BASIC RATING PRINCIPLES

38 CFR Part 4

Subpart A and B

GENERAL POLICY

• 4.1 Essentials of evaluative rating• Rating Schedule is a guide in evaluations

• Percentages represent average impairment in earning capacity

• Degrees of disability are considered adequate to compensate for considerable loss of working time from exacerbations or illness

• Each disability must be viewed in relation to history

GENERAL POLICY

• 4.2 Interpretation of examination reports– Different examiners use different language to describe

same disability– Some features that have persisted unchanged may be

overlooked– The whole recorded history must be considered– Each disability must be considered from point of view

of working or seeking work– If there is no support of the findings, the RVSR must

deem the examination as inadequate and return it

GENERAL POLICY

• 4.