O

**ORGANIC MENTAL DISORDERS**

Due to impairment of brain tissue function, organic mental disorders are
characterized by impairment of memory, judgment or language, personality
changes, hallucinations, delusions and convulsions. These abnormalities
result from a clearly defined physical condition, which is diagnosable,
and is related to the onset, course, and outcome of the condition. These
disorders are classified according to the cause of the brain damage.

**Underwriting Requirements**

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

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  Organic brain disease, including Alzheimer's       
  (Presenile Dementia), multi-infarct dementia,      
  Karsakoff's Syndrome                               

  Present, cause unknown                             R

  Due to infection, trauma, nutritional, metabolic,  
  endocrine                                          

  Complete recovery                                  0

  Others                                             Refer to Section
                                                     Chief
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OSTEITIS DEFORMANS

(Paget's Disease)

Osteitis deformans, or better known as Paget\'s disease, is a bone
disorder of unknown etiology. Most cases are asymptomatic and are
discovered through an abnormal x-ray or blood test done for some other
reason. Pain, deformity, pathological fractures and other complications
may occur in more extensive cases. Typically, the serum alkaline
phosphatase is elevated (except in the most limited cases) and the
degree of elevation correlates reasonably well with the extent and
activity of the disorder.

Most cases never require treatment, but relief of bone pain, healing of
bony lesions and improvement in biochemical parameters can be achieved
with current medications.

**Underwriting Requirements**

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

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  Asymptomatic, single bone or other limited involvement, 55
  stable or slowly progressing                            

  More extensive, symptomatic or being treated with       75
  medication                                              

  Extensive, complicated, progressive                     125
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**OSTEOCHONDRITIS**

Osteochondritis is a chronic inflammation of bone and cartilage. It
occurs in adolescence during the period of active development of the
bones. Trauma (injury) plus infection are usually responsible. Symptoms
are aching, tenderness, and thickening in the affected area. Common
locations are in the hip (Leg-Calve-Perthes disease), knee,
(Osgood-Schlatter\'s disease), wrist (Kienbock\'s disease), ankle
(Kohler\'s disease), and spine (vertebral osteochondritis). The term
epiphysitis is sometimes used in connection with these disorders.

**Underwriting Requirements**

If there is a history of treatment within 3 years obtain an APS (VA Form
29-8158).

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  Hip or spine                                                

  Present and active                                          75

  Inactive                                                    

  Less than 1 year                                            25

  Within 2 years                                              10

  After 2 years                                               0

                                                              

  Other location                                              

  Present and active                                          50

  Inactive                                                    

  Less than 1 year                                            20

  Within 2 years                                              0

  After 2 years                                               0
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**OSTEOMA AND OSTEOCHONDROMA**

An osteoma is a hard tumor of bonelike structure developing on a bone
and occasionally on other structures. An osteochondroma is a tumor that
is partly bone and partly cartilage. Both conditions are usually benign
but may undergo malignant changes. They are not to be confused with
\"giant cell\" tumor of bone, which is malignant and rated under cancer.
For conditions described as exostosis or \"bone spur \" see rating under
Exostosis.

**Underwriting Requirements**

If there is a history of treatment within 3 years obtain an APS (VA Form
29-8158).

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  Present                                                     

  Single, small, asymptomatic, no change in size for at least 0
  2 years                                                     

  Multiple                                                    30

  Operated                                                    

  Surgically removed, upon recovery                           0
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**OSTEOMALACIA AND OSTEOPOROSIS**

There are two types of nonneoplastic bone disturbances that occur in
elderly people (especially women), which may readily be confused with
neoplastic disease of the bone. These are osteomalacia and (senile)
osteoporosis. They are characterized by demmeralization, especially in
the spine where it leads to collapse of vertebra, pain, disability and
deformity.

**Osteomalacia** in the adult is the analogue of rickets in the child.
It results from calcium and phosphorus deficiency in the bone. Virtually
all cases of osteomalacia today are due to some conditioning factor
relative to abnormal calcium and phosphorus metabolism such as: (l)
diet; (2) faulty absorption; (3) excessive intestinal loss; (4)
increased renal excretion (failure of tubular reabsorption or tubular
acidosis); (5) lack of or resistance to the action of vitamin D. Almost
all forms of osteomalacia are associated with compensatory, secondary
hyperparathyroidism, set off by low calcium level. The most frequent
complaints are vague aches and pains in lower back, pelvis, legs, with
muscular weakness worse while standing or walking. Since this is a
potentially curable disease, except in the vitamin D resistant forms or
for Fanconi\'s disease, the prognosis is usually excellent if diagnosed
early. Hypercalcemia may occur as a complication of therapy. In the
renal forms the ultimate prognosis is that of the basic kidney disease.
Respiratory paralysis due to hypokalemia may prove fatal.

**Osteoporosis** is the most commonly seen metabolic bone disease in the
United States. It is caused by failure of mineralization of bone. The
principal causes are*:* lack of activity (immobilization); lack of
hormones (post menopausal) and low intake of calcium. The less common
causes are: developmental disturbances; nutritional disturbances
(protein starvation, ascorbic acid deficiency); chronic calcium
depletion; low endocrine diseases (androgens-senility,
pituitary-acromegaly, thyrotoxicosis, excessive ACTH-corticoids, Cushing
Syndrome, long uncontrolled diabetes mellitus), bone marrow disorders
(myeloma or leukemia).

