T

TESTICLES

The testicles produce sperm and hormones for secondary male sexual
characteristics. Atrophy or degeneration of the testes is caused by a
variety of conditions. Epididymitis is an inflammation of the spermatic
chord. The acute form may be due to gonorrhea. Chronic epididymitis may
have similar origins, but is occasionally tuberculosis.

A hydrocele is an abnormal accumulation of fluid surrounding the testes.
Orchitis is an inflammation of the testicle. It is a common complication
of mumps, but may result from injury, gonorrhea, other infections, and
occasionally from tumors. Atrophy and sterility may follow.

Undescended testes (cryptorchidism) is a condition in which one or both
testicles remain in the abdomen or inguinal canal. They are usually
removed surgically because of their potential for malignant change.

**Underwriting Requirements**

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

+--------------------------------------------+-------------------------+
| Atrophy                                    |                         |
+--------------------------------------------+-------------------------+
| Due to mumps or other infection            | 0                       |
+--------------------------------------------+-------------------------+
| Others or cause unknown                    | Refer to Section Chief  |
+--------------------------------------------+-------------------------+
|                                            |                         |
+--------------------------------------------+-------------------------+
| Enlargement                                |                         |
+--------------------------------------------+-------------------------+
| Due to trauma, hydrocele, infection or     | RFC                     |
| tumor                                      |                         |
+--------------------------------------------+-------------------------+
| Cause unknown                              | Refer to Section Chief  |
+--------------------------------------------+-------------------------+
|                                            |                         |
+--------------------------------------------+-------------------------+
| Epididymitis                               |                         |
+--------------------------------------------+-------------------------+
| Due to gonorrhea or unknown cause          | Rate for Gonorrhea      |
+--------------------------------------------+-------------------------+
| Due to tuberculosis                        | RFC                     |
+--------------------------------------------+-------------------------+
| Present, cause unknown                     | 100                     |
+--------------------------------------------+-------------------------+
| Other acute history                        |                         |
+--------------------------------------------+-------------------------+
| Single attack -- recovered                 | 0                       |
+--------------------------------------------+-------------------------+
| Multiple attacks                           |                         |
+--------------------------------------------+-------------------------+
| Within 1 year                              | 30                      |
+--------------------------------------------+-------------------------+
| After 1 year                               | 0                       |
+--------------------------------------------+-------------------------+
|                                            |                         |
+--------------------------------------------+-------------------------+
| Removal of testicle                        |                         |
+--------------------------------------------+-------------------------+
| Due to injury                              | 0                       |
+--------------------------------------------+-------------------------+
| Others                                     | RFC                     |
+--------------------------------------------+-------------------------+
| Orchitis                                   |                         |
+--------------------------------------------+-------------------------+
| Single acute attack after recovery         | 0                       |
+--------------------------------------------+-------------------------+
| > Evidence of chronic inflammation, or     | R-30                    |
| > progressive enlargement                  |                         |
+--------------------------------------------+-------------------------+
| Due to gonorrhea                           | RFC                     |
+--------------------------------------------+-------------------------+
|                                            |                         |
+--------------------------------------------+-------------------------+
| Undescended testicle(s)                    |                         |
+--------------------------------------------+-------------------------+
| Present                                    |                         |
+--------------------------------------------+-------------------------+
| No symptoms                                | 0                       |
+--------------------------------------------+-------------------------+
| With symptoms                              | 55-0                    |
+--------------------------------------------+-------------------------+
| Corrected by surgery                       | 0                       |
+--------------------------------------------+-------------------------+
|                                            |                         |
+--------------------------------------------+-------------------------+
| Vasectomy                                  |                         |
+--------------------------------------------+-------------------------+
| For sterilization                          | 0                       |
+--------------------------------------------+-------------------------+
| Other causes                               | RFC                     |
+--------------------------------------------+-------------------------+

TETANUS

Tetanus, or lockjaw, is an acute infectious disease usually caused by
contamination of a wound. Symptoms consist of restlessness, headache,
and muscular stiffness, particularly in the neck and abdomen, followed
by locking of the jaw and severe convulsions.

**Underwriting Requirements**

If complicated or residual impairment shown, an APS (VA Form 29-8158)
will be required.

  -------------------------------------------- --------------------------
  No complications or sequelae -- after        0
  recovery                                     

  With complications or sequelae               Rate for complication or
                                               impairment
  -------------------------------------------- --------------------------

THROMBOSIS

Thrombosis is the formation, development or presence of a clot
(thrombus) within a blood vessel. It is attached to the wall and may
partially or completely block (occlude) the vessel, causing interference
or stoppage to the flow of blood. If a thrombus breaks loose into the
blood stream it is called an embolus.

Embolism is a circulatory condition in which a clot of blood or a
foreign particle floating in the blood stream may partially or
completely block a blood vessel. An embolus may lodge in the heart,
lung, brain, liver, or in vessels of the extremities.

These conditions may follow such histories as thrombophlebitis,
abdominal or pelvic surgery, fractures and bruises of the extremities,
arteriosclerosis, heart disease, pregnancy and childbirth. They may
develop suddenly without any apparent predisposing cause as in coronary
thrombosis or occlusion.

