# **A**

###### ABDOMINAL TENDERNESS

This term describes a symptom rather than an impairment. It implies an
acute or chronic disease or injury of the abdominal organs and must be
adequately explained before an evaluation may be made.

  ------------------------------------------------------- ---------------
  Temporary -- associated with acute gastro-intestinal    0
  symptoms                                                

  Others                                                  RFC
  ------------------------------------------------------- ---------------

###### ABORTION

The untimely delivery of a child before it is capable of living outside
the mother's body, usually before the 26^th^ week, is known as
miscarriage or abortion. There are many causes, but the most common are
glandular and emotional disturbances, injury, urinary or kidney
disorders, death of the child before birth, acute infections, and
tumors. Repeated abortions may be due to syphilis.

  ------------------------------------------------------- ---------------
  Spontaneous or elective                                 0

  Therapeutic                                             RFC
  ------------------------------------------------------- ---------------

## ABSCESSES

An abscess is a collection of pus caused by infection, or a cavity
formed by necrosis within a tissue or organ.

Abscess of the brain, kidney, heart, pancreas, liver or other organ may
be of variable significance depending on the extent, effect on the
function, and adequacy of treatment.

## Underwriting Requirements

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

+-----------------------------------------------+----------------------+
| # Brain                                       |                      |
+-----------------------------------------------+----------------------+
| No residuals                                  |                      |
+-----------------------------------------------+----------------------+
| Within 2 years of recovery                    | 125                  |
+-----------------------------------------------+----------------------+
| 3^rd^ -- 5^th^ year                           | 75                   |
+-----------------------------------------------+----------------------+
| After 5 years                                 | 0                    |
+-----------------------------------------------+----------------------+
| Others                                        | Rate as above, plus  |
|                                               | rate for residuals   |
+-----------------------------------------------+----------------------+
| Kidney                                        | Rate under           |
|                                               | Nephrectomy          |
+-----------------------------------------------+----------------------+
| Liver                                         |                      |
+-----------------------------------------------+----------------------+
| Present                                       | 100                  |
+-----------------------------------------------+----------------------+
| History                                       |                      |
+-----------------------------------------------+----------------------+
| No residuals, treated medically or surgically |                      |
+-----------------------------------------------+----------------------+
| Within 1^st^ year                             | 30                   |
+-----------------------------------------------+----------------------+
| 2^nd^ year                                    | 20                   |
+-----------------------------------------------+----------------------+
| 3^rd^ year                                    | 10                   |
+-----------------------------------------------+----------------------+
| After 3 years                                 | 0                    |
+-----------------------------------------------+----------------------+
|                                               |                      |
+-----------------------------------------------+----------------------+
| Lung                                          |                      |
+-----------------------------------------------+----------------------+
| Present                                       | 100                  |
+-----------------------------------------------+----------------------+
| Full recovery, no residuals                   |                      |
+-----------------------------------------------+----------------------+
| Within 1 year                                 | 50                   |
+-----------------------------------------------+----------------------+
| Within 2 years                                | 25                   |
+-----------------------------------------------+----------------------+
| After 2 years                                 | 0                    |
+-----------------------------------------------+----------------------+
|                                               |                      |
+-----------------------------------------------+----------------------+
| Minor Abscesses -- after recovery             |                      |
+-----------------------------------------------+----------------------+
| Alveolar (tooth)                              | 0                    |
+-----------------------------------------------+----------------------+
| Anal                                          |                      |
+-----------------------------------------------+----------------------+
| No fistula                                    | 0                    |
+-----------------------------------------------+----------------------+
| Fistula                                       | 0                    |
+-----------------------------------------------+----------------------+
| Axillary                                      | 0                    |
+-----------------------------------------------+----------------------+
| Others                                        | 0                    |
+-----------------------------------------------+----------------------+
| Breast (see also cyst)                        | 0                    |
+-----------------------------------------------+----------------------+
| Groin                                         | If due to venereal   |
|                                               | infection, see       |
|                                               | Gonorrhea (Sexually  |
|                                               | Transmitted          |
|                                               | Diseases)            |
+-----------------------------------------------+----------------------+
| Intestinal                                    | See Appendicitis     |
+-----------------------------------------------+----------------------+
| Neck                                          | See Lymphadenitis    |
+-----------------------------------------------+----------------------+
| Parotid -- no Fistula                         | 0                    |
+-----------------------------------------------+----------------------+
| Fistula present                               | 30                   |
+-----------------------------------------------+----------------------+
| Skin                                          | 0                    |
+-----------------------------------------------+----------------------+
| Tonsil                                        | See Quinsy           |
+-----------------------------------------------+----------------------+
|                                               |                      |
+-----------------------------------------------+----------------------+
| Pancreatic                                    |                      |
+-----------------------------------------------+----------------------+
| Present                                       |                      |
+-----------------------------------------------+----------------------+
| Single                                        | 50                   |
+-----------------------------------------------+----------------------+
| Multiple                                      | 100                  |
+-----------------------------------------------+----------------------+
| Operated                                      | 0                    |
+-----------------------------------------------+----------------------+
|                                               |                      |
+-----------------------------------------------+----------------------+
| Perinephritic                                 |                      |
+-----------------------------------------------+----------------------+
| Present                                       | 50                   |
+-----------------------------------------------+----------------------+
| Full recovery, no residuals                   |                      |
+-----------------------------------------------+----------------------+
| Within 1 year                                 | 20                   |
+-----------------------------------------------+----------------------+
| 2^nd^ year                                    | 15                   |
+-----------------------------------------------+----------------------+
| Within 2 years                                | 0                    |
+-----------------------------------------------+----------------------+
|                                               |                      |
+-----------------------------------------------+----------------------+
| Prostatic                                     | See Prostatic        |
|                                               | Disorders            |
+-----------------------------------------------+----------------------+

