50802 Federal Register / Vol. 82, No. 211 / Thursday, November 2, 2017 / Rules and Regulations 

Section 301.75–15 issued under Sec. 204, 

Title II, Public Law 106–113, 113 Stat. 

1501A–293; sections 301.75–15 and 301.75– 

16 issued under Sec. 203, Title II, Public Law 

106–224, 114 Stat. 400 (7 U.S.C. 1421 note). 

Done in Washington, DC, this 30th day of 

October 2017. 

Michael C. Gregoire, 

Acting Administrator, Animal and Plant 

Health Inspection Service. 

[FR Doc. 2017–23897 Filed 11–1–17; 8:45 am] 

BILLING CODE 3410–34–P 

DEPARTMENT OF AGRICULTURE 

Rural Business-Cooperative Service 

Rural Utilities Service 

7 CFR Part 4279 

Guaranteed Loanmaking 

CFR Correction 

In Title 7 of the Code of Federal 

Regulations, Part 2000 to End, revised as 

of January 1, 2017, on page 749, 

§ 4279.162 is added to read as follows: 

§ 4279.162 Strategic economic and 

community development. 

Applicants with projects that support 

the implementation of strategic 

economic development and community 

development plans are encouraged to 

review and consider 7 CFR part 1980, 

subpart K, which contains provisions 

for providing priority to projects that 

support the implementation of strategic 

economic development and community 

development plans on a Multijurisdictional basis. 

[81 FR 10457, Mar. 1, 2016] 

[FR Doc. 2017–23912 Filed 11–1–17; 8:45 am] 

BILLING CODE 1301–00–D 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Part 4 

RIN 2900–AO44 

Schedule for Rating Disabilities; The 

Endocrine System 

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 endocrine 

conditions and disorders of the 

endocrine system. The effect of this 

action is to ensure that the VASRD uses 

current medical terminology and to 

provide detailed and updated criteria 

for evaluation of endocrine disorders. 

DATES: This rule is effective on 

December 10, 2017. 

FOR FURTHER INFORMATION CONTACT: 

Ioulia Vvedenskaya, Medical Officer, 

Part 4 VASRD Regulations Staff (211C), 

Compensation Service, Veterans 

Benefits Administration, Department of 

Veterans Affairs, 810 Vermont Avenue 

NW., Washington, DC 20420, 

Ioulia.Vvedenskaya@va.gov, (202) 461– 

9700 (this is not a toll-free telephone 

number). 

SUPPLEMENTARY INFORMATION: VA 

published a proposed rule in the 

Federal Register at 80 FR 39011 on July 

8, 2015, to amend the portion of the 

VASRD dealing with endocrine 

disorders. VA provided a 60-day public 

comment period, and interested persons 

were invited to submit written 

comments, suggestions, or objections on 

or before September 8, 2015. VA 

received comments from four 

individuals. In addition, VA received a 

comment from a veterans service 

organization. Unless otherwise 

indicated below, VA adopts the changes 

set forth in the proposed rule. 

Public Comments 

One commenter asked whether VA 

would recognize polycystic ovarian 

syndrome (PCOS) under the VA rating 

schedule. VA has a mechanism in place 

to address PCOS under 38 CFR 4.116. 

Specifically, the rating schedule for 

Gynecological Conditions and Disorders 

of the Breast addresses various ovarian 

conditions under Diagnostic Code (DC) 

7615, ‘‘Ovary, disease, injury, or 

adhesions of’’ and allows VA to rate 

based on whether symptoms are 

controlled by or require continuous 

treatment. In exceptional cases where 

the schedular evaluation is inadequate, 

38 CFR 3.321 allows for extraschedular 

evaluation. Therefore, VA makes no 

changes based on this comment. 

