[Code of Federal Regulations]
[Title 38, Volume 1]
[Revised as of July 1, 2003]
From the U.S. Government Printing Office via GPO Access
[CITE: 38 CFR 4.1]
[Page 359-360]
TITLE 38 -- PENSIONS, BONUSES, AND VETERANS' RELIEF
CHAPTER I --
DEPARTMENT OF VETERANS AFFAIRS
PART 4 -- SCHEDULE FOR RATING DISABILITIES--Table of Contents
Subpart A -- General Policy in Rating
Sec. 4.1 Essentials of evaluative rating.
Sec. 4.2 Interpretation of examination reports.
Sec. 4.3 Resolution of reasonable doubt.
Sec. 4.6 Evaluation of evidence.
Sec. 4.7 Higher of two evaluations.
Sec. 4.9 Congenital or developmental defects.
Sec. 4.10 Functional impairment.
Sec. 4.13 Effect of change of diagnosis.
Sec. 4.14 Avoidance of pyramiding.
Sec. 4.15 Total disability ratings.
Sec. 4.16 Total disability ratings for compensation
based on unemployability of the individual.
Sec. 4.17 Total disability ratings for pension based on unemployability
and age of the individual.
Sec. 4.18 Unemployability.
Sec. 4.19 Age in service-connected claims.
Sec. 4.20 Analogous ratings.
Sec. 4.21 Application of rating schedule.
Sec. 4.22 Rating of disabilities aggravated by active service.
Sec. 4.23 Attitude of rating officers.
Sec. 4.24 Correspondence.
Sec. 4.25 Combined ratings table.
Chart
Sec. 4.26 Bilateral factor.
Sec. 4.27 Use of diagnostic code numbers.
Sec. 4.28 Prestabilization rating from date of discharge from service.
Sec. 4.29 Ratings for service-connected disabilities requiring hospital treatment
or observation.
Sec. 4.30 Zero percent evaluations
Sec. 4.31 Zero percent evaluations.
Complete Part 4 TOC
Sec. 4.1 Essentials of evaluative rating.
This rating schedule is primarily a guide in the evaluation of
disability resulting from all types of diseases and injuries encountered
as a result of or incident to military service. The percentage ratings
represent as far as can practicably be determined the average impairment
in earning capacity resulting from such diseases and injuries and their
residual conditions in civil occupations. Generally, the degrees of
disability specified are considered adequate to compensate for
considerable loss of working time from exacerbations or illnesses
proportionate to the severity of the several grades of disability. For
the application of this schedule, accurate and fully descriptive medical
examinations are required, with emphasis upon the limitation of activity
imposed by the disabling condition. Over a period of many years, a
veteran's disability claim may require reratings in accordance with
changes in laws, medical knowledge and his or her physical or mental
condition. It is thus essential, both in the examination and in the
evaluation of disability, that each disability be viewed in relation to its history.
[41 FR 11292, Mar. 18, 1976]
Sec. 4.2 Interpretation of examination reports.
Different examiners, at different times, will not describe the same
disability in the same language. Features of the disability which must
have persisted unchanged may be overlooked or a change for the better or
worse may not be accurately appreciated or described. It is the
responsibility of the rating specialist to interpret reports of
examination in the light of the whole recorded history, reconciling the
various reports into a consistent picture so that the current rating may
accurately reflect the elements of disability present. Each disability
must be considered from the point of view of the veteran working or
seeking work. If a diagnosis is not supported by the findings on the
examination report or if the report does not contain sufficient detail,
it is incumbent upon the rating board to return the report as inadequate
for evaluation purposes.
Sec. 4.3 Resolution of reasonable doubt.
It is the defined and consistently applied policy of the Department
of Veterans Affairs to administer the law under a broad interpretation,
consistent, however, with the facts shown in every case. When after
careful consideration of all procurable and assembled data, a reasonable
doubt arises regarding the degree of disability such doubt will be
resolved in favor of the claimant. See Sec. 3.102 of this chapter.