Underwriting Requirements

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

  ------------------------------------------ ----------------------------
  Coronary embolism or thrombosis            See Heart Disease

  Cerebral embolism or thrombosis            See Cerebral Hemorrhage

  Pulmonary embolism or thrombosis           

  Present                                    100

  Fully recovered -- within 3 months         25

  Fully recovered -- after 3 months from     RFC
  diagnosis                                  

  Thrombosis of vein(s)                      See Thrombophlebitis

  Other embolism or thrombosis               Refer to Section Chief
  ------------------------------------------ ----------------------------

**THYMOMAS**

The thymus gland is located in the mediastinum and has a role in
immunologic response.

Thymomas are tumors, approximately 25% of which are malignant. These
usually invade locally and metastasis is rare. Symptoms occur because of
compression of the trachea and large blood vessels in the chest.

For unknown reasons, myasthenia gravis occurs in about half of people
with thymomas. Improvement of the disease is usually seen after surgical
removal of the thymus gland.

**Underwriting Requirements**

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

  ---------------------------------------------- ------------------------
  Thymic carcinoma                               See Tumor Rating Chart A

  Benign thymomas                                

  Present                                        R

  If operated                                    

  Within 1 year                                  30

  Within 2 years                                 20

  Within 3 years                                 10

  After 3 years                                  0

  With myasthenia gravis                         See Myasthenia Gravis
  ---------------------------------------------- ------------------------

THYROID DISORDERS

The thyroid is a gland of internal secretion consisting of two lobes,
one on either side of the trachea (windpipe) joined by a connecting arch
(isthmus). In association with other endocrine glands, it governs the
energy expenditure of the body and is an important factor in metabolism
and other body functions.

**[Hyperparathyroidism]{.underline}**

Primary hyperparathyroidism is characterized by elevated calcium levels
in the blood and is caused by excessive secretion from one or more
parathyroid glands. This disorder is treated by surgical removal of the
overactive gland. Non-parathyroid causes of hypercalcemia include
malignancy, kidney disease and a variety of other conditions including
sarcoidosis. Their treatment is that of the underlying disorder. The
primary disease is manifested by elevated calcium, non-specific symptoms
such as weakness and fatigue, bone disorder, kidney problems, and x-ray
findings.

**Underwriting Requirements**

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

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

  Complicated or not stabilized                       100

  History                                             

  Calcium levels normal                               0

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

**[Hyperthyroidism]{.underline}**

Patients with overactive thyroid glands have hyperfunctioning nodules,
toxic multinodular goiter, lymphocytic thyroiditis (Hashimoto's Disease)
or subacute thyroiditis. One form of hyperthyroidism, Graves' Disease,
consists of a goiter, the typical eye signs and skin changes in the
legs. Patients with hyperthyroidism may exhibit nervousness, tremor,
palpitations, weight loss, heat intolerance and muscle weakness. On
physical exam they may demonstrate sinus tachycardia or atrial
fibrillation, as well as elevation of the systolic blood pressure. Beta
blocking drugs or antithyroid drugs may be used to control symptoms.
Long term remission or cure can be achieved with thyroidectomy,
radioactive iodine therapy or 6 to 24 months of therapy with antithyroid
drugs. Successful treatment may result in hypothyroidism, making thyroid
replacement therapy necessary.

**Underwriting Requirements**

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

  ----------------------------------------------------- -----------------
  Hyperthyroidism                                       

  Treated and controlled (thyroid tests normal, pulse   0
  normal)                                               

  Others                                                55
  ----------------------------------------------------- -----------------

**[Hypoparathyroidism]{.underline}**

This disease is characterized by the lack of the parathyroid hormone.
This biochemical syndrome may be idiopathic or acquired. There is a
hypocalcemia and hyperphosphatemia.

The acquired is most commonly seen following thyroidectomy, x-ray
irradiation of neck or massive radioactive iodine for cancer of the
thyroid. In about 70 percent of these cases the presenting symptom is
overt or latent tetany. In the chronic or latent disease there are
personality changes, anxiety state and mental retardation. This anxiety
state in adults may progress to a severe depressive psychosis for which
they are admitted to mental institutions. Some patients develop
unexplained cardiac failure. With prompt diagnosis and treatment the
outlook is fair.

Idiopathic hypoparathyroidism is a rare congenital condition and is
manifested by tetany in the infant or early childhood. This is often
associated with candidiasis and Addison\'s disease.

Pseudohypoparathyroidism and psuedo-pseudohypoparathyroidism has in
addition a genetic defect associated with short stature, round face
(often with perpetual smile) and deformities of bones of hands and feet.

Hypoparathyroidism is most often due to accidental removal of the
parathyroid glands during thyroid surgery, or removal of too much
parathyroid tissue during surgery for hyperparathyroidism. It is
characterized by low serum calcium levels.

**Underwriting Requirements**

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

  ----------------------------------------------- -----------------------
  Asymptomatic, normal calcium level              0

  Symptomatic, abnormal calcium level             R
  ----------------------------------------------- -----------------------

**[Hypothyroidism]{.underline}**

Hypothyroidism may be due to lymphocytic thyroiditis, prior radioactive
iodine therapy for hyperthyroidism, thyroidectomy, or less commonly,
X-ray treatment to the neck, iodine excess or deficiency, congenital
disorders and drug side effects. Symptoms are non-specific and include
weakness and fatigue, dry skin, cold intolerance, muscle and joint pain,
constipation, anorexia and weight gain. There may also be a decrease in
the pulse rate and a decline in the systolic blood pressure.