Two commenters proposed additional 

modifications to DC 7913, ‘‘Diabetes 

mellitus.’’ One commenter suggested 

adding a note to address the issue of 

regulation of activities. Another 

commenter suggested not changing the 

insulin requirements within DC 7913 

without considering the other 

requirements in the DC such as 

regulation of activities. The same 

commenter suggested removing the 

insulin requirement for a 20-percent 

rating and the regulation of activities 

requirement at all disability ratings 

under the DC. The commenter stated 

that the functional impairment caused 

by required use of insulin is greater than 

impairment caused by ingestion of oral 

medication to control diabetes. As 

stated in the proposed rule, VA is not 

proposing any change to the evaluation 

criteria for DC 7913 at this time other 

than requiring ‘‘one or more daily 

injection’’ of insulin for a 20-, 40- or 60- 

percent rating and instead intends to 

establish a work group to specifically 

address this condition. Therefore, these 

comments are beyond the scope of this 

rulemaking. However, VA will take 

these comments into consideration in 

connection with a possible future 

rulemaking. 

One commenter suggested changing 

the terminology for a 100-percent rating 

under DC 7903, ‘‘Hypothyroidism’’ from 

‘‘myxedema’’ to ‘‘myxedema coma or 

crisis’’ because myxedema can be 

present without causing the requisite 

level of symptoms for a 100-percent 

rating. Myxedema is a term used to 

denote severe hypothyroidism, and 

myxedema coma or myxedema crisis is 

a medical emergency and represents a 

specific rare life-threatening clinical 

condition. Because the clinical picture 

of myxedema appears in the most 

extreme cases of hypothyroidism, we 

believe that this manifestation of the 

disability warrants a 100-percent rating 

(See Greenspan’s Basic & Clinical 

Endocrinology (D.G. Gardner et al. eds., 

9th ed. 2011) available at http://

accessmedicine.mhmedical.com/

content.aspx?bookid=380&

sectionid=39744047#8401831). 

Therefore, VA makes no changes based 

on this comment. 

The same commenter proposed that 

VA retain a 10-percent minimum 

evaluation in the DCs for endocrine 

disabilities because of the need for 

continuous medication to control the 

symptoms of these disabilities. VA 

disagrees. In the absence of symptoms, 

medical management of chronic 

endocrine disorders does not present a 

significant lifestyle adjustment, and it 

does not result in impairment of earning 

capacity (see 38 U.S.C. 1155). Therefore, 

VA makes no changes based on this 

comment. 

The same commenter noted a 

typographical error in the text of 

proposed DC 7911. The word 

‘‘adrenocortical’’ was misspelled as 

‘‘adrenalcortical.’’ VA has changed the 

spelling of the term based on this 

comment. 

One commenter was supportive of the 

overall changes and additions to this 

section of the VASRD, such as 

additional DCs, clarification of notes on 

residuals affecting other body systems, 

instructions to rate some residuals 

separately, accounting for additional 

symptoms, and formation of a new work 

group for diabetes mellitus. The 


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commenter also commented that 

proposed DCs 7900 (Hyperthyroidism), 

7903 (Hypothyroidism), and 7905 

(Hypoparathyroidism) do not 

adequately account for disability due to 

uncontrolled thyroid hormone or 

calcium imbalance because proposed 

DCs 7900 and 7903 only provide a 30- 

percent rating for symptoms existing for 

up to six months after diagnosis and 

proposed DC 7905 provides a 100- 

percent rating for symptoms occurring 

for up to three months after diagnosis; 

thereafter, residual effects are rated 

under the body system affected by the 

endocrine disability. The commenter 

stated that endocrine function may still 

be disturbed while the correct dosage of 

medication is being determined and that 

some patients may not have received 

treatment. 

We first point out that the ratings 

under DC 7900 and 7903 are for ‘‘six 

months after initial diagnosis’’ and the 

rating under DC 7905 is for ‘‘three 

months after initial diagnosis.’’ Thus, 

the claimants are likely receiving 

treatment. In addition, as VA explained 

in the notice of proposed rulemaking, 

most symptoms of hyperthyroidism and 

hypothyroidism are alleviated within 

six months of treatment (see 80 FR 

39011, 39013 (Jul. 8, 2015)). 

