H

## HAY FEVER

Hay fever is a condition characterized by acute inflammation of the
membranes of the nose and eyes, often with asthmatic symptoms. It is
basically an allergic condition excited by a plant pollen to which the
individual is sensitive. Its appearance is usually seasonal. Disability
is rare although a change in climate may be required in seeking relief.
The term "hay fever" in popular usage may also refer to an allergy to
such substances as protein foods, dusts and animal emanations. Hay fever
is also called rose cold and pollenosis.

# 

  ----------------------------------------------- -----------------------
  Hay fever                                       Disregard

  Associated with asthma                          Rate for Asthma
  ----------------------------------------------- -----------------------

**HEADACHE**

**(Cephalalgia)**

A headache is a symptom. Its causes are many and sometimes obscure.
Underwriting should, in general, follow rules for cause.

The term "migraine headache" applies to a specific type of headache. Its
use is justified only in the unquestioned absence of any other condition
to which the headache might be related. It tends to be unilateral
(occurring on, or affecting one side only) in location, periodically
recurrent, often hereditary, and severe and frequently disabling. They
are usually accompanied by nausea and often by vomiting. "Sick
headaches" and "bilious headaches" are usually attacks of migraine and
should be regarded as such.

With a history of increasing frequency, duration and severity of
attacks, endeavor to rule out increased intra-cranial pressure.

Cluster headaches are paroxysmal, severe, with sudden onset and usually
unilateral. The eye, temporal region and face are involved. Attacks tend
to be grouped close together with remissions.

# **Underwriting Requirements**

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

+---------------------------------------------+------------------------+
| Headache                                    |                        |
+---------------------------------------------+------------------------+
| Cause known                                 | RFC                    |
+---------------------------------------------+------------------------+
| Cause unknown, mild to moderate,            | 0                      |
| occasional, few hours duration, not         |                        |
| incapacitating                              |                        |
+---------------------------------------------+------------------------+
| More severe                                 | Rate as migraine       |
+---------------------------------------------+------------------------+
| # Migraine or Cluster                       |                        |
+---------------------------------------------+------------------------+
| Mild, no more than once a month, not        | Disregard              |
| incapacitating, not under treatment         |                        |
+---------------------------------------------+------------------------+
| Moderate, no more than once a month,        | 30\* - 0               |
| incapacitating not more than 2 days         |                        |
+---------------------------------------------+------------------------+
| More severe                                 | R -- 30\*              |
+---------------------------------------------+------------------------+
| If no attacks in 3 years                    | 0                      |
+---------------------------------------------+------------------------+

\* If onset within 6 months consider possibility of brain disorder
(tumor) or if transient neurological signs or symptoms, use higher
ratings to R.

### **HEART DISORDERS**

**[Cardiomegaly (Enlarged Heart)]{.underline}**

Cardiomegaly is almost always secondary to organic disease such as valve
defects, hypertension, ischemic heart disease or cardiomyopathy. A
chamber may be enlarged because of: 1) hypertrophy; 2) dilatation; or 3)
a combination of hypertrophy and dilatation.

1)  **Hypertrophy of the myocardium** -- thickened muscular wall. Left
    ventricular hypertrophy (LVH) will develop after long standing high
    blood pressure or aortic valve stenosis because of the extra work
    needed to force the blood out of the left ventricle. The most
    accurate way to measure wall thickness is by an echocardiogram but
    hypertrophy may be suggested by the ECG.

2)  **Dilatation of a ventricle** -- over distended chamber. The dilated
    heart may appear enlarged on a chest x-ray.

3)  **Combined hypertrophy and dilatation** -- The most common causes of
    LVH are hypertension and aortic stenosis. The most common causes of
    RVH are pulmonic stenosis, congenital heart disease, left
    ventricular failure and chronic lung disease. Common causes of
    dilatation of the left ventricle are aortic insufficiency, mitral
    insufficiency, myocardial infarction and cardiomyopathies.

The presence of any type of heart enlargement is a sign that the
underlying heart disease is moderate to severe.

