## Section I. Conditions of Other Body Systems

#### Overview

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| #          | > This section contains the following topics:           |
| #### In th |                                                         |
| is Section |                                                         |
+------------+---------------------------------------------------------+

  ------------ ---------------------------------------------- ------------
  Topic        Topic Name                                     See Page

  33           Digestive System Conditions                    4-I-2

  34           Genitourinary and Gynecological Conditions     4-I-4

  35           Spina Bifida and Other Covered Birth Defects   4-I-6

  36           Hemic and Lymphatic System Conditions          4-I-7
  ------------ ---------------------------------------------- ------------

#### 33. Digestive System Conditions

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| ##### In   | > This topic contains information about digestive       |
| troduction | > system conditions, including                          |
|            |                                                         |
|            | -   gastrointestinal disorders and tropical service     |
|            |                                                         |
|            | -   inguinal hernia                                     |
|            |                                                         |
|            | -   recurrence of hemorrhoids                           |
|            |                                                         |
|            | -   the definition of the term ***infectious            |
|            |     hepatitis***                                        |
|            |                                                         |
|            | -   occurrence of infectious hepatitis, and             |
|            |                                                         |
|            | -   determining service connection for infectious       |
|            |     hepatitis.                                          |
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| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
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| #####      | > If the issue is service connection for dysentery or   |
| a. Gastroi | > other gastrointestinal diseases, assign great weight  |
| ntestinal  | > to any service under the following conditions, since  |
| Disorders  | > these conditions may have been the etiological or     |
| and Tropic | > aggravating factor in cases of dysentery or other     |
| al Service | > gastrointestinal diseases:                            |
|            |                                                         |
|            | -   tropical service                                    |
|            |                                                         |
|            | -   imprisonment or internment under unsanitary         |
|            |     conditions, or                                      |
|            |                                                         |
|            | -   food deprivation.                                   |
|            |                                                         |
|            | > ***Reference***: For more information on establishing |
|            | > service connection for dysentery and other tropical   |
|            | > diseases, see 38 CFR 3.309(b).                        |
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| ####       | > Do not assume the preexistence of a hernia. Establish |
| # b. Ingui | > or determine preexistence on a factual basis.         |
| nal Hernia | >                                                       |
|            | > The following conditions are sufficient bases for     |
|            | > service connection:                                   |
|            |                                                         |
|            | -   in-service initial manifestation of hernial         |
|            |     protrusion, and                                     |
|            |                                                         |
|            | -   recurrence during service, by aggravation, of a     |
|            |     hernia previously surgically repaired.              |
|            |                                                         |
|            | > ***Note***: Operation for repair of a preexisting     |
|            | > inguinal hernia is not, of itself, evidence of        |
|            | > aggravation.                                          |
|            | >                                                       |
|            | > ***Reference***: For information on the presumption   |
|            | > of soundness at entrance into service, see 38 CFR     |
|            | > 3.304(b).                                             |
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Continued on next page

33\. Digestive System Conditions, Continued

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| #####      | > Unless the granting of service connection for         |
| c. Conside | > hemorrhoids was in error, consider recurrences after  |
| ring Recur | > service as service-connected (SC).                    |
| rence of H | >                                                       |
| emorrhoids | > ***Reference***: For information on reversing an      |
|            | > erroneous decision, see                               |
|            |                                                         |
|            | -   38 CFR 3.105(a)                                     |
|            |                                                         |
|            | -   M21-1MR, Part III, Subpart iv, 2.B.4, and           |
|            |                                                         |
|            | -   M21-1MR, Part IV, Subpart ii, 3.A.2.                |
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| #          | > The diagnostic term ***infectious hepatitis***        |
| #### d. De | > includes                                              |
| finition:  |                                                         |
| Infectious | -   epidemic infectious, or viral, hepatitis, often     |
|  Hepatitis |     called catarrhal jaundice, and                      |
|            |                                                         |
|            | -   homologous serum hepatitis.                         |
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| ###        | > Infectious hepatitis is common throughout the world   |
| ## e. Occu | > and was especially prevalent during World War II      |
| rrence of  | > (WWII), following administration of the yellow fever  |
| Infectious | > vaccine in 1942 and in the Mediterranean Theater.     |
|  Hepatitis |                                                         |
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| ####       | > Service connection for infectious hepatitis generally |
| # f. Deter | > depends upon an explicit reference or other evidence  |
| mining Ser | > of the disease in service.                            |
| vice Conne | >                                                       |
| ction for  | > Consider the following factors when determining       |
| Infectious | > service connection for viral hepatitis:               |
|  Hepatitis |                                                         |
|            | -   the incubation period for viral hepatitis is from   |
|            |     15 to 50 days                                       |
|            |                                                         |
|            | -   the incubation period for homologous serum          |
|            |     hepatitis is 50 to 180 days following               |
|            |     administration of vaccines or transfusions          |
|            |                                                         |
|            | -   following recovery from the acute infection, a      |
|            |     clinical syndrome of gastrointestinal symptoms may  |
|            |     follow, characterized by intolerance for fats,      |
|            |     fatigue, and mental depression, and                 |
|            |                                                         |
|            | -   recurring episodes                                  |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   last from one to four months at varying intervals,  |
|            |     and                                                 |
|            |                                                         |
|            | -   are precipitated by intercurrent infections and     |
|            |     overexertion.                                       |
|            |                                                         |
|            | > ***Note***: Liver function tests are of particular    |
|            | > importance                                            |
|            |                                                         |
|            | -   in the initial diagnosis, and                       |
|            |                                                         |
|            | -   when the disability is severe.                      |
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#### 34. Genitourinary and Gynecological Conditions