##### 

##### ACHLORHYDRIA AND ACHYLIA GASTRICA

Achlorhydria is the absence of hydrochloric acid in the gastric juices.
Achylia gastrica is a diminished or complete absence of all gastric
secretion -- both ferments and acid. It is detected by means of a
fractional analysis of the stomach contents usually done because of
gastrointestinal complaints, or in the search for the cause of anemia.
Pernicious anemia, stomach ulcer, and chronic atrophic gastritis may be
associated with this condition.

######### **Underwriting Requirements**

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

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

  No associated disease                            

  Present or within 1 year                         30

  2^nd^ year                                       10

  Over 2 years                                     0
  ------------------------------------------------ ----------------------

## ACIDOSIS

A diminished alkalinity of the blood with resultant increase and excess
of acid describes acidosis. It most commonly occurs during uncontrolled
diabetes, and at times during extreme starvation, cardiorenal disease,
and severe infections.

+------------------------------------------------+---------------------+
| # Determine cause                              | RFC                 |
+------------------------------------------------+---------------------+

**ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)**

AIDS is caused by a retrovirus (Human Immunodeficiency Virus), which
destroys the body's defenses against infection. HIV is a blood borne
infection usually transmitted by intimate sexual contact or the use of
contaminated needles in drug abusers.

**Positive Antibody Test --** Within weeks of infection, antibodies
usually develop which may be detected by appropriate tests. Because
there may be a prolonged asymptomatic phase (10 years or more) the use
of such test is a practical and accurate indicator of preceding HIV
infection.

**AIDS --** Acquired immune deficiency is a clinical syndrome which
eventually occurs as a result of immune system dysfunction caused by HIV
infection. It is manifested by lymphadenopathy, fatigue, weight loss,
diarrhea and neurological abnormalities. Commonly malignancies and
opportunistic infections occur.

Opportunistic infections are those which establish themselves while the
body's defenses are weakened. The most common of these is pneumocystis
carinii pneumonia (PCP). Others include candida esophagitis,
cytomegalovirus (CMV) infections, cryptococcosis, herpes simplex,
cryptosporidiosis and toxoplasmosis. Several other infections or
conditions may also be associated with AIDS, such as tuberculosis,
disseminated histoplasmosis, isosporiosis causing chronic diarrhea,
bronchial or pulmonary candidiasis, non-Hodgkin's lymphoma and Kaposi's
sarcoma.

**Underwriting Requirements**

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

  -------------------------------------------------- --------------------
  HIV infection and/or AIDS                          

  Confirmed positive antibody test                   R

  Unexplained opportunistic infection                R

  AIDS                                               R
  -------------------------------------------------- --------------------

## ADHESIONS

Adhesions are fibrous bands that result from inflammation. Such
inflammation may occur following abdominal operations, perforation of
the intestines, and disease of the peritoneum, serious cavities, i.e.,
pleural, pericardial, joints, etc. They may bind the intestines
together, interfere with their normal function, and occasionally cause
partial to complete intestinal obstruction. Adhesions may cause
recurrent indigestion, cramp-like pain, and, in the event of bowel
obstruction, an acute surgical emergency. Hazard to life increases with
repeated obstruction. They may cause impaired function or embarrassment
of heart, lungs and joints.