The apparent width of the heart on a chest x-ray is influenced by
positioning, build, depth of inspiration, chest wall deformities and
cardiac cycle. Therefore, any debits applied will be greatly influenced
by a history of conditions known to enlarge the heart (hypertension,
valve disorder, heart attack, etc.) and supporting evidence such as
abnormal ECG or echocardiogram.

Clinicians use the cardio-thoracic ratio (heart width divided by the
width of the chest) to report heart size. If less than 50%, it is
normal; 51% to 53%, mild; 54% to 57%, moderate; and over 58% is marked
enlargement. At best, this is a very inexact guide.

The insurance industry, however, uses the Clark-Ungerleider table for
heart size. The actual heart width and build are used to determine the
degree of enlargement.

  ----------------------- ----------------------- -----------------------
  [C-U Table]{.underline} [C/T Ratio]{.underline} [Debits]{.underline}

                                                  

  No other evidence of                            
  cardiovascular disease:                         

  Up to 20%               Up to 55%               0

  20 to 25%               55 to 57%               75

  Over 25%                58% and up              R

                                                  

  With other evidence of                          
  cardiovascular disease:                         

  Up to 10%               Up to 50%               0

  11 to 15%               50 to 52%               75

  16 to 20%               53 to 55%               125

  Over 20%                55% and up              R
  ----------------------- ----------------------- -----------------------

### **[Cardiomyopathy]{.underline}**

A group of disorders primarily affecting the myocardium,
Cardiomyopathies are classified as: 1) hypertrophic; 2) congestive; or
3) restrictive.

1)  There are two distinct forms of hypertrophic cardiomyopathy:

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a)  Asymmetric septal hypertrophy (ASH), and idiopathic hypertrophic
    subaortic stenosis (IHSS). In this disorder, the interventricular
    septum hypertrophies out of proportion to the rest of the left
    ventricle, and poses a risk of serious arrhythmias and sudden death.

b)  Concentric or left ventricular hypertrophy (LVH). This form may be
    seen with hypertension and valvular heart disease. Heart size is the
    critical factor in determining a rating.

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1)  Congestive Cardiomyopathy -- includes muscle injury from vial
    myocarditis, toxic effects of drugs or alcohol and the affect of
    systemic diseases such as systemic lupus erythematosis, amyloidosis
    and others.

2)  Restrictive Cardiomyopathy -- in the United States this is an
    unusual form. It is manifested by scarring of the myocardium which
    restricts ventricular filling in diastole.

#### **Underwriting Requirements**

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

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

  Hypertrophic                                    

  ASH, IHSS                                       300

  Concentric or LVH                               Rate for Heart Size

  Congestive                                      R-100

  Restrictive                                     R-100

  History                                         RFC

  Type or severity unknown                        R
  ----------------------------------------------- -----------------------

**[Endocarditis, Acute and Subacute]{.underline}**

Endocarditis is a severe infectious process involving the inner lining
and valves of the heart, caused by various organisms. Since there is
almost invariably organic heart involvement, the condition rarely heals
without trace. Permanent valvular deformity usually results.

**Underwriting Requirements**

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

  ------------------------------------------------ ----------------------
  Acute without residual murmur                    Rate as Rheumatic
                                                   Fever, two or more
                                                   attacks

  Subacute bacterial endocarditis                  

  Within 1 year                                    400

  Within 2 to 3 years                              200

  Within 4 to 5 years                              100

  After 5 years                                    50

  Chronic -- (other than subacute bacterial)       Rate for Murmur
  ------------------------------------------------ ----------------------

**[Heart Failure, Congestive Heart Failure (CHF), Cardiac
Decompensation, Cor Pulmonale]{.underline}**

If the left ventricle fails, shortness of breath from lung congestion
(pulmonary edema) is the common symptom. With right ventricular failure,
swelling of the feet, ankles and legs (Pedal edema, pre-tibial edma)
occurs.