[40 FR 42535, Sept. 15, 1975]
Sec. 4.6 Evaluation of evidence.
The element of the weight to be accorded the character of the
veteran's service is but one factor entering into the considerations of
the rating boards in arriving at determinations of the evaluation of
disability. Every element in any way affecting the probative value to be
assigned to the evidence in each individual claim must be thoroughly and
conscientiously studied by each member of the rating board in the light
of the established policies of the Department of Veterans Affairs to the
end that decisions will be equitable and just as contemplated by the
requirements of the law.
Sec. 4.7 Higher of two evaluations.
Where there is a question as to which of two evaluations shall be
applied, the higher evaluation will be assigned if the disability
picture more nearly approximates the criteria required for that rating.
Otherwise, the lower rating will be assigned.
Sec. 4.9 Congenital or developmental defects.
Mere congenital or developmental defects, absent, displaced or
supernumerary parts, refractive error of the eye, personality disorder
and mental deficiency are not diseases or injuries in the meaning of
applicable legislation for disability compensation purposes.
[41 FR 11292, Mar. 18, 1976]
Sec. 4.10 Functional impairment.
The basis of disability evaluations is the ability of the body as a
whole, or of the psyche, or of a system or organ of the body to function
under the ordinary conditions of daily life including employment.
Whether the upper or lower extremities, the back or abdominal wall, the
eyes or ears, or the cardiovascular, digestive, or other system, or
psyche are affected, evaluations are based upon lack of usefulness, of
these parts or systems, especially in self-support. This imposes upon
the medical examiner the responsibility of furnishing, in addition to
the etiological, anatomical, pathological, laboratory and prognostic
data required for ordinary medical classification, full description of
the effects of disability upon the person's ordinary activity. In this
connection, it will be remembered that a person may be too disabled to
engage in employment although he or she is up and about and fairly
comfortable at home or upon limited activity.
Sec. 4.13 Effect of change of diagnosis.
The repercussion upon a current rating of service connection when
change
[[Page 361]]
is made of a previously assigned diagnosis or etiology must be kept in
mind. The aim should be the reconciliation and continuance of the
diagnosis or etiology upon which service connection for the disability
had been granted. The relevant principle enunciated in Sec. 4.125,
entitled ``Diagnosis of mental disorders,'' should have careful
attention in this connection. When any change in evaluation is to be
made, the rating agency should assure itself that there has been an
actual change in the conditions, for better or worse, and not merely a
difference in thoroughness of the examination or in use of descriptive
terms. This will not, of course, preclude the correction of erroneous
ratings, nor will it preclude assignment of a rating in conformity with
Sec. 4.7.
[29 FR 6718, May 22, 1964, as amended at 61 FR 52700, Oct. 8, 1996]
Sec. 4.14 Avoidance of pyramiding.
The evaluation of the same disability under various diagnoses is to
be avoided. Disability from injuries to the muscles, nerves, and joints
of an extremity may overlap to a great extent, so that special rules are
included in the appropriate bodily system for their evaluation. Dyspnea,
tachycardia, nervousness, fatigability, etc., may result from many
causes; some may be service connected, others, not. Both the use of
manifestations not resulting from service-connected disease or injury in
establishing the service-connected evaluation, and the evaluation of the
same manifestation under different diagnoses are to be avoided.
Sec. 4.15 Total disability ratings.
The ability to overcome the handicap of disability varies widely
among individuals. The rating, however, is based primarily upon the
average impairment in earning capacity, that is, upon the economic or
industrial handicap which must be overcome and not from individual
success in overcoming it. However, full consideration must be given to
unusual physical or mental effects in individual cases, to peculiar
effects of occupational activities, to defects in physical or mental
endowment preventing the usual amount of success in overcoming the
handicap of disability and to the effect of combinations of disability.
