8204 Federal Register / Vol. 62, No. 36 / Monday, February 24, 1997 / Proposed Rules

(f) Chronic periodontal disease. Teeth

extracted because of chronic periodontal

disease will be service connected only

if they were extracted after 180 days or

more of active service.

(Authority: 38 U.S.C. 1712)

§ 3.382 [Removed]

3. Section 3.382 is removed.

PART 4—SCHEDULE FOR RATING

DISABILITIES

Subpart B—Disability Ratings

4. The authority citation for part 4

continues to read as follows:

Authority: 38 U.S.C. 1155.

§ 4.149 [Removed]

5. Section 4.149 is removed.

[FR Doc. 97–4419 Filed 2–21–97; 8:45 am]

BILLING CODE 8320–01–P

38 CFR Part 4

RIN 2900–AI22

Intervertebral Disc Syndrome

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

SUMMARY: This document proposes to

amend the Department of Veterans

Affairs (VA) Schedule for Rating

Disabilities by revising the evaluation

criteria for diagnostic code 5293,

intervertebral disc syndrome. The

intended effect of this amendment is to

clarify the criteria to ensure that

veterans diagnosed with this condition

meet uniform criteria and receive

consistent evaluations.

DATES: Comments must be received by

VA on or before April 25, 1997.

ADDRESSES: Mail or hand deliver written

comments to: Director, Office of

Regulations Management (02D),

Department of Veterans Affairs, 810

Vermont Ave., NW, Room 1154,

Washington DC 20420. Comments

should indicate that they are in

response to ‘‘RIN 2900–AI22.’’ All

written comments will be available for

public inspection at the above address

in the Office of Regulations

Management, Room 1158, between the

hours of 8:00 a.m. and 4:30 p.m.,

Monday through Friday (except

holidays).

FOR FURTHER INFORMATION CONTACT:

Caroll McBrine, M.D., Consultant,

Regulations Staff (213A), Compensation

and Pension Service, Veterans Benefits

Administration, Department of Veterans

Affairs, 810 Vermont Ave., NW,

Washington, DC 20420, (202) 273–7230.

SUPPLEMENTARY INFORMATION: The

central portion of one or more

intervertebral discs, cartilages that

separate the spinal vertebrae, may

protrude or rupture through the outer

fibrous part of the disc and compress or

irritate the adjacent nerve root.

Intervertebral disc syndrome is a group

of signs and symptoms due to nerve root

irritation that commonly includes back

pain and sciatica (pain along the course

of the sciatic nerve) in the case of

lumbar disc disease, and neck and arm

or hand pain in the case of cervical disc

disease. It may also include scoliosis,

paravertebral muscle spasm, limitation

of motion of the spine, tenderness over

the spine, limitation of straight leg

raising, and neurologic findings

corresponding to the level of the disc. If

the disc compresses the cauda equina

(the collection of nerve roots extending

from the lower end of the spinal cord),

bowel or bladder sphincter functions or

sexual function may also be affected.

Intervertebral disc syndrome has a

variable course and variable

manifestations. Many people have a

series of relapses and remissions of back

pain and sciatica over a long period of

time with no symptoms during

remission; other patients experience

chronic signs and symptoms.

The current evaluation criteria for

intervertebral disc syndrome (DC 5293)

include: a 60-percent evaluation for

persistent sciatic neuropathy or other

neurologic findings, with little

intermittent relief; a 40-percent

evaluation for severe recurring attacks; a

20-percent evaluation for moderate

recurring attacks; a 10-percent

evaluation if the condition is mild; and

a zero-percent evaluation if the

condition is postoperative, cured. These

criteria require rating agencies to make

a subjective determination as to whether

the condition is ‘‘mild,’’ ‘‘moderate,’’ or

‘‘severe.’’ In addition, they raise

questions as to whether any neurologic

manifestation, regardless of severity,

warrants a 60-percent evaluation, or

whether intervertebral disc syndrome

with neurologic manifestations may be

evaluated higher or lower than 60

percent.

