Federal Register / Vol. 86, No. 187 / Thursday, September 30, 2021 / Rules and Regulations 54081 

because it does not have a substantial 

direct effect on one or more Indian 

tribes, on the relationship between the 

Federal Government and Indian tribes, 

or on the distribution of power and 

responsibilities between the Federal 

Government and Indian tribes. 

E. Unfunded Mandates Reform Act 

The Unfunded Mandates Reform Act 

of 1995 (2 U.S.C. 1531–1538) requires 

Federal agencies to assess the effects of 

their discretionary regulatory actions. In 

particular, the Act addresses actions 

that may result in the expenditure by a 

State, local, or tribal government, in the 

aggregate, or by the private sector of 

$100,000,000 (adjusted for inflation) or 

more in any one year. Though this rule 

will not result in such an expenditure, 

we do discuss the effects of this rule 

elsewhere in this preamble. 

F. Environment 

We have analyzed this rule under 

Department of Homeland Security 

Directive 023–01, Rev. 1, associated 

implementing instructions, and 

Environmental Planning COMDTINST 

5090.1 (series), which guide the Coast 

Guard in complying with the National 

Environmental Policy Act of 1969 (42 

U.S.C. 4321–4370f), and have 

determined that this action is one of a 

category of actions that do not 

individually or cumulatively have a 

significant effect on the human 

environment. This rule involves a 

temporary safety zone in the navigable 

waters around the loading, staging, 

transit, and display of fireworks near 

Pier 50 and Pier 27 in San Francisco 

Bay. It is categorically excluded from 

further review under paragraph L60(a) 

of Appendix A, Table 1 of DHS 

Instruction Manual 023–01–001–01, 

Rev. 1. A Record of Environmental 

Consideration supporting this 

determination is available in the docket. 

For instructions on locating the docket, 

see the ADDRESSES section of this 

preamble. 

G. Protest Activities 

The Coast Guard respects the First 

Amendment rights of protesters. 

Protesters are asked to call or email the 

person listed in the FOR FURTHER

INFORMATION CONTACT section to 

coordinate protest activities so that your 

message can be received without 

jeopardizing the safety or security of 

people, places or vessels. 

List of Subjects in 33 CFR Part 165 

Harbors, Marine safety, Navigation 

(water), Reporting and recordkeeping 

requirements, Security measures, 

Waterways. 

For the reasons discussed in the 

preamble, the Coast Guard amends 33 

CFR part 165 as follows: 

PART 165—REGULATED NAVIGATION 

AREAS AND LIMITED ACCESS AREAS 

■ 1. The authority citation for part 165 

continues to read as follows: 

Authority: 46 U.S.C. 70034, 70051; 33 CFR 

1.05–1, 6.04–1, 6.04–6, and 160.5; 

Department of Homeland Security Delegation 

No. 00170.1, Revision No. 01.2. 

■ 2. Add § 165.T11–067 to read as 

follows: 

§ 165.T11–067 Safety Zone; Pier 27 

Fireworks Display, San Francisco Bay, San 

Francisco, CA. 

(a) Location. The following area is a 

safety zone: all navigable waters of San 

Francisco Bay, from surface to bottom, 

within a circle formed by connecting all 

points 100 feet out from the fireworks 

barge during loading and staging at Pier 

50 in San Francisco, as well as transit 

and arrival at Pier 27, San Francisco, 

CA. Between 9:20 p.m. and 10:30 p.m. 

on October 1, 2021, the safety zone will 

expand to all navigable waters, from 

surface to bottom, within a circle 

formed by connection all points 500 feet 

out from the fireworks barge in 

approximate position 37°48′23.0′′ N, 

122°23′51.1′′ W (NAD 83) or as 

announced via Broadcast Notice to 

Mariners. 

(b) Definitions. As used in this 

section, ‘‘designated representative’’ 

means a Coast Guard Patrol 

Commander, including a Coast Guard 

coxswain, petty officer, or other officer 

operating a Coast Guard vessel, or a 

Federal, State, or Local officer 

designated by or assisting the Captain of 

the Port San Francisco (COTP) in the 

enforcement of the safety zone. 

(c) Regulations. (1) Under the general 

safety zone regulations in subpart C of 

this part, you may not enter the safety 

zone described in paragraph (a) of this 

section unless authorized by the COTP 

or the COTP’s designated representative. 

(2) The safety zone is closed to all 

vessel traffic, except as may be 

permitted by the COTP or the COTP’s 

designated representative. 

(3) Vessel operators desiring to enter 

or operate within the safety zone must 

contact the COTP or the COTP’s 

designated representative to obtain 

permission to do so. Vessel operators 

given permission to enter or operate in 

the safety zone must comply with all 

lawful orders or directions given to 

them by the COTP or the COTP’s 

designated representative. Persons and 

vessels may request permission to enter 

the safety zone on VHF–23A or through 

the 24-hour Command Center at 

telephone (415) 399–3547. 

(d) Enforcement period. This section 

will be enforced from 9 a.m. until 10:30 

p.m. on October 1, 2021. 

(e) Information broadcasts. The COTP 

or the COTP’s designated representative 

will notify the maritime community of 

periods during which this zone will be 

enforced, in accordance with § 165.7. 

Dated: September 22, 2021. 

Taylor Q. Lam, 

Captain, U.S. Coast Guard, Captain of the 

Port, San Francisco. 

[FR Doc. 2021–21098 Filed 9–29–21; 8:45 am] 

BILLING CODE 9110–04–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 4 

RIN 2900–AQ71 

Schedule for Rating Disabilities; The 

Genitourinary Diseases and 

Conditions 

AGENCY: Department of Veterans Affairs. 

ACTION: Final rule. 

SUMMARY: This document amends the 

Department of Veterans Affairs (VA) 

Schedule for Rating Disabilities 

(VASRD) by revising the portion of the 

schedule that addresses the 

genitourinary system. This action 

ensures that the rating schedule uses 

current medical terminology and 

provides detailed and updated criteria 

for evaluation of genitourinary 

conditions for disability rating 

purposes. 

DATES: This final rule is effective 

November 14, 2021. 

FOR FURTHER INFORMATION CONTACT: 

Ioulia Vvedenskaya, M.D., M.B.A., 

Medical Officer, VASRD Program Office 

(210), Compensation Service (21C), 

Veterans Benefits Administration, 

Department of Veterans Affairs, 810 

Vermont Avenue NW, Washington, DC 

20420, (202) 461–9752. (This is not a 

toll-free telephone number.) 