Total disability will be considered to exist when there is present any
impairment of mind or body which is sufficient to render it impossible
for the average person to follow a substantially gainful occupation;
Provided, That permanent total disability shall be taken to exist when
the impairment is reasonably certain to continue throughout the life of
the disabled person. The following will be considered to be permanent
total disability: the permanent loss of the use of both hands, or of
both feet, or of one hand and one foot, or of the sight of both eyes, or
becoming permanently helpless or permanently bedridden. Other total
disability ratings are scheduled in the various bodily systems of this
schedule.
Sec. 4.16 Total disability ratings for compensation based on unemployability
of the individual.
(a) Total disability ratings for compensation may be assigned, where
the schedular rating is less than total, when the disabled person is, in
the judgment of the rating agency, unable to secure or follow a
substantially gainful occupation as a result of service-connected
disabilities: Provided That, if there is only one such disability, this
disability shall be ratable at 60 percent or more, and that, if there
are two or more disabilities, there shall be at least one disability
ratable at 40 percent or more, and sufficient additional disability to
bring the combined rating to 70 percent or more. For the above purpose
of one 60 percent disability, or one 40 percent disability in
combination, the following will be considered as one disability: (1)
Disabilities of one or both upper extremities, or of one or both lower
extremities, including the bilateral factor, if applicable, (2)
disabilities resulting from common etiology or a single accident, (3)
disabilities affecting a single body system, e.g. orthopedic, digestive,
respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple
injuries incurred in action, or (5) multiple disabilities incurred as a
prisoner of war. It is provided further that the existence or degree of
nonservice-connected disabilities or previous unemployability status will be disregarded where the percentages
referred to in this paragraph for the service-connected disability or
disabilities are met and in the judgment of the rating agency such
service-connected disabilities render the veteran unemployable. Marginal
employment shall not be considered substantially gainful employment. For
purposes of this section, marginal employment generally shall be deemed
to exist when a veteran's earned annual income does not exceed the
amount established by the U.S. Department of Commerce, Bureau of the
Census, as the poverty threshold for one person. Marginal employment may
also be held to exist, on a facts found basis (includes but is not
limited to employment in a protected environment such as a family
business or sheltered workshop), when earned annual income exceeds the
poverty threshold. Consideration shall be given in all claims to the
nature of the employment and the reason for termination.
(Authority: 38 U.S.C. 501)
(b) It is the established policy of the Department of Veterans
Affairs that all veterans who are unable to secure and follow a
substantially gainful occupation by reason of service-connected
disabilities shall be rated totally disabled. Therefore, rating boards
should submit to the Director, Compensation and Pension Service, for
extra-schedular consideration all cases of veterans who are unemployable
by reason of service-connected disabilities, but who fail to meet the
percentage standards set forth in paragraph (a) of this section. The
rating board will include a full statement as to the veteran's service-
connected disabilities, employment history, educational and vocational
attainment and all other factors having a bearing on the issue.
[40 FR 42535, Sept. 15, 1975, as amended at 54 FR 4281, Jan. 30, 1989;
55 FR 31580, Aug. 3, 1990; 58 FR 39664, July 26, 1993; 61 FR 52700, Oct.
8, 1996]
Sec. 4.17 Total disability ratings for pension based on unemployability
and age of the individual.
All veterans who are basically eligible and who are unable to secure
and follow a substantially gainful occupation by reason of disabilities
which are likely to be permanent shall be rated as permanently and
totally disabled. For the purpose of pension, the permanence of the
percentage requirements of Sec. 4.16 is a requisite. When the percentage
requirements are met, and the disabilities involved are of a permanent
nature, a rating of permanent and total disability will be assigned if
the veteran is found to be unable to secure and follow substantially
gainful employment by reason of such disability. Prior employment or
unemployment status is immaterial if in the judgment of the rating board
the veteran's disabilities render him or her unemployable. In making
such determinations, the following guidelines will be used:
(a) Marginal employment, for example, as a self-employed farmer or
other person, while employed in his or her own business, or at odd jobs
or while employed at less than half the usual remuneration will not be
considered incompatible with a determination of unemployability, if the
restriction, as to securing or retaining better employment, is due to
disability.