**Underwriting Requirements**

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

  ----------------------------------------------------- -----------------
  Hypothyroidism                                        

  With or without replacement therapy                   

  Asymptomatic                                          0

  Symptomatic                                           55

  Congenital hypothyroidism (cretinism)                 

  Prompt diagnosis and institution of therapy, no       0
  adverse effects                                       

  Others, depending on degree of mental impairment, if  R-55
  any                                                   
  ----------------------------------------------------- -----------------

**[Thyroiditis, Goiter, Thyroid Nodules]{.underline}**

Subacute thyroiditis is a self-limited disorder associated with a viral
illness. Treatment is symptomatic with aspirin and Cortisone.

Enlargement of the thyroid may be generalized or nodular and associated
with an increase, decrease or no change in thyroid hormone activity. The
possibility of malignancy must be excluded in thyroid nodules.

**Underwriting Requirements**

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

  ----------------------------------------------------- -----------------
  Thyroiditis                                           

  Full recovery                                         0

  Symptomatic or on treatment                           55

                                                        

  Thyroid enlargement                                   

  Asymptomatic, stable                                  0

  Others                                                100

                                                        

  Solitary nodule                                       

  No evidence of malignancy, asymptomatic               0

  Others -- symptomatic, inadequately investigated      100
  ----------------------------------------------------- -----------------

TIC DOULOUREUX

Tic Douloureux, also called trifacial or trigeminal neuralgia of the
sensory nerve of the face, tongue, and teeth, manifested by severe
stabbing pain. There is a tendency for the condition to recur. Severe
cases may require an operation to sever the nerve or to excise the
ganglion, or an injection of the nerve with alcohol. This is noted for
sudden attacks of excruciating facial pain. Suicides are not uncommon in
severe cases.

**Underwriting Requirements**

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

  ----------------------------------------------------- -----------------
  Unoperated -- mild to moderate, controlled by         
  medication, nondisabling, no narcotics used           

  Within 1 year                                         30

  After 1 year                                          0

  Unoperated -- severe or treated by injections         

  Within 1 year                                         100

  Within 2 years                                        40

  After 2 years                                         0

  Operated -- ganglion excised or nerve root severed,   
  no sequelae                                           

  Within 1 year                                         30

  After 1 year                                          0

  Others                                                Rate as
                                                        unoperated

  Within 1 year of onset                                55-30

  Others, treated medically or surgically               30-0
  ----------------------------------------------------- -----------------

TORTICOLLIS (Wry Neck)

This is a condition in which contraction of the neck muscles causes a
tilting of the head. The deformity is one-sided. The muscle chiefly
involved is that which extends from the mastoid region behind the ear to
the collarbone and upper margin of the sternum. The head is pulled down,
the face turned to the opposite side and the chin is thrust forward.
Spinal curvature may result.

Acute torticollis is rare and temporary, and may result from exposure to
cold or from injury. Recovery is usually uneventful.

Chronic torticollis may be due to inflammation or disease of nearby
structures, such as glands or vertebrae, or to nerve disorders,
including central nervous disease and poliomyelitis. It is sometimes an
assumed attitude due to defect of the eye muscles which requires tilting
of the head to balance objects in line of vision.

Underwriting Requirements

Obtain an APS (VA Form 29-8158) when there is history of treatment
within 2 years.

  --------------------------------------------- -------------------------
  Acute torticollis -- mild or no deformity     

  After recovery                                0

  Chronic torticollis                           

  Cause removed                                 

  Slight to moderate deformity                  0

  Marked deformity                              15

  Cause not removed                             RFC
  --------------------------------------------- -------------------------

TOXOPLASMOSIS

There are two main types of toxoplasmosis: congenital and acquired. The
congenital form can occur in newborns or appear in the patient\'s 20\'s
or 30\'s. The latent variety occurs as toxoplasmic retinochoroiditis.
This is usually chronic and is mostly limited to the eyes, with
progressive loss of vision. The acquired form is a febrile illness with
notable enlargement of the lymph nodes. Other organs may also be
involved, including the myocardium, respiratory system, skeletal muscle,
liver, brain and skin. The presence of organ involvement with
retinochoroiditis is often fatal, but if the patient recovers, prognosis
is good.

**Underwriting Requirements**

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

  -------------------------------------------- --------------------------
  Congenital                                   Rate for maximum expected
                                               blindness

  Acquired                                     

  0-2 years                                    Refer to Section Chief

  After 2 years                                Refer to Section Chief

  If immuno-suppression is suspected           See AIDS
  -------------------------------------------- --------------------------

TRACHEOTOMY

Tracheotomy is the operative procedure of cutting into the trachea for
the purpose of creating an opening into it because of an obstruction
above it. The obstruction may be caused by a foreign body or may be due
to disease.

**Underwriting Requirements**

Wound closed, an APS (VA Form 29-8158) is required for cause.

  -------------------------------------------- --------------------------
  Wound closed                                 RFC

  Wound open                                   Add 30 to the rating for
                                               cause
  -------------------------------------------- --------------------------

TRANSIENT ISCHEMIC ATTACK (TIA)

A common form of TIA is amaurosis fugax, a temporary blindness in one
eye. Other common forms include unilateral facial or limb weakness,
impaired speech (aphasia) or gait (ataxia).

**Underwriting Requirements**

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

  ------------------------------------------------------ ----------------
  Single or multiple episodes                            100

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

TRAUMA

Anyone who has suffered from trauma (burns, spinal cord and head
injuries, near electrocution, fractures, amputations, near drowning,
crush injuries, shock, etc.) should be postponed until recovery is
complete, or if recovery is unlikely, until the level of recovery has
reached a plateau. There should be no need for indwelling catheters,
IVs, or other tubing. All planned and surgical procedures have been
completed.