In order to clarify the evaluation

criteria, and thereby assure more

consistent evaluations, we propose to

eliminate subjective terms such as mild,

moderate, and severe in favor of more

objective criteria, and to provide

specific instructions for evaluating both

the orthopedic and neurologic

manifestations of intervertebral disc

syndrome. We also propose that these

criteria apply both pre-operatively and

post-operatively.

We propose to evaluate intervertebral

disc syndromes that are primarily

disabling because of periods of acute

symptoms that require bed rest

according to the cumulative amount of

time over the course of a year that the

patient is incapacitated, i.e., requires

bed rest and treatment by a physician.

Incapacitating episodes of at least six

weeks total duration per year would be

evaluated at 60 percent; incapacitating

episodes of at least four but less than six

weeks total duration per year at 40

percent; incapacitating episodes of at

least two but less than four weeks total

duration per year at 20 percent; and

incapacitating episodes of at least one

but less than two weeks total duration

per year at 10 percent. Evaluating the

condition in this manner will assure

more consistent evaluations when the

disc disease is episodic because

percentage evaluations will be assigned

based on an objective standard—yearly

cumulative duration of incapacitating

episodes—rather than a subjective

assessment of whether the condition is

mild, moderate, or severe.

We propose to evaluate intervertebral

disc syndromes that are disabling

primarily because of chronic orthopedic

manifestations (e.g., painful muscle

spasm or limitation of motion), chronic

neurologic manifestations (e.g.,

footdrop, muscle atrophy, or sensory

loss), or a combination of both, by

assigning separate evaluations for the

orthopedic and neurologic

manifestations, using DC 5293

hyphenated with the appropriate

orthopedic or neurologic code.

Assigning separate evaluations for the

orthopedic and neurologic

manifestations will assure that

evaluations accurately reflect the actual

disabling effects of the condition, and

that neurologic manifestations in

particular will not be over-or underevaluated by being considered

categorically rather than individually.

When an intervertebral disc syndrome

is disabling both because of

incapacitating episodes and persistent

orthopedic or neurologic manifestations,

we propose that the rating agency use

whichever alternative method of

evaluation results in a higher

evaluation.

The Secretary hereby certifies that

this regulatory amendment will not

have a significant economic impact on

a substantial number of small entities as

they are defined in the Regulatory

Flexibility Act (RFA), 5 U.S.C. 601–612.

The reason for this certification is that

this amendment would not directly

affect any small entities. Only VA

beneficiaries could be directly affected.

Therefore, pursuant to 5 U.S.C. 605(b),
Federal Register / Vol. 62, No. 36 / Monday, February 24, 1997 / Proposed Rules 8205

this amendment is exempt from the

initial and final regulatory flexibility

analysis requirements of sections 603

and 604.

This regulatory amendment has been

reviewed by the Office of Management

and Budget under the provisions of

Executive Order 12866, Regulatory

Planning and Review, dated September

30, 1993.

The Catalog of Federal Domestic

Assistance program numbers are 64.104 and

64.109.

List of Subjects in 38 CFR Part 4

Disability benefits, Individuals with

disabilities, Pensions, Veterans.

Approved: November 5, 1996.

Jesse Brown,

Secretary of Veterans Affairs.

For the reasons set out in the

preamble, 38 CFR part 4, subpart B, is

proposed to be amended as set forth

below:

PART 4—SCHEDULE FOR RATING

DISABILITIES

1. The authority citation for part 4

continues to read as follows:

Authority: 38 U.S.C. 1155.

2. Section 4.71a is amended by

revising diagnostic code 5293 and

adding an authority citation at the end

of the section to read as follows:

§ 4.71a Schedule of ratings—

musculoskeletal system.

The Spine

* * * * *

5293 Intervertebral disc syndrome:

Evaluate intervertebral disc syndrome

(preoperatively or postoperatively)

based on either its chronic

manifestations or on the annual

duration of incapacitating episodes,

whichever results in a higher

evaluation.

With incapacitating episodes having a

total duration of at least six weeks

per year ...................................................60

With incapacitating episodes having a

total duration of at least four weeks

but less than six weeks per year

.................................................................40

With incapacitating episodes having a

total duration of at least two weeks

but less than four weeks per year

.................................................................20

With incapacitating episodes having a

total duration of at least one week

but less than two weeks per year

.................................................................10

Note (1): An incapacitating episode of

intervertebral disc syndrome means a

period of acute symptoms (orthopedic,

neurologic, or both), requiring bed rest

and treatment by a physician.