(b) Claims of all veterans who fail to meet the percentage standards
but who meet the basic entitlement criteria and are unemployable, will
be referred by the rating board to the Adjudication Officer under
Sec. 3.321(b)(2) of this chapter.
(Authority: 38 U.S.C. 1155; 38 U.S.C. 3102)
[43 FR 45348, Oct. 2, 1978, as amended at 56 FR 57985, Nov. 15, 1991]
Sec. 4.17a Misconduct etiology.
A permanent and total disability rating under the provisions of
Secs. 4.15, 4.16 and 4.17 will not be precluded by reason of the
coexistence of misconduct disability when:
(a) A veteran, regardless of employment status, also has innocently
acquired 100 percent disability, or
(b) Where unemployable, the veteran has other disabilities
innocently acquired which meet the percentage requirements of Secs. 4.16
and 4.17 and would render, in the judgment of the rating agency, the
average person unable to secure or follow a substantially gainful occupation.
[40 FR 42536, Sept. 15, 1975, as amended at 43 FR 45349, Oct. 2, 1978]
Sec. 4.18 Unemployability.
A veteran may be considered as unemployable upon termination of
employment which was provided on account of disability, or in which
special consideration was given on account of the same, when it is
satisfactorily shown that he or she is unable to secure further
employment. With amputations, sequelae of fractures and other residuals
of traumatism shown to be of static character, a showing of continuous
unemployability from date of incurrence, or the date the condition
reached the stabilized level, is a general requirement in order to
establish the fact that present unemployability is the result of the
disability. However, consideration is to be given to the circumstances
of employment in individual claims, and, if the employment was only
occasional, intermittent, tryout or unsuccessful, or eventually
terminated on account of the disability, present unemployability may be
attributed to the static disability. Where unemployability for pension
previously has been established on the basis of combined service-
connected and nonservice-connected disabilities and the service-
connected disability or disabilities have increased in severity,
Sec. 4.16 is for consideration.
[40 FR 42536, Sept. 15, 1975, as amended at 43 FR 45349, Oct. 2, 1978]
Sec. 4.19 Age in service-connected claims.
Age may not be considered as a factor in evaluating service-
connected disability; and unemployability, in service-connected claims,
associated with advancing age or intercurrent disability, may not be
used as a basis for a total disability rating. Age, as such, is a factor
only in evaluations of disability not resulting from service, i.e., for
the purposes of pension.
[29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978]
Sec. 4.20 Analogous ratings.
When an unlisted condition is encountered it will be permissible to
rate under a closely related disease or injury in which not only the
functions affected, but the anatomical localization and symptomatology
are closely analogous. Conjectural analogies will be avoided, as will
the use of analogous ratings for conditions of doubtful diagnosis, or
for those not fully supported by clinical and laboratory findings. Nor
will ratings assigned to organic diseases and injuries be assigned by
analogy to conditions of functional origin.
Sec. 4.21 Application of rating schedule.
In view of the number of atypical instances it is not expected,
especially with the more fully described grades of disabilities, that
all cases will show all the findings specified. Findings sufficiently
characteristic to identify the disease and the disability therefrom, and
above all, coordination of rating with impairment of function will,
however, be expected in all instances.
[41 FR 11293, Mar. 18, 1976]
Sec. 4.22 Rating of disabilities aggravated by active service.
In cases involving aggravation by active service, the rating will
reflect only the degree of disability over and above the degree existing
at the time of entrance into the active service, whether the particular
condition was noted at the time of entrance into the active service, or
it is determined upon the evidence of record to have existed at that
time. It is necessary therefore, in all cases of this character to
deduct from the present degree of disability the degree, if
ascertainable, of the disability existing at the time of entrance into
active service, in terms of the rating schedule, except that if the
disability is total (100 percent) no deduction will be made. The
resulting difference will be recorded on the rating sheet. If the degree
of disability at the time of entrance into the service is not
ascertainable in terms of the schedule, no deduction will be made.