With prolonged treatment for postclimateric the prognosis is good.
Spinal involvement is not reversible on x-ray, but progression of the
disease is often halted. The idiopathic variety does not respond
appreciably to any form of treatment. In general, osteoporosis is a
crippling rather than a killing disease and the prognosis is essentially
that of the underlying disorder.

Underwriting Requirements

If there is a history of treatment within 3 years, obtain APS (VA Form
29-8158).

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  Mild -- stable following treatment                   0

  Moderate -- under treatment, controlled              75-25

  Severe -- under treatment                            400-200

  Without treatment or resistant to treatment, rate    400-100
  for degree of disability or underlying disorder      

  Secondary to disease                                 Rate for disease

  Incidental finding, no fracture or disability        0

  With fracture, disability or predisposing disorder   RFC
  ---------------------------------------------------- ------------------

**OSTEOMYELITIS**

Osteomyelitis is an inflammation of bone and bone marrow. The infective
agent is usually blood borne and first affects the bone marrow from
which the inflammation spreads outward. Occasionally direct infection
occurs from open fracture. The course of the disease is inclined to be
prolonged with chronic intermittent draining areas when antibiotics and
sulfa drugs are not used freely.

Underwriting Requirements

Obtain an APS (VA Form 29-8158) if there was only limited involvement of
small bones with inactivity in the past 2 years. The debit to be used
will be determined by the bones involved, the duration and severity of
the history.

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  History with complete resolution, treatment ended    0
  over six months ago                                  

  Present or chronic, single bone in extremity         55

  Multiple bones or multiple recurrences or            100
  nonextremity bones (i.e. skull or vertebrae)         

  Tuberculosis                                         Rate for
                                                       Extrapulmonary
                                                       Tuberculosis
  ---------------------------------------------------- ------------------

**OSTEOPETROSIS**

**(Albers-Schonberg Disease, Osteosclerosis,**

**Fragilis Generalisata, Marble Bones, Chalky Bone)**

A rare hereditary and familial abnormality in bone tissue development,
resulting in very hard, dense, brittle bones, prone to spontaneous
fracture and giving rise to the synonym-Marble bone disease. The disease
is usually fatal.

This is often encountered in infancy and may present a severe form at
birth. The congenital type is considered malignant and is associated
with optic atrophy, hydrocephalus, marked anemia, lessened resistance to
infection, and early death. If they have a less rapid course they may
live to early childhood and present evidences of mental, sexual, dental
deficiencies, anemia, and dwarfism. Those with mild disease survive to
adulthood. A benign form (which permits the achievement of even a normal
lifespan), without symptoms, may or may not be related to the relatively
malignant disorder of infancy and childhood. The changes in the bone may
be due to overproduction of thyrocalcitonin. Those who present no
evidence of this disorder until adult life may then learn of it by
accident when roentgenographic examination is made for some other
reason.

The earlier in life the manifestation occurs the worse the prognosis is
apt to be. If the patient survives early childhood he has a fair chance
of attaining adulthood. The longer he lives the less likely he is to die
of the disease, though sarcoma has been reported as a late complication.
Those who live through childhood may develop difficulties at any time
thereafter with a progressive anemia whether due to a bona fide instant
of solitary focal osteopetrosis or some other sclerosing disease,
prognosis is not certain.

Osteopetrosis also occurs sporadically in adults as a consequence of
intoxication by fluoride, phosphorus or strontium and is sometimes a
consequence of primary blood dyscrasias.

Clinically, patients show dwarfism skeletal deformities; i.e., chest,
spine, large square head and a propensity to fracture. Peculiarly, rate
of fracture healing is normal, but remodeling of the callus is delayed.
The symptomatology, fragility of bones (fractures) sclerosis of the
skeleton parts (osteosclerotic or myelophthisic anemia), narrowing of
the foramina (deafness and impairment of vision) optic atrophy and
cataracts may be present. With the increased density of the bone and
absence of osteoclasts there is no modeling of the callus from fracture.
There is an increase in encroachment on the marrow cavity with reduction
of the hematopoietic tissue and the resultant pancytopenia, leading to
aplastic anemia, hepatosplenomegaly, abnormal bleeding tendencies and
immature blood cell pattern. Lymphoid tissue as well as the liver and
kidney often reveal extramedullary hematopoiesis. Bodies of vertebrae,
pelvic bones and ribs are conspicuously affected. An associated
syndactylism and dyschondroplasia are suggestive of a hereditary basis
for the disease.

There is no satisfactory therapy for osteopetrosis. A severe restriction
of calcium intake combined with phytate or cellulose phosphate has been
reported to be beneficial, but further experience is needed to evaluate
this approach.

Underwriting Requirements

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

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  Mild -- stable, normal blood count                        0

  Moderate -- under treatment, not more than moderate       100-25
  pancytopenia                                              

  Advanced -- severe anemia, under treatment, bleeding      500-200
  tendency, enlargement of liver and spleen, x-ray evidence 
  of advanced narrowing of marrow cavity -- history of      
  fractures                                                 

  Without treatment, but with advanced degree of disease -- 500-100
  consider degree of disability                             
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