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. 37

Covering period of *Federal Register* issues

through October 23, 2005

Copyright © 2005 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. 37**

31 October 2005

Covering the period of Federal Register issues

through October 23, 2005

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. 37**

**October 25, 2005**

*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**

4.42-1 to 4.45-1 4.42-1 to 4.45-1 §4.45

**Be sure to complete the**

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

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

> **HIGHLIGHTS**

**Book C, Supplement No. 37**

**October 25, 2005**

***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 correction was made in §4.45, introductory paragraph, to change
the word "plants" to "planes."

**§4.42 Complete medical examination of injury cases.**

The importance of complete medical examination of injury cases at the
time of first medical examination by the Department of Veterans Affairs
cannot be overemphasized. When possible, this should include complete
neurological and psychiatric examination, and other special examinations
indicated by the physical condition, in addition to the required general
and orthopedic or surgical examinations. When complete examinations are
not conducted covering all systems of the body affected by disease or
injury, it is impossible to visualize the nature and extent of the
service connected disability. Incomplete examination is a common cause
of incorrect diagnosis, especially in the neurological and psychiatric
fields, and frequently leaves the Department of Veterans Affairs in
doubt as to the presence or absence of disabling conditions at the time
of the examination.

**§4.43 Osteomyelitis.**

Chronic, or recurring, suppurative osteomyelitis, once clinically
identified, including chronic inflammation of bone marrow, cortex, or
periosteum, should be considered as a continuously disabling process,
whether or not an actively discharging sinus or other obvious evidence
of infection is manifest from time to time, and unless the focus is
entirely removed by amputation will entitle to a permanent rating to be
combined with other ratings for residual conditions, however, not
exceeding amputation ratings at the site of election.

**§4.44 The bones.**

The osseous abnormalities incident to trauma or disease, such as
malunion with deformity throwing abnormal stress upon, and causing
malalignment of joint surfaces, should be depicted from study and
observation of all available data, beginning with inception of injury or
disease, its nature, degree of prostration, treatment and duration of
convalescence, and progress of recovery with development of permanent
residuals. With shortening of a long bone, some degree of angulation is
to be expected- the extent and direction should be brought out by X-ray
and observation. The direction of angulation and extent of deformity
should be carefully related to strain on the neighboring joints,
especially those connected with weight-bearing.

**§4.45 The joints.**

As regards the joints the factors of disability reside in reductions of
their normal excursion of movements in different planes. Inquiry will be
directed to these considerations:

\(a\) Less movement than normal (due to ankylosis, limitation or
blocking, adhesions, tendon-tie-up, contracted scars, etc.).

\(b\) More movement than normal (from flail joint, resections, nonunion
of fracture, relaxation of ligaments, etc.).

\(c\) Weakened movement (due to muscle injury, disease or injury of
peripheral nerves, divided or lengthened tendons, etc.).

\(d\) Excess fatigability.

\(e\) Incoordination, impaired ability to execute skilled movements
smoothly.

\(f\) Pain on movement, swelling, deformity or atrophy of disuse.
Instability of station, disturbance of locomotion, interference with
sitting, standing and weight-bearing are related considerations. For the
purpose of rating disability from arthritis, the shoulder, elbow, wrist,
hip, knee, and ankle are considered major joints; multiple involvements
of the interphalangeal, metacarpal and carpal joints of the upper
extremities, the interphalangeal, metatarsal and tarsal joints of the
lower extremities, the cervical vertebrae, the dorsal vertebrae, and the
lumbar vertebrae, are considered groups of minor joints, ratable on a
parity with major joints. The lumbosacral articulation and both
sacroiliac joints are considered to be a group of minor joints, ratable
on disturbance of lumbar spine functions.

**Supplement *Highlights* reference**: 37(1)