With regard to residual symptoms, the 

primary effect of chronic 

hyperthyroidism, hypothyroidism, and 

hypoparathyroidism is on body systems 

regulated by the thyroid. Therefore, in 

cases where veterans still have 

symptoms after six months for 

hyperthyroidism or hypothyroidism or 

after three months for 

hypoparathyroidism, VA addresses 

residual symptoms by rating all 

residuals based on the specific disability 

presented under the most appropriate 

DCs within the appropriate body 

system(s). 

The residuals of endocrine disorders 

such as uncontrolled thyroid hormone 

or calcium imbalance produce 

measurable disability including muscle 

damage, blood-clotting issues, nerve and 

kidney damage, depression, and many 

others. Therefore, VA makes no changes 

based on this comment. 

The commenter also stated that VA 

has not provided a reasoned argument 

for eliminating a 10-percent evaluation 

when continued medication is required 

under DCs 7900 and 7903. Ratings 

under the schedule are ‘‘based, as far as 

practicable, upon the average 

impairments of earning capacity 

resulting from [specific] injuries’’ or 

combination of injuries (see 38 U.S.C. 

1155). As detailed above, VA explained 

in the notice of proposed rulemaking 

that symptoms of hyperthyroidism and 

hypothyroidism generally resolve 

completely within six months after 

diagnosis and that symptoms of 

hypoparathyroidism are generally 

eliminated following treatment with 

calcium and vitamin D supplementation 

(see 80 FR 39011, 39012–14 (Jul. 8, 

2015)). Because symptoms are generally 

eliminated or minimal once a patient 

receives appropriate medication, there 

is no impairment of earning capacity 

and therefore no need to retain the 10- 

percent rating under DCs 7900, 7903, 

and 7905. As explained above, any 

disabling residuals may be rated under 

the most appropriate rating code. 

Further, if medication is discontinued 

and symptoms reappear, the disability 

could again be rated under the schedule 

for rating disabilities of the endocrine 

system. 

The same commenter suggested that 

proposed DC 7912 should account for 

residuals of common treatment 

procedures such as the Whipple 

procedure, which is also used for the 

treatment of pancreatic cancer. VA 

regulations allow for secondary service 

connection for disabilities that are 

proximately due to or the result of a 

service-connected disease or injury (see 

38 CFR 3.310(a)). Disabilities that are 

secondarily service connected and have 

distinguishable symptoms, to include 

disabilities that arise from the treatment 

of a service-connected disability, are 

rated separately under the VA rating 

schedule. Therefore, VA makes no 

changes based on this comment. 

The same commenter proposed that 

VA amend DCs 7901 and 7902 to 

account for the specific characteristics 

of disfigurement due to thyroid 

enlargement rather than rating such 

disfigurement under DC 7800 because 

the criteria in DC 7800 do not match the 

features of thyroid enlargement. The 

commenter provided two examples of 

this alleged inconsistency, cystic 

thyroid nodules requiring draining and 

soft swelling of the neck. If 

disfigurement related to thyroid 

enlargement does not satisfy the criteria 

in DC 7800, the disfigurement does not 

result in impairment of earning capacity 

and is not compensable (see 38 U.S.C. 

1155). Therefore, VA makes no changes 

based on these comments. 

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 with the 

change noted. 

We are additionally adding updates to 

38 CFR part 4, Appendices A, B, and C, 

to reflect changes to the endocrine 

system rating criteria made by this 

rulemaking. The appendices are tools 

for users of the VASRD and do not 

contain substantive content regarding 

evaluation of disabilities. As such, we 

believe it is appropriate to include these 

updates in this final rule. 

Benefits Costs 

The change to the proposed rule will 

not alter the estimated costs provided in 

the previous Notice of Proposed 

Rulemaking. 

Effective Date of Final Rule 

Veterans Benefits Administration 

(VBA) personnel utilize the Veterans 

Benefit Management System for Rating 

(VBMS–R) to process disability 

compensation claims that involve 

disability evaluations made under the 

VASRD. In order to ensure that there is 

no delay in processing veterans’ claims, 

VA must coordinate the effective date of 

this final rule with corresponding 

VBMS–R system updates. As such, this 

final rule will apply effective December 

10, 2017, the date VBMS–R system 

updates related to this final rule will be 

complete. 