Underwriting Requirements

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

  --------------------------------------------------- -------------------
  Fully recovered, no residual impairments            0

  Others -- rate for residual impairments, summing    Rate for residual
  debits for each. Be aware that residuals also may   impairments
  be psychiatric.                                     
  --------------------------------------------------- -------------------

TREMORS

Tremors may be voluntary or involuntary. Generally they are associated
with underlying causes, the nature of which should be studied.

**Underwriting Requirements**

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

  ---------------------------------------------------- ------------------
  Mild or diagnosed as an intention tremor (increased  0
  by voluntary movement which may cease on rest), no   
  change for several years, nervous system otherwise   
  normal                                               

  Others -- cause known                                RFC

  Otherwise                                            Refer to Section
                                                       Chief
  ---------------------------------------------------- ------------------

TUBERCULOSIS

Tuberculosis is a chronic infectious disease which is usually spread by
the inhalation of infected droplets. Once known as "the white plague",
the advent of public health measures and effective medications resulted
in a steady decline in the importance of tuberculosis. Worldwide travel,
AIDS, drug abuse and a lowered suspicion on the part of physicians are
resulting once again in an increased incidence.

Tuberculosis may be pulmonary (involving the lungs), or extrapulmonary
(involving virtually any other organ in the body). Pulmonary
tuberculosis may be asymptomatic and found on routine chest x-ray.
Classical symptoms include cough, fever, weight loss and hemoptysis. The
signs and symptoms of extrapulmonary disease, of course, depend on the
organ involved.

Treatment may be given on a prophylactic basis, usually when the
tuberculin skin test is found to be positive in an infant, or when it
changes from negative to positive in an adult without other evidence of
disease. Treatment of established tuberculosis always requires
multi-drug therapy, careful follow-up and strict patient compliance.
Under optimum circumstances relapses are unusual and the need for
surgical procedures is rare.

**Underwriting Requirements**

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

  --------------------------------------------------- -------------------
  Positive skin test only, prophylactic treatment     0

                                                      

  Tuberculosis, active or recovered                   

  Pulmonary                                           

  Determined to be drug resistant strain              R

  Others                                              

  Single attack, present or recovered within the time 
  period, currently under treatment, no progression,  
  not currently disabled                              

  Within 1^st^ year                                   20

  2^nd^ year                                          10

  Thereafter                                          0

  Relapsed and still present on treatment, or         
  recovered within the time period                    

  Within 1^st^ year                                   40

  2^nd^ year                                          30

  3^rd^ year                                          20

  4^th^ year                                          10

  Thereafter                                          0

  Others                                              Refer to Section
                                                      Chief

                                                      

  Extrapulmonary                                      

  Currently under treatment, or recovered within the  
  time period                                         

  Within 1^st^ year                                   40

  2^nd^ year                                          30

  3^rd^ year                                          20

  4^th^ year                                          10

  Thereafter                                          0

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

**TULAREMIA**

Tularemia, or rabbit fever, is a disease transmitted to man from small
animals. The infection most commonly occurs in the handling of rabbits
in which the infective agent enters the body through cuts or abrasion in
the skin. The usual symptoms are fever, headache, generalized aching and
weakness.

Underwriting Requirements

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

  --------------------------------------------------- -------------------
  Within 1 year of recovery                           20

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

TUMORS (Neoplasms)

A tumor is a swelling or an enlargement of tissue. The determination of
its true nature, whether benign or malignant, will depend on the
location, physical characteristics and the microscopic morphology of the
tissue. Certain tumors may be diagnosed accurately without microscopy.
Tumors suspected of being malignant require adequate documentation.

A neoplasm may grow to such proportion as to impinge on adjacent
structures and thus impair their function. It may actually invade these
tissues and destroy them. Malignant tumors also have the ability to
metastasize; that is, small groups of tumor cells dislodge and are
carried via the arteries, veins and other means to widely separated
areas of the body where they start another tumorous growth. Certain
types of tumors have a tendency to recur after therapy. The microscopic
appearance of cells is sometimes used to indicate the degree of
malignancy. In those incidences where tissue biopsy is not feasible,
cellular smears may be obtained. The Papanicolau smear grades I and II
indicate benign cells; grade III an intermediate form and grades IV and
V signify the presence of malignant cells. If the grade is not given, it
must be considered that the grade is either IV or V.

Tumors are generally divided into two groups: Malignant and benign.
Often, there is no clear line of demarcation between the two groups.

Malignant Neoplasms -- Malignant tumors are composed of cells exhibiting
a disregard for normal limitations of growth with a loss of organization
and useful function. They are also characterized by the ability to
continue their abnormal growth after the initiating stimulus is removed.
Most are classified according to cell type from which they originate.

Carcinoma -- A malignancy originating in epithelial tissue; the tissue
that covers the body, lines the cavities and ducts and forms the
functional part of glands. The common types include squamous cell, basal
cell, epithelial and adenocarcinoma.

Sarcoma -- The malignant cells of this tumor are of connective tissue
and mesenchymal tissue origin. These include the cancers of fat, bone,
cartilage, muscle and fibrous tissue. Leukemia, bone marrow and lymph
tissue tumors are also included in this group.