SUPPLEMENTARY INFORMATION: On 

October 15, 2019, VA published the 

proposed rule for Schedule of Rating 

Disabilities; The Genitourinary Diseases 

and Conditions in the Federal Register. 

See 84 FR 55086. VA received 12 

comments during the 60-day comment 

period. VA appreciates the comments 

submitted in response to the proposed 

rule. Based on the rationale stated in the 

proposed rule and in this document, the 

proposed rule is adopted as a final rule 

with minor changes noted below. 


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I. Comments of General Support 

One commenter welcomed the 

proposed changes to 38 CFR 4.115a, 

including the replacement of a vague 

term (‘‘intermittent intensive 

management’’) with a more specific 

reference (‘‘suppressive drug therapy’’) 

in the urinary tract infection (UTI) 

criteria. The commenter supported VA’s 

proposal to eliminate subjective terms 

such as ‘‘markedly,’’ ‘‘some,’’ and 

‘‘slight’’ in the renal dysfunction criteria 

and to replace them with specific, 

objective laboratory findings, such as 

the glomerular filtration rate (GFR) and 

albumin/creatinine ratio (ACR). The 

commenter noted that these revisions 

will likely result in a more efficient 

application of the rating schedule of 

disabilities and will benefit many 

veterans with kidney diseases. VA 

appreciates the commenter’s support 

and makes no changes based on this 

comment. 

Another commenter supported VA’s 

proposal to update medical terminology 

and 38 CFR 4.115a. The commenter 

noted that the proposed changes include 

more specific, objective laboratory 

findings such as GFR. The commenter 

also noted that the National Kidney 

Foundation indicated that an estimated 

glomerular filtration (eGFR) is the best 

test to measure the level of kidney 

function and to determine the stage of 

the kidney disease. VA appreciates the 

commenter’s support and makes no 

changes based on this comment. 

II. Comments Regarding 38 CFR 4.115a 

One commenter expressed an opinion 

that the GFR values in a previously 

proposed rule, which was published on 

July 28, 2017, are more in line with 

National Kidney Foundation standards. 

See 82 FR 35140. However, that July 

2017 proposal was formally withdrawn 

through notice published in the Federal 

Register on March 5, 2019. See 84 FR 

7844. Although the commenter asserted 

that the July 2017 proposal’s GFR values 

more accurately reflected disease 

progression, VA found during its 

internal review that the renal 

dysfunction rating criteria proposed in 

July 2017 contained erroneous values 

and units of measure for ACR and GFR. 

These erroneous proposed values were 

not in line with the National Kidney 

Foundation guidelines and would have 

resulted in erroneous disability 

evaluations for multiple renal 

disabilities. In contrast, the October 

2019 proposed rule cited corrected GFR 

values aligned with the National Kidney 

Foundation’s definition and 

classification of chronic kidney disease. 

Nat’l Kidney Found., ‘‘KDIGO 2012 

Clinical Practice Guideline for the 

Evaluation and Management of Chronic 

Kidney Disease,’’ 3(1) Kidney Int’l 

Suppl. 5 (Jan. 2013), available at https:// 

kdigo.org/wp-content/uploads/2017/02/ 

KDIGO_2012_CKD_GL.pdf (last viewed 

May 15, 2020) [hereinafter ‘‘KDIGO’’]. 

Therefore, VA makes no changes based 

on this comment. 

Another commenter stated that a 

recent study showed that an 

overestimation of renal function was 

correlated with patients’ postamputation status. The commenter 

stated that this study suggested that a 

cystatin C test would be a more accurate 

measure of kidney function in patients 

who have had amputations. According 

to the National Kidney Foundation, a 

blood test for cystatin C can be helpful 

in some instances, but it is not the usual 

or regular way to estimate a GFR. 

National Kidney Foundation, ‘‘Cystatin 

C,’’ https://www.kidney.org/atoz/ 

content/cystatinC (last viewed May 15, 

2020). A recently published study 

examined the accuracy of kidney 

function estimates when prescribing 

renally-eliminated medications in nontraumatic amputees. Aakjaer et al., 

‘‘Differences in Kidney Function 

Estimates Based on Creatinine and/or 

Cystatin C in Non-Traumatic 

Amputation Patients and Their Impact 

on Drug Prescribing,’’ 8(1) J Clin Med. 

89 (2019), https://www.ncbi.

nlm.nih.gov/pmc/articles/PMC6351924/ 

(last viewed May 15, 2020). The 

conclusions of this study highlighted 

the fact that a non-traumatic amputation 

of a lower extremity has a significant 

effect on both eGFR and cystatin C. 

Furthermore, there are significant 

differences between eGFR and cystatin 

C (both before and after amputation) and 

these differences impact how renallyeliminated medications should be 

prescribed. VA appreciates this 

comment. However, the VA rating 

schedule for disabilities is not used for 

diagnosis and treatment of medical 

conditions; it is used to evaluate 

disabilities in accord with average 

earnings loss. VA has determined that, 

for VA disability evaluation purposes, 

GFR, eGFR, and ACR values present 

adequate measurements of functional 

impairment due to kidney disease. VA 

makes no changes based on this 

comment. 

Another commenter disagreed with 

the changes made in 38 CFR 4.115a by 

stating that decreasing the required GFR 

for the 80, 60 and 30 percent rating 

criteria would disqualify many veterans 

with chronic kidney disease from future 

increases in their disability rating if 

their conditions worsen. However, VA 

did not propose a decrease in GFR 

values; rather, VA replaced subjective 

terms such as ‘‘markedly,’’ ‘‘some,’’ and 

‘‘slight’’ in the current evaluation 

criteria with specific, objective 

laboratory findings, such as GFR and 

ACR. To the extent that the comment 

was intended to suggest that VA should 

use the GFR values in the proposed rule 

published in July 2017 and later 

withdrawn, VA has determined, as 

stated above, that the GFR values 

proposed in October 2019 are more 

accurate and better aligned with the 

National Kidney Foundation’s 

definition and classification of chronic 

kidney disease. VA makes no changes 

based on this comment. 

