tropical diseases, see . b. Digestive Condition Evaluations Under 38 CFR 4.114 Which Will Not Be Combined With Each Other specifies that evaluations of digestive conditions under certain diagnostic codes (DCs) will not be combined with each other or assigned separate evaluations. Instead, a single evaluation should be assigned under the DC which reflects the predominant disability, with elevation to the next higher evaluation when the severity of the overall disability warrants such elevation. Do not combine separate evaluations of digestive conditions with each other under the following DCs: 7301 to 7329, inclusive (meaning all the DCs from 7301 to 7329) 7331 7342, and 7345 to 7348, inclusive (meaning all the DCs from 7345 to 7348). Example: A Veteran with a duodenal ulcer, evaluated as 20-percent disabling under , and ulcerative colitis, evaluated as 30-percent disabling under , would be assigned a single 30-percent evaluation under as ulcerative colitis represents the predominant disability picture. Separate evaluations for the duodenal ulcer and ulcerative colitis are not permitted under . c. Establishing SC for Inguinal Hernia Do not assume the preexistence of a hernia. Determine preexistence on a factual basis. The following conditions are sufficient bases for SC in-service initial manifestation of hernial protrusion, and recurrence during service, by aggravation, of a hernia previously surgically repaired. Note: Operation for repair of a preexisting inguinal hernia is not necessarily evidence of aggravation. Reference: For information on the presumption of soundness at entrance into service, see . d. Considering Recurrence of Hemorrhoids Initial awards of SC for hemorrhoids are governed by customary rules for SC included in . After SC is initially established, unless the award of SC for hemorrhoids was in error, consider recurrences after service as (SC). Reference: For more information on reversing an erroneous decision, see
d. Interpreting Lab Reports for HCV After 1992 The table below provides an example of a laboratory interpretation of serology testing for HCV for testing performed after 1992. Tests Results Interpretation anti-HCV positive (probable chronic hepatitis) need to verify diagnosis EIA positive supplemental test required RIBA positive diagnostic HCVRNA follow-up of chronic hepatitis C not needed for rating e. Risk Factors for HBV and HCV Risk factors for the development of HBV and HCV are similar. The table below describes the medically recognized risk factors for HBV and HCV infection, provides transmission information concerning those risk factors, and includes tips for confirming the risk factors. Note: Resolve reasonable doubt under in favor of the Veteran when the evidence favoring risk factor(s) in service is equal to the evidence favoring risk factor(s) before or after service. Risk Factor Transmission Information Rating Tips transfusion of blood or blood product before 1992 for HCV, or before 1975 for HBV organ transplant before 1992, or hemodialysis Blood donor screening for HCV was not available until 1989 when HCV was identified. In 1992, more effective screening of blood became possible for HCV. If blood transfusion is a claimed risk factor, obtain the relevant hospital records from service, if possible. Look for evidence of blood transfusions in surgical reports, especially the anesthesia sheet surgical record operative clinical records, or post-operative clinical notes. tattoos body piercing, and acupuncture with needles transmitted through the use of unsterilized equipment Review for indications of tattoos or piercings on induction and separation exams to help determine whether tattooing or piercing
took place in service. intravenous drug use transmitted through the use of shared instruments Records of drug treatment may reflect the type of drug abuse. high-risk sexual activity Transmission risk is relatively low but increases with multiple sexual partners. Periodic health assessments or records of treatment for sexually transmitted diseases may document a history of high-risk sexual activity or multiple sexual partners. intranasal cocaine use transmitted through the use of shared instruments Records of drug treatment may reflect the type of drug abuse. accidental exposure to blood by percutaneous exposure or on mucous membranes common for the following health care workers combat medics, and corpsmen Consider service department or other records reflecting occupational history. sharing of toothbrushes, or shaving razors transmitted through direct percutaneous exposure to blood This type of in-service exposure will not generally be documented in service records. Consider buddy statements in the context of the entire evidence picture pertaining to risk factors. immunization with a jet air gun injector one documented case of HBV transmission Despite the lack of any scientific evidence to document transmission of HCV with air gun injectors, it is biologically possible. A medical report linking hepatitis to air gun injectors must include a full discussion of all potential modes of transmission and a rationale as to why the examiner believes the air gun injector was the source for the hepatitis infection. f. Development for Hepatitis As VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, does not inform the claimant to submit evidence of