Sudden, acute CHF may be fatal or it may resolve partially or
completely. It may be seen shortly after a myocardial infarction. The
degree of heart failure should be assessed from tests and symptoms
recorded after recovery or period of stability.

Treatment of the underlying heart disease may improve heart function but
the heart's reserve power and its ability to survive new heart injuries
or stress is diminished. This condition is called compensated CHF.

Cor pulmonale is enlargement of the right ventricles as a result of
pulmonary hypertension. Chronic lung disease, primary pulmonary
hypertension, multiple pulmonary emboli and massive obesity with sleep
apnea are common causes. An ECG interpreted as showing "p-pulmonale"
suggests that cor pulmonale is present.

# **Underwriting Requirements**

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

  ------------------------------------------------ ----------------------
  Heart failure, present                           R

  History, compensated CHF                         Refer to Section Chief
  ------------------------------------------------ ----------------------

## [Myocarditis]{.underline}

Inflammation of the heart muscle is myocarditis. It is usually an acute
viral illness. If severe, permanent heart muscle damage may occur.

# **Underwriting Requirements**

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

  ------------------------------------------------ ----------------------
  Recovered, no evidence of significant heart      
  injury                                           

  Within 1 year                                    75

  2^nd^ and 3^rd^ year                             55

  Thereafter                                       0

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

## [Pericarditis]{.underline}

Pericarditis is an inflammatory disease involving the outer covering of
the heart. Its causes are many and include tuberculosis, rheumatic
fever, virus and bacteria infections and possibly coronary artery
disease.

**Underwriting Requirements**

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

  ------------------------------------------------ ----------------------
  Acute, with or without recurrences, full         0
  recovery                                         

  Chronic, cause known, idiopathic                 Rate as chronic
                                                   constrictive operated

  Chronic, cause known, others                     RFC

  Chronic, cause unknown                           R

  Chronic, constrictive, unoperated                R

  Chronic, constrictive, operated, no other heart  75
  disease, restrictive cardiomyopathy ruled out,   
  full recovered, asymptomatic                     

  Others                                           R
  ------------------------------------------------ ----------------------

## [Transplants]{.underline}

Cardiac transplantation is an investigational procedure for end-stage
heart failure of any cause.

# **Underwriting Requirements**

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

  ------------------------------------------------ ----------------------
  Transplants                                      R

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

**HEAT EXHAUSTION AND SUNSTROKE**

Heat exhaustion is a condition usually caused by prolonged exposure to
high temperatures, although it may occur from exposure to the sun\'s
heat. Heat exhaustion is characterized by weakness, pallor, cold sweat,
rapid feeble pulse, and high blood pressure. Heat cramps are often
associated.

Sunstroke or heat stroke is a more serious condition, which is usually
caused by long direct exposure to the sun\'s rays with high
temperatures. It is characterized by high body temperature, hot dry
skin, a rapid bounding pulse, deep respiration, and early collapse.
Convulsions occur in some cases. An attack of sunstroke predisposes to
recurrence with increasing hazard.

Both heat exhaustion and sunstroke are more likely to occur in
individuals who are in poor general physical condition. Alcoholics are
particularly susceptible.

**Underwriting Requirements**

Obtain an APS (VA Form 29-8158) if not adequately described on the
application. It is advisable to consider the possibility of a heart
attack at any age, but especially over 40.

  ------------------------------------- ------------------- -------------------
                                        Disabled            

  One attack                            [1 week or          [Over 1
                                        less]{.underline}   week]{.underline}

  Within 1 year of recovery             0                   20

  After 1 year                          0                   0

  Two Attacks                                               

  Within 1 year of recovery             30                  50

  Within 2 years                        10                  30

  After 2 years                         0                   10

  Three or more attacks                                     

  Within 1 year of recovery             60                  120

  Within 2 years                        40                  75

  Within 3 years                        20                  35

  Within 4 years                        0                   15
  ------------------------------------- ------------------- -------------------

**HEMATEMESIS**

Vomiting blood is known as hematemesis. The most frequent cause is
peptic ulcer (gastric or duodenal). It may also result from some blood
disorders, advanced diseases of the heart, liver and gastric cancer.
Melena (dark stools) follows practically every case of hematemesis.
Vomited blood usually has the color and appearance of \"coffee
grounds.\" This is not to be confused with hemoptysis (blood spitting).
Occasionally no cause will be found even after extensive tests and
surgery.