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| ##### In   | > This topic contains information about genitourinary   |
| troduction | > and gynecological conditions, including               |
|            |                                                         |
|            | -   deformity of the penis with loss of erectile power  |
|            |                                                         |
|            | -   Special Monthly Compensation (SMC) for loss of use  |
|            |     of a creative organ                                 |
|            |                                                         |
|            | -   evaluating residuals of multiple sclerosis or       |
|            |     diabetes mellitus, and                              |
|            |                                                         |
|            | -   considering residuals of venereal disease or human  |
|            |     immunodeficiency virus (HIV) related illness.       |
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| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > The following two requirements must be met before a   |
| Deformity  | > 20 percent evaluation can be assigned for deformity   |
| of the Pen | > of the penis with loss of erectile power under        |
| is With Lo | > diagnostic code (DC) 7522:                            |
| ss of Erec |                                                         |
| tile Power | -   deformity must be evident, and                      |
|            |                                                         |
|            | -   the deformity *must* be accompanied by loss of      |
|            |     erectile power.                                     |
|            |                                                         |
|            | > ***Important***: The condition is *not* compensable   |
|            | > in the absence of penile deformity.                   |
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| ##### b.   | > Award SMC for loss of use of a creative organ if loss |
|  SMC for L | > of erectile power is shown, with or without penile    |
| oss of Use | > deformity.                                            |
|  of a Crea | >                                                       |
| tive Organ | > ***Reference***: For more information, see            |
|            |                                                         |
|            | -   38 CFR 3.350(a)(1)                                  |
|            |                                                         |
|            | -   38 CFR 4.115b, DC 7522, and                         |
|            |                                                         |
|            | -   M21-1MR, Part IV, Subpart ii, 2.H.39.               |
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+------------+---------------------------------------------------------+
| ##         | > When evaluating residuals of multiple sclerosis or    |
| ### c. Eva | > diabetes mellitus, where loss of erectile power is    |
| luating Re | > shown but penile deformity is not present, grant      |
| siduals of | > service connection for loss of erectile power, rated  |
|  Multiple  | > with the disease process.                             |
| Sclerosis  | >                                                       |
| or Diabete | > ***Example***: DC 7913, Diabetes mellitus with loss   |
| s Mellitus | > of erectile power.                                    |
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Continued on next page

34\. Genitourinary and Gynecological Conditions, Continued

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| #          | > Do *not* consider specific residuals of venereal      |
| #### d. Re | > disease, or human immunodeficiency virus (HIV)        |
| siduals of | > related illness, to be the result of willful          |
|  Venereal  | > misconduct.                                           |
| Disease or | >                                                       |
|  HIV Relat | > Determine service connection for residuals of         |
| ed Illness | > venereal disease or HIV-related illness by the same   |
|            | > general principles applicable to resolution of the    |
|            | > issue of service connection for other diseases.       |
|            | >                                                       |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   willful misconduct and venereal disease, see 38 CFR |
|            |     3.301(c)(1).                                        |
|            |                                                         |
|            | -   disability or death from use of drugs, see M21-1MR, |
|            |     Part IV, Subpart ii, 2.K.68.                        |
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#### 35. Spina Bifida and Other Covered Birth Defects