The same commenter was concerned 

that, under the proposed GFR values, a 

veteran would have to be at the point of 

getting a kidney transplant in order to 

reach an 80 percent disability 

evaluation. VA proposed an 80 percent 

evaluation for individuals with a GFR 

between 15 and 29 mL/min/1.73 m2 for 

at least three consecutive months. This 

aligned VA’s functional impairment 

evaluation with the most current 

clinical guidelines. Nat’l Kidney 

Found., ‘‘Managing Your Adult Patients 

Who Have a Kidney Transplant,’’ at 2 

(2011), available at https://

www.kidney.org/sites/default/files/02- 

50-4079_ABB_ManagingTransRecipBk_

PC.pdf (last viewed May 15, 2020) 

[hereinafter ‘‘Managing’’]. According to 

the National Kidney Foundation 

guidelines, only patients with kidney 

failure (GFR value <15 or dialysis) are 

considered for kidney replacement 

therapy (kidney transplant). Id. For 

patients with severely decreased kidney 

function (GFR between 15 and 29 mL/ 

min/1.73 m2), a referral to a 

nephrologist for evaluation of chronic 

kidney disease progression is 

recommended. Id. Such evaluation 

would include a range of activities in 

preparation for kidney replacement 

therapy such as patient and family 

education, dialysis access, and 

preemptive transplant. Id. VA makes no 

changes based on this comment. 

Another commenter referenced a 

study that showed a link between 

kidney disease and/or kidney failure 

and prolonged use of proton pump 

inhibitors such as Prilosec and Nexium. 

The commenter suggested that the 

overuse and/or prolonged use of proton 

pump inhibitors during military service 

and the medications’ side effects should 

be included in the schedule for rating 

disabilities. VA appreciates this 

comment. The comment appears 

directed more toward establishment of 

service connection for a condition 

resulting in disability than to rating the 

level of disability attributable to the 


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condition. Nonetheless, to ensure that 

the full range of relevant factors is 

adequately addressed, VA intends to 

establish a work group that will 

consider this issue at a future time. 

Upon consideration and assessment of 

the work group’s findings, VA will 

determine whether any additional 

amendments to the criteria are 

necessary; if so, they would be 

addressed in a future proposal. At this 

time, however, VA makes no changes 

based on this comment. 

Another commenter expressed 

concern that the proposed rule did not 

make clear how the stages of chronic 

kidney disease (CKD) translate into the 

proposed rating criteria for renal 

disfunction. To be clear, VA proposed 

100, 80, 60, 30, and 0 percent 

evaluations based on the stages of CKD 

according to most current clinical 

guidelines, specifically, those of the 

National Kidney Foundation. See 

KDIGO at 8. The National Kidney 

Foundation guidelines distinguish 

between patients with kidney failure 

(that is, GFR value <15 or dialysis), 

severely decreased kidney function 

(GFR value 15 to 29), moderately to 

severely decreased kidney function 

(GFR value 30 to 44), mildly to 

moderately decreased kidney function 

(GFR value 45 to 59), and mildly 

decreased kidney function (GFR value 

60 to 89). Id. VA’s proposed (and now 

final) rating criteria for renal 

dysfunction provide the same staging. 

VA makes no changes based on this 

comment. 

Another commenter welcomed VA’s 

decision to base its disability 

evaluations for renal dysfunction on 

GFR and ACR laboratory findings, but 

was concerned that VA would use only 

these laboratory findings without taking 

into consideration other available 

evidence in the claims file. By law, VA 

must consider all available evidence 

when determining whether the criteria 

for a particular a disability evaluation 

are met. 38 U.S.C. 5107(b). As noted 

above, the GFR and ACR laboratory 

findings are an objective, accurate, and 

standard method for measuring renal 

dysfunction. Other relevant evidence in 

the claims file may implicate broader 

issues such as separate ratings or 

secondary service connection in a given 

case but, for the renal dysfunction rating 

specifically, the GFR and ACR 

laboratory findings will govern. VA 

makes no changes based on this 

comment. 

The same commenter referenced a 

National Institutes of Health (NIH) study 

and alleged that renal dysfunction due 

to cold injury-related venous congestion 

cannot be rated based on GFR values. 

VA disagrees. The NIH report does not 

appear to make such an allegation; 

indeed, it used GFR values to measure 

renal impairment. Mullens et al., 

‘‘Importance of Venous Congestion for 

Worsening of Renal Function in 

Advanced Decompensated Heart 

Failure,’’ 53(7) J Am Coll Cardiol. 589– 

596 (2009), available at https://

pubmed.ncbi.nlm.nih.gov/19215833/ 

(last visited May 19, 2020). According to 

the National Kidney Foundation, GFR is 

widely accepted as the best overall 

index of kidney function, KDIGO at 19, 

and the commenter does not appear to 

present an alternative measure. VA 

makes no changes based on this 

comment. 

The same commenter stated that 

basing the renal dysfunction rating on 

GFR values would exclude combat 

veterans with warm water immersion 

foot and paddy foot injuries from 

receiving VA disability compensation. 

VA disagrees. To the extent that these 

injuries cause renal dysfunction, that 

dysfunction can be measured through 

GFR, and compensation can be provided 

based on the GFR value. VA makes no 

changes based on this comment. 

The same commenter proposed the 

addition of new diagnostic codes for 

kidney dysfunction due to the warm 

water immersion foot and paddy foot 

injuries. VA appreciates this comment. 

To ensure that the full range of relevant 

factors is adequately addressed, VA 

intends to establish a work group that 

will consider this issue at a future time. 

Upon consideration and assessment of 

the work group’s findings, VA will 

determine whether any additional 

amendments to the criteria are 

necessary; if so, they would be 

addressed in a future proposal. At this 

time, however, VA makes no changes 

based on this comment. 

Based on its internal review, however, 

VA makes one change to the general 

rating formula for renal dysfunction: 

Adding the word ‘‘eligible’’ to the 100 

percent evaluation that describes a 

kidney transplant recipient. This 

addition is made to ensure that all 

veterans with service-connected renal 

disease who are eligible to receive a 

kidney transplant will be entitled to a 

100 percent evaluation as soon as they 

are deemed eligible for a kidney 

transplant, whether or not the transplant 

has been scheduled. 

III. Comments Regarding Diagnostic 

Codes 7520 Through 7522 

VA received several comments 

regarding the proposed changes to DCs 

7520 through 7522, which address 

removal and deformity of the penis. 

One commenter asked VA to provide 

a rationale for its decision to remove the 

ability to rate the removal of the penis 

or glans as voiding dysfunction. Under 

most circumstances, the removal of the 

penis or glans does not result in voiding 

dysfunction. Most commonly, the loss 

of penis or glans will affect the ability 

to void while standing, which is not 

considered a compensable functional 

impairment under the criteria for 

voiding dysfunction in 38 CFR 4.115a. 