**Underwriting Requirements**

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

  ------------------------------------------------------ ----------------
  Present or history                                     RFC

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

**HEMOPHILIA**

Known as bleeder's disease, is a hereditary bleeding disease of males.
Females transmit the disease but do not suffer from it. The blood lacks
the ability to coagulate. Nosebleed and hemorrhage into the soft tissue
is common. Severe hemorrhage may follow the most trivial injury. There
are also hemophiloid states of varying degrees, which are not true
hemophilia. In these, the only consistently abnormal laboratory finding
is prolonged bleeding time. Coagulation time is normal. Outlook for life
is relatively good.

**Classic Hemophilia** -- classic hemophilia is the most common major
bleeding disorder. It is inherited by the male offspring of a mother who
carries a faulty gene.

**Mild hemophilia** -- rare minor bleeding episodes, surgical and dental
procedures uncomplicated and no history of using replacement factors
except at surgery. No restrictions in activity.

**Moderate hemophilia** -- rare episodes of major bleeding, joint
bleeding only after obvious trauma, factor replacement used rarely or
only for surgical and dental procedures.

**Severe hemophilia** -- history of major bleeding episodes, or bleeding
without trauma, joint involvement.

**Underwriting Requirements**

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

  ----------------------- -------------------- ------------------------ ----------------------
  [Age]{.underline}       [Mild]{.underline}   [Moderate]{.underline}   [Severe]{.underline}

  15 -- 39                100                  200                      300

  40 -- 59                50                   100                      200

  60 and over             0                    50                       100
  ----------------------- -------------------- ------------------------ ----------------------

**Hemophilia B. Christmas Disease** -- Christmas disease (reduced
clotting factor activity) is almost identical to classic hemophilia.

**Underwriting Requirements**

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

  ------------------------------------ ----------------------------------
  Christmas disease                    Rate as Classic Hemophilia

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

**Von Willebrand's Disease (VWD)** -- decrease in VW factor or its
function that causes abnormality in the platelet's role in clotting.
"Acquired" VWD appears in association with autoimmune and immune system
diseases such as monoclonal gammopathy, myeloproliferative disorders and
others.

**Underwriting Requirements**

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

  ------------------------------------ ----------------------------------
  Mild                                 0

  Moderate                             100

  Severe                               Rate per Hemophilia schedule

  Acquired VWD                         Sum debits
  ------------------------------------ ----------------------------------

**Hereditary Hemorrhagic Telangrectasia (Osler-Weber-Rendu Syndrome)**
-- tufts of abnormal blood vessels beneath mucous membranes of the nose,
mouth, lungs and GI tract that may be the source of bleeding. Larger
malformations (aniomas) may occur in the liver, lungs, or brain.

**Underwriting Requirements**

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

  -------------------------------------------------------- --------------
  Minor nose bleeds only and no major vascular             0
  malformations                                            

  History of extensive nose bleeds; infrequent             75
  gastrointestinal bleeding; no evidence of major vascular 
  malformation in the brain, liver or lungs                

  Major vascular malfunctions in GI tract, liver, lung or  200
  other organ                                              
  -------------------------------------------------------- --------------

**Vascular purpuras** -- disruption of small blood vessels may result in
bleeding into any tissue, particularly the skin and GI tract.

**Underwriting Requirements**

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

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

  Cause unknown                                            0
  -------------------------------------------------------- --------------

**HEMOPTYSIS**

Blood spitting is called hemoptysis. It may be the first sign of
tuberculosis, which is the most common cause of hemoptysis, or it may be
due to bronchiectasis, lung abscess, pneumonia, aneurysm or cancer. It
may vary from slight bloody streaking of the sputum to massive
hemorrhage. Fatal hemorrhage occurs in only a small percentage of the
cases, and then usually in cases of long standing.