**Underwriting Requirements**

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

The following ratings apply to abdominal and pelvic adhesions without
obstruction. If there is obstruction, refer to the instructions covering
the obstructed area.

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

  Currently asymptomatic                                      0

  Symptomatic                                                 30
  ----------------------------------------------------------- -----------

###### ADRENAL HYPERPLASIA

Congenital adrenal hyperplasia is due to a defect in any one of several
processes involved in the production of cortisone-like hormones in the
adrenal gland. Symptoms in females may include menstrual irregularities
and increased body hair. Signs of the disease in males are those of male
hormone excess. The disorder is treated with cortisone.

  --------------------------------------------- -------------------------
  Present                                       Rate as Addison's Disease

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

## ADRENAL INSUFFICIENCY 

## (Addison's Disease)

Primary adrenal insufficiency or Addison's Disease, is uncommon. Atrophy
(presumably autoimmune) is the most frequently identified cause.
Secondary adrenal insufficiency is most commonly due to withdrawal of
therapeutic dosages of steroids.

Replacement therapy with cortisone and patient education regarding the
need to adjust the dosage appropriately in response to stress and
concurrent illness are the most important features of treatment.

**Underwriting Requirements**

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

  --------------------------------------------- -------------------------
  Primary                                       R-30

  Secondary                                     RFC
  --------------------------------------------- -------------------------

# **ALCOHOLISM**

The word "alcoholism" may refer to either of two different situations:

1.  Acute Alcoholism -- alcohol poisoning caused by heavy drinking on a
    single occasion.

    Chronic Alcoholism -- A behavioral disorder manifested by repeated
    consumption of alcohol in quantities that exceed the dietary and
    social uses of the community and interfere with the health,
    interpersonal relations or economic functioning of the drinker.

For the purposes of this manual, the term "alcoholism" refers to chronic
alcoholism.

Alcoholism is caused by complex interaction of biological, psychological
and sociological factors, which may include genetic and chemical
abnormalities in the body, poor nutrition, emotional problems, childhood
deprivations and environmental conditions. The role of each of these
factors in alcoholism is still being studied.

Alcoholism is a progressive disease and individuals termed "alcoholic"
may vary widely in the severity of their condition. It may take several
years for a "problem drinker" to become a chronic alcoholic. If
untreated, alcoholism becomes severe and may even be fatal.

The true alcoholic is uninsurable, unless service-connected conditions
precipitate this disease. Any individual with delirium tremens,
alcoholic psychoses or any evidence of brain damage should be rejected.
A record of sanitarium treatment or reform under a doctor's order
suggests a history of alcoholism that should be looked into.

**Alcoholic** -- an individual whose drinking is out of control and
self-destructive.

**Problem drinker** -- an individual whose drinking frequently affects
his/her work adversely.

**Recovered alcoholic** -- an individual who has undergone
rehabilitation and whose disease has been arrested through abstinence.

**Underwriting Requirements**

An APS (VA Form 29-8158) may be needed in cases where there is a history
or record of more than occasional overindulgence of alcohol or treatment
by a physician, hospital or institution for alcoholism. In cases with
long history of overindulgence or record of hospitalization for
intoxication or institutional care, special inquiry should be made
regarding the habits, physical, mental, social or business
manifestations of overindulgence which required the necessary treatment.

  ---------------------------------------------------------- ------------
  Drinking to mild excess, exhilaration or stimulation       Not ratable

  Recovered alcoholics who presently do not use alcohol, or  
  use it only occasionally with very mild effects:           

  0-1 year after treatment                                   300-50

  1-3 years after treatment                                  200-25

  3-5 years after treatment                                  100-0
  ---------------------------------------------------------- ------------

Prolonged use of alcohol can produce secondary impairments. The most
serious complication is cirrhosis of the liver, but there is also a
positive correlation between alcohol abuse and gastrointestinal disease,
heart disease, diabetes and neuropathy. Debits for impairments secondary
to alcoholism will be added to the total.