Endothelial Malignancies -- Endothelium is a flat tissue that lines
blood vessels, lymphatic channels and serious cavities.

Mixed Tumors -- These contain more than one type of tissue. The usual
forms include mixed tumors of the parotid, dermoid, cysts and teratomas.

Benign Neoplasms -- These tumors are localized growths, do not
metastasize and usually do not recur after removal. They may be treated
as having low mortality significance.

Precancerous Conditions -- These conditions are prone to malignant
degeneration. Any rapid enlargement, inflammation, irritation,
ulceration, bleeding, induration, change of color, or other changes in
these lesions should arouse suspicion of malignant degeneration.

[Tumor Rating Charts A, B, and C]{.underline}

The tumor chart of table A is to be used for determining the rate in
each class of tumor other than brain tumors and minor impairments, when
present, and within the number of years elapsed since the tumor was
removed. By finding the tumor in the following pages, the class of
rating can then be obtained in the tumor rating charts or tables that
follow the listings. If the tumor is found to be present on examination,
the rating under \"Exam\" will be assigned. If the tumor has been
removed, the rating will be that figure which appears under the column
for the number of years since removed and in the line extended to the
right from the class number for the tumor.

The brain tumor chart or table B is to be used for determining the rate
in each class of brain tumor, when present, and within the number of
years elapsed since the tumor was removed. By finding the name of the
tumor on chart B, the class can then be referred to the tumor rating
chart at the bottom of the same page. If the tumor is found on current
examination, the rating under \"Present\" will be assigned. If the tumor
has been removed, the rating will be that figure which appears under the
column for the number of years since removed and in the line extended to
the right from the class number for the tumor.

Chart C, Minor Tumors or Impairments, will be used to determine the
rating, if any, where the impairment or disability is considered of a
minor degree, permanent and stable,

[Cytology Classification Chart - Papanicolau Technique]{.underline}

CLASS I - Normal cells, negative for cancer

CLASS II - Artificial cells, most probably benign

CLASS III - Borderline cell changes, needs follow-up

CLASS V - Definitely abnormal cells, positive for cancer

CLASS IV - Positive cell changes, most probably cancer

**Underwriting Requirements**

The records must give an adequate description of the condition or a
current examination will be necessary. An APS (VA Form 29-8158) is
required and may obviate requesting a current examination. Extreme care
must be taken to positively determine the possibility of malignancy
before ratings are applied.

TUMOR RATING CHART A

  ------------------------------------------------ ----------------------
  Acanthoma                                        V

  Acidophilic adenoma                              See Pituitary Adenoma,
                                                   Tumor Rating Chart B

  Acanthosis nigricans                             

  Benign -- no progression 1 year                  0

  Others                                           IV

  Acoustic neuroma (neurinoma)                     See Tumor Rating Chart
                                                   B

  Adamantinoma                                     III

  Adenocarcinoma                                   Rate as to tissue
                                                   involved

  Adenocystoma (cystadenoma)                       See Tumor Rating Chart
                                                   C

  Adenofibroma (fibroadenoma)                      See Tumor Rating Chart
                                                   C

  Adenoma -- Thyroid                               

  Simple                                           See Thyroid Disorders

  Papillary cystic                                 VIII

  Pituitary                                        Rate as brain tumor
                                                   class IV

  Testes                                           See individual tumors
                                                   under Testes

  Breast and ovary                                 

  Present with histological study                  0

  Without histological study                       VII

  After excision with histological study           0

  Andenomyosarcoma                                 Rate for carcinoma of
                                                   tissue involved

  Amelanotic melanoma                              See Melanoma

  Argentaffinoma (carcinoid)                       X

  Basal cell carcinoma                             See Epithelioma

  Basophilic adenoma                               See Pituitary Adenoma,
                                                   Tumor Rating Chart B

  Bone cyst                                        

  Solitary, present no change within 1 year        25

  After removal                                    15

  Others                                           Refer to Section Chief

  Brain cyst                                       Rate as brain tumor,
                                                   class IV

  Carcinoid                                        X

  Carcinoma (cancer) with recurrence or metastasis Rate as present

  Bladder                                          XIII

  Bone                                             XIV

  Brain                                            See Tumor Rating Chart
                                                   B

  Breast                                           XV

  Cervix uteri                                     XVI

  Cervix uteri (in-situ)                           VI

  Hodgkin's                                        XVII

  Intestine, large and small                       XIV

  Kidney                                           XIV

  Larynx                                           XIII

  Lip                                              X

  Liver                                            XVI

  Lung                                             XVI

  Ovary                                            XVI

  Pancreas                                         X

  Parotid                                          XIII

  Pericardium (cyst or diverticulum)               XIV

  Prostate                                         XV

  Rectum                                           XV

  Simplex                                          Rate under Paget's
                                                   Disease

  Stomach                                          XV

  Thyroid                                          

  Papillary                                        XIII

  Follicular and undifferentiated                  XV

  Tongue                                           XIV

  Uterus -- other than cervix                      XIII

  Carcinosarcoma                                   Rate as carcinoma of
                                                   tissue involved

  Chocolate cyst (endometrial cyst)                

  Present                                          75

  After operation with recovery within 2 years     25

  After 2 years                                    0

  Cholangioma                                      XI

  Cholesteatoma, intracranial                      See Tumor Rating Chart
                                                   B