**Underwriting Requirements**

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

  ----------------------------------------------------------- -----------
  Cause determined                                            RFC

  Single episode, cause undetermined                          

  Adequately investigated, including x-ray studies, etc.,     
  where determined necessary                                  

  Age 40 and under                                            0

  40 and over -- within 1 year                                45

  40 and over -- within 2 years                               15

  40 and over -- after 2 years                                0

  Inadequately investigated or full information no available  
  such as 1 x-ray only                                        

  Under 40 -- within 1 year                                   55

  Under 40 -- within 2 years                                  30

  Under 40 -- after 2 years                                   0

  40 and over -- within 6 months                              400

  40 and over -- 6 months to 1 year                           75

  40 and over -- within 2 years                               25

  40 and over -- after 2 years                                0
  ----------------------------------------------------------- -----------

For recurrent attacks, double the above ratings.

**HEPATITIS, VIRAL**

Viral hepatitis (sometimes called infectious hepatitis) is a common
illness that is caused by a number of viruses. The typical course of
this illness includes a non-specific prodromal phase, an icteric phase
characterized by jaundice and laboratory abnormalities, and a recovery
phase.

Based on serological tests, usual route of transmission and expected
outcome, three broad types of hepatitis have been identified.

**Hepatitis A** -- food and water borne, individuals are not carriers
and the infection does not lead to chronic hepatitis.

**Hepatitis B** -- blood or needle borne, or through direct personal
contact such as sexual partners. Recovery usually results in immunity
but the individual may become a carrier or develop chronic hepatitis.

**Hepatitis C** -- this includes many of the cases formerly called
Non-A, Non-B. Like hepatitis B, it is blood borne, usually resulting
from transfusion of infected blood. Chronic hepatitis is a common
outcome.

In those cases of hepatitis in which liver function abnormalities
persist beyond six months, chronic hepatitis can be assumed. This is of
two types:

1)  Chronic Persistent Hepatitis -- usually asymptomatic, showing only
    mild liver enzyme abnormalities and is non-progressive, in that it
    does not lead to cirrhosis or liver failure.

2)  Chronic Active Hepatitis -- may be symptomatic, usually associated
    with more extensive liver function abnormalities and may progress to
    cirrhosis or liver failure.

A liver biopsy may be necessary for the clinician to reliably
differentiate the types of chronic hepatitis.

From an underwriting standpoint, the type of hepatitis is important and
is an indication of its source (drug abuse, STD) and its expected
outcome. Full recovery can be expected with hepatitis A, chronic disease
may result in 10% of hepatitis B cases, and in up to 40% of hepatitis C.

  ---------------------------------------------------- ------------------
  Hepatitis, acute (all types)                         

  One attack, complete recovery, LFT's not ratable     0

  Others                                               See Chronic
                                                       Hepatitis

  Hepatitis, chronic                                   

  Persistent or carrier state                          

  Asymptomatic, confirmed by biopsy, LFT's not ratable 55

  Others                                               200

  Active                                               R
  ---------------------------------------------------- ------------------

**HERNIA**

A hernia is a protrusion of an organ, or part of it, through the wall of
the cavity which normally contains it. It is spoken of being reducible
or nonreducible. A reducible hernia is one in which the organ can be
returned to its normal position within the body cavity.

**Underwriting Requirements**

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

  ---------------------------------------------------- ------------------
  Abdominal, femoral, inguinal, ventral                

  Present                                              

  Reducible                                            0

  Non-reducible                                        50

  History with surgical cure and return to normal      0
  duties                                               

  Diaphragmatic, hiatal                                

  Present                                              

  Asymptomatic                                         0

  Symptomatic or complicated                           50

  History with surgical cure and return to duties      0
  ---------------------------------------------------- ------------------

**HERPES SIMPLEX VIRUS (HSV-1 AND HSV-2)**

HSV-1 causes the common cold sore and other infections of the skin and
eyes. HSV-2 is the usual cause of genital herpes (though a small percent
is due to HSV-1) and is treated with acyclovir.