observation, or surveillance. No immediate specific therapy is being used, but cancer is active. expectancy is short due to age or other illness since prostate cancer is slow- growing. percent, despite the lack of treatment and possible lack of symptoms. radical prostatectomy surgery which is characterized by removal of prostate gland and seminal vesicles most common treatment for localized cancer can be curative, and nerve-sparing procedure can be performed to improve chances that the patient will retain normal erectile function. impotence, and/or incontinence. In all cases of radical prostatectomy, award SMC (k) for loss of use of a creative organ. Consider SC for ED on a facts-found basis. Cryotherapy, also known as cryosurgery or cryoablation, is a procedure by which the prostate and nearby tissues are frozen with liquid nitrogen via probes in the perineum. impotence incontinence urethral scarring, and rectourethral fistula (rare). Consider SMC (k) on a facts-found basis. Radiation can be curative if cancer is confined to the prostate and surrounding tissues and PSA is 15 nanograms (ng)/ml or less is also used as palliative therapy to relieve symptoms of advanced cancer, such as bone pain due to metastasis after external beam radiation impotence, and/or incontinence after brachytherapy impotence incontinence bowel problems, and/or urethral complications. After internal HDR the radiation continues only for hours or days, so a six-month assignment of temporary 100 percent under is appropriate, and consider SMC (k) for impotence on a facts-found basis. After internal LDR the effective radiation should be
of Cervical Dysplasia injury. It is a cellular abnormality of the cervix revealed by Papanicolaou (Pap) smear testing that generally resolves without treatment or residuals. In these cases, there is an abnormal laboratory finding but no disability, and SC is not warranted. SC may be warranted if cervical dysplasia/CIN requires treatment that leaves residuals, or is linked to the subsequent development of cervical cancer. Use the table below to determine the appropriate actions to take when SC is claimed following an in-service confirmed finding of cervical dysplasia/CIN. If Medical Evidence Shows the Subsequent Development of… Then Award SC for… Additional Information to Consider chronic or severe dysplasia/CIN requiring treatment, and chronic residuals of the required treatment residuals of cervical dysplasia/CIN. Common procedures for treatment of chronic or severe dysplasia/CIN include cauterization laser surgery cryosurgery, or loop electrosurgical excision procedure (LEEP). cervical cancer, and a link between the dysplasia/CIN and the cancer cervical cancer and/or residuals. In-service cervical dysplasia that resolved without residuals is less likely to be related to later-developing cervical cancer. However, these cases require a medical opinion to determine whether a relationship exists between the conditions. Note: Cervical dysplasia is often associated with human papillomavirus (HPV) infection. There are over 60 types of HPV infection, and only certain types are associated with high-grade cervical dysplasia and cancer. Reference: For more information on considering claims for SC of HPV and/or genital warts, see M21-1, Part III, Subpart iv, 4.I.3.f.
sickle cell thalassemia, and sickle-hemoglobin C disease. Note: The phenomenon of sickling of red blood cells is a hereditary abnormality that of itself usually produces few ill effects. b. Definition: Sickle Cell Anemia Sickle cell anemia is a hereditary and familial disorder characterized clinically by symptoms of anemia arthritis leg ulcers, and acute attacks of pain. Note: The age of onset is generally early childhood. c. Definition: Bone Marrow Transplant and Stem Cell Transplant A bone marrow transplant, also called a stem cell transplant, is a procedure used to infuse healthy cells, called stem cells, into the body to replace damaged or diseased bone marrow. Important: There is no difference between a bone marrow transplant and a stem cell transplant; therefore, an SC hemic-lymphatic disability requiring a stem cell transplant should be evaluated by analogy to . Notes: Assign the 100-percent evaluation from the date of hospital admission and continue with a mandatory VA examination six months following hospital discharge. Any change in evaluation based on that or any subsequent examination shall be subject to the provisions of . If no local recurrence or metastasis has occurred, then evaluate on residuals. d. Inheritance of Sickle Cell Trait Inheritance of sickle cell trait may be from one or both parents. If sickle hemoglobin is inherited from one parent and normal hemoglobin from the other, the combination (Hb S + Hb A) is referred to as sickle cell trait. Note: Except for unusual circumstances, this is a benign asymptomatic condition and is not associated with increased morbidity.