  Cholesteatoma -- without intracranial extension  

  Present -- small and stationary                  0

  Removed and histological study benign            0

  Others                                           100

  Chondrosarcoma                                   Rate as carcinoma of
                                                   tissue involved

  Chordoma                                         IV

  Chorioepithelioma                                Also see Testes Tumor
                                                   Rating Chart A XII

  Choiriom                                         Rate as
                                                   Chorioepithelioma

  Choroids Plexus                                  See Tumor Rating Chart
                                                   B

  Chromophobe -- adenoma                           See Pituitary Adenoma
                                                   Tumor Rating Chart B

  Craniopharyngioma (craniopharyngeal cyst)        See Tumor Rating Chart
                                                   B

  Cylindroma                                       

  Local, skin                                      25

  Mucous membranes and others                      VII

  Dermatofibrosarcoma                              III

  Dysgerminoma                                     X

  Echinococcus (hydatid cyst)                      V

  Embryoma                                         XII

  Endothelioma                                     X

  Ependymoma                                       See Tumor Rating Chart
                                                   B

  Epidermoid Carcinoma                             Rate as Squamous cell
                                                   epithelioma

  Epithelial Carcinoma                             Rate as Epithelioma

  Epithelioma                                      

  Basal cell (rodent ulcer)                        

  Present with histological study                  50

  Without histological study                       150

  Removed with histological study                  0

  Without histological study                       35

  Recurrent                                        

  Present, multiple with histological study        II

  Removed, with histological study                 0

  Squamous cell                                    

  Present with histological study                  III to VI

  Removed -- no recurrence within 2 years          I

  Recurrent -- multiple present                    X

  Removed, no recurrence within 2 years            IV

  Anaplasia (Differentiation)                      

  GRADE 1                                          Good prognosis -- well
                                                   differentiated

  GRADE 2                                          Fair prognosis

  GRADE 3                                          Not good prognosis

  GRADE 4                                          Bad prognosis

  Erythroblastoma                                  XII

  Ewing tumor                                      XI

  Fibrocystadenoma                                 Rate as Adenoma,
                                                   breast

  Fibroid (myoma, Fibroma, fibromyoma, leiomyoma)  See Tumor Rating Chart
  of uterus                                        C

  Fibroma of uterus                                Rate as Fibroid

  Others                                           Rate as Adenofibroma

  Fibromyoma                                       Rate as Fibroid of
                                                   uterus

  Fibrosarcoma                                     X

  Giant Cell Sarcoma                               X

  Glioblastoma                                     See Tumor Rating Chart
                                                   B

  Glioma                                           General term for
                                                   majority of brain
                                                   tumors

  Granuloma fungoides                              XII

  Hemangioblastoma                                 See Tumor Rating Chart
                                                   B

  Hemangio-endothelioma                            See Tumor Rating Chart
                                                   B, Class IV

  Hepatoma                                         XI

  Hydatid cyst                                     Rate as Echinococcus
                                                   cyst

  Hypernephroma                                    XII

  Kaposi's sarcoma                                 XI

  Krukenberg tumor                                 XI

  Linitis plastica                                 XII

  Liposarcoma                                      X

  Lymphangioendothelioma                           See Tumor Rating Chart
                                                   B

  Lymphoblastoma                                   XII

  Lymphocytoma                                     XII

  Lymphocytoma cutis                               I

  Lymphoepithelioma                                XI

  Lymphoma                                         XII

  Lymphosarcoma                                    XV

  Medulloblastoma                                  See Tumor Rating Chart
                                                   B

  Melanoma                                         XII

  Meningioma                                       See Tumor Rating Chart
                                                   B

  Mesothelioma                                     VII

  Mixed tumor of parotid                           

  Present or within 1 year                         II

  Recurrent with histological study                III

  Surgically removed with no recurrence            I

  Multiple myeloma                                 XII

  Myeloma, solitary, early stage of multiple       XII

  Myxosarcoma                                      IX

  Neuroblastoma                                    XII

  Neurosarcoma                                     XI

  Osteogenic sarcoma                               XII

  Osteosarcoma                                     XII

  Ovarian cyst                                     

  Benign                                           0

  Malignant                                        XI

  Paget's Disease                                  

  Nipple or breast                                 X

  Bone                                             See Osteitis Deformans

  Pheochromocytoma                                 X

  Prickle cell epithelioma                         Rate as Basal Cell
                                                   Epithelioma

  Reticulum cell sarcoma                           X

  Rhabdomyoma                                      VI

  Rhabdomyosarcoma                                 X

  Sarcoma                                          Rate for carcinoma of
                                                   tissue involved if
                                                   type is not rated

  Schwannoma                                       IX

  Seminoma                                         XII

  Single giant cell sarcoma                        XII

  Squamous cell epithelioma                        See Epithelioma

  Sympathicoblastoma                               XII

  Synovioma                                        

  Benign                                           II

  Malignant                                        XII

  Testes choriocarcinoma                           

  Chorioepithelioma                                XII

  Embryonal                                        XII

  Seminoma                                         XII

  Teratocarcinoma                                  XII

  Teratoid tumor of lungs                          Rate as Squamous cell
                                                   epithelioma

  Teratoma                                         

  Benign                                           III

  Malignant                                        XI

  Thecoma                                          II

  Thymoma                                          

  Benign                                           IV

  Malignant                                        XV

  Von Recklinghausen's disease                     Rate as
                                                   Neurofibromatosis

  Wilm's Tumor                                     XII
  ------------------------------------------------ ----------------------

TUMOR RATING CHART A

In rating tumors, wherever the lesion is still present (unoperated,
untreated, or inadequately treated) the numerical rating in the"On Exam"
column will always apply. Recurrences, except as otherwise indicated,
will be rated as inadequate treatment. The columns with "years"
involved, refer to number of years subsequent to the operation or other
treatment, and provided there has been no recurrence.