**Underwriting Requirements**

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

  --------------------------------------- -------------------------------
  Genital herpes                          See Sexually Transmitted
                                          Diseases

  Others                                  0
  --------------------------------------- -------------------------------

**HERPES ZOSTER (Shingles)**

Shingles, or Herpes Zoster, is an acute infectious disease characterized
by an inflammation of one or more nerve roots accompanied by
blister-like eruptions along the course of the nerve. This is usually
seen in adults and is caused by the same virus that causes chicken pox
in children. Pain may be severe, and neuralgia may persist long after
the original disease has cleared. Herpes Zoster has been identified, in
some cases, as an opportunistic infection associated with AIDS.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required in complicated cases or repeated
attacks.

  ---------------------------------------------------- ------------------
  Uncomplicated -- single attack, after recovery       0

  Complicated or repeated attacks                      

  Within 1 year                                        0

  After recovery                                       0
  ---------------------------------------------------- ------------------

**HICCOUGH**

Hiccough, or hiccup, is an intermittent sudden spasm of the diaphragm
recurring at brief intervals. Usually it is temporary due to
indigestion, nervous influences, etc. The attacks are usually of short
duration.

Persistent attacks lasting from hours to days may be associated with
diseases in the chest, abdominal tumors, or central nervous system
disorders. The cause of transient episodes may never become apparent but
with prolonged or recurrent attacks the cause can usually be determined.

**Underwriting Requirements**

An APS (VA Form 29-8158) will be required where there is a history of
prolonged attacks.

  ---------------------------------------------------- ------------------
  Occasional temporary attacks, no treatment           0

  Prolonged single, or mild recurrent attacks          

  Within 6 months                                      25

  After 6 months                                       0

  Recurrent prolonged attacks                          

  Cause known                                          RFC

  Others                                               

  Present                                              150

  Within 1 year of recovery                            50

  After 1 year                                         0
  ---------------------------------------------------- ------------------

**HODGKIN'S DISEASE**

Hodgkin\'s disease is a chronic progressive and fatal disease for which
there is no known cure. The cause is unknown and many feel that it is
malignant while others consider it infectious. The condition usually
becomes generalized and involves the lymph nodes, spleen, liver and bone
marrow. The first sign is usually a painless superficial lymph
enlargement in the cervical (neck) nodes. The progress of the disease is
evidenced by increasing exhaustion to the point of collapse and death
sometimes occurs within a few months.

Occasionally, an original diagnosis of Hodgkin\'s Disease becomes
questionable because no symptoms are found in a current examination. In
such cases the rating will depend upon the number of years, which have
elapsed since the last such diagnosis was made.

**Underwriting Requirements**

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

  ----------------------------------------------- -----------------------
  Hodgkin's disease                               See Tumor Rating Chart
                                                  A under Carcinoma

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

**HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION, AIDS**

See Acquired Immunodeficiency Syndrome (AIDS)

**HYPERGLYCEMIA**

Hypoglycemia means there is not enough sugar in the blood. It occurs
occasionally in diabetics when an overdose of insulin is administered
and may result in \"insulin shock.\" Disturbances of pancreatic or liver
function may disrupt the balance between insulin and blood sugar to
produce an excess of insulin. This is known as hyperinsulinism or
hypoglycemia. It may be due to infection, pregnancy, hemorrhage, sarcoma
or tumors of the pancreas. Usually the cause is functional without
organic disease.

Symptoms include sweating, flushing, numbness, chills, hunger, changes
in pulse rate and blood pressure. If not relieved it can produce
disorientation, convulsions, coma and death.

**Underwriting Requirements**

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

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

  Others                                              

  Within 1 year                                       100

  After 1 year                                        35
  --------------------------------------------------- -------------------