Executive Orders 12866 and 13563 

Executive Orders 13563 and 12866 

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. Executive Order 

12866 (Regulatory Planning and 

Review) defines a ‘‘significant 

regulatory action,’’ requiring review by 

the Office of Management and Budget 

(OMB), unless OMB waives such 

review, as ‘‘any regulatory action that is 

likely to result in a rule that may: (1) 

Have an annual effect on the economy 

of $100 million or more or adversely 

affect in a material way the economy, a 

sector of the economy, productivity, 

competition, jobs, the environment, 

public health or safety, or State, local, 

or tribal governments or communities; 

(2) Create a serious inconsistency or 

otherwise interfere with an action taken 

or planned by another agency; (3) 

Materially alter the budgetary impact of 

entitlements, grants, user fees, or loan 

programs or the rights and obligations of 

recipients thereof; or (4) Raise novel 

legal or policy issues arising out of legal 

mandates, the President’s priorities, or 


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50804 Federal Register / Vol. 82, No. 211 / Thursday, November 2, 2017 / Rules and Regulations 

the principles set forth in this Executive 

Order.’’ 

The economic, interagency, 

budgetary, legal, and policy 

implications of this final rule have been 

examined, and have been determined 

not to be a significant regulatory action 

under Executive Order 12866. VA’s 

impact analysis can be found as a 

supporting document at http://

www.regulations.gov, usually within 48 

hours after the rulemaking document is 

published. Additionally, a copy of this 

rulemaking and its impact analysis are 

available on VA’s Web site at http://

www.va.gov/orpm/, by following the 

link for ‘‘VA Regulations Published 

From FY 2004 Through Fiscal Year to 

Date.’’ 

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. This final rule 

will not directly affect any small 

entities. Only certain VA beneficiaries 

could be directly affected. Therefore, 

pursuant to 5 U.S.C. 605(b), this 

rulemaking is exempt from the initial 

and final regulatory flexibility analysis 

requirements of sections 603 and 604. 

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). 

Catalog of Federal Domestic Assistance 

The Catalog of Federal Domestic 

Assistance program numbers and titles 

for this rule 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; and 64.110, Veterans 

Dependency and Indemnity 

Compensation for Service-Connected 

Death. 

Signing Authority 

The Secretary of Veterans Affairs, or 

designee, approved this document 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. Gina 

S. Farrisee, Deputy Chief of Staff, 

Department of Veterans Affairs, 

approved this document on April 19, 

2017, for publication. 

List of Subjects in 38 CFR Part 4 

Disability benefits, Pensions, 

Veterans. 

Approved: April 19, 2017. 

Jeffrey Martin, 

Office Program Manager, Office of Regulation 

Policy & Management, Office of the Secretary, 

Department of Veterans Affairs 

Editor’s Note: This document was 

received for publication at the Office of the 

Federal Register on October 19, 2017. 

For the reasons set out in the 

preamble, the Department of Veterans 

Affairs amends 38 CFR part 4 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, unless 

otherwise noted. 

Subpart B—Disability Ratings 

■ 2. Amend § 4.104 by revising the entry 

for 7008 to read as follows: 

§ 4.104 Schedule of ratings-cardiovascular 

system. 

DISEASES OF THE HEART

Rating 

* * * * * 

7008 Hyperthyroid heart disease. 

Rate under the appropriate cardiovascular diagnostic code, depending 

on particular findings. 

* * * * * 

■ 3. Amend § 4.119 by: 

■ a. Revising the entries for 7900 

through 7905; 

■ b. Adding in numerical order an entry 

for 7906; and 

■ c. Revising the entries for 7907 

through 7909, 7911 through 7913, and 

7915 through 7919. 

The revisions and addition read as 

follows: 

§ 4.119 Schedule of ratings—endocrine 

system. 

Rating 

7900 Hyperthyroidism, including, but not limited to, Graves’ disease: 

For six months after initial diagnosis .................................................................................................................................................... 30 

Thereafter, rate residuals of disease or complications of medical treatment within the appropriate diagnostic code(s) within the 

appropriate body system. 

