Document ID: chunk:federal_register_of_legislation:F2023C00151:reg:15:p24
Version: federal_register_of_legislation:F2023C00151
Segment Type: reg
Provision Reference: reg 15 (pt 24/28)
Character Range: 393640–396562

ratings for the affected body systems.

Depending on the body systems that are affected by the malignant condition and its treatment, each of the relevant chapters of the Guide is to be used and appropriate ratings obtained.

If other accepted or non-accepted conditions also affect any of the same body systems, Chapter 19 (Partially Contributing Impairment) or Chapter 20 (Apportionment) may have to be applied depending upon the circumstances.

Step 3: Determine the total combined impairment rating for the various body system impairments attributable to the malignant condition.

The total combined impairment rating for the various body system impairments associated with the malignant condition is determined by combining the attributable impairment ratings by applying Chapter 18 (Combined Values Chart).

Unless the malignant condition is the only accepted condition, this combined rating is to be regarded as an intermediate rating only.

Step 4: Determine the impairment rating based on Table 14.1 (Malignant Disorders).

Apply Table 14.1 and find the relevant impairment rating for the entire set of effects which have arisen from the malignant disorder treatment, including surgical resection, chemotherapy and radiotherapy.

For the purposes of Table 14.1, "symptoms" encompasses the symptoms of both the malignant condition itself and the symptoms of the effects of its treatment.

If non-accepted conditions or accepted but non-malignant conditions have contributed to the impairment rating obtained from Table 14.1, Chapter 19 (Apportionment) or Chapter 20 (Partially Contributing Impairment) are to be applied depending on the circumstances of the case.

Step 5: Determine the impairment rating based on life expectancy.

If an impairment rating has not been determined on any previous occasion by applying Table 14.2 (Life Expectancy) or its predecessor in an earlier edition of this Guide, a rating is to be obtained from Table 14.2. If a rating has been obtained from Table 14.2 or its predecessor in an earlier edition of this Guide, on a previous occasion, that same rating is to be applied again in all further assessments of the condition.

Whenever possible, the rating from Table 14.2 is to be based on an estimate from an oncologist or other treating specialist of the veteran's survival. If such information is unavailable, data from standard reference texts is to be applied to provide an estimate. Such an estimate is to be based on malignancies of the same type and degree of spread as that affecting the veteran.

Estimated life expectancy is projected from the time of diagnosis, or from any subsequent major staging procedure or operation. Thus, once a rating from Table 14.2 has been made it is not to be changed, unless subsequent findings indicate that the earlier prognosis was based on incorrect clinical information.

If the assessment is made posthumously, the