Sec. 4.23 Attitude of rating officers.
It is to be remembered that the majority of applicants are disabled
persons who are seeking benefits of law to which they believe themselves
entitled. In the exercise of his or her functions, rating officers must
not allow their personal feelings to intrude; an antagonistic, critical, or even abusive
attitude on the part of a claimant should not in any instance influence
the officers in the handling of the case. Fairness and courtesy must at
all times be shown to applicants by all employees whose duties bring
them in contact, directly or indirectly, with the Department's
claimants.
[41 FR 11292, Mar. 18, 1976]
Sec. 4.24 Correspondence.
All correspondence relative to the interpretation of the schedule
for rating disabilities, requests for advisory opinions, questions
regarding lack of clarity or application to individual cases involving
unusual difficulties, will be addressed to the Director, Compensation
and Pension Service. A clear statement will be made of the point or
points upon which information is desired, and the complete case file
will be simultaneously forwarded to Central Office. Rating agencies will
assure themselves that the recent report of physical examination
presents an adequate picture of the claimant's condition. Claims in
regard to which the schedule evaluations are considered inadequate or
excessive, and errors in the schedule will be similarly brought to
attention.
[41 FR 11292, Mar. 18, 1976]
Sec. 4.25 Combined ratings table.
Chart
Table I, Combined Ratings Table, results from the consideration of
the efficiency of the individual as affected first by the most disabling
condition, then by the less disabling condition, then by other less
disabling conditions, if any, in the order of severity. Thus, a person
having a 60 percent disability is considered 40 percent efficient.
Proceeding from this 40 percent efficiency, the effect of a further 30
percent disability is to leave only 70 percent of the efficiency
remaining after consideration of the first disability, or 28 percent
efficiency altogether. The individual is thus 72 percent disabled, as
shown in table I opposite 60 percent and under 30 percent.
(a) To use table I, the disabilities will first be arranged in the
exact order of their severity, beginning with the greatest disability
and then combined with use of table I as hereinafter indicated. For
example, if there are two disabilities, the degree of one disability
will be read in the left column and the degree of the other in the top
row, whichever is appropriate. The figures appearing in the space where
the column and row intersect will represent the combined value of the
two. This combined value will then be converted to the nearest number
divisible by 10, and combined values ending in 5 will be adjusted
upward. Thus, with a 50 percent disability and a 30 percent disability,
the combined value will be found to be 65 percent, but the 65 percent
must be converted to 70 percent to represent the final degree of
disability. Similarly, with a disability of 40 percent, and another
disability of 20 percent, the combined value is found to be 52 percent,
but the 52 percent must be converted to the nearest degree divisible by
10, which is 50 percent. If there are more than two disabilities, the
disabilities will also be arranged in the exact order of their severity
and the combined value for the first two will be found as previously
described for two disabilities. The combined value, exactly as found in
table I, will be combined with the degree of the third disability (in
order of severity). The combined value for the three disabilities will
be found in the space where the column and row intersect, and if there
are only three disabilities will be converted to the nearest degree
divisible by 10, adjusting final 5's upward. Thus, if there are three
disabilities ratable at 60 percent, 40 percent, and 20 percent,
respectively, the combined value for the first two will be found
opposite 60 and under 40 and is 76 percent. This 76 will be combined
with 20 and the combined value for the three is 81 percent. This
combined value will be converted to the nearest degree divisible by 10
which is 80 percent. The same procedure will be employed when there are
four or more disabilities. (See table I).