Note (1): If hyperthyroid cardiovascular or cardiac disease is present, separately evaluate under DC 7008 (hyperthyroid heart 

disease). 

Note (2): Separately evaluate eye involvement occurring as a manifestation of Graves’ Disease as diplopia (DC 6090); impairment of central visual acuity (DCs 6061–6066); or under the most appropriate DCs in § 4.79. 

7901 Thyroid enlargement, toxic: 

Note (1): Evaluate symptoms of hyperthyroidism under DC 7900, hyperthyroidism, including, but not limited to, Graves’ disease. 

Note (2): If disfigurement of the neck is present due to thyroid disease or enlargement, separately evaluate under DC 7800 

(burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the

head, face, or neck). 

7902 Thyroid enlargement, nontoxic: 

Note (1): Evaluate symptoms due to pressure on adjacent organs (such as the trachea, larynx, or esophagus) under the appropriate diagnostic code(s) within the appropriate body system. 

Note (2): If disfigurement of the neck is present due to thyroid disease or enlargement, separately evaluate under DC 7800 

(burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the

head, face, or neck). 

7903 Hypothyroidism: 


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Rating 

Hypothyroidism manifesting as myxedema (cold intolerance, muscular weakness, cardiovascular involvement (including, but not 

limited to hypotension, bradycardia, and pericardial effusion), and mental disturbance (including, but not limited to dementia,

slowing of thought and depression)) ................................................................................................................................................ 100 

Note (1): This evaluation shall continue for six months beyond the date that an examining physician has determined crisis stabilization. Thereafter, the residual effects of hypothyroidism shall be rated under the appropriate diagnostic code(s) within the 

appropriate body system(s) (e.g., eye, digestive, and mental disorders). 

Hypothyroidism without myxedema ...................................................................................................................................................... 30 

Note (2): This evaluation shall continue for six months after initial diagnosis. Thereafter, rate residuals of disease or medical 

treatment under the most appropriate diagnostic code(s) under the appropriate body system (e.g., eye, digestive, mental disorders). 

Note (3): If eye involvement, such as exophthalmos, corneal ulcer, blurred vision, or diplopia, is also present due to thyroid disease, also separately evaluate under the appropriate diagnostic code(s) in § 4.79, Schedule of Ratings—Eye (such as diplopia 

(DC 6090) or impairment of central visual acuity (DCs 6061–6066)). 

7904 Hyperparathyroidism: 

For six months from date of discharge following surgery .................................................................................................................... 100 

Note (1): After six months, rate on residuals under the appropriate diagnostic code(s) within the appropriate body system(s) 

based on a VA examination. 

Hypercalcemia (indicated by at least one of the following: Total Ca greater than 12 mg/dL (3–3.5 mmol/L), Ionized Ca greater 

than 5.6 mg/dL (2–2.5 mmol/L), creatinine clearance less than 60 mL/min, bone mineral density T-score less than 2.5 SD 

(below mean) at any site or previous fragility fracture) .................................................................................................................... 60 

Note (2): Where surgical intervention is indicated, this evaluation shall continue until the day of surgery, at which time the provisions pertaining to a 100-percent evaluation shall apply. 

Note (3): Where surgical intervention is not indicated, this evaluation shall continue for six months after pharmacologic treatment 

begins. After six months, rate on residuals under the appropriate diagnostic code(s) within the appropriate body system(s) 

based on a VA examination. 

Symptoms such as fatigue, anorexia, nausea, or constipation that occur despite surgery; or in individuals who are not candidates for surgery but require continuous medication for control ................................................................................................... 10 

Asymptomatic ....................................................................................................................................................................................... 0 

Note (4): Following surgery or other treatment, evaluate chronic residuals, such as nephrolithiasis (kidney stones), decreased 

renal function, fractures, vision problems, and cardiovascular complications, under the appropriate diagnostic codes. 

