Custom Federal Regulations Service™

**This is supplemental material**

**for Book C of your set of**

**Federal Regulations**

Title 38, Part 4

*Schedule for Rating Disabilities*

**Veterans Benefits Administration**

Supplement No. 23

Covering period of *Federal Register* issues

from December 23, 1997, through June 22, 1998

Copyright © 1998 Jonathan Publishing

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> **GENERAL INSTRUCTIONS**

Custom Federal Regulations Service™

**Supplemental Materials for *Book C***

**Code of Federal Regulations**

**Title 38, Part 4**

***Schedule for Rating Disabilities***

**Veterans Benefits Administration**

**Supplement No. 23**

25 June 199­8

Covering the period of Federal Register issues

from December 23, 1997, through June 22, 1998

When **Book C** was originally prepared, it was current through final
regulations published in the *Federal Register* of 24 March 1992. These
supple­mental materials are designed to keep your regulations up to date.
You should file the attached pages immediately, and record the fact that
you did so on the *Supplement Filing Record* which is at page C-8 of
Book C, *Schedule for Rating Disabilities*.

> **To ensure accuracy and timeliness of your materials,**
>
> **it is important that you follow these simple procedures:**
>
> 1\. Always file your supplemental materials immediately upon receipt.
>
> 2\. Before filing, always check the Supplement Filing Record (page
> C-8) to be sure that all prior supplements have been filed. If you are
> missing any supple­ments, contact the Veterans Benefits Administration
> at the address listed on page C-2.
>
> 3\. After filing, enter the relevant information on the Supplement
> Filing Record sheet (page C-8)---the date filed, name/initials of
> filer, and date through which the *Federal Register* is covered.
>
> 4\. If as a result of a failure to file, or an undelivered supplement,
> you have more than one supplement to file at a time, be certain to
> file them in chronological order, lower number first.
>
> 5\. Always retain the filing instructions (simply insert them at the
> back of the book) as a backup record of filing and for reference in
> case of a filing error.
>
> 6\. Be certain that you *permanently discard* any pages indicated for
> removal in the filing instructions in order to avoid confusion later.

To execute the filing instructions, simply remove *and throw away* the
pages listed under *Remove These Old Pages,* and replace them in each
case with the corres­pond­ing pages from this supplement listed under *Add
These New Pages*. Occasionally new pages will be added without removal
of any old material (reflecting new regulations), and occasionally old
pages will be removed with­out addition of any new material (reflecting
rescinded regulations)---in these cases the word *None* will appear in
the appropriate column.

> **FILING INSTRUCTIONS**

**Book C, Supplement No. 23**

**June 25, 1998**

*Remove these Add these Section(s)*

*[old pages]{.underline} [new pages]{.underline} [Affected]{.underline}*

**Do not file this supplement until you confirm that all prior
supplements have been filed**

4.88-1 to 4.88b-1 4.88-1 to 4.88b-1 Tech corr.

**Be sure to complete the**

***Supplement Filing Record* (page C-8)**

**when you have finished filing this material.**

> **HIGHLIGHTS**

**Book C, Supplement No. 23**

**June 25, 1998**

***Supplement* Highlights *references***: Where substantive changes are
made in the text of regulations, the paragraphs of *Highlights* sections
are cited at the end of the relevant section of text. Thus, if you are
reading §3.263, you will see a note at the end of that section which
reads: "Supplement *Highlights* references---6(2)." This means that
paragraph 2 of the *Highlights* section in Supplement No. 6 contains
information about the changes made in §3.263. By keeping and filing the
*Highlights* sections, you will have a reference source explaining all
substantive changes in the text of the regulations.

***Supplement frequency***: This Book C (*Schedule for Rating
Disabilities*) was originally supplemented four times a year, in
February, May, August, and November. Beginning 1 August 1995,
supplements will be issued *every month* during which a final rule
addition or modification is made to the parts of Title 38 covered by
this book. Supplements will be numbered consecutively as issued.

**Modifications in this supplement include the following:**

1\. A technical correction is being made to insert a previously omitted
table of contents for the Infectious Diseases, Immune Disorders and
Nutritional Deficiencies portion (§§4.88--4.89) of the Schedule for
Rating Disabilities.

**Infectious Diseases, Immune Disorders and Nutritional Deficiencies**

4.88 \[Removed and reserved\]

4.88a Chronic fatigue syndrome

4.88b Schedule of ratings---infectious diseases, immune disorders,

and nutritional deficiencies

4.88c Ratings for inactive nonpulmonary tuberculosis initially entitled

after August 19, 1968

4.89 Ratings for inactive nonpulmonary tuberculosis in effect on August
19, 1968

**§4.88** \[Removed and reserved\]

**§4.88a Chronic fatigue syndrome.**

\(a\) For VA purposes, the diagnosis of chronic fatigue syndrome
requires:

\(1\) New onset of debilitating fatigue severe enough to reduce daily
activity to less than 50 percent of the usual level for at least six
months; and

\(2\) The exclusion, by history, physical examination, and laboratory
tests, of all other clinical conditions that may produce similar
symptoms; and

\(3\) Six or more of the following:

\(i\) Acute onset of the condition,

\(ii\) Low grade fever,

\(iii\) Nonexudative pharyngitis,

\(iv\) Palpable or tender cervical or axillary lymph nodes,

\(v\) Generalized muscle aches or weakness,

\(vi\) Fatigue lasting 24 hours or longer after exercise,

\(vii\) Headaches (of a type, severity, or pattern that is different
from headaches in the pre-morbid state),

\(viii\) Migratory joint pains,

\(ix\) Neuropsychologic symptoms,

\(x\) Sleep disturbance.

\(b\) \[Reserved\]

\[59 FR 60902, Nov. 29, 1994, and 60 FR 37012, July 19, 1995\]

**Supplement *Highlights* references**: 11(1), 13(1).

*Next Section is §4.88b*

**§4.88b Schedule of ratings-infectious diseases, immune disorders**

**and nutritional deficiencies.**

Rating

**6300** Cholera, Asiatic:

As active disease, and for 3 months convalescence 100

Thereafter rate residuals such as renal necrosis under the

appropriate system.

**6301** Visceral Leishmaniasis:

During treatment for active disease 100

Note: A 100 percent evaluation shall continue beyond the cessation of
treatment for active disease. Six months after discontinuance of such
treatment, the appropriate disability rating shall be determined by
mandatory VA examination. Any change in evaluation based upon that or
any subsequent examination shall be subject to the provisions of
§3.105(e) of this chapter. Rate residuals such as liver damage or
lymphadenopathy under the appropriate system.

**6302** Leprosy (Hansen's Disease):

As active disease 100

Note: A 100 percent evaluation shall continue beyond the date that an
examining physician has determined that this has become inactive. Six
months after the date of inactivity, the appropriate disability rating
shall be determined by mandatory VA examination. Any change in
evaluation based upon that or any subsequent examination shall be
subject to the provisions of §3.105(e) of this chapter. Rate residuals
such as skin lesions or peripheral neuropathy under the appropriate
system.

**6304** Malaria:

As active disease 100

Note: The diagnosis of malaria depends on the identification of the
malarial parasites in blood smears. If the veteran served in an endemic
area and presents signs and symptoms compatible with malaria, the
diagnosis may be based on clinical grounds alone. Relapses must be
confirmed by the presence of malarial parasites in blood smears

Thereafter rate residuals such as liver or spleen damage under the

appropriate system.

**6305** Lymphatic Filariasis:

As active disease 100

Thereafter rate residuals such as epididymitis or lymphangitis

under the appropriate system.