Santucci et al., ‘‘Penile Fracture and 

Trauma,’’ Medscape (updated 2019), 

https://emedicine.medscape.com/ 

article/456305-overview (last visited 

May 15, 2020). Furthermore, if, in the 

course of penis or glans surgical 

removal, there is associated urethral 

trauma resulting in voiding dysfunction, 

it should be separately rated under DC 

7518, which addresses the stricture of 

the urethra. For these reasons, VA does 

not find it appropriate to direct rating 

personnel to reference the voiding 

dysfunction criteria of 38 CFR 4.115a 

when evaluating DCs 7520 and 7521. 

VA therefore makes no changes based 

on this comment. 

The same commenter recognized that 

erectile dysfunction alone may not 

equate to a reduction in earning 

capacity, but nevertheless asserted that 

VA should acknowledge that erectile 

dysfunction could lead to mental 

distress, such as depression and anxiety, 

and could impact a veteran’s ability to 

work. The commenter recommended 

that VA grant compensation for any 

secondary condition that is related to 

erectile dysfunction that causes a 

reduction in earning capacity. VA agrees 

with the commenter’s assessment that a 

mental disorder related to serviceconnected erectile dysfunction could 

warrant secondary service connection. 

That mental disorder would require its 

own diagnosis, service connection, and 

a disability evaluation under 38 CFR 

4.130, which governs ratings for mental 

disorders. VA already recognizes this 

concept in 38 CFR 3.310(a), which 

directs that any disability which is 

proximately due to or the result of a 

service-connected disability shall be 

service connected. VA makes no 

changes based on this comment. 

Another commenter disagreed with 

the proposed changes to DC 7522, 

which addresses erectile dysfunction 

and penile deformity. The commenter 

expressed concern that, by removing a 

compensable evaluation for penis 

deformity, VA will unreasonably 

deprive certain veterans of benefits, 

specifically, veterans with Peyronie’s 

disease. The commenter listed several 

signs and symptoms of Peyronie’s 

disease to include scar tissue, a 


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significant bend to the penis, erection 

problems, shortening of the penis, pain 

with or without erection, and mental 

health disorders due to stress and 

anxiety. The commenter indicated that 

the severity of the overall impact of 

Peyronie’s disease on male veterans is 

evidenced by the prevalence of mental 

health disorders associated with it. The 

commenter expressed an opinion that 

the functional impairment due to 

Peyronie’s disease affects veterans’ 

ability to function under the ordinary 

conditions of life and work. 

Additionally, the commenter stated that, 

though disabilities relating to creative 

organs may not affect earning capacity 

directly, they impact non-economic 

factors such as personal inconvenience, 

social inadaptability, or psychological 

factors. The commenter proposed the 

addition of a diagnostic code and 

specific rating criteria for Peyronie’s 

disease, including penile deformity and 

pain. 

Moreover, two commenters asked VA 

to provide a rationale for its decision to 

exclude Peyronie’s disease from ratable 

conditions. The commenters expressed 

concern that Peyronie’s disease may be 

caused by trauma as a result of an inservice injury and, in some cases, 

prevent a veteran from having sexual 

intercourse or make it difficult to get or 

maintain an erection. 

Peyronie’s disease is typically 

associated with painful erections or 

intercourse or a curve in the penis that 

prevents sexual intercourse. According 

to the NIH, and based on studies of men 

who reported having symptoms of 

Peyronie’s disease, researchers estimate 

that Peyronie’s disease affects more than 

one in 10 men. ‘‘Penile Curvature 

(Peyronie’s Disease),’’ National Institute 

of Diabetes and Digestive and Kidney 

Diseases (NIDDK), NIH, https://

www.niddk.nih.gov/health-information/ 

urologic-diseases/penile-curvaturepeyronies-disease (last viewed May 15, 

2020). The etiology of Peyronie’s disease 

remains partially understood. More 

recently, Peyronie’s disease has been 

thought to result from vascular trauma 

or injury to the penis that causes 

scarring and deformity of the penis. 

Lizza et al., ‘‘Peyronie’s Disease,’’ 

Medscape (2018), https://emedicine.

medscape.com/article/456574- 

overview#a7 (last visited May 15, 2020). 

VA agrees with the commenters that 

penile trauma as a result of an in-service 

injury should be recognized under DC 

7522. Accordingly, VA in this final rule 

is adding a note under DC 7522 to 

clarify how rating personnel should 

evaluate disabling effects of penile 

trauma or disease, to include Peyronie’s 

disease. The note states that, for the 

purpose of VA disability evaluation, a 

disease or traumatic injury of the penis 

resulting in scarring or deformity shall 

be rated under DC 7522. With this 

clarification, VA ensures that a 

traumatic injury or disease of the penis 

will be recognized by the VASRD. VA 

would review any mental health 

disorders associated with erectile 

dysfunction or Peyronie’s disease under 

38 CFR 4.125, 4.126, and 4.130. 

Furthermore, DC 7522’s footnote 

regarding consideration of special 

monthly compensation for loss of use of 

a creative organ, where warranted, will 

apply for both erectile dysfunction or 

Peyronie’s disease. 

Nevertheless, as noted in the 

preamble to the proposed rule, VA 

provides disability compensation for 

conditions based on the average 

impairment of earning capacity 

pursuant to 38 U.S.C. 1155. Erectile 

dysfunction, with or without penile 

deformity, is not associated directly 

with reductions in earning capacity, 

which is why VA proposed to provide 

a noncompensable evaluation for 

erectile dysfunction under DC 7522. 

Similarly, the potentially painful 

erections and intercourse associated 

with Peyronie’s disease do not, on 

average, impair earning capacity at a 

compensable level. To the extent these 

conditions impact social or 

psychological factors, VA has a variety 

of mental health and counseling 

services available for service-connected 

veterans. But the law specifically links 

disability compensation to impairment 

of earning capacity. 38 U.S.C. 1155. VA 

thanks the commenters for their input. 