7905 Hypoparathyroidism: 

For three months after initial diagnosis ................................................................................................................................................ 100 

Thereafter, evaluate chronic residuals, such as nephrolithiasis (kidney stones), cataracts, decreased renal function, and congestive heart failure under the appropriate diagnostic codes. 

7906 Thyroiditis: 

With normal thyroid function (euthyroid) .............................................................................................................................................. 0 

Note: Manifesting as hyperthyroidism, evaluate as hyperthyroidism, including, but not limited to, Graves’ disease (DC 7900); 

manifesting as hypothyroidism, evaluate as hypothyroidism (DC 7903). 

7907 Cushing’s syndrome: 

As active, progressive disease, including areas of osteoporosis, hypertension, and proximal upper and lower extremity muscle 

wasting that results in inability to rise from squatting position, climb stairs, rise from a deep chair without assistance, or raise 

arms .................................................................................................................................................................................................. 100 

Proximal upper or lower extremity muscle wasting that results in inability to rise from squatting position, climb stairs, rise from a 

deep chair without assistance, or raise arms ................................................................................................................................... 60 

With striae, obesity, moon face, glucose intolerance, and vascular fragility ....................................................................................... 30 

Note: The evaluations specifically indicated under this diagnostic code shall continue for six months following initial diagnosis. 

After six months, rate on residuals under the appropriate diagnostic code(s) within the appropriate body system(s). 

7908 Acromegaly: 

Evidence of increased intracranial pressure (such as visual field defect), arthropathy, glucose intolerance, and either hypertension or cardiomegaly .................................................................................................................................................................... 100 

Arthropathy, glucose intolerance, and hypertension ............................................................................................................................ 60 

Enlargement of acral parts or overgrowth of long bones .................................................................................................................... 30 

7909 Diabetes insipidus: 

For three months after initial diagnosis ................................................................................................................................................ 30 

Note: Thereafter, if diabetes insipidus has subsided, rate residuals under the appropriate diagnostic code(s) within the appropriate body system. 

With persistent polyuria or requiring continuous hormonal therapy ..................................................................................................... 10 

7911 Addison’s disease (adrenocortical insufficiency): 

Four or more crises during the past year ............................................................................................................................................. 60 

Three crises during the past year, or; five or more episodes during the past year ............................................................................ 40 

One or two crises during the past year, or; two to four episodes during the past year, or; weakness and fatigability, or; 

corticosteroid therapy required for control ........................................................................................................................................ 20 

Note (1): An Addisonian ‘‘crisis’’ consists of the rapid onset of peripheral vascular collapse (with acute hypotension and shock), 

with findings that may include: anorexia; nausea; vomiting; dehydration; profound weakness; pain in abdomen, legs, and back; 

fever; apathy, and depressed mentation with possible progression to coma, renal shutdown, and death. 

Note (2): An Addisonian ‘‘episode,’’ for VA purposes, is a less acute and less severe event than an Addisonian crisis and may 

consist of anorexia, nausea, vomiting, diarrhea, dehydration, weakness, malaise, orthostatic hypotension, or hypoglycemia, 

but no peripheral vascular collapse. 

Note (3): Tuberculous Addison’s disease will be evaluated as active or inactive tuberculosis. If inactive, these evaluations are 

not to be combined with the graduated ratings of 50 percent or 30 percent for non-pulmonary tuberculosis specified under 

§ 4.88b. Assign the higher rating. 

7912 Polyglandular syndrome (multiple endocrine neoplasia, autoimmune polyglandular syndrome): 


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Rating 

Evaluate according to major manifestations to include, but not limited to, Type I diabetes mellitus, hyperthyroidism, 

hypothyroidism, hypoparathyroidism, or Addison’s disease. 

7913 Diabetes mellitus: 

Requiring more than one daily injection of insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications 

that would be compensable if separately evaluated ........................................................................................................................ 100 

Requiring one or more daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated .................................................................................................. 60 

Requiring one or more daily injection of insulin, restricted diet, and regulation of activities ............................................................... 40 

Requiring one or more daily injection of insulin and restricted diet, or; oral hypoglycemic agent and restricted diet ........................ 20 

Manageable by restricted diet only ...................................................................................................................................................... 10 

Note (1): Evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100-

percent evaluation. Noncompensable complications are considered part of the diabetic process under DC 7913. 

