured by surgery                     

  Within 1^st^ year                               20

  2^nd^ year                                      10

  After 2 years                                   0

  Urine abnormal                                  Rate for urine plus any
                                                  rating for stricture
  ----------------------------------------------- -----------------------

**URETHRAL DISORDERS**

**[Hypospadias]{.underline}**

Hypospadias is a congenital opening along the floor of the urethra
between the scrotum and the end of the penis. The condition is
frequently treated by surgery that may result in stricture, chronic
urethritis or cystitis.

**Underwriting Requirements**

An APS (VA Form 29-815) is required.

  ----------------------------------------------- -----------------------
  Present                                         Rate for urinary
                                                  findings

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

[**Stricture of Urethra**]{.underline}

A urethral stricture in the male is a narrowing of the duct between the
urinary bladder and the exterior of the body.

**Underwriting Requirements**

An APS (VA Form 29-815) is required.

  ----------------------------------------------- -----------------------
  Present                                         Rate for urinary
                                                  findings

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

[**Urethritis**]{.underline}

Urethritis is an inflammation of the urethra. Common causes are
Gonococcus and Chlamydia. Cases in which no organism can be isolated are
termed "nonspecific" urethritis. There may be associated infection in
the bladder and/or prostate.

**Underwriting Requirements**

An APS (VA Form 29-815) is required.

  ----------------------------------------------- -----------------------
  Acute, with prompt recovery                     0

  Chronic or repeated attacks                     R
  ----------------------------------------------- -----------------------

**URINE**

Urinalysis may provide information regarding genitourinary disease,
diabetes and other disorders. Most frequently routine tests are for
albumin, casts, white cells, red cells, glucose, nicotine and cocaine.

Specific gravity reflects the ability of the kidneys to concentrate or
dilute urine. Without history or evidence of cardiovascular or renal
disease or abnormal urinary finding, specific gravity may usually be
disregarded. A higher specific gravity, 1.020 to 1.030, is a reasonably
good indicator of adequate renal function. With history or evidence of
cardiovascular or renal disease or abnormal urinary findings, specific
gravities less than 1.008 should be questioned. If positive findings of
albumin, etc., are being rechecked, the specific gravity should be 1.008
or higher on at least one specimen to be satisfactory for insurance
purposes.

[**Albuminuria**]{.underline}

Albuminuria is the presence of albumin in the urine. Occasional, minor
albuminuria is of little significance. Frequent, constant or significant
albuminuria may indicate kidney disease.

Albuminuria ratings are determined from the table below by the age of
the applicant and the average number of milligrams of albumin found in
all new specimens.

+--------------------------------+------------------+------------------+
|                                | ## Ages          |                  |
+--------------------------------+------------------+------------------+
| ### Average Mg/D1\*            | [Under           | [40 and          |
|                                | 40]{.underline}  | O                |
|                                |                  | ver]{.underline} |
+--------------------------------+------------------+------------------+
| 11-50                          | 50               | 75               |
+--------------------------------+------------------+------------------+
| 51-125                         | 100              | 150              |
+--------------------------------+------------------+------------------+
| 126-200                        | 200              | 300              |
+--------------------------------+------------------+------------------+
| 201 and up                     | R                | R                |
+--------------------------------+------------------+------------------+

\*If only one of two or three specimens is abnormal (i.e., more than 11
Mg/D1) generally do not rate if the average is 50 mgms or less.

When associated with other impairments or urinary findings, see those
impairments.

##### [Casts]{.underline}

Casts are cylindrical bodies found on microscopic examination of the
urinary sediment. They are so named because they represent an actual
cast of the kidney tubule.

**Hyaline casts** represent protein that has precipitated in the tubule.
They are of little significance unless there is known kidney disease or
ratable albuminuria.

**Granular casts** may represent casts containing epithelial cells,
WBC's, or RBC's in various stages of degeneration. They may be
identified as RBC casts or WBC casts if that is the main element. RBC
casts are associated with kidney disease and WBC casts with conditions
such as pyelonephritis.

  ------------------------------------- --------------------- ---------------------
  Hyaline                                                     Disregard

  Granular                                                    

  Cause known                                                 RFC

  Otherwise                                                   Average number of
                                                              casts in all
                                                              specimens and use
                                                              table below

                                                              

  [Average number]{.underline}          [Debit]{.underline}   

  0-15                                  0                     

  16-40                                 50                    

  41-60                                 100                   

  Over 60                               200                   
  ------------------------------------- --------------------- ---------------------

[**Glycosuria**]{.underline}

Glycosuria is the presence of sugar (glucose) in the urine. Glycosuria
is an abnormal finding in any quantity and suggests that the individual
may be diabetic. This probability increases with the quantity of sugar
found. Diabetes has a familial tendency (see Family History) and tends
to occur more frequently among overweight individuals.

+-----------------+-----------------+-----------------+-----------------+
|                 | ## Ages         |                 |                 |
+-----------------+-----------------+-----------------+-----------------+
| [Amou           | [Under          | [40-            | [50 and         |
| nt]{.underline} | 40]{.underline} | 49]{.underline} | Up]{.underline} |
+-----------------+-----------------+-----------------+-----------------+
| 0.11 to 0.30%   | 0               | 30              | 30              |
+-----------------+-----------------+-----------------+-----------------+
| 0.31 to 0.50%   | 30              | 30              | 55              |
+-----------------+-----------------+-----------------+-----------------+
| 0.51 to 1.00%   | 55              | 55              | 80              |
+-----------------+-----------------+-----------------+-----------------+
| 1.01 to 2.00%   | 80              | 100             | 125             |
+-----------------+-----------------+-----------------+-----------------+

[**Red Blood Cells (RBC's)**]{.underline}

RBC's, unlike casts, may originate at any point in the urinary tract. In
women of child bearing age, they may be related to menstruation and a
repeat specimen may be indicated. Persistent hematuria is an indication
for urological investigation.

  -------------------------------------------- --------------------------
  Red Blood Cells -- average number in all     
  specimens                                    

  Cause known                                  RFC

  Cause unknown                                

  0-30                                         0

  Over 30                                      55
  -------------------------------------------- --------------------------

[**White Blood Cells (WBC's)**]{.underline}

WBC's usually indicate infection at some point in the urinary tract.
Most commonly this would be conditions such as urethritis, prostatitis,
cystitis and infection in the kidney.

  -------------------------------------------- --------------------------
  White Blood Cells -- average number in all   
  specimens                                    

  Cause known                                  RFC

  Cause unknown                                

  0-150                                        0

  Over 150                                     55

  Any combination of urinary impairments       Sum debits for other
                                               findings
  -------------------------------------------- --------------------------