IV. Comments Regarding Diagnostic 

Code 7542 

One commenter expressed concern 

with VA’s proposal to rate neurogenic 

bladder as voiding dysfunction or 

urinary tract infection, whichever is 

predominant. The commenter asserted 

that VA would fail to adequately 

compensate a veteran who suffers from 

both effects. Historically, 38 CFR 4.115a 

has recognized that ‘‘[d]iseases of the 

genitourinary system generally result in 

disabilities related to renal or voiding 

dysfunctions, infections, or a 

combination of these.’’ Further, § 4.115a 

directs rating personnel to evaluate such 

disabilities on the ‘‘predominant area of 

dysfunction.’’ VA’s proposal for DC 

7542 to evaluate neurogenic bladder 

conditions based on voiding 

dysfunction or urinary tract infection 

mirrors the instructions in § 4.115a, 

which instruct that only the 

predominant area of dysfunction shall 

be considered when evaluating 

genitourinary conditions. Moreover, 

§ 4.14 directs that the evaluation of the 

same disability under various diagnoses 

is to be avoided. Both urinary tract 

infections and voiding dysfunctions 

affect urinary tract functioning, 

specifically, urination. Consequently, 

these dysfunctions do not lend 

themselves to distinct and separate 

disability evaluations without violating 

the fundamental principle relating to 

pyramiding as outlined in § 4.14. VA 

declines to make any changes based on 

this comment. 

V. Comments Regarding Diagnostic 

Code 7543 

One commenter expressed concern 

that the noncompensable disability 

rating for varicocele and hydrocele 

under proposed DC 7543 does not 

provide proper compensation for 

individuals with severe cases of 

varicocele or hydrocele that result in 

acute pain during walking or driving. 

The commenter suggested a 10 percent 

disability rating for such severe cases of 

varicocele or hydrocele. However, the 

evidence indicates that varicoceles are 

often asymptomatic and hydroceles are 

usually painless and disappear without 

treatment. See Junnile, J. and Lassen, P., 

‘‘Testicular Masses,’’ 57(4) Am Fam 

Physician 685–692 (1998), available at 

https://www.aafp.org/afp/1998/0215/ 

p685.html (last viewed May 15, 2020). 

While these conditions may cause a 

decrease in fertility, or the existence of 

infertility, neither cause a reduction in 

earning capacity that would warrant a 

compensable rating. However, where 

varicocele or hydrocele causes pain that 

necessitates surgery, a rating under an 

appropriate diagnostic code may be 

available for post-surgery residuals. 

Also, in any instance in which a veteran 

has loss of use of a creative organ due 

to a service-connected condition, VA 

provides special monthly compensation 

for this functional loss. See 38 CFR 

3.350(a). VA makes no changes based on 

these comments. 

VI. Comments Beyond the Scope of This 

Rulemaking 

One commenter stated that many 

combat veterans are unknowingly and 

silently enduring cold injury kidney 

dysfunction, and VA neglected to notify 

1.7 million combat veterans of the longterm sequelae of warm water immersion 

foot injuries. These aspects of the 

comment relate to notice and education 

for veterans, not the rating criteria used 

in the evaluation of service-connected 

genitourinary conditions. Therefore, 

these issues are not within the scope of 

this rulemaking. VA makes no changes 

based on these comments. 


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The same commenter stated that 

physicians at VA medical centers do not 

know and have no reasonable means to 

ascertain information related to the 

disability rating criteria associated with 

immersion foot injuries and related 

kidney dysfunction, in order to properly 

treat disabled veterans. Furthermore, the 

commenter discussed in detail his 

medical conditions and claims’ 

adjudication process. VA appreciates 

these comments; however, the 

comments relate to diagnosis and 

treatment of cardiovascular and renal 

conditions rather than disability 

evaluations in the rating schedule. 

Therefore, these issues are not within 

the scope of this rulemaking. VA makes 

no changes based on these comments. 

VII. Proposed Changes to § 4.115 

In its proposed rule, VA deemed the 

first three sentences of § 4.115 

unnecessary and proposed to remove 

them. However, during its internal 

review and additional considerations of 

such removal, VA realized that further 

study of this action is warranted to 

account for complex relationships 

between cardiovascular and 

genitourinary disabilities. 

Currently, VA does not assign 

separate evaluations for heart disease 

and any form of nephritis due to its 

close interrelationship with 

cardiovascular disabilities. However, 

VA can separately evaluate nonnephritis renal disease and 

cardiovascular disease (e.g., diabetic 

nephropathy and coronary artery 

disease) when complications do not 

overlap. 

VA proposed new terminology for 

§ 4.115, but did not clearly define renal 

disease and its relationship with 

cardiovascular conditions. Thus, if the 

proposed changes were to be made 

effective, they might be interpreted as 

precluding separate evaluations for nonnephritis renal disease and 

cardiovascular disabilities. This was not 

an intended consequence of this 

rulemaking, and would be 

disadvantageous to veterans who suffer 

from service-connected renal and 

cardiovascular conditions. 

Therefore, VA withdraws its proposal 

to revise § 4.115. VA will review and 

update § 4.115 during its next revision 

of the VA Rating Schedule for 

Disabilities. 

VII. Technical Correction 

In the proposed rule, VA updated its 

general rating formula for renal 

dysfunction by replacing subjective 

criteria with specific, objective 

laboratory findings, such as the GFR and 

ACR. Upon further review, VA realized 

that it inadvertently omitted a reference 

to the period of evaluation for the GFR 

and ACR values. VA makes a clarifying 

change in the text for the 100, 80, 60, 

30, and 0 percent disability evaluations 

by adding the reference ‘‘during the past 

12 months’’ to ‘‘Chronic kidney disease 

with GFR . . . for at least 3 consecutive 

months.’’ This change to the language 

does not result to any substantive 

changes to the criteria in the general 

rating formula for renal dysfunction. 

Executive Orders 12866 and 13563 

Executive Orders 12866 and 13563 

direct agencies to assess the costs and 

benefits of available regulatory 

alternatives and, when regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health, and safety 

effects, and other advantages; 

distributive impacts; and equity). 

Executive Order 13563 (Improving 

Regulation and Regulatory Review) 

emphasizes the importance of 

quantifying both costs and benefits, 

reducing costs, harmonizing rules, and 

promoting flexibility. The Office of 

Information and Regulatory Affairs has 

determined that this rule is a significant 

regulatory action under Executive Order 

12866. The Regulatory Impact Analysis 

associated with this rulemaking can be 

found as a supporting document at 

www.regulations.gov. 

Regulatory Flexibility Act 

The Secretary hereby certifies that 

this final rule will not have a significant 

economic impact on a substantial 

number of small entities as they are 

defined in the Regulatory Flexibility Act 

(5 U.S.C. 601–612). The certification is 

based on the fact that small entities or 

businesses are not affected by revisions 

to the VASRD. Therefore, pursuant to 5 

U.S.C. 605(b), the initial and final 

regulatory flexibility analysis 

requirements of 5 U.S.C. 603 and 604 do 

not apply. 