Note (2): When diabetes mellitus has been conclusively diagnosed, do not request a glucose tolerance test solely for rating purposes. 

* * * * * * * 

7915 Neoplasm, benign, any specified part of the endocrine system: 

Rate as residuals of endocrine dysfunction. 

7916 Hyperpituitarism (prolactin secreting pituitary dysfunction): 

Note: Evaluate as malignant or benign neoplasm, as appropriate. 

7917 Hyperaldosteronism (benign or malignant): 

Note: Evaluate as malignant or benign neoplasm, as appropriate. 

7918 Pheochromocytoma (benign or malignant): 

Note: Evaluate as malignant or benign neoplasm as appropriate. 

7919 C-cell hyperplasia of the thyroid: 

If antineoplastic therapy is required, evaluate as a malignant neoplasm under DC 7914. If a prophylactic thyroidectomy is performed (based upon genetic testing) and antineoplastic therapy is not required, evaluate as hypothyroidism under DC 7903. 

* * * * * * * 

■ 4. Amend the table in appendix A to 

part 4 in the entries for Sec. 4.104 and 

Sec. 4.119 by: 

■ a. Revising the entry for 7008; 

■ b. Revising the entries for 7900 

through 7905; 

■ c. Adding in numerical order an entry 

for 7906; and 

■ d. Revising the entries for 7907 

through 7909, 7911 through 7913, and 

7915 through 7919. 

The revisions and addition read as 

follows: 

Appendix A to Part 4—Table of 

Amendments and Effective Dates Since 

1946 

Sec. Diagnostic 

code No. 

*******

7008 Evaluation January 12, 1998; criterion December 10, 2017. 

*******

4.119 ....... 7900 Criterion August 13, 1981; evaluation June 9, 1996; title December 10, 2017; evaluation December 10, 2017; criterion December 10, 2017; note December 10, 2017. 

7901 Criterion August 13, 1981; evaluation June 9, 1996; title December 10, 2017; evaluation December 10, 2017; criterion December 10, 2017; note December 10, 2017. 

7902 Evaluation August 13, 1981; criterion June 9, 1996; title December 10, 2017; evaluation December 10, 2017; criterion December 10, 2017; note December 10, 2017. 

7903 Criterion August 13, 1981; evaluation June 9, 1996; evaluation December 10, 2017; criterion December 10, 2017; 

note December 10, 2017. 

7904 Criterion August 13, 1981; evaluation June 9, 1996; evaluation December 10, 2017; criterion December 10, 2017; 

note December 10, 2017. 

7905 Evaluation; August 13, 1981; evaluation June 9, 1996; evaluation December 10, 2017; criterion December 10, 2017. 

7906 Added December 10, 2017. 

7907 Evaluation; August 13, 1981; evaluation June 9, 1996; criterion December 10, 2017; note December 10, 2017. 

7908 Criterion August 13, 1981; criterion June 9, 1996; criterion December 10, 2017. 

7909 Evaluation August 13, 1981; criterion June 9, 1996; evaluation June 9, 1996; criterion December 10, 2017; evaluation December 10, 2017; note December 10, 2017. 

7910 Removed June 9, 1996. 

7911 Evaluation March 11, 1969; evaluation August 13, 1981; criterion June 9, 1996; title December 10, 2017; note December 10, 2017. 

7912 Title December 10, 2017; criterion December 10, 2017. 

7913 Criterion September 9, 1975; criterion August 13, 1981; criterion June 6, 1996; evaluation June 9, 1996; criterion December 10, 2017; note December 10, 2017. 


nlaroche on DSK9F9SC42PROD with RULES
Federal Register / Vol. 82, No. 211 / Thursday, November 2, 2017 / Rules and Regulations 50807 

Sec. Diagnostic 

code No. 