Note (2): When evaluating on the

basis of chronic manifestations, evaluate

orthopedic manifestations, such as

limitation of motion of lumbar or

cervical spine, paravertebral muscle

spasm, or scoliosis of the spine, under

DC 5293, using evaluation criteria for an

appropriate diagnostic code; evaluate

neurologic manifestations, such as

footdrop, muscle atrophy, sensory loss,

or neurogenic bladder separately under

DC 5293, using evaluation criteria for an

appropriate diagnostic code.

* * * * *

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

[FR Doc. 97–4415 Filed 2–21–97; 8:45 am]

BILLING CODE 8320–01–P

ENVIRONMENTAL PROTECTION

AGENCY

40 CFR Part 52

[CA–13–0027b; FRL–5688–1]

Approval and Promulgation of State

Implementation Plans; California State

Implementation Plan Revision, South

Coast Air Quality Management District

and Yolo-Solano Air Quality

Management District

AGENCY: Environmental Protection

Agency (EPA).

ACTION: Proposed rule.

SUMMARY: EPA is proposing to approve

revisions to the California State

Implementation Plan (SIP) which

concern the control of volatile organic

compound (VOC) emissions from

wastewater separators and

pharmaceutical manufacturing

operations.

The intended effect of proposing

approval of these rules is to regulate

emissions of VOCs in accordance with

the requirements of the Clean Air Act,

as amended in 1990 (CAA or the Act).

In the final rules section of this Federal

Register, the EPA is approving the

state’s SIP revision as a direct final rule

without prior proposal because the

Agency views this as a noncontroversial

revision amendment and anticipates no

adverse comments. A detailed rationale

for this approval is set forth in the direct

final rule. If no adverse comments are

received in response to this proposed

rule, no further activity is contemplated

in relation to this rule. If EPA receives

adverse comments, the direct final rule

will be withdrawn and all public

comments received will be addressed in

a subsequent final rule based on this

proposed rule. The EPA will not

institute a second comment period on

this document. Any parties interested in

commenting on this action should do so

at this time.

DATES: Comments on this proposed rule

must be received in writing by March

26, 1997.

ADDRESSES: Written comments on this

action should be addressed to: Andrew

Steckel, Rulemaking Section [Air-4], Air

Division, U.S. Environmental Protection

Agency, Region 9, 75 Hawthorne Street,

San Francisco, CA 94105–3901.

Copies of the rule revisions and EPA’s

evaluation report of each rule are

available for public inspection at EPA’s

Region 9 office during normal business

hours. Copies of the submitted rule

revisions are also available for

inspection at the following locations:

California Air Resources Board,

Stationary Source Division, Rule

Evaluation Section, 2020 ‘‘L’’ Street,

Sacramento, CA 95812.

South Coast Air Quality Management

District, 21865 E. Copley Drive,

Diamond Bar, CA 91765–4182.

Yolo-Solano Air Quality Management

District, 1947 Galileo Court, Suite

103, Davis, CA 95616.

FOR FURTHER INFORMATION CONTACT:

Christine Vineyard, Rulemaking Section

[Air-4], Air Division, Air and Toxics

Division, U.S. Environmental Protection

Agency, Region 9, 75 Hawthorne Street,

San Francisco, CA 94105–3901,

Telephone: (415) 744–1197.

SUPPLEMENTARY INFORMATION: This

document concerns South Coast Air

Quality Management District Rule 464,

Wastewater Separators; and Yolo-Solano

Air Quality Management District, Rule

2.35, Pharmaceutical Manufacturing

Operations, submitted to EPA on May

13, 1991 and November 30, 1994,

respectively, by the California Air

Resources Board. For further

information, please see the information

provided in the direct final action

which is located in the rules section of

this Federal Register.

Authority: 42 U.S.C. 7401–7671q.

Dated: February 3, 1997.

Felicia Marcus,

Regional Administrator.

[FR Doc. 97–4420 Filed 2–21–97; 8:45 am]

BILLING CODE 6560–50-P