\*Note: The Section Chief may reduce the above rating in those cases
where there is presently no overindulgence, disability, loss of time
from employment, or functional or mental impairment. Special
consideration should be given to those with a well-adjusted social life
and to reformed alcoholics who are members of Alcoholics Anonymous.
Consideration should be given to service-connected conditions and
correlation of these service-connected conditions with the veteran's
alcohol consumption.

###### ALKAPTONURIA

This is a rare congenital disorder due to the absence of a liver enzyme
which alters the aromatic amino acid metabolism. The diagnosis rests on
the classical triad of arthritis, pigmentation of cartilages, and
darkening of the urine, caused by the presence of homogentisic acid.
Staining of the cartilage of the nose, ears (ochronosis) may occur in
older patients and sometimes causes cartilaginous degeneration of joints
and severe arthritis. A positive urine test for homogentisic acid
confirms the diagnosis. This disorder is compatible with a long life. No
specific treatment is available.

**Underwriting Requirements**

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

  ----------------------------------------- -----------------------------
  Alkaptonuria                              See Osteoarthritis
                                            (Arthritis) -- rate for
                                            degree of disability

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

**ALLERGY**

Most allergic reactions are mild and of little underwriting concern.
These include conditions such as allergic rhinitis, hay fever, atopic
dermatitis, contact dermatitis and urticaria. Other conditions such as
asthma require careful evaluation.

Sudden, severe allergic reactions, known as anaphylactic shock, may be
manifested by extreme breathing problems and vascular collapse. Under
these conditions, the allergic reactions are life threatening. This
happens most commonly with certain drugs, insect stings and food.

## Underwriting Requirements

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

  ----------------------------------------- -----------------------------
  Anaphylactic shock                        

  Full recovery, single episode             0

  Otherwise                                 35

  Other allergies                           0
  ----------------------------------------- -----------------------------

**ALOPECIA (Baldness)**

Alopecia or absence of hair, may be patchy (alopecia areata), or total
loss of hair may occur secondary to burns, x-ray treatment, skin
infections, lupus erythematosus, high fevers, emotional shock and
debilitating diseases. The most common causes are heredity and the
general aging process.

  ------------------------------------------ ----------------------------
  Cause known                                0

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

## AMPUTATIONS

Amputation is the loss of part or an entire appendage or limb. Most are
due to trauma, but a variety of diseases, particularly diabetes and
tumors, may result in amputation.

**Underwriting Requirements**

An APS (VA Form 29-8158) may be necessary to determine the cause, and
the present condition of a recent amputation.

  ------------------------------------------ ----------------------------
  Due to disease                             RFC

  Due to trauma                              

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

## ANEMIA

Anemia is the name applied to a reduction below normal in the number of
red blood corpuscles, a decrease in the hemoglobin (the coloring matter
of the red blood corpuscles), or both. Anemia is characterized by a
decrease in the blood's ability to carry oxygen. Anemia itself gives
very few symptoms, unless severe or developing acutely. The causes are
internal or external hemorrhage, defective blood formation caused by
nutritional deficiencies, such as pernicious anemia, toxins and poisons,
or increased destruction of blood cells by such diseases as malaria and
hemolytic anemia.

**Underwriting Requirements**

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

  ------------------------------------------------- ---------------------
  Elliptocytosis (Oval-cell Anemia)                 

  With no overt hemolysis or anemia                 0

  With overt hemolysis or anemia                    100-40

                                                    

  Hemolytic                                         

  Unoperated                                        100

  Operated, splenectomy (spleen removed) CBC normal 

  Within 1 year                                     50

  Within 2 years                                    20

  After 2 years                                     0

  Cause known                                       RFC

  Cause unknown, present                            100

  History, recovered, normal stable hemoglobin      

  Less than 1 year                                  55

  Thereafter                                        0

                                                    

  Mediterranean (Cooley's Anemia; Thalassemia-Major 
  and Minor)                                        

  Mediterranean Anemia, Cooley's Anemia,            200
  Thalassemia Major                                 

  Thalassemia Intermedia                            175

  Thalassemia Minor discovered accidentally, no     0
  subjective symptoms, good blood count, hemoglobin 
  within normal limits                              

  Others                                            40

                                                    

  Pernicious (Addisonian, primary or macrocytic)    

  Uncomplicated, case controlled                    

  Within 1 year                                     55-30

  Thereafter                                        0

  Complications                                     250

                                                    

