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. 33

Covering period of *Federal Register* issues

through 23 September 2003

Copyright © 2003 Jonathan Publishing

**Need Assistance?**

Printing for all supplements is performed by the United States
Government

Printing Office. Distribution is the responsibility of the

VA Forms and Publications Depot. Accordingly:

Questions concerning **[missing supplements]{.smallcaps}**, need for
**[additional books]{.smallcaps}**, and other **[distribution
list]{.smallcaps}** issues for this loose-leaf service should be
directed to:

Department of Veterans Affairs

Veterans Benefits Administration

Directives, Forms and Records Staff

Mail Code: 20S5

810 Vermont Avenue, N.W.

Washington DC 20420

Telephone: 202/273-7080

Fax: 202/275-5947

Questions concerning the **[filing instructions]{.smallcaps}** for this
loose-leaf service,

or the reporting of **[substantive errors]{.smallcaps}** in the text,

may be directed to:

Jonathan Publishing

855 Yorks Crossing

Driftwood TX 78619

Telephone: 512/858-1225

Fax: 512/858-1230

E-mail: garyknight@ev1.net

**Internet: http://www.jonpub.com**

Copyright © 2003 Jonathan Publishing

> **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. 33**

25 September 2003

Covering the period of Federal Register issues

through September 23, 2003

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. 33**

**September 25, 2003**

*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**

**C-1 to C-2 C-1 to C-2 Cover page**

[index]{.smallcaps}-1 to [index]{.smallcaps} --2 [index]{.smallcaps}-1
to [index]{.smallcaps} --2 Index

[index]{.smallcaps}-35 to [index]{.smallcaps} --38
[index]{.smallcaps}-35 to [index]{.smallcaps} --38 Index

[index]{.smallcaps}-45 to [index]{.smallcaps} --48
[index]{.smallcaps}-45 to [index]{.smallcaps} --48 Index

[index]{.smallcaps}-55 to [index]{.smallcaps} --56
[index]{.smallcaps}-55 to [index]{.smallcaps} --56 Index

**4.71a-17 to 4.71a-28 4.71a-17 to [4.71a-30]{.underline} §4.71a**

**Be sure to complete the**

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

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

> **HIGHLIGHTS**

**Book C, Supplement No. 33**

**September 25, 2003**

***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\. On 27 August 2003, the VA published a final rule, effective 26
September 2003, to amend the *Schedule for Rating Disabilities* by
revising that portion of the musculoskeletal system that addresses
disabilities of the spine in order to update this portion of the rating
schedule to ensure that it uses current medical terminology and
unambiguous criteria, and that it reflects medical advances that have
occurred since the last review. Change:

• In §4.71a, revised the table "The Spine," and relocated it so that it
precedes the table "The Hip and Thigh;" and added Plate V immediately
following the table "The Spine."

**Veterans Benefits Administration**

**Department of Veterans Affairs**

Custom Federal Regulations Service™

**Book C---Schedule for Rating Disabilities**

Code of Federal Regulations

Title 38, Part 4

Jonathan Publishing

Copyright © 2003 Jonathan Publishing

**Need Assistance?**

Printing for all supplements is performed by the United States
Government

Printing Office. Distribution is the responsibility of the

VA Forms and Publications Depot. Accordingly:

Questions concerning **[missing supplements]{.smallcaps}**, need for
**[additional books]{.smallcaps}**, and other **[distribution
list]{.smallcaps}** issues for this loose-leaf service should be
directed to:

Department of Veterans Affairs

Veterans Benefits Administration

Directives, Forms and Records Staff

Mail Code: 20S5

810 Vermont Avenue, N.W.

Washington DC 20420

Telephone: 202/273-7080

Fax: 202/275-5947

Questions concerning the **[filing instructions]{.smallcaps}** for this
loose-leaf service,

or the reporting of **[substantive errors]{.smallcaps}** in the text,

may be directed to:

Jonathan Publishing

855 Yorks Crossing

Driftwood TX 78619

Telephone: 512/858-1225

Fax: 512/858-1230

**Internet: http://www.jonpub.com**

Copyright © 2003 Jonathan Publishing

Index 2 --- Alphabetical

***Note***: This index is not part of the *Code of Federal Regulations*.

It was created, and is maintained, by Jonathan Publishing

specifically for this looseleaf service.

**Note to users of this index** --- We want to continually improve this
index as a

search tool in any way that will be useful to you. If you have
suggestions for

additional cross-references, multiple entries, special groupings of
terms, or

any other change, simply fax your ideas to Jonathan Publishing at:

512/858-1230

*Diagnostic Code*

*Term (where applicable) Section*

**A**

Abdominal conditions, coexisting 4.113

Abscess:

Kidney 7501 4.115b

Lung, chronic 6824 4.97

Accommodation, paralysis of (eye) 6030 4.84a

Acne 7828 4.118

Acromegaly 7908 4.119

Actinomycosis 6822 4.97

Addison's disease (adrenal cortical

hypofunction) 7911 4.119

Adenitis, tuberculous, active or inactive 7710 4.117

Adhesions, pericardial 7003 4.104

Adjustment disorder, chronic (*see* Mental Disorders---Schedule of
Ratings)

Adrenal cortical hypofunction 7911 4.119

Age in service-connected claims 4.19

Agoraphobia 9412 4.130

Agranulocytosis, acute 7702 4.117

Alopecia:

Areata 7831 4.118

Scarring 7830 4.118

Alzheimer's type dementia 9312 4.130

Amebiasis 7321 4.114

Aminoacidurias 7532 4.115b

Amnestic disorders (*see* Mental Disorders---Schedule of Ratings)

Amputation, generally (*see* specific item)

Amputations: Upper Extremity (*see* Musculoskeletal System---Schedule

of Ratings---Amputations, Upper Extremity and Lower Extremity)

Amyotrophic lateral sclerosis 8017 4.124a

Analogous ratings 4.20

Anemia, hypochromic-microcytic and

megaloblastic 7700 4.117

Aneurysm, aortic 7110 4.104

Angioneurotic edema 7118 4.104

Anorexia nervosa 9520 4.130

Ankle:

Ankylosis of 5270 4.71a

Astragalectomy 5274 4.71a

Limited motion of 5271 4.71a

Os calcis or astragalus, malunion of 5273 4.71a

Replacement (prosthesis) 5056 4.71a

Subastragalar or tarsal joint, ankylosis of 5272 4.71a

Ankylosis and joint motion, measurement Plates I--II 4.71

Ano, fistula in 7335 4.114

Anxiety disorders (*see* Mental Disorders---Schedule of Ratings)

Aphakia 6029 4.84a

Aphonia, complete organic 6519 4.97

Aplastic anemia 7716 4.117

Application of rating schedule 4.21

Arm, amputation of:

Above insertion of deltoid 5121 4.71a

Below insertion of deltoid 5122 4.71a

Disarticulation 5120 4.71a

Limitation of motion of 5201 4.71a

Arrhythmias:

Supraventricular 7010 4.104

Ventricular (sustained) 7011 4.104

Arteries and veins, diseases of:

Aneurysm, aortic 7110 4.104

Angioneurotic edema 7118 4.104

Arteriosclerosis obliterans 7114 4.104

Arteriovenous fistula, traumatic 7113 4.104

Artery, any large, aneurysm of 7111 4.104

Artery, any small, aneurysm of 7112 4.104

Cold injury residuals 7122 4.104

Erythromelalgia 7119 4.104

Hypertensive vascular disease 7101 4.104 Post-phlebitic syndrome of any
etiology 7121 4.104

Raynaud's syndrome 7117 4.104

Soft-tissue sarcoma (of vascular origin) 7123 4.104

Thrombo-angiitis obliterans (Buerger's disease) 7115 4.104

Varicose veins 7120 4.104

#  Amputations: Upper Extremity

Arm, amputation of:

Above insertion of deltoid 5121 4.71a

Below insertion of deltoid 5122 4.71a

Disarticulation 5120 4.71a

Forearm, amputation of:

Above insertion of pronator teres 5123 4.71a

Below insertion of pronator teres 5124 4.71a

Hand, loss of use of 5125 4.71a

Multiple finger amputations:

Five digits of one hand, amputation 5126 4.71a

Four digits of one hand, amputation of:

Thumb, index, long and ring 5127 4.17a

Thumb, index, long and little 5128 4.17a

Thumb, index, ring and little 5129 4.17a

Thumb, long, ring and little 5130 4.17a

Index, long, ring and little 5131 4.17a

Three digits of one hand, amputation of:

Thumb, index, and long 5132 4.17a

Thumb, index and ring 5133 4.17a

Thumb, index and little 5134 4.17a

Thumb, long and ring 5135 4.17a

Thumb, long and little 5136 4.17a

Thumb, ring and little 5137 4.17a

Index, long and ring 5138 4.17a

Index, long and little 5139 4.17a

Index, ring and little 5140 4.17a

Long, ring and little 5141 4.17a

Two digits of one hand, amputation of:

Thumb and index 5142 4.17a

Thumb and long 5143 4.17a

Thumb and ring 5144 4.17a

Thumb and little 5145 4.17a

Index and long 5146 4.17a

Index and ring 5147 4.17a

Index and little 5148 4.17a

Long and ring 5149 4.17a

Long and little 5150 4.17a

Ring and little 5151 4.17a

Single finger amputations:

Thumb, amputation of 5152 4.17a

Index finger, amputation of 5153 4.17a

Long finger, amputation of 5154 4.17a

Ring finger, amputation of 5155 4.17a

Little finger, amputation of 5156 4.17a

**Ankle**

Ankylosis of 5270 4.71a

Astragalectomy 5274 4.71a

Limited motion of 5271 4.71a

Os calcis or astragalus, malunion of 5273 4.71a

Subastragalar or tarsal joint, ankylosis of 5272 4.71a

**Ankylosis of Individual Digits**

Index finger 5225 4.71a

Long finger 5226 4.71a

Ring or little finger 5227 4.71a

Thumb 5224 4.71a

**Coccyx**

Removal of 5298 4.71a

**Combinations of Disabilities**

Anatomical loss of one hand and

loss of use of one foot 5104 4.71a

Anatomical loss of one foot and

loss of use of one hand 5105 4.71a

Anatomical loss of both hands 5106 4.71a

Anatomical loss of both feet 5107 4.71a

Anatomical loss of one hand and one foot 5108 4.71a

Loss of use of both hands 5109 4.71a

Loss of use of both feet 5110 4.71a

Loss of use of one hand and one foot 5111 4.71a

**Elbow and Forearm**

Elbow, ankylosis of 5205 4.71a

Elbow, other impairment of Flail joint 5209 4.71a

Forearm, flexion limited to 100º

and extension to 45º 5208 4.71a

Forearm, limitation of extension of 5207 4.71a

Forearm, limitation of flexion of 5206 4.71a

Radius and ulna, nonunion of 5210 4.71a

Radius, impairment of 5212 4.71a

Supination and pronation, impairment of 5213 4.71a

Ulna, impairment of 5211 4.71a

**Foot**

Claw foot (pes cavus), acquired 5278 4.71a

Flatfoot, acquired 5276 4.71a

Hallux rigidus, unilateral, severe 5281 4.71a

Hallux valgus, unilateral 5280 4.71a

Hammer toe 5282 4.71a

Injuries, other 5284 4.71a

Metatarsalgia, anterior (Morton's disease) 5279 4.71a

Tarsal, or metatarsal bones, malunion of 5283 4.71a

Tarsal, or metatarsal bones, nonunion of 5283 4.71a

Weak foot, bilateral 5277 4.71a

##  Hip and Thigh

Femur, impairment of 5255 4.71a

Hip, ankylosis of 5250 4.71a

Hip, flail joint 5254 4.71a

Thigh, impairment of 5253 4.71a

Thigh, limitation of extension of 5251 4.71a

Thigh, limitation of flexion of 5252 4.71a

**Knee and Leg**

Cartilage, semilunar, dislocated 5258 4.71a

Cartilage, semilunar, removal of 5259 4.71a

Genu recurvatum 5263 4.71a

Knee, ankylosis of 5256 4.71a

Knee, other impairment of 5257 4.71a

Leg, limitation of extension of 5261 4.71a

Leg, limitation of flexion of 5260 4.71a

Tibia and fibula, impairment of 5262 4.71a

##  Lower Extremity, Shortening of the

Bones of the lower extremity, shortening of 5275 4.71a

##  Multiple Digits: Favorable Ankylosis

Five digits of one hand 5220 4.71a

Four digits of one hand 5221 4.71a

Three digits of one hand 5222 4.71a

Two digits of one hand 5223 4.71a

##  Multiple Digits: Unfavorable Ankylosis

Five digits of one hand 5216 4.71a

Four digits of one hand 5217 4.71a

Three digits of one hand 5218 4.71a

Two digits of one hand 5219 4.71a

**Multiple Losses of Extremities, Ratings for** Table II 4.71a

##  Prosthetic Implants

Ankle replacement (prosthesis) 5056 4.71a

Hip replacement (prosthesis) 5054 4.71a

Shoulder replacement (prosthesis) 5051 4.71a

Elbow replacement (prosthesis) 5052 4.71a

Knee replacement (prosthesis) 5055 4.71a

Wrist replacement (prosthesis) 5053 4.71a

**Ribs**

Removal of 5297 4.71a

**Shoulder and Arm**

Arm, limitation of motion of 5201 4.71a

Clavicle or scapula, impairment of 5203 4.71a

Humerus, other impairment of 5202 4.71a

Scapulohumeral articulation, ankylosis of 5200 4.71a

**Skull**

Loss of part of, both inner and outer tables 5296 4.71a

**Spine**

Ankylosing spondylitis 5240 4.71a

Degenerative arthritis of the spine

(see diagnostic code 5003) 5242 4.71a

Intervertebral disc syndrome 5243 4.71a

Lumbrosacral or cervical strain 5237 4.71a

Range of motion of cervical and

thoracolumbar spine Plate V 4.71a

Sacroiliac injury and weakness 5236 4.71a

Spinal fusion 5241 4.71a

Spinal stenosis 5238 4.71a

Spondylolisthesis or segmental instability 5239 4.71a

Vertebral fracture or dislocation 5235 4.71a

**Wrist**

Ankylosis of 5214 4.71a

Limitation of motion of 5215 4.71a

Myasthenia gravis 8025 4.124a

Myelitis 8010 4.124a

Myocardial infarction 7006 4.104

Myositis 5021 4.71a

Myositis ossificans 5023 4.71a

**O**

Obsessive compulsive disorder 9404 4.130

Obstructed voiding 4.115a

Obstructive pulmonary disease, chronic 6604 4.97

Oral conditions (*see* Dental and Oral Conditions)

Organs of special sense:

Computation of average concentric contraction of visual fields 4.76a

Computing aggravation 4.78

Differences between distant and near visual acuity 4.84

Examination of field vision 4.76

Examination of muscle function 4.77

Examination of visual acuity 4.75

Impairment of central visual acuity:

General 4.83a

Table Table V 4.84a

Loss of use of one eye, having only light perception 4.79

Normal visual field extent Table III 4.76a

Rating of one eye 4.80

Ratings at scheduled steps and distances 4.83

Osteitis deformans 5016 4.71a

Osteomalacia 5014 4.71a

Osteomyelitis, acute, subacute, or chronic 5000 4.71a

Osteoporosis, with join manifestation 5013 4.71a

Otitis, externa (chronic) 6210 4.87

Otitis media:

Nonsuppurative, chronic 6201 4.87

Suppurative, chronic 6200 4.87

Otosclerosis 6202 4.87

Ovaries, atrophy of both, complete 7620 4.116

Ovary:

Disease, injury, or adhesions of 7615 4.116

Removal of 7619 4.116

**P**

Pacemakers, cardiac (implantable) 7018 4.104

Pain disorder 9422 4.130

Pancreatitis 7347 4.114

Panic disorder 9412 4.130

Papillary necrosis 7538 4.115b

Papulosquamous disorders (not listed elsewhere) 7822 4.118

Paralysis agitans 8004 4.124a

Paramyoclonus multiplex 8104 4.124a

Parasitic diseases otherwise not specified 6320 4.88b

Pectus carinatum 6842 4.97

Pectus excavatum 6842 4.97

Pellagra 6315 4.88b

Pelvic girdle and thigh---muscle injury:

Group XIII 5313 4.73

Group XIV 5314 4.73

Group XV 5315 4.73

Group XVI 5316 4.73

Group XVII 5317 4.73

Group XVIII 5318 4.73

Penis:

Deformity, with loss of erectile power 7522 4.115b

Removal of glans 7521 4.115b

Removal of half or more 7520 4.115b

Pericardial adhesions 7003 4.104

Pericarditis 7002 4.104

Periostitis 5022 4.71a

Peripheral nerves, diseases of (*see* Neurological Conditions and
Convulsive Disorders---Schedule of Ratings)

Peripheral vestibular disorders 6204 4.87

Peritoneum, adhesions of 7301 4.114

Peritonitis, tuberculous, active or inactive 7331 4.114

Pernicious anemia 7700 4.117

Personality disorders and mental retardation 4.127

Pharynx, injuries to 6521 4.97

Pheochromocytoma (benign or malignant) 7918 4.119

Phobia, specific (simple) 9403 4.130

Plague 6307 4.88b

**Plates:**

Ankylosis and joint motion, measurement Plates I--II 4.71

Bones of the foot Plate IV 4.71

Bones of the hand Plate III 4.71

Range of motion of cervical and

thoracolumbar spine Plate V 4.71a

Pleural effusion or fibrosis, chronic 6845 4.97

Pluriglandular syndrome 7912 4.119

Pneumococcic arthritis 5005 4.71a

Pneumoconiosis (silicosis, anthracosis, etc.) 6832 4.97

Pneumonitis:

Desquamative interstitial 6826 4.97

Pulmonary, and fibrosis, drug-induced 6829 4.97

Hypersensitivity (extrinsic allergic

alveolitis) 6831 4.97

Pulmonary, and fibrosis, drug-induced 6829 4.97

Poliomyelitis, anterior 8011 4.124a

Polycystic disease 7533 4.115b

Polycythemia vera 7704 4.117

Postgastrectomy syndromes:

General 4.111

Rating 7308 4.114

Post-phlebitic syndrome of any etiology 7121 4.104

Post-surgical residual (lobectomy,

pneumonectomy, etc.) 6844 4.97

Post-traumatic stress disorder 9411 4.130

Pregnancy, surgical complications of 7623 4.116

Prestabilization rating from date of discharge

from service 4.28

Progressive muscular atrophy 8023 4.124a

Prolactin secreting pituitary dysfunction 7916 4.119

Prostate gland injuries, infections, hypertrophy,

post-operative residuals 7527 4.115b

Pruritus ani 7337 4.114

Psoriasis 7816 4.118

Psychotic disorders (*see* Mental Disorders---Schedule of Ratings)

Pterygium 6034 4.84a

Ptosis, unilateral or bilateral 6019 4.84a

Pulmonary alveolar proteinosis 6827 4.97

Pulmonary disease, obstructive, chronic 6604 4.97

Pulmonary pneumonitis and fibrosis:

Drug-induced 6829 4.97

Radiation-induced 6830 4.97

Pulmonary vascular disease 6817 4.97

Pyelonephritis, chronic 7504 4.115b

Pyramiding, avoidance of 4.14

**Q**

No entries

Neoplasms, skin

Benign 7819 4.118

Malignant 7818 4.118

Papulosquamous disorders (not listed elsewhere) 7822 4.118

Psoriasis 7816 4.118

Scars:

Other 7805 4.118

Other than head, face, or neck:

Deep or cause limited motion 7801 4.118

Superficial; do not cause limited motion 7802 4.118

Superficial:

Painful on examination 7804 4.118

Unstable 7803 4.118

Tuberculosis luposa, active or inactive 7811 4.118

Urticaria 7825 4.118

Vasculitis, primary cutaneous 7826 4.118

Vitiligo 7823 4.118

Skull:

Loss of part of, both inner and outer tables 5296 4.71a

Sleep apnea syndromes 6847 4.97

Smell, loss of sense of, complete 6275 4.87a

Social phobia 9403 4.130

Soft-tissue sarcoma (of vascular origin) 7123 4.104

Somatization disorder 9421 4.130

Somatoform disorders (*see* Mental Disorders---Schedule of Ratings)

Spinal cord:

Injury with respiratory insufficiency 6841 4.97

New growths of:

Benign 8022 4.124a

Malignant 8021 4.124a

Spine:

Ankylosing spondylitis 5240 4.71a

Degenerative arthritis of the spine

(see diagnostic code 5003) 5242 4.71a

Intervertebral disc syndrome 5243 4.71a

Lumbrosacral or cervical strain 5237 4.71a

Range of motion of cervical and

thoracolumbar spine Plate V 4.71a

Sacroiliac injury and weakness 5236 4.71a

Spinal fusion 5241 4.71a

Spinal stenosis 5238 4.71a

Spondylolisthesis or segmental instability 5239 4.71a

Vertebral fracture or dislocation 5235 4.71a

Spleen, injury of, healed 7707 4.117

Splenectomy 7706 4.117

Stomach:

Injury of 7310 4.114

Stenosis of 7309 4.114

Streptococcic arthritis 5008 4.71a

Stress (post-traumatic) disorder 9411 4.130

Stress (traumatic), mental disorders due to 4.129

Supination and pronation, impairment of 5213 4.71a

Supraventricular arrhythmias 7010 4.104

Symblepharon 6091 4.84a

Synovitis 5020 4.71a

Syphilis:

And other treponemal infections 6310 4.88b

Cerebrospinal 8013 4.124a

Meningovascular 8014 4.124a

Syphilitic arthritis 5007 4.71a

Syphilitic heart disease 7004 4.104

Syringomyelia 8024 4.124a

**5227** Ring or little finger, ankylosis of:

Unfavorable or favorable 0 0

> **Note**: Also consider whether evaluation as amputation is warranted
> and whether an additional evaluation is warranted for resulting
> limitation of motion of other digits or interference with overall
> function of the hand.

**IV. Limitation of Motion of Individual Digits**

Rating

*Major Minor*

**5228** Thumb, limitation of motion:

With a gap of more than two inches (5.1 cm.) between the

thumb pad and the fingers, with the thumb attempting to

oppose the fingers 20 20

With a gap of one to two inches (2.5 to 5.1 cm.) between the

thumb pad and the fingers, with the thumb attempting to

oppose the fingers\...\...\...\...\...\...\...\...\...\...\...\..... 10
10

With a gap of less than one inch (2.5 cm.) between the thumb

pad and the fingers, with the thumb attempting to oppose

the fingers 0 0

**5229** Index or long finger, limitation of motion:

With a gap of one inch (2.5 cm.) or more between the fingertip

and the proximal transverse crease of the palm, with the

finger flexed to the extent possible, or; with extension limited

by more than 30 degrees 10 10

With a gap of less than one inch (2.5 cm.) between the fingertip

and the proximal transverse crease of the palm, with the finger

flexed to the extent possible, and; extension is limited by no

more than 30 degrees 0 0

**5230** Ring or little finger, limitation of motion:

Any limitation of motion 0 0

### The Spine

Rating

**General Rating Formula for Diseases and Injuries of the Spine**

(For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the
Formula for Rating

Intervertebral Disc Syndrome Based on Incapacitating Episodes):

With or without symptoms such as pain (whether or not it radiates),
stiffness, or aching in the area of the spine affected by residuals of
injury or disease

Unfavorable ankylosis of the entire spine 100

Unfavorable ankylosis of the entire thoracolumbar spine 50

Unfavorable ankylosis of the entire cervical spine; or, forward flexion

of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis
of

the entire thoracolumbar spine 40

Forward flexion of the cervical spine 15 degrees or less; or, favorable

ankylosis of the entire cervical spine 30

Forward flexion of the thoracolumbar spine greater than 30 degrees but
not

greater than 60 degrees; or, forward flexion of the cervical spine
greater

than 15 degrees but not greater than 30 degrees; or, the combined range
of

motion of the thoracolumbar spine not greater than 120 degrees; or, the

combined range of motion of the cervical spine not greater than 170
degrees;

or, muscle spasm or guarding severe enough to result in an abnormal gait

or abnormal spinal contour such as scoliosis, reversed lordosis, or

abnormal kyphosis 20

Forward flexion of the thoracolumbar spine greater than 60 degrees but
not

greater than 85 degrees; or, forward flexion of the cervical spine
greater than

30 degrees but not greater than 40 degrees; or, combined range of motion
of

the thoracolumbar spine greater than 120 degrees but not greater than
235

degrees; or, combined range of motion of the cervical spine greater than

170 degrees but not greater than 335 degrees; or, muscle spasm,
guarding,

or localized tenderness not resulting in abnormal gait or abnormal
spinal

contour; or, vertebral body fracture with loss of 50 percent or more of
the

height 10

**Note (1):** Evaluate any associated objective neurologic
abnormalities, including, but not limited to, bowel or bladder
impairment, separately, under an appropriate diagnostic code.

**Note (2):** (See also Plate V.) For VA compensation purposes, normal
forward flexion of the cervical spine is zero to 45 degrees, extension
is zero to 45 degrees, left and right lateral flexion are zero to 45
degrees, and left and right lateral rotation are zero to 80 degrees.
Normal forward flexion of the thoracolumbar spine is zero to 90 degrees,
extension is zero to 30 degrees, left and right lateral flexion are zero
to 30 degrees, and left and right lateral rotation are zero to 30
degrees. The combined range of motion refers to the sum of the range of
forward flexion, extension, left and right lateral flexion, and left and
right rotation. The normal combined range of motion of

the cervical spine is 340 degrees and of the thoracolumbar spine is 240
degrees. The normal ranges of motion for each component of spinal motion
provided in this note are the maximum that can be used for calculation
of the combined range of motion.

> **Note (3):** In exceptional cases, an examiner may state that because
> of age, body habitus, neurologic disease, or other factors not the
> result of disease or injury of the spine, the range of motion of the
> spine in a particular individual should be considered normal for that
> individual, even though it does not conform to the normal range of
> motion stated in Note (2). Provided that the examiner supplies an
> explanation, the examiner's assessment that the range of motion is
> normal for that individual will be accepted.