<table style="width:100%;">
<colgroup>
<col style="width: 7%" />
<col style="width: 8%" />
<col style="width: 6%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
</colgroup>
<tbody>
<tr class="odd">
<td>Class</td>
<td>On Exam</td>
<td>Within 1 yr.</td>
<td>2 yrs.</td>
<td>3 yrs.</td>
<td>4 yrs.</td>
<td>5 yrs.</td>
<td>6 yrs.</td>
<td>7 yrs.</td>
<td>8 yrs.</td>
<td>9 yrs.</td>
<td>10 yrs.</td>
<td><p>11 to 15</p>
<p>Yrs.</p></td>
<td>15 &amp; Over</td>
</tr>
<tr class="even">
<td>I</td>
<td>150</td>
<td>50</td>
<td>25</td>
<td>0</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>II</td>
<td>200</td>
<td>75</td>
<td>50</td>
<td>25</td>
<td>0</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>III</td>
<td>250</td>
<td>125</td>
<td>100</td>
<td>100</td>
<td>0</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>IV</td>
<td>300</td>
<td>175</td>
<td>100</td>
<td>75</td>
<td>50</td>
<td>25</td>
<td>0</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>V</td>
<td>400</td>
<td>250</td>
<td>150</td>
<td>150</td>
<td>100</td>
<td>100</td>
<td>75</td>
<td>75</td>
<td>50</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>VI</td>
<td>500</td>
<td>300</td>
<td>100</td>
<td>75</td>
<td>35</td>
<td>20</td>
<td>0</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>VII</td>
<td>700</td>
<td>350</td>
<td>175</td>
<td>100</td>
<td>50</td>
<td>25</td>
<td>0</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>VIII</td>
<td>900</td>
<td>600</td>
<td>400</td>
<td>300</td>
<td>200</td>
<td>100</td>
<td>50</td>
<td>25</td>
<td>0</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>IX</td>
<td>1200</td>
<td>700</td>
<td>600</td>
<td>400</td>
<td>250</td>
<td>150</td>
<td>75</td>
<td>75</td>
<td>35</td>
<td>0</td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>X</td>
<td>M</td>
<td>800</td>
<td>700</td>
<td>500</td>
<td>300</td>
<td>200</td>
<td>150</td>
<td>75</td>
<td>50</td>
<td>25</td>
<td>0</td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>XI</td>
<td>M</td>
<td>850</td>
<td>750</td>
<td>600</td>
<td>400</td>
<td>250</td>
<td>125</td>
<td>75</td>
<td>50</td>
<td>25</td>
<td>0</td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>XII</td>
<td>M</td>
<td>900</td>
<td>800</td>
<td>700</td>
<td>600</td>
<td>500</td>
<td>250</td>
<td>200</td>
<td>100</td>
<td>75</td>
<td>25</td>
<td>0</td>
<td></td>
</tr>
<tr class="even">
<td>XIII</td>
<td>M</td>
<td>1600</td>
<td>1400</td>
<td>1200</td>
<td>1000</td>
<td>900</td>
<td>600</td>
<td>500</td>
<td>300</td>
<td>200</td>
<td>100</td>
<td>50</td>
<td>0</td>
</tr>
<tr class="odd">
<td>XIV</td>
<td>M</td>
<td>2000</td>
<td>1600</td>
<td>1400</td>
<td>1200</td>
<td>1100</td>
<td>700</td>
<td>600</td>
<td>400</td>
<td>200</td>
<td>50</td>
<td>25</td>
<td>0</td>
</tr>
<tr class="even">
<td>XV</td>
<td>M</td>
<td>M</td>
<td>2000</td>
<td>1700</td>
<td>1500</td>
<td>1300</td>
<td>1100</td>
<td>900</td>
<td>600</td>
<td>300</td>
<td>100</td>
<td>50</td>
<td>0</td>
</tr>
<tr class="odd">
<td>XVI</td>
<td>M</td>
<td>M</td>
<td>M</td>
<td>M</td>
<td>2500</td>
<td>2000</td>
<td>1500</td>
<td>1000</td>
<td>700</td>
<td>400</td>
<td>150</td>
<td>75</td>
<td>0</td>
</tr>
<tr class="even">
<td>XVII</td>
<td>M</td>
<td>M</td>
<td>M</td>
<td>M</td>
<td>M</td>
<td>M</td>
<td>3000</td>
<td>2000</td>
<td>1200</td>
<td>500</td>
<td>300</td>
<td>100</td>
<td>0</td>
</tr>
</tbody>
</table>

October 1, 2003 M29-1, Part V

**TUMOR RATING CHART B**

(Brain Tumors)