Unfunded Mandates 

The Unfunded Mandates Reform Act 

of 1995 requires, at 2 U.S.C. 1532, that 

agencies prepare an assessment of 

anticipated costs and benefits before 

issuing any rule that may result in the 

expenditure by State, local, and tribal 

governments, in the aggregate, or by the 

private sector, of $100 million or more 

(adjusted annually for inflation) in any 

one year. This final rule will have no 

such effect on State, local, and tribal 

governments, or on the private sector. 

Paperwork Reduction Act 

This final rule contains no provisions 

constituting a collection of information 

under the Paperwork Reduction Act of 

1995 (44 U.S.C. 3501–3521). 

Congressional Review Act 

Pursuant to the Congressional Review 

Act (5 U.S.C. 801 et seq.), the Office of 

Information and Regulatory Affairs 

designated this rule as not a major rule, 

as defined by 5 U.S.C. 804(2). 

Catalog of Federal Domestic Assistance 

The Catalog of Federal Domestic 

Assistance program numbers and titles 

affected by this document are 64.009, 

Veterans Medical Care Benefits; 64.104, 

Pension for Non-Service-Connected 

Disability for Veterans; 64.109, Veterans 

Compensation for Service-Connected 

Disability. 

List of Subjects in 38 CFR Part 4 

Disability benefits, Pensions, 

Veterans. 

Signing Authority 

Denis McDonough, Secretary of 

Veterans Affairs, approved this 

document on June 22, 2021, and 

authorized the undersigned to sign and 

submit the document to the Office of the 

Federal Register for publication 

electronically as an official document of 

the Department of Veterans Affairs. 

Jeffrey M. Martin, 

Assistant Director, Office of Regulation Policy 

& Management, Office of the Secretary, 

Department of Veterans Affairs. 

For the reasons set out in the 

preamble of this rule and the proposed 

rule, the Department of Veterans Affairs 

amends 38 CFR part 4 as follows: 

PART 4—SCHEDULE FOR RATING 

DISABILITIES 

■ 1. The authority citation for part 4 

continues to read as follows: 

Authority: 38 U.S.C. 1155, unless 

otherwise noted. 

Subpart B—Disability Ratings 

■ 2. Amend § 4.115a by revising the 

introductory text and the table entries 

for ‘‘Renal dysfunction’’ and ‘‘Urinary 

tract infection’’ to read as follows: 

§ 4.115a Ratings of the genitourinary 

system—dysfunctions. 

Diseases of the genitourinary system 

generally result in disabilities related to 

renal or voiding dysfunctions, 

infections, or a combination of these. 

The following section provides 

descriptions of various levels of 

disability in each of these symptom 


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areas. Where diagnostic codes refer the 

decision maker to these specific areas of 

dysfunction, only the predominant area 

of dysfunction shall be considered for 

rating purposes. Distinct disabilities 

may be evaluated separately under this 

section, pursuant to § 4.14, if the 

symptoms do not overlap. Since the 

areas of dysfunction described below do 

not cover all symptoms resulting from 

genitourinary diseases, specific 

diagnoses may include a description of 

symptoms assigned to that diagnosis. 

Rating 

Renal dysfunction: 

Chronic kidney disease with glomerular filtration rate (GFR) less than 15 mL/min/1.73 m2 for at least 3 consecutive months 

during the past 12 months; or requiring regular routine dialysis; or eligible kidney transplant recipient ................................. 100 

Chronic kidney disease with GFR from 15 to 29 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 

months ...................................................................................................................................................................................... 80 

Chronic kidney disease with GFR from 30 to 44 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 

months ...................................................................................................................................................................................... 60 

Chronic kidney disease with GFR from 45 to 59 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 

months ...................................................................................................................................................................................... 30 

GFR from 60 to 89 mL/min/1.73 m2 and either recurrent red blood cell (RBC) casts, white blood cell (WBC) casts, or 

granular casts for at least 3 consecutive months during the past 12 months; or 

GFR from 60 to 89 mL/min/1.73 m2 and structural kidney abnormalities (cystic, obstructive, or glomerular) for at least 3 

consecutive months during the past 12 months; or 

GFR from 60 to 89 mL/min/1.73 m2 and albumin/creatinine ratio (ACR) ≥30 mg/g for at least 3 consecutive months during 

the past 12 months ................................................................................................................................................................... 0 

Note: GFR, estimated GFR (eGFR), and creatinine-based approximations of GFR will be accepted for evaluation purposes 

under this section when determined to be appropriate and calculated by a medical professional. 

*******

Urinary tract infection: 

Poor renal function: Rate as renal dysfunction. 

Recurrent symptomatic infection requiring drainage by stent or nephrostomy tube; or requiring greater than 2 hospitalizations per year; or requiring continuous intensive management ............................................................................................... 30 

Recurrent symptomatic infection requiring 1–2 hospitalizations per year or suppressive drug therapy lasting six months or 

longer ........................................................................................................................................................................................ 10 

Recurrent symptomatic infection not requiring hospitalization, but requiring suppressive drug therapy for less than 6 months 0 

■ 3. Amend § 4.115b by: 

■ a. Revising the entry for diagnostic 

code 7508; 

■ b. Removing the entry for diagnostic 

code 7510; 

■ c. Revising the entries for diagnostic 

codes 7520, 7521, 7522, 7524, 7525, 

7527, 7533, 7534, 7537, 7539, 7541, and 

7542; and 

■ d. Adding entries in numerical order 

for diagnostic codes 7543, 7544, and 

7545. 

The revisions and additions read as 

follows: 

§ 4.115b Ratings of the genitourinary 

system—diagnoses. 

Rating 

*******

7508 Nephrolithiasis/Ureterolithiasis/Nephrocalcinosis: 

Rate as hydronephrosis, except for recurrent stone formation requiring invasive or non-invasive procedures more than two 

times/year .................................................................................................................................................................................. 30 

*******

7520 Penis, removal of half or more ................................................................................................................................................ 1 30 

7521 Penis, removal of glans ........................................................................................................................................................... 1 20 

7522 Erectile dysfunction, with or without penile deformity .............................................................................................................. 1 0 

Note: For the purpose of VA disability evaluation, a disease or traumatic injury of the penis resulting in scarring or deformity 

shall be rated under diagnostic code 7522. 

* * * * * * * 

7524 Testis, removal: 

Both .............................................................................................................................................................................................. 1 30 

One ............................................................................................................................................................................................... 1 0 

Note: In cases of the removal of one testis as the result of a service-incurred injury or disease, other than an undescended or

congenitally undeveloped testis, with the absence or nonfunctioning of the other testis unrelated to service, an evaluation of 

30 percent will be assigned for the service-connected testicular loss. Testis, undescended, or congenitally undeveloped is not 

a ratable disability. 