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| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > ***Reference***: For information on spina bifida and  |
|  Informati | > other covered birth defects, see M21-1MR, Part VI.    |
| on on Spin |                                                         |
| a Bifida a |                                                         |
| nd Other C |                                                         |
| overed Bir |                                                         |
| th Defects |                                                         |
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#### 36. Hemic and Lymphatic System Conditions

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| ##### In   | > This topic contains information about hemic and       |
| troduction | > lymphatic conditions, including                       |
|            |                                                         |
|            | -   definition of the term ***sickle cell disease***    |
|            |                                                         |
|            | -   definition of the term ***sickle cell anemia***     |
|            |                                                         |
|            | -   inheritance of sickle cell trait                    |
|            |                                                         |
|            | -   inheritance of sickle cell anemia                   |
|            |                                                         |
|            | -   characteristics of sickle cell anemia, and          |
|            |                                                         |
|            | -   mechanism of inheritance of sickle hemoglobin.      |
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| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
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| ##### a. D | > ***Sickle cell disease*** is a generic term for all   |
| efinition: | > disorders characterized by the presence of sickle     |
|  Sickle Ce | > hemoglobin, Hb S, in the red blood cell and includes  |
| ll Disease |                                                         |
|            | -   sickle cell anemia                                  |
|            |                                                         |
|            | -   sickle cell trait, and                              |
|            |                                                         |
|            | -   other hemoglobinopathies such as                    |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   sickle cell thalassemia, and                        |
|            |                                                         |
|            | -   Sickle-Hemoglobin C disease.                        |
|            |                                                         |
|            | > ***Note***: The phenomenon of sickling of red blood   |
|            | > cells is a hereditary abnormality that of itself      |
|            | > usually produces few ill effects.                     |
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| ##### b.   | > ***Sickle cell anemia*** is a hereditary and familial |
| Definition | > disorder characterized clinically by symptoms of      |
| : Sickle C |                                                         |
| ell Anemia | -   anemia                                              |
|            |                                                         |
|            | -   arthritis                                           |
|            |                                                         |
|            | -   leg ulcers, and                                     |
|            |                                                         |
|            | -   acute attacks of pain.                              |
|            |                                                         |
|            | > ***Note***: The age of onset is generally early       |
|            | > childhood.                                            |
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36\. Hemic and Lymphatic System Conditions, Continued

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| #          | > Inheritance of sickle cell trait may be from one or   |
| #### c. In | > both parents.                                         |
| heritance  | >                                                       |
| of Sickle  | > If sickle hemoglobin is inherited from one parent and |
| Cell Trait | > normal hemoglobin from the other, the combination (Hb |
|            | > S + Hb A) is referred to as sickle cell trait.        |
|            | >                                                       |
|            | > ***Note***: Except for unusual circumstances, this is |
|            | > a benign asymptomatic condition and is not associated |
|            | > with increased morbidity.                             |
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+------------+---------------------------------------------------------+
| ##         | > The inheritance of sickle hemoglobin from each parent |
| ### d. Inh | > results in the combination (Hb S + Hb S), referred to |
| eritance o | > as sickle cell anemia.                                |
| f Sickle C | >                                                       |
| ell Anemia | > Sickle cell anemia is usually accompanied by          |
|            |                                                         |
|            | -   moderate to severe anemia, and                      |
|            |                                                         |
|            | -   appropriate clinical signs and symptoms, such as    |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   enlargement of the heart                            |
|            |                                                         |
|            | -   abnormalities of the musculoskeletal system         |
|            |                                                         |
|            | -   bone and joint pain, and/or                         |
|            |                                                         |
|            | -   fever.                                              |
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| #####      | > Sickle cell anemia is a morbid state characterized by |
| e. Charact | > hemolytic anemia and the following manifestations:    |
| eristics o |                                                         |
| f Sickle C | -   the presence of peculiar sickle-shaped, or          |
| ell Anemia |     oat-shaped, red blood cells                         |
|            |                                                         |
|            | -   signs of excessive blood destruction and active     |
|            |     blood formation, and                                |
|            |                                                         |
|            | -   repeated vaso-occlusive episodes.                   |
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+------------+---------------------------------------------------------+
| ####       | > The presence of sickle hemoglobin, Hb S, a variant of |
| # f. Mecha | > the normal hemoglobin in human red blood cells, is    |
| nism of In | > subject to the usual mechanisms of biologic           |
| heritance  | > inheritance.                                          |
| of Sickle  |                                                         |
| Hemoglobin |                                                         |
+------------+---------------------------------------------------------+