**Note (4):** Round each range of motion measurement to the nearest five
degrees.

**Note (5):** For VA compensation purposes, unfavorable ankylosis is a
condition in which the entire cervical spine, the entire thoracolumbar
spine, or the entire spine is fixed in flexion or extension, and the
ankylosis results in one or more of the following: difficulty walking
because of a limited line of vision; restricted opening of the mouth and
chewing; breathing limited to diaphragmatic respiration;
gastrointestinal symptoms due to pressure of the costal margin on the
abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or
dislocation; or neurologic symptoms due to nerve root stretching.
Fixation of a spinal segment in neutral position (zero degrees) always
represents favorable ankylosis.

**Note (6):** Separately evaluate disability of the thoracolumbar and
cervical spine segments, except when there is unfavorable ankylosis of
both segments, which will be rated as a single disability.

5235 Vertebral fracture or dislocation

5236 Sacroiliac injury and weakness

5237 Lumbosacral or cervical strain

5238 Spinal stenosis

5239 Spondylolisthesis or segmental instability

5240 Ankylosing spondylitis

5241 Spinal fusion

5242 Degenerative arthritis of the spine (see also diagnostic code 5003)

5243 Intervertebral disc syndrome

Evaluate intervertebral disc syndrome (preoperatively or
postoperatively) either under the General Rating Formula for Diseases
and Injuries of the Spine or under the Formula for Rating Intervertebral
Disc Syndrome Based on Incapacitating Episodes, whichever method results
in the higher evaluation when all disabilities are combined under §4.25.

**Formula for Rating Intervertebral Disc Syndrome Based on
Incapacitating Episodes**

With incapacitating episodes having a total duration of at least 6 weeks
during the

past 12 months 60

With incapacitating episodes having a total duration of at least 4 weeks
but less than

6 weeks during the past 12 months 40

With incapacitating episodes having a total duration of at least 2 weeks
but less than

4 weeks during the past 12 months 20

With incapacitating episodes having a total duration of at least one
week but less than

2 weeks during the past 12 months 10

**Plate V -- Range of Motion of Cervical and Thoracolumbar
Spine**![](media/image1.wmf)

**[The Hip and Thigh]{.smallcaps}**

Rating

**5250** Hip, ankylosis of:

Unfavorable, extremely unfavorable ankylosis,

the foot not reaching ground, crutches necessitated 903

Intermediate 70

Favorable in flexion at an angle between 20º and 40º and

slight adduction or abduction 60

**5251** Thigh, limitation of extension of:

Extension limited to 5º 10

**5252** Thigh, limitation of flexion of:

Flexion limited to 10º 40

Flexion limited to 20º 30

Flexion limited to 30º 20

Flexion limited to 45º 10

**5253** Thigh, impairment of:

Limitation of abduction of, motion lost beyond 10º 20

Limitation of adduction of, cannot cross legs 10

Limitation of rotation of, cannot toe-out more than 15º,

affected leg 10

**5254** Hip, flail joint 80

**5255** Femur, impairment of:

Fracture of shaft or anatomical neck of:

With nonunion, with loose motion (spiral or oblique fracture) 80

With nonunion, without loose motion, weightbearing preserved

with aid of brace. 60

Fracture of surgical neck of, with false joint 60

Malunion of:

With marked knee or hip disability 30

With moderate knee or hip disability 20

With slight knee or hip disability 10

3Entitled to special monthly compensation.

[**The Knee and Leg**]{.smallcaps}

Rating

**5256** Knee, ankylosis of:

Extremely unfavorable, in flexion at an angle of 45° or more 60

In flexion between 20° and 45° 50

In flexion between 10° and 20° 40

Favorable angle in full extension, or in slight flexion between 0° and
10° 30

**5257** Knee, other impairment of:

Recurrent subluxation or lateral instability:

Severe 30

Moderate 20

Slight 10

**5258** Cartilage, semilunar, dislocated, with frequent episodes of

"locking," pain, and effusion into the joint 20

**5259** Cartilage, semilunar, removal of, symptomatic. 10

**5260** Leg, limitation of flexion of:

Flexion limited to 15° 30

Flexion limited to 30° 20

Flexion limited to 45° 10

Flexion limited to 60° 0

**5261** Leg, limitation of extension of:

Extension limited to 45° 50

Extension limited to 30° 40

Extension limited to 20° 30

Extension limited to 15° 20

Extension limited to 10° 10

Extension limited to 5° 0

**5262** Tibia and fibula, impairment of:

Nonunion of, with loose motion, requiring brace 40

Malunion of:

With marked knee or ankle disability 30

With moderate knee or ankle disability 20

With slight knee or ankle disability 10

**5263** Genu recurvatum (acquired, traumatic, with weakness and

insecurity in weight-bearing objectively demonstrated) 10

**[The Ankle]{.smallcaps}**

Rating

**5270** Ankle, ankylosis of:

In plantar flexion at more than 40º, or in dorsiflexion at more

than 10˚ or with abduction, adduction, inversion or eversion

deformity 40

In plantar flexion, between 30º and 40º, or in dorsiflexion,

between 0º and 10º 30 30

In plantar flexion, less than 30º 20

**5271** Ankle, limited motion of:

Marked 20

Moderate 10

**5272** Subastragalar or tarsal joint, ankylosis of:

In poor weight-bearing position 20 ,,,,,, 20

In good weight-bearing position 10

**5273** Os calcis or astragalus, malunion of:

Marked deformity 20 ,,,., ,,,,,,,, .,,,,, 20

Moderate deformity 10

**5274** Astragalectomy 20

**[Shortening of the Lower Extremity]{.smallcaps}**

Rating

**5275** Bones, of the lower extremity, shortening of:

Over 4 inches (1 0.2 cms.) 603 3 60

3-1/2 to 4 inches (8.9 cms. to 10.2 cms.) 503

3 to 3-1/2 inches (7.6 cms.to 8.9 cms.) 40

2-1/2 to 3 inches (6.4 cms. to 7.6 cms.) 30 30

2 to 2-1/2 inches (5.1 cms. to 6.4 cms.) 20 20

1-1/4 to 2 inches (3.2 cms. to 5.1 cms.) 10

Note: Measure both lower extremities from anterior superior spine of the
ilium to the internal malleolus of the tibia. Not to be combined with
other ratings for fracture or faulty union in the same extremity.