  Posthemorrhagic                                   

  If cause not ratable, upon recovery               0

  Present                                           RFC

  Chronic                                           RFC

  Unoperated                                        1000

  After splenectomy                                 

  Within 1 year                                     200

  Within 2 years                                    100

  Within 3 years                                    50

  Within 4 years                                    25

  After 4 years                                     0

                                                    

  Sickle Cell                                       

  If anemia definitely established                  400

  If sickling trait (sicklemia)                     50

  Mild-moderate                                     125

  Complications                                     Refer to Section
                                                    Chief

  After successful bone marrow transplant           

  Within 5 years                                    Refer to Section
                                                    Chief

  Within 6-10 years                                 100

  After 10 years                                    55
  ------------------------------------------------- ---------------------

## ANGIOMA

Angioma is a benign tumor made up of either blood vessels, in which case
it is called a hemangioma, or lymph vessels, when it is called a
lymphangioma. Other terms used for hemangioma are nevus, birthmark,
strawberry mark and port wine stain. These vessels are imbedded in the
skin or mucous membrane and are usually congenital. Usually they remain
dormant but occasionally increase in size or undergo degenerative
changes. They may be removed for cosmetic reasons but usually are
removed for some other reasons.

**Underwriting Requirements**

If any change in size or appearance or recent operation obtain APS (VA
Form 29-8158) as to possibility of malignancy.

  ------------------------------------------ ----------------------------
  Involving skin, no change in size, no      0
  operation                                  

  Operation, benign pathological report      0

  Others                                     Refer to Tumor Rating Chart
                                             C

  Present                                    

  Stable, uncomplicated                      0

  Others, extensive, complicated             Refer to Section Chief

  History, partial or complete removal on    0
  recovery                                   
  ------------------------------------------ ----------------------------

**ANIMAL BITE**

**(Rabies)**

The principal hazard of an animal bite is rabies (hydrophobia) which is
fatal. Symptoms of rabies do not develop until from 2 weeks to 6 months
after infection.

## Underwriting Requirements

An APS (VA Form 29-8158) is required within 6 months.

  ------------------------------------------ ----------------------------
  No complications -- upon recovery          0

  Rabies (if animal declared or suspected to 
  be rabid)                                  

  Without treatment                          

  Within 6 months                            500

  After 6 months                             0

  After prompt and complete Pasteur          
  treatment                                  

  Within 3 months                            20

  After 3 months                             0
  ------------------------------------------ ----------------------------

###### 

###### 

###### ANOREXIA NERVOSA

Victims of anorexia nervosa have a disturbed sense of body image and a
morbid fear of obesity that is not relieved even with weight loss to the
point of cachexia. Most cases occur in women and are mild, but the
condition can be serious and result in death. The prognosis may be worse
if the onset is after age 25 and the course prolonged.

**Underwriting Requirements**

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

  ----------------------------------------------------- -----------------
  Not associated with affective disorders or substance  
  abuse                                                 

  Present                                               R

  Within 1^st^ year of recovery                         80

  2^nd^ year                                            55

  3^rd^ year                                            30

  After 3 years                                         0

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

## 

## 

## APPENDICITIS

Appendicitis is an inflammation of the appendix, a narrow tube 3 to 4
inches long, located in the lower abdomen, suspended from the large
bowel. An inflamed appendix may form an abscess (appendiceal), may
rupture, and result in peritonitis (an inflammation of the membrane that
lines the abdominal walls). If the abscess does not rupture, the
inflammation may cause adhesions that obstruct bowel action. If
unoperated, recurrent attacks of appendicitis are common.

  ------------------------------------------------------ ----------------
  One Attack                                             

  Unoperated                                             

  Within 6 months                                        0

  After 6 months                                         0

  Operated -- with recovery                              0

  Two or More attacks                                    

  Unoperated                                             

  Within 6 months                                        0

  After 6 months                                         0

  Operated -- with recovery                              0
  ------------------------------------------------------ ----------------

**ARTERIOSCLEROSIS**

**(Atherorna, Atherosclerosis)**

Arteriosclerosis (hardening of the arteries) is the thickening of the
artery walls and the loss of some of their elasticity. Advancing age is
the chief cause. As the artery walls become thicker, a diminished supply
of blood for bodily needs occurs and impaired bodily function results.
The arteries may become blocked and could result in death.