(b) Except as otherwise provided in this schedule, the disabilities
arising from a single disease entity, e.g., arthritis, multiple
sclerosis, cerebrovascular accident, etc., are to be rated separately as
are all other disabiling conditions, if any. All disabilities are
then to be combined as described in paragraph (a) of this section. The
conversion to the nearest degree divisible by 10 will be done only once
per rating decision, will follow the combining of all disabilities, and
will be the last procedure in determining the combined degree of
disability.
(Authority: 38 U.S.C. 1155)
[41 FR 11293, Mar. 18, 1976, as amended at 54 FR 27161, June 28, 1989;
54 FR 36029, Aug. 31, 1989]
Sec. 4.26 Bilateral factor.
When a partial disability results from disease or injury of both
arms, or of both legs, or of paired skeletal muscles, the ratings for
the disabilities of the right and left sides will be combined as usual,
and 10 percent of this value will be added (i.e., not combined) before
proceeding with further combinations, or converting to degree of
disability. The bilateral factor will be applied to such bilateral
disabilities before other combinations are carried out and the rating
for such disabilities including the bilateral factor in this section
will be treated as 1 disability for the purpose of arranging in order of
severity and for all further combinations. For example, with
disabilities evaluated at 60 percent, 20 percent, 10 percent and 10
percent (the two 10's representing bilateral disabilities), the order of
severity would be 60, 21 and 20. The 60 and 21 combine to 68 percent and
the 68 and 20 to 74 percent, converted to 70 percent as the final degree
of disability.
(a) The use of the terms ``arms'' and ``legs'' is not intended to
distinguish between the arm, forearm and hand, or the thigh, leg, and
foot, but relates to the upper extremities and lower extremities as a
whole. Thus with a compensable disability of the right thigh, for
example, amputation, and one of the left foot, for example, pes planus,
the bilateral factor applies, and similarly whenever there are
compensable disabilities affecting use of paired extremities regardless
of location or specified type of impairment.
(b) The correct procedure when applying the bilateral factor to
disabilities affecting both upper extremities and both lower extremities
is to combine the ratings of the disabilities affecting the 4
extremities in the order of their individual severity and apply the
bilateral factor by adding, not combining, 10 percent of the combined
value thus attained.
(c) The bilateral factor is not applicable unless there is partial
disability of compensable degree in each of 2 paired extremities, or
paired skeletal muscles.
Sec. 4.27 Use of diagnostic code numbers.
The diagnostic code numbers appearing opposite the listed ratable
disabilities are arbitrary numbers for the purpose of showing the basis
of the evaluation assigned and for statistical analysis in the
Department of Veterans Affairs, and as will be observed, extend from
5000 to a possible 9999. Great care will be exercised in the selection
of the applicable code number and in its citation on the rating sheet.
No other numbers than these listed or hereafter furnished are to be
employed for rating purposes, with an exception as described in this
section, as to unlisted conditions. When an unlisted disease, injury, or
residual condition is encountered, requiring rating by analogy, the
diagnostic code number will be ``built-up'' as follows: The first 2
digits will be selected from that part of the schedule most closely
identifying the part, or system, of the body involved; the last 2 digits
will be ``99'' for all unlisted conditions. This procedure will
facilitate a close check of new and unlisted conditions, rated by analogy. In the
selection of code numbers, injuries will generally be represented by the
number assigned to the residual condition on the basis of which the
rating is determined. With diseases, preference is to be given to the
number assigned to the disease itself; if the rating is determined on
the basis of residual conditions, the number appropriate to the residual
condition will be added, preceded by a hyphen. Thus, rheumatoid
(atrophic) arthritis rated as ankylosis of the lumbar spine should be
coded ``5002-5289.'' In this way, the exact source of each rating can be
easily identified. In the citation of disabilities on rating sheets, the
diagnostic terminology will be that of the medical examiner, with no
attempt to translate the terms into schedule nomenclature. Residuals of
diseases or therapeutic procedures will not be cited without reference
to the basic disease.