3Also entitled to special monthly compensation.

**[The Foot]{.smallcaps}**

Rating

**5276** Flatfoot, acquired:

Pronounced; marked pronation, extreme tenderness of plantar

surfaces of the feet, marked inward displacement and severe spasm

of the tendo achillis on manipulation, not improved by orthopedic

shoes or appliances:

Bilateral 50 ,.,, ,,,,.,,,,,,,,.,,,,,.,,, , ,,,,,,,,,,,,,,,,,,,,, 50

Unilateral 30

Severe; objective evidence of marked deformity (pronation,

abduction, etc.), pain on manipulation and use accentuated,

indication of swelling on use, characteristic callosities:

Bilateral 30

Unilateral 20 , ,, ,,,,,,,,,,, 20

Moderate; weight-bearing line over or medial to great toe, inward

bowing of the tendo achillis, pain on manipulation and use of

the feet, bilateral or unilateral 10

Mild: symptoms relieved by built-up shoe or arch support 0

**5277** Weak Foot, bilateral:

A symptomatic condition secondary to many constitutional conditions,

characterized by atrophy of the musculature, disturbed circulation,

and weakness:

Rate the underlying condition, minimum rating 10

**5278** Claw foot (pes cavus), acquired:

Marked contraction of plantar fascia with dropped forefoot, all toes

hammer toes, very painful callosities, marked varus deformity:

Bilateral 50

Unilateral 30

All toes tending to dorsiflexion, limitation of dorsiflexion at ankle

to right angle, shortened plantar fascia, and marked tenderness

under metatarsal heads:

Bilateral 30

Unilateral 20

Great toe dorsiflexed, some limitation of dorsiflexion at ankle,

definite tenderness under metatarsal heads:

Bilateral 10

Unilateral 10

Slight 0

**5279** Metatarsalgia, anterior (Morton's disease), unilateral, or
bilateral 10

**5280** Hallux valgus, unilateral:

Operated with resection of metatarsal head 10

Severe, if equivalent to amputation of great toe 10

**5281** Hallux rigidus, unilateral, severe:

Rate as hallux valgus, severe.

Note: Not to be combined with claw foot ratings.

**5282** Hammer toe:

All toes, unilateral without claw foot 10

Single toes 0

**5283** Tarsal, or metatarsal bones, malunion of, or nonunion of:

Severe 30

Moderately severe 20

Moderate 10

Note: With actual loss of use of the foot, rate 40 percent.

**5284** Foot injuries, other:

Severe 30

Moderately severe 20

Moderate 10

Note: With actual loss of use of the foot, rate 40 percent.

**[The Skull]{.smallcaps}**

Rating

**5296** Skull, loss of part of, both inner and outer tables:

With brain hernia 80

Without brain hernia:

Area larger than size of a 50-cent piece or 1.140 in2 (7.355 cm2 ) 50

Area intermediate 30

Area smaller than the size of a 25-cent piece

or 0.716 in2 (4.619 cm2 ) 10

Note: Rate separately for intracranial complications.

**[The Ribs]{.smallcaps}**

Rating

**5297** Ribs, removal of:

More than six 50

Five or six 40

Three or four 30

Two 20

One or resection of two or more ribs without regeneration 10

**Note (1):** The rating for rib resection or removal is not to be
applied with ratings for purulent pleurisy, lobectomy, pneumonectomy or
injuries of pleural cavity.

**Note (2):** However, rib resection will be considered as rib removal
in thoracoplasty performed for collapse therapy or to accomplish
obliteration of space and will be combined with the rating for lung
collapse, or with the rating for lobectomy, pneumonectomy or the
graduated ratings for pulmonary tuberculosis.

**[The Coccyx]{.smallcaps}**

Rating

**5298** Coccyx, removal of:

Partial or complete, with painful residuals 10

Without painful residuals 0

(Authority: 38 U.S.C. 1155)

\[29 FR 6718, May 22,1964, as amended at 34 FR 5062, Mar. 11, 1969; 40
FR 42536, Sept. 15, 1975; 41 FR 11294, Mar. 18, 1976; 43 FR 45350, Oct.
2, 1978; 51 FR 6411, Feb. 24, 1986; 61 FR 20439, May 7, 1996; 64 FR
32410, June 17, 1999; 67 FR 48785, July 26, 2002; 67 FR 54349, Aug. 22,
2002; 68 FR 51456, Aug. 27, 2003\]