7525 Prostatitis, urethritis, epididymitis, orchitis (unilateral or bilateral), chronic only: 

Rate as urinary tract infection. 

For tubercular infections: Rate in accordance with §§ 4.88b or 4.89, whichever is appropriate. 

7527 Prostate gland injuries, infections, hypertrophy, postoperative residuals, bladder outlet obstruction: 

Rate as voiding dysfunction or urinary tract infection, whichever is predominant. 


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Rating 

*******

7533 Cystic diseases of the kidneys: 

Rate as renal dysfunction. 

Note: Cystic diseases of the kidneys include, but are not limited to, polycystic disease, uremic medullary cystic disease, medullary sponge kidney, and similar conditions such as Alport’s syndrome, cystinosis, primary oxalosis, and Fabry’s disease. 

7534 Atherosclerotic renal disease (renal artery stenosis, atheroembolic renal disease, or large vessel disease, unspecified): 

Rate as renal dysfunction. 

*******

7537 Interstitial nephritis, including gouty nephropathy, disorders of calcium metabolism: 

Rate as renal dysfunction. 

*******

7539 Renal amyloid disease: 

Rate as renal dysfunction. 

Note: This diagnostic code pertains to renal involvement secondary to all glomerulonephritis conditions, all vasculitis conditions 

and their derivatives, and other renal conditions caused by systemic diseases, such as Lupus erythematosus, systemic lupus 

erythematosus nephritis, Henoch-Schonlein syndrome, scleroderma, hemolytic uremic syndrome, polyarthritis, Wegener’s 

granulomatosis, Goodpasture’s syndrome, and sickle cell disease. 

* * * * * * * 

7541 Renal involvement in diabetes mellitus type I or II: 

Rate as renal dysfunction. 

7542 Neurogenic bladder: 

Rate as voiding dysfunction or urinary tract infection, whichever is predominant. 

7543 Varicocele/Hydrocele ............................................................................................................................................................... 1 0 

7544 Renal disease caused by viral infection such as human immunodeficiency virus (HIV), Hepatitis B, and Hepatitis C: 

Rate as renal dysfunction. 

7545 Bladder, diverticulum of: 

Rate as voiding dysfunction or urinary tract infection, whichever is predominant. 

1 Review for entitlement to special monthly compensation under § 3.350 of this chapter. 

■ 4. Amend appendix A to part 4 by: 

■ a. Revising the entry for § 4.115a; 

■ b. Under the entry for § 4.115b, 

revising the entries for diagnostic codes 

7500, 7501, 7502, 7504, 7507, 7508, 

7509, 7510, 7511, 7516, 7520, 7521, 

7522, 7524, 7525, 7527, 7528, 7529, 

7530, 7531, 7532, 7533, 7534, 7535, 

7536, 7537, 7538, 7539, 7540, 7541, and 

7542; and 

■ c. Under the entry for § 4.115b, adding 

in numerical order entries for diagnostic 

codes 7543 through 7545. 

The revisions and additions read as 

follows: 

Appendix A to Part 4—Table of 

Amendments and Effective Dates Since 

1946 

Sec. Diagnostic 

code No. 

*******

4.115a ............ ........................ Re-designated and revised as § 4.115b; new § 4.115a ‘‘Ratings of the genitourinary system-dysfunctions’’ 

added February 17, 1994; revised November 14, 2021. 

4.115b ............ 7500 Note July 6, 1950; evaluation February 17, 1994, criterion September 8, 1994; criterion November 14, 2021. 

7501 Evaluation February 17, 1994; criterion November 14, 2021. 

7502 Evaluation February 17, 1994; criterion November 14, 2021. 

* * * * * * * 

7504 Evaluation February 17, 1994; criterion November 14, 2021. 

* * * * * * * 

7507 Evaluation February 17, 1994; criterion November 14, 2021. 

7508 Evaluation February 17, 1994; title, criterion November 14, 2021. 

7509 Evaluation February 17, 1994; criterion November 14, 2021. 

7510 Evaluation February 17, 1994; removed November 14, 2021. 

7511 Evaluation February 17, 1994; criterion November 14, 2021. 

* * * * * * * 

7516 Evaluation February 17, 1994; criterion November 14, 2021. 

* * * * * * * 

7520 Criterion February 17, 1994; criterion, footnote November 14, 2021. 

7521 Criterion February 17, 1994; criterion, footnote November 14, 2021. 

7522 Criterion September 8, 1994; title, criterion, note November 14, 2021. 

* * * * * * * 

7524 Note July 6, 1950; evaluation February 17, 1994; evaluation September 8, 1994; note November 14, 2021. 

7525 Criterion March 11, 1969; evaluation February 17, 1994; title and criterion November 14, 2021. 


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Sec. Diagnostic 

code No. 

*******

7527 Criterion February 17, 1994; title and criterion November 14, 2021. 

7528 Criterion March 10, 1976; criterion February 17, 1994; criterion November 14, 2021. 

7529 Evaluation February 17, 1994; criterion November 14, 2021. 

7530 Added September 9, 1975; evaluation February 17, 1994; criterion November 14, 2021. 

7531 Added September 9, 1975; criterion February 17, 1994; criterion November 14, 2021. 

7532 Evaluation February 17, 1994; criterion November 14, 2021. 

7533 Added February 17, 1994; title, criterion, and note November 14, 2021. 

7534 Added February 17, 1994; title and criterion November 14, 2021. 

7535 Evaluation February 17, 1994; criterion November 14, 2021. 

7536 Evaluation February 17, 1994; criterion November 14, 2021. 

7537 Added February 17, 1994; title and criterion November 14, 2021. 

7538 Evaluation February 17, 1994; criterion November 14, 2021. 

7539 Added February 17, 1994; note and criterion November 14, 2021. 

7540 Evaluation February 17, 1994; criterion November 14, 2021. 

7541 Added February 17, 1994; title and criterion November 14, 2021. 

7542 Added February 17, 1994; criterion November 14, 2021. 

7543 Added November 14, 2021. 

7544 Added November 14, 2021. 

7545 Added November 14, 2021. 

* * * * * * * 

■ 5. Amend appendix B to part 4 by: 

■ a. Revising the entries for diagnostic 

codes 7508, 7522, 7525, 7527, 7533, 

7534, 7537, and 7541; 

■ b. Removing the entry for diagnostic 

code 7510; and 

■ c. Adding in numerical order entries 

for diagnostic codes 7543 through 7545. 

