[Federal Register Volume 62, Number 60 (Friday, March 28, 1997)]
[Proposed Rules]
[Pages 14832-14833]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-7833]


      
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Proposed Rules
                                                Federal Register
________________________________________________________________________

This section of the FEDERAL REGISTER contains notices to the public of 
the proposed issuance of rules and regulations. The purpose of these 
notices is to give interested persons an opportunity to participate in 
the rule making prior to the adoption of the final rules.

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Federal Register / Vol. 62, No. 60 / Friday, March 28, 1997 / 
Proposed Rules

[[Page 14832]]



DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 4

RIN 2900-AI46


Schedule for Rating Disabilities: Cold Injuries

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: This document proposes to amend the Department of Veterans 
Affairs (VA) Schedule for Rating Disabilities (38 CFR part 4) by 
revising the evaluation criteria for frozen feet. The intended effect 
of this amendment is to provide evaluation criteria based on current 
medical knowledge about the long-term effects of cold injury that can 
be applied to any part of the body affected by cold injury.

DATES: Comments must be received by VA on or before May 27, 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-AI46.'' All written 
comments received will be available for public inspection at the above 
address in the Office of Regulations Management, Room 1158, between the 
hours of 8 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: Disability due to frozen feet is currently 
evaluated under diagnostic code (DC) 7122 in 38 CFR 4.104, the section 
of VA's Schedule for Rating Disabilities that is titled ``Schedule of 
ratings--cardiovascular system.'' Because much more is now known about 
the long-term effects of cold injury than when these criteria were 
established, we propose to update the criteria to assure that they are 
consistent with modern medical knowledge and encompass the broad range 
of residuals that may result from cold injury. Since cold injuries may 
affect parts of the body other than the feet, particularly the hands, 
nose, and ears, we propose to retitle DC 7122 ``Cold injury, residuals 
of'' to indicate that it may be used to evaluate any cold injury.
    The current evaluation criteria for frozen feet provide three 
levels of evaluation, with separate evaluations at each level, for 
unilateral and bilateral involvement. The evaluations, which range from 
10 to 50 percent, are based on the presence of chilblains, swelling, 
tenderness, and redness, and there are subjective indicators, e.g., 
``mild'' symptoms, ``persistent severe'' symptoms, at each level. A 
major goal of the overall revision of VA's rating schedule that is 
underway is to provide more objective evaluation criteria. We therefore 
propose to provide criteria that are both more objective and more 
consistent with the current state of medical knowledge.
    We propose new criteria based on the presence of pain, numbness, 
cold sensitivity, or arthralgia for a 10-percent evaluation; the same 
symptoms plus tissue loss, nail abnormalities, color changes, locally 
impaired sensation, hyperhidrosis, or X-ray abnormalities such as 
osteoporosis, subarticular punched out lesions, and osteoarthritis for 
a 20-percent evaluation and the same symptoms plus two or more of the 
following: Tissue loss, nail abnormalities, color changes, locally 
impaired sensation, hyperhidrosis, or X-ray abnormalities (same as 
above) for a 30-percent evaluation. These are the most common long-term 
residuals of cold injury (``Harrison's Principles of Internal 
Medicine'' 2199 (Jean D. Wilson, M.D. et al. eds., 12th ed. 1991)), and 
the proposed criteria should assure consistent evaluations of veterans 
with cold injury.
    In the current schedule, a note under DC 7122 advises that higher 
ratings may be warranted for amputation of toes. We propose to revise 
the note to indicate that there are other conditions besides 
amputations, such as squamous cell carcinoma at the site of a cold 
injury scar, or peripheral neuropathy, that warrant separate 
evaluation.
    In addition to revising the criteria themselves, and in light of 
the fact that under the revised code, parts of the body other than the 
feet may be evaluated, we propose to revise the method of determining 
an overall evaluation when more than one body part is affected. Rather 
than providing specific evaluations for unilateral and bilateral 
evaluations, we propose to add a second note following DC 7122 
directing that each affected part (hand, foot, ear, nose) be evaluated 
separately and the ratings combined. This will not only allow separate 
evaluations for affected parts other than the feet but will, unlike the 
current schedule, provide a means of appropriately evaluating each of 
paired parts when they are not equally affected.
    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), 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: December 17, 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:

[[Page 14833]]

PART 4--SCHEDULE FOR RATING DISABILITIES

Subpart B--Disability Ratings

    1. The authority citation for part 4 continues to read as follows:

    Authority: 38 U.S.C. 1155.

    2. Section 4.104 is amended by revising diagnostic code 7122 and 
adding a new authority citation at the end of the section, to read as 
follows:


Sec. 4.104  Schedule of ratings--cardiovascular system.

* * * * *

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
7122  Cold injury, residuals of:                                        
    With pain, numbness, cold sensitivity, or arthralgia plus           
     two or more of the following: Tissue loss, nail                    
     abnormalities, color changes, locally impaired sensation,          
     hyperhidrosis, X-ray abnormalities (osteoporosis,                  
     subarticular punched out lesions, or osteoarthritis) of            
     affected parts.............................................      30
    With pain, numbness, cold sensitivity, or arthralgia plus           
     tissue loss, nail abnormalities, color changes, locally            
     impaired sensation, hyperhidrosis, or X-ray abnormalities          
     (osteoporosis, subarticular punched out lesions, or                
     osteoarthritis) of affected parts..........................      20
    With pain, numbness, cold sensitivity, or arthralgia........      10
------------------------------------------------------------------------

    Note (1): Amputations of fingers or toes, and complications such 
as squamous cell carcinoma at the site of a cold injury scar or 
peripheral neuropathy should be separately evaluated under other 
diagnostic codes.

    Note (2): Evaluate each affected part (hand, foot, ear, nose) 
separately and combine the ratings, if appropriate, in accordance 
with 38 CFR 4.25.
* * * * *
(Authority: 38 U.S.C. 1155)

[FR Doc. 97-7833 Filed 3-27-97; 8:45 am]
BILLING CODE 8320-01-P