Routine chest x-rays may show an aorta that is not normal in size or
shape and these may be the warning signs of arteriosclerosis.
Examination of the blood vessels in the eye's retina may show changes
from normal that must be considered as evidence of artery disease. The
arteries at the wrists and temples may be more prominent or feel harder
than normal. In the lower extremities, it may give rise to pain in the
legs and calves on walking. This is known as intermittent claudication.
Ratings are necessary because of the higher probability of associated
coronary disease.

**Underwriting Requirements**

When an application shows evidence of arteriosclerosis greater than
consistent with age, an APS (VA Form 29-8158) may be necessary if not
adequately described.

  -------------------------------------------- ----------------- -----------------
                                               [Under age        [Over age
                                               50]{.underline}   50]{.underline}

  Slight                                       0                 0

  Moderate (beaded)                            50                25

  Marked (pipe stream)                         100               75

  Add any required debits for Intermittent                       
  Claudication                                                   
  -------------------------------------------- ----------------- -----------------

## 

## 

## ARTHRITIS

Arthritis is an inflammation of a joint. The inflammation is usually
accompanied by pain and swelling. If the attacks are prolonged or
recurrent, degenerative changes and varying degrees of disability may
occur. The infective agent may be blood-borne or extend from a
neighboring abscess or point of infection, such as teeth or tonsils.
Occasionally, a joint becomes inflamed following a penetrating wound.
Arthritis may occur in acute or chronic form. In certain forms the
cartilage deteriorates and erodes. The bony surfaces of the joint become
rough, spurs and bony lips develop.

**Acute Infectious Arthritis** may be due to a specific local infection
of a joint, to toxic substances from a distant source such as teeth and
tonsils; it may also result from acute infectious diseases like
pneumonia and gonorrhea. Pain and swelling is usually of short duration
and recovery is prompt.

**Traumatic Arthritis** is the result of an injury; usually to a single
joint and recovery occurs in most cases without deformity.

**Rheumatoid Arthritis** is a chronic symmetric inflammatory arthritis
with a variable clinical course. It commonly is associated with fatigue,
weakness and anorexia and less commonly with fever, lymphadenopathy and
splenomegaly. When accompanied by splenomegaly and leukopenia and
occasionally thrombocytopenia it is referred to as Felty's syndrome.
Complications may include muscle weakness and atrophy, vasculitis which
may involve any organ, pleuritis, pulmonary fibrosis or nodules, or
rarely pulmonary hypertension, symptomatic pericarditis, episcleritis or
scleritis. In severe cases it may be accompanied by an anemia due to
chronic disease. Excess mortality in rheumatoid arthritis has been
associated with infection, gastrointestinal bleeding and adverse drug
reactions.

**Osteoarthritis**, also known as hypertrophic, and degenerative, is a
common chronic form usually resulting in a knobby appearance of the
joints of the hands, feet and knees. It usually occurs in middle-aged or
elderly people, causes deformity and impairs function of joints. While
it does not have any great effect on the length of life, disability is
almost certain. Progress is slow and recurrences are common. There is no
specific therapy. Joint changes remain after discomfort has been
relieved.

**Periarthritis** is inflammation of tissues around a joint, usually
confined to the shoulder joint. It can be likened to and is sometimes
mistaken for bursitis. It causes gradually increasing pain with
progressive limitation of motion, and runs a chronic course lasting from
several months to 2 or 3 years. After running its course, the pain
subsides and the shoulder motion is slowly regained. Its affect on
longevity is almost nil. From an underwriting standpoint, periarthritis
more closely resembles osteoarthritis than rheumatoid arthritis.

**Underwriting Requirements**

An APS (VA Form 29-8158) may be necessary unless adequately described.
For acute infections, traumatic, and minimal rheumatoid arthritis the
requirements vary. If there is a long history of treatment with ACTH or
cortisone, the case is to be referred to the Section Chief. Prolonged
treatment with these drugs has unfavorable reactions in some cases.

\*In cases of infections, traumatic, osteoarthritis, or periarthritis
where there is no loss of time from employment (because of this
illness), no limitation of motion or disability and clinically the
applicant appears normal even though the x-ray of spine or joint has
been reported as showing moderate arthritis, rate as "Minimal".