[41 FR 11293, Mar. 18, 1976]
Sec. 4.28 Prestabilization rating from date of discharge from service.
The following ratings may be assigned, in lieu of ratings prescribed
elsewhere, under the conditions stated for disability from any disease
or injury. The prestabilization rating is not to be assigned in any case
in which a total rating is immediately assignable under the regular
provisions of the schedule or on the basis of individual
unemployability. The prestabilization 50-percent rating is not to be
used in any case in which a rating of 50 percent or more is immediately
assignable under the regular provisions.
------------------------------------------------------------------------
Rating
------------------------------------------------------------------------
Unstabilized condition with severe disability --
Substantially gainful employment is not feasible or
advisable ......................................................... 100
Unhealed or incompletely healed wounds or injuries --
Material impairment of employability likely ............... 50
------------------------------------------------------------------------
Note (1): Department of Veterans Affairs examination is not required
prior to assignment of prestabilization ratings; however, the fact that
examination was accomplished will not preclude assignment of these
benefits. Prestabilization ratings are for assignment in the immediate
postdischarge period. They will continue for a 12-month period following
discharge from service. However, prestabilization ratings may be changed
to a regular schedular total rating or one authorizing a greater benefit
at any time. In each prestabilization rating an examination will be
requested to be accomplished not earlier than 6 months nor more than 12
months following discharge. In those prestabilization ratings in which
following examination reduction in evaluation is found to be warranted,
the higher evaluation will be continued to the end of the 12th month
following discharge or to the end of the period provided under
Sec. 3.105(e) of this chapter, whichever is later. Special monthly
compensation should be assigned concurrently in these cases whenever
records are adequate to establish entitlement.
Note (2): Diagnosis of disease, injury, or residuals will be cited,
with diagnostic code number assigned from this rating schedule for
conditions listed therein.
[35 FR 11906, July 24, 1970]
Sec. 4.29 Ratings for service-connected disabilities requiring hospital
treatment or observation.
A total disability rating (100 percent) will be assigned without
regard to other provisions of the rating schedule when it is established
that a service-connected disability has required hospital treatment in a
Department of Veterans Affairs or an approved hospital for a period in
excess of 21 days or hospital observation at Department of Veterans
Affairs expense for a service-connected disability for a period in
excess of 21 days.
(a) Subject to the provisions of paragraphs (d), (e), and (f) of
this section this increased rating will be effective the first day of
continuous hospitalization and will be terminated effective the last day
of the month of hospital discharge (regular discharge or release to non-
bed care) or effective the last day of the month of termination of
treatment or observation for the service-connected disability. A
temporary release which is approved by an attending Department of
Veterans Affairs physician as part of the treatment plan will not be
considered an absence.
(1) An authorized absence in excess of 4 days which begins during
the first 21 days of hospitalization will be regarded as the equivalent
of hospital discharge effective the first day of such authorized
absence. An authorized absence of 4 days or less which results in a
total of more than 8 days of authorized absence during the first 21 days
of hospitalization will be regarded as the
equivalent of hospital discharge effective the ninth day of authorized
absence.
(2) Following a period of hospitalization in excess of 21 days, an
authorized absence in excess of 14 days or a third consecutive
authorized absence of 14 days will be regarded as the equivalent of
hospital discharge and will interrupt hospitalization effective on the
last day of the month in which either the authorized absence in excess
of 14 days or the third 14 day period begins, except where there is a
finding that convalescence is required as provided by paragraph (e) or
(f) of this section. The termination of these total ratings will not be
subject to Sec. 3.105(e) of this chapter.
(b) Notwithstanding that hospital admission was for disability not
connected with service, if during such hospitalization, hospital
treatment for a service-connected disability is instituted and continued
for a period in excess of 21 days, the increase to a total rating will
be granted from the first day of such treatment. If service connection
for the disability under treatment is granted after hospital admission,
the rating will be from the first day of hospitalization if otherwise in
order.