**Supplement *Highlights* references**: 16(1), 26(2), 30(1), 31(1),
33(1).

#### Table II

**[Ratings for Multiple Losses of Extremities with Dictator's Rating
Code and 38 CFR Citation]{.smallcaps}**

Impairment of other extremity

+---------+---------+---------+---------+---------+---------+---------+
| Imp     | Ana     | Ana     | Ana     | Ana     | Ana     | Ana     |
| airment | tomical | tomical | tomical | tomical | tomical | tomical |
| of one  | loss or | loss or | loss or | loss or | loss    | loss    |
| ex      | loss of | loss of | loss of | loss of | near    | near    |
| tremity | use     | use     | use     | use     | s       | hip     |
|         | below   | below   | above   | above   | houlder | (pre    |
|         | elbow   | knee    | elbow   | knee    | (pre    | venting |
|         |         |         | (pre    | (pre    | venting | use of  |
|         |         |         | venting | venting | use of  | pros    |
|         |         |         | use of  | use of  | pros    | thesis) |
|         |         |         | pros    | pros    | thesis) |         |
|         |         |         | thesis) | thesis) |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| Ana     | M Codes | L Codes | M 1/2   | L 1/2   | N Code  | M Code  |
| tomical | M-1 a,  | L-1 d,  | Code    | Code    | N-3, 38 | M-3 c,  |
| loss or | b,      | e, f,   | M-5,    | L-2 c,  | CFR     | 38 CFR  |
| loss of |         |         |         |         | 3       | 3.3     |
| use     | or c,   | or g,   | 38 CFR  | 38 CFR  | .350(f) | 50(f)(1 |
| below   | 38 CFR  | 38 CFR  | 3.350(f | 3       | (1)(xi) | )(viii) |
| elbow   | 3.350(c | 3       | )(1)(x) | .350(f) |         |         |
|         | )(1)(i) | .350(b) |         | (1)(vi) |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| Ana     | 3       | L Codes | L 1/2   | L 1/2   | M Code  | M Code  |
| tomical | .350(b) | L-1 a,  | Code    | Code    | M-3 b,  | M-3 a,  |
| loss or |         | b,      | L-2 b,  | L-2 a,  |         |         |
| loss of |         |         |         |         | 38 CFR  | 38 CFR  |
| use     |         | or c,   | 38 CFR  | 38 CFR  | 3       | 3       |
| below   |         | 38 CFR  | 3.350(f | 3       | .350(f) | .350(f) |
| knee    |         | 3.350   | )(1)(i) | .350(f) | (1)(ii) |         |
|         |         | (       |         | (1)(iv) |         |         |
|         |         | 1)(iii) |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| Ana     |         |         | N Code  | M Code  | N 1/2   | M 1/2   |
| tomical |         |         | N-1,    | M-2 a,  | Code    | Code    |
| loss or |         |         |         |         | N-4     | M-4 c,  |
| loss of |         |         | 38 CFR  | 38 CFR  |         |         |
| use     |         |         | 3.35    | 3       | 38 CFR  | 38 CFR  |
| above   |         |         | 0(d)(1) | .350(c) | 3       | 3       |
| elbow   |         |         |         | (       | .350(f) | .350(f) |
| (pre    |         |         |         | 1)(iii) | (1)(ix) |         |
| venting |         |         |         |         |         | (1)(xi) |
| use of  |         |         |         |         |         |         |
| pros    |         |         |         |         |         |         |
| thesis) |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| Ana     |         |         |         | M Code  | M 1/2   | M 1/2   |
| tomical |         |         |         | M-2 a,  | Code    | Code    |
| loss or |         |         |         |         | M-4 b,  | M-4 a,  |
| loss of |         |         |         | 38 CFR  |         |         |
| use     |         |         |         | 3       | 38 CFR  | 38 CFR  |
| above   |         |         |         | .350(c) | 3       | 3       |
| knee    |         |         |         | (1)(ii) | .350(f) | .350(f) |
| (pre    |         |         |         |         |         |         |
| venting |         |         |         |         | (       | (1)(v)  |
| use of  |         |         |         |         | 1)(vii) |         |
| pros    |         |         |         |         |         |         |
| thesis) |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| Ana     |         |         |         |         | O Code  | N Code  |
| tomical |         |         |         |         | O-1,    | N-2 b,  |
| loss    |         |         |         |         |         |         |
| near    |         |         |         |         | 38 CFR  | 38 CFR  |
| s       |         |         |         |         | 3       | 3       |
| houlder |         |         |         |         | .350(e) | .350(d) |
| (pre    |         |         |         |         | (1)(i)  | (3)     |
| venting |         |         |         |         |         |         |
| use of  |         |         |         |         |         |         |
| pros    |         |         |         |         |         |         |
| thesis) |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| Ana     |         |         |         |         |         | N Code  |
| tomical |         |         |         |         |         | N-2 a,  |
| loss    |         |         |         |         |         |         |
| near    |         |         |         |         |         | 38 CFR  |
| hip     |         |         |         |         |         | 3       |
| (pre    |         |         |         |         |         | .350(d) |
| venting |         |         |         |         |         | (2)     |
| use of  |         |         |         |         |         |         |
| pros    |         |         |         |         |         |         |
| thesis) |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+

Note: Need for aid attendance or permanently bedridden qualifies for
subpar. L. Code L-1 h, i (38 CFR 3.350(b)). Paraplegia with loss of use
of both lower extremities and loss of anal and bladder sphincter control
qualifies for subpar. O. Code O-2 (38 CFR 3.350(e)(2). Where there are
additional disabilities rated 50% or 100%, or anatomical or loss of use
of a third extremity see 38 CFR 3.350(f)(3), (4), or (5). (Authority: 38
U.S.C. 1115)