  -------------------------------------------------- --------------------
  Acute Infectious Arthritis                         

  Present or under treatment                         

  Duration of illness is:                            

  Over 1 month                                       50

  Less than 1 month                                  30

  After a year                                       0

  Within a year                                      20

  Single attack duration 3 weeks or less, recovered  0

                                                     

  Traumatic Arthritis                                

  Rate for degree of disability                      35-0

                                                     

  Chronic-Symptomatic -- Multiple Joint Deformity    

  Rate for degree of limited motion and disability   200-50

                                                     

  Marie-Strumpell Arthritis -- Ankylosing            
  Spondylitis                                        

  Present -- active and symptomatic early stages     100

  Advanced                                           200

  Mild to moderate                                   0

  Ankylosis, only part of spine involved             30

  Others, or entire spine involved                   80-30

                                                     

  Osteoarthritis                                     0

                                                     

  Periarthritis                                      

  Minimal -- slight interference with the use of     10
  shoulder, elbow, hip or knee                       

  Others -- marked interference with the use of      30
  shoulder, elbow, hip or knee                       

                                                     

  Rheumatoid Arthritis                               

  Minimal involvement affecting hands only           0

  More extensive involvement                         

  Within 1^st^ year of last symptom                  30

  2^nd^ year                                         20

  3^rd^ year                                         10

  After 3 years                                      0

  Within 1 year of onset and during active treatment Add 55 to above
  with corticosteriods                               

  Others, severe deformity, wheelchair-bound, on     Refer to Section
  gold or methotrexate, multiple surgeries or other  Chief
  complications                                      
  -------------------------------------------------- --------------------

**ASCITES**

Ascites is an accumulation of fluid in the abdominal cavity usually
secondary to liver, heart or kidney disease. Cirrhosis is a frequent
cause.

**Underwriting Requirements**

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

  -------------------------------------------------- --------------------
  All cases                                          RFC

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

**ASTHMA**

Asthma is a respiratory disorder characterized by episodes of cough,
shortness of breath, and wheezing. The symptoms of asthma vary in
severity and duration across an extremely wide spectrum. Individuals may
be entirely free from asthma for years before recurrence; other
asthmatics have continuous symptoms and frequent exacerbations. A life
threatening complication called status astmaticus requires hospital
treatment.

Asthma is usually divided into two types, extrinsic (seasonal or
allergic) and intrinsic (perennial), though this division is only
marginally useful since features of both types frequently co-exist.

Extrinsic asthma tends to have its onset in childhood in individuals
with a personal and family history of allergy. It is triggered by such
things as airborne pollens, dust, dander and molds.

Intrinsic asthma may be caused by non-allergic factors such as exercise,
stress, pulmonary infection, cold, environmental or occupational
irritants.

In determining a rating, not only the type of asthma but the frequency
and severity of attacks are important. Severity can be categorized as
follows:

**Mild** -- infrequent or seasonal attacks of short duration; not
incapacitating; lungs clear between attacks; continuing medication not
required; and normal pulmonary function tests between attacks.

**Moderate** -- more severe attacks; incapacitating up to 24 hours;
requiring occasional medications such as injections, spray, adrenalin or
ephedrine; there may be slight wheezing or a few musical rales on
examination; no emphysema.

**Severe** -- prolonged, frequently disabling attacks for periods of
more than 24 hours; requiring frequent medication; attacks which require
hospitalization, intravenous therapy and steroids.

Asthma may sometimes be associated with serious impairment of heart,
kidneys, and lungs, such as: cardiac asthma related to cardiovascular
and renal diseases; Miner's asthma related to anthracosis and silicosis;
etc. Such asthma is usually uninsurable.

**Underwriting Requirements**

An APS (VA Form 29-8158) is required at all times unless the condition
is adequately described on the application or in the records. It is
necessary to know the type, number of attacks, duration, and severity,
as well as the amount of medication or treatment required, if any.

  -------------------------------------------- --------------------------
  Extrinsic                                    

  Mild                                         0

  Moderate                                     50

  Severe                                       75

                                               

  Intrinsic                                    

  Mild                                         30

  Moderate                                     70

  Severe                                       100
  -------------------------------------------- --------------------------

**ATELECTASIS**

Atelectasis is the collapse of air cells in the lung, in either small
area or large, due to obstructed bronchus. It may follow surgery
(especially general anesthesia, upper abdominal) or trauma.

  -------------------------------------------- --------------------------
  Recovered, no residuals                      0

  Others                                       Refer to Section Chief
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