(c) The assignment of a total disability rating on the basis of
hospital treatment or observation will not preclude the assignment of a
total disability rating otherwise in order under other provisions of the
rating schedule, and consideration will be given to the propriety of
such a rating in all instances and to the propriety of its continuance
after discharge. Particular attention, with a view to proper rating
under the rating schedule, is to be given to the claims of veterans
discharged from hospital, regardless of length of hospitalization, with
indications on the final summary of expected confinement to bed or
house, or to inability to work with requirement of frequent care of
physician or nurse at home.
(d) On these total ratings Department of Veterans Affairs
regulations governing effective dates for increased benefits will
control.
(e) The total hospital rating if convalescence is required may be
continued for periods of 1, 2, or 3 months in addition to the period
provided in paragraph (a) of this section.
(f) Extension of periods of 1, 2 or 3 months beyond the initial 3
months may be made upon approval of the Adjudication Officer.
(g) Meritorious claims of veterans who are discharged from the
hospital with less than the required number of days but need post-
hospital care and a prolonged period of convalescence will be referred
to the Director, Compensation and Pension Service, under
Sec. 3.321(b)(1) of this chapter.
[29 FR 6718, May 22, 1964, as amended at 41 FR 11294, Mar. 18, 1976; 41
FR 34256, Aug. 13, 1976; 54 FR 4281, Jan. 30, 1989; 54 FR 34981, Aug.
23, 1989]
Sec. 4.30 Convalescent ratings.
A total disability rating (100 percent) will be assigned without
regard to other provisions of the rating schedule when it is established
by report at hospital discharge (regular discharge or release to non-bed
care) or outpatient release that entitlement is warranted under
paragraph (a) (1), (2) or (3) of this section effective the date of
hospital admission or outpatient treatment and continuing for a period
of 1, 2, or 3 months from the first day of the month following such
hospital discharge or outpatient release. The termination of these total
ratings will not be subject to Sec. 3.105(e) of this chapter. Such total
rating will be followed by appropriate schedular evaluations. When the
evidence is inadequate to assign a schedular evaluation, a physical
examination will be scheduled and considered prior to the termination of
a total rating under this section.
(a) Total ratings will be assigned under this section if treatment
of a service-connected disability resulted in:
(1) Surgery necessitating at least one month of convalescence
(Effective as to outpatient surgery March 1, 1989.)
(2) Surgery with severe postoperative residuals such as incompletely
healed surgical wounds, stumps of recent amputations, therapeutic
immobilization of one major joint or more, application of a body cast,
or the necessity for house confinement, or the necessity for continued use of a wheelchair or
crutches (regular weight-bearing prohibited). (Effective as to
outpatient surgery March 1, 1989.)
(3) Immobilization by cast, without surgery, of one major joint or
more. (Effective as to outpatient treatment March 10, 1976.)
A reduction in the total rating will not be subject to Sec. 3.105(e) of
this chapter. The total rating will be followed by an open rating
reflecting the appropriate schedular evaluation; where the evidence is
inadequate to assign the schedular evaluation, a physcial examination
will be scheduled prior to the end of the total rating period.
(b) A total rating under this section will require full
justification on the rating sheet and may be extended as follows:
(1) Extensions of 1, 2 or 3 months beyond the initial 3 months may
be made under paragraph (a) (1), (2) or (3) of this section.
(2) Extensions of 1 or more months up to 6 months beyond the initial
6 months period may be made under paragraph (a) (2) or (3) of this
section upon approval of the Adjudication Officer.
[41 FR 34256, Aug. 13, 1976, as amended at 54 FR 4281, Jan. 30, 1989]
Sec. 4.31 Zero percent evaluations.
In every instance where the schedule does not provide a zero percent
evaluation for a diagnostic code, a zero percent evaluation shall be
assigned when the requirements for a compensable evaluation are not met.
[58 FR 52018, Oct. 6, 1993]
PART I -- DEPT OF VA
CFR
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