*******

7915 Criterion June 9, 1996; criterion December 10, 2017. 

7916 Added June 9, 1996; note December 10, 2017. 

7917 Added June 9, 1996; note December 10, 2017. 

7918 Added June 9, 1996; note December 10, 2017. 

7919 Added June 9, 1996; evaluation June 9, 1996; criterion December 10, 2017; note December 10, 2017. 

*******

■ 5. Amend Appendix B to part 4 by: 

■ a. Revising the entries for diagnostic 

codes 7900 through 7902; 

■ b. Adding, in numerical order, an 

entry for diagnostic code 7906; and 

■ c. Revising the entries for diagnostic 

codes 7911 and 7912. 

The revisions and addition read as 

follows: 

Appendix B to Part 4—Numerical Index 

of Disabilities 

Diagnostic 

code No. 

*******

THE ENDOCRINE SYSTEM 

7900 .................................... Hyperthyroidism, including, but not limited to, Graves’ disease. 

7901 .................................... Thyroid enlargement, toxic. 

7902 .................................... Thyroid enlargement, nontoxic. 

* * * * * * * 

7906 .................................... Thyroiditis. 

* * * * * * * 

7911 .................................... Addison’s disease (adrenocortical insufficiency). 

7912 .................................... Polyglandular syndrome (multiple endocrine neoplasia, autoimmune polyglandular syndrome). 

*******

■ 6. Amend Appendix C to Part 4 as 

follows: 

■ a. Add, in alphabetical order, entries 

for ‘‘Graves’ disease’’ and 

‘‘Polyglandular syndrome’’; 

■ b. Revise the entry for ‘‘Thyroid 

gland’’; and 

■ c. Add, in alphabetical order, an entry 

for ‘‘Thyroiditis’’. 

The additions and revision read as 

follows: 

Appendix C to Part 4—Alphabetical 

Index of Disabilities 

Diagnostic 

code No. 

* * * * * 

Graves’ disease ........................ 7900 

* * * * * 

Polyglandular syndrome ........... 7912 

* * * * * 

Thyroid gland.

Nontoxic thyroid enlargement 7902 

Toxic thyroid enlargement ..... 7901 

Thyroiditis ................................. 7906 

* * * * * 

[FR Doc. 2017–23044 Filed 11–1–17; 8:45 am] 

BILLING CODE 8320–01–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 52 

[EPA–R05–OAR–2016–0327; FRL–9970–14– 

Region 5] 

Air Plan Approval; Minnesota; State 

Board Requirements 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Final rule. 

SUMMARY: The Environmental Protection 

Agency (EPA) is approving a state 

implementation plan (SIP) submission 

from Minnesota addressing the state 

board requirements of the Clean Air Act 

(CAA). EPA is also approving elements 

of Minnesota’s submission addressing 

the infrastructure requirements relating 

to state boards for the 1997 ozone, 1997 

fine particulate (PM2.5), 2006 PM2.5, 

2008 lead (Pb), 2008 ozone, 2010 

nitrogen dioxide (NO2), 2010 sulfur 

dioxide (SO2), and 2012 PM2.5 National 

Ambient Air Quality Standards 

(NAAQS). The proposed rulemaking 

associated with this final action was 

published on July 17, 2017, and EPA 

received no comments during the 

comment period, which ended on 

August 16, 2017. 

DATES: This final rule is effective on 

December 4, 2017. 

ADDRESSES: EPA has established a 

docket for this action under Docket ID 

No. EPA–R05–OAR–2016–0327. All 

documents in the docket are listed on 

the www.regulations.gov Web site. 

Although listed in the index, some 

information is not publicly available, 

i.e., Confidential Business Information 

(CBI) or other information whose 

disclosure is restricted by statute. 

Certain other material, such as 

copyrighted material, is not placed on 

the Internet and will be publicly 

available only in hard copy form. 

Publicly available docket materials are 

available either through 

www.regulations.gov or at the 

Environmental Protection Agency, 

Region 5, Air and Radiation Division, 77 

West Jackson Boulevard, Chicago, 

Illinois 60604. This facility is open from 


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