The revisions and additions read as 

follows: 

Appendix B to Part 4—Numerical Index 

of Disabilities 

Diagnostic 

code No. 

The Genitourinary System 

*******

7508 ............... Nephrolithiasis/Ureterolithiasis/Nephrocalcinosis. 

*******

7522 ............... Erectile dysfunction, with or without penile deformity. 

*******

7525 ............... Prostatitis, urethritis, epididymitis, orchitis (unilateral or bilateral), chronic only. 

7527 ............... Prostate gland injuries, infections, hypertrophy, postoperative residuals, bladder outlet obstruction. 

*******

7533 ............... Cystic diseases of the kidneys. 

7534 ............... Atherosclerotic renal disease (renal artery stenosis, atheroembolic renal disease, or large vessel disease, unspecified). 

* * * * * * * 

7537 ............... Interstitial nephritis, including gouty nephropathy, disorders of calcium metabolism. 

* * * * * * * 

7541 ............... Renal involvement in diabetes mellitus type I or II. 

* * * * * * * 

7543 ............... Varicocele/Hydrocele. 

7544 ............... Renal disease caused by viral infection such as HIV, Hepatitis B, and Hepatitis C. 

7545 ............... Bladder, diverticulum of. 

* * * * * * * 

■ 6. Amend appendix C to part 4 by: 

■ a. Under the heading ‘‘Bladder,’’ 

adding in alphabetical order an entry for 

‘‘Diverticulum of’’ (diagnostic code 

7545); 

■ b. Revising the entry for ‘‘Interstitial 

nephritis’’ (diagnostic code 7537); 

■ c. Revising the entry for 

‘‘Nephrolithiasis’’ (diagnostic code 

7508); 

■ d. Under the heading ‘‘Penis,’’ 

removing the entry for ‘‘Deformity, with 

loss of erectile power’’ (diagnostic code 

7522), and adding an entry for ‘‘Erectile 

dysfunction’’ in its place; 


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■ e. Revising the entry for ‘‘Prostate 

gland’’ (diagnostic code 7527); 

■ f. Under the heading ‘‘Renal,’’ adding 

in alphabetical order an entry for 

‘‘Disease caused by viral infection such 

as HIV, Hepatitis B, and Hepatitis C’’ 

(diagnostic code 7544); 

■ g. Under the heading ‘‘Renal,’’ 

removing the entry for ‘‘Involvement in 

systemic diseases’’ (diagnostic code 

7541), and adding an entry for 

‘‘Involvement in diabetes mellitus type 

I or II’’ in its place; 

■ h. Removing the entry for 

‘‘Ureterolithiasis’’ (diagnostic code 

7510); 

■ i. Removing the entry for ‘‘Epididymoorchitis’’ (diagnostic code 7525); 

■ j. Adding in alphabetical order an 

entry for ‘‘Prostatitis, urethritis, 

epididymitis, orchitis (unilateral or 

bilateral), chronic only’’ (diagnostic 

code 7525); and 

■ k. Adding in alphabetical order an 

entry for ‘‘Varicocele/Hydrocele’’ 

(diagnostic code 7543). 

The additions and revisions read as 

follows: 

Appendix C to Part 4—Alphabetical 

Index of Disabilities 

Diagnostic 

code No. 

*******

Bladder: 

Calculus in .................................................................................................................................................................................... 7515 

Diverticulum of .............................................................................................................................................................................. 7545 

Fistula in ....................................................................................................................................................................................... 7516 

Injury of ......................................................................................................................................................................................... 7517 

Neurogenic ................................................................................................................................................................................... 7542 

*******

Interstitial nephritis, including gouty nephropathy, disorders of calcium metabolism ......................................................................... 7537 

*******

Nephrolithiasis/Ureterolithiasis/Nephrocalcinosis ................................................................................................................................ 7508 

*******

Penis: 

Erectile dysfunction ...................................................................................................................................................................... 7522 

Removal of glans .......................................................................................................................................................................... 7521 

Removal of half or more ............................................................................................................................................................... 7520 

*******

Prostate gland injuries, infections, hypertrophy, postoperative residuals, bladder outlet obstruction ................................................ 7527 

Prostatitis, urethritis, epididymitis, orchitis (unilateral or bilateral), chronic only ................................................................................. 7525 

*******

Renal: 

Amyloid disease ........................................................................................................................................................................... 7539 

Disease, chronic ........................................................................................................................................................................... 7530 

Disease caused by viral infection such as HIV, Hepatitis B, and Hepatitis C ............................................................................. 7544 

Involvement in diabetes mellitus type I or II ................................................................................................................................. 7541 

Tubular disorders .......................................................................................................................................................................... 7532 

*******

Varicocele/Hydrocele ........................................................................................................................................................................... 7543 

*******

[FR Doc. 2021–19997 Filed 9–29–21; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 4 

RIN 2900–AQ67 

Schedule for Rating Disabilities: The 

Cardiovascular System 

AGENCY: Department of Veterans Affairs. 

ACTION: Final rule. 

SUMMARY: This document amends the 

Department of Veterans Affairs (VA) 

Schedule for Rating Disabilities 

(‘‘VASRD’’ or ‘‘rating schedule’’) by 

revising the portion of the rating 

schedule that addresses the 

cardiovascular system. The purpose of 

this revision is to ensure that this 

portion of the rating schedule uses 

current medical terminology and 

provides detailed and updated criteria 

for the evaluation of cardiovascular 

disabilities by incorporating medical 

advances that have occurred since the 

last review. 

DATES: This rule is effective November 

14, 2021. 

FOR FURTHER INFORMATION CONTACT: Gary 

Reynolds, M.D., Regulations Staff 

(211D), Compensation Service, Veterans 

Benefits Administration, Department of 

Veterans Affairs, 810 Vermont Avenue 

NW, Washington, DC 20420, (202) 461– 

9700. (This is not a toll-free number.) 

SUPPLEMENTARY INFORMATION: VA 

published a proposed rule in the 

Federal Register at 84 FR 37594 on 

August 1, 2019, to amend the 

regulations involving the cardiovascular 

system. VA provided a 60-day public 

comment period and invited interested 

persons to submit written comments, 

suggestions, or objections on or before 

September 30, 2019. VA received 

comments from National Organization 

of Veterans’ Advocates (NOVA), 

Military Disability Made Easy (two 

comments), Veterans of Foreign Wars 

(VFW), National Veterans Legal Services 


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