+-------------+---------------+-------------+-------------------------+
| CLASS I     | CLASS II      | CLASS III   | CLASS IV                |
|             |               |             |                         |
| Primary     | Astrocytoma   | A           | Acoustic neuroma        |
| carcinoma   | of cerebrum   | ngioblasoma | (neurinoma)             |
| and sarcoma |               |             | neurofibroma            |
| and         | Dermoid cyst  | Astrocytoma |                         |
| metastic    |               | of          | Arachnoidal or          |
|             | Ependymoma    |             | Meningeal fibroblastoma |
| Brain       |               | Cerebellum  |                         |
| carcinomas  | Olig          |             | Endothelioma            |
|             | odendroglioma | Granio      |                         |
| As          |               | pharyngioma | Memingioma              |
| troblastoma | Teratoma      |             |                         |
|             |               | (Crani      | Memingothelioma         |
| G           |               | opharyngeal |                         |
| lioblastoma |               |             | Papilloma of Choroid    |
|             |               | Cyst)       | Plexus                  |
| Medu        |               |             |                         |
| lloblastoma |               | Heman       | Pituitary adenoma       |
|             |               | gioblastoma | (Chromophobe,           |
| Spon        |               |             | Acidophile,             |
| gioblastoma |               | Hemangiomas |                         |
|             |               |             | Basophile)              |
|             |               | I           |                         |
|             |               | ntracranial | Psammoma                |
|             |               |             |                         |
|             |               | c           |                         |
|             |               | holeseatoma |                         |
+-------------+---------------+-------------+-------------------------+

**BRAIN TUMOR RATING CHART**

  ------- --------- ----- ------ ------ ------ ------ ------ ------ ------ ------ ------ ------ ------
          Present   1 yr  2 yrs. 3 yrs. 4 yrs. 5 yrs. 6 yrs. 7 yrs. 8 yrs. 9 yrs. 10     11 to  15 &
                                                                                  yrs.   15     Over
                                                                                         yrs.   

  CLASS I M         M     M      M      M      400    400    200    100    100    50     50     0

  CLASS   M         400   400    200    150    100    100    50     50     0      0      0      0
  II                                                                                            

  CLASS   M         400   400    150    100    100    75     75     50     25     0      0      0
  III                                                                                           

  CLASS   M         400   200    200    150    150    100    100    75     50     25     0      0
  IV                                                                                            
  ------- --------- ----- ------ ------ ------ ------ ------ ------ ------ ------ ------ ------ ------

TUMOR RATING CHART C

(Minor Tumors or Impairments)

  -------------------------------------------------- --------------------
  Adenofibroma, fibroadenoma and fibrocystadenoma    25

  After excision and histological study              0

  Adenomyoma                                         25

  Birthmark, angioma, hemangioma (except brain),     0
  lymphangioma nevus, port wine spot, etc., no       
  change 1 year                                      

  Others                                             25

  Blue Dome                                          See Mastitis

  Blue nevus                                         0

  Cystadenoma, adenocystoma                          0

  Exostosis                                          0

  Fibroadenoma                                       See Adenofibroma

  Fibroid (fibroma, fibromyoma, myoma, leiomyoma) of 
  uterus                                             

  Small -- under observation for at least 2 years    25

  After surgery                                      0

  After irradiation                                  30

  Large or less than 2 years observation             Refer to Section
                                                     Chief

  Glomus tumor (angioeuromyoma)                      0

  Hamartoma                                          Rate as birthmark

  Hydradenoma (hidradenoma)                          0

  Hygroma                                            Rate as birthmark

  Keloid                                             0

  Keratoacanthoma -- small, stationary               0

  Others                                             25

  Keratosis (plain), hyperkeratosis (senilis)        25

  When minor tumor is removed                        0

  Leiomyoma                                          Rate as fibroid

  Leukoplakia -- mild                                0

  Extensive                                          50

  Lymphangioma                                       Rate as birthmark

  Meibomian (chalazion)                              0

  Mole (pigmented and nonpigmented) stationary       

  No change for years                                0

  Growing, indurated, tender, etc                    See Melanoma

  Myxoma                                             0

  Neuroma                                            0

  Nevus                                              Rate as birthmark

  Odontoma                                           Rate as alveolar
                                                     cyst, dental

  Osteophyte                                         0

  Paraganglioma                                      20

  Pilonidal cyst                                     0

  Sebaceous cyst                                     0

  Spider or strawberry nevus                         Rate as birthmark

  Telangiectasis                                     

  Of long duration                                   0

  Others, recent and growing                         Refer to Section
                                                     Chief

  Wen                                                0

  Xanthoma and xanthomatosis                         0

  When minor tumor is removed                        0
  -------------------------------------------------- --------------------

**TYPHOID FEVER**

Typhoid Fever (Enteric Fever) is an acute generalized infection, caused
by the typhoid bacillus. The usual manifestations are high fever,
abdominal tenderness, prostration and transient enlargement of the
spleen. Ulcer formation may occur in the intestine resulting in
hemorrhage or intestinal perforation, producing an acute peritonitis.
The disease is usually transmitted by contaminated food, water, or milk.

**Underwriting Requirements**

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

  ----------------------------------------------------------- -----------
  Uncomplicated -- after recovery (examination within 1 year) 0

  Complicated (perforation of intestine), under treatment or  40
  within 6 months after recovery (examination required)       

  6 months to 1 year after recovery (examination required)    20

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

TYPHUS FEVER

Typhus Fever (Brill\'s Disease) also known as Jail Fever, is an acute
infectious disease characterized by fever, chills, headache, and skin
eruption. It may be transmitted from man to man by the body louse
(epidemic typhus), from rats to man by the flea (endemic typhus), and
from rats and mice to man by mites (scrub typhus).

Underwriting Requirements

If present, obtain an APS (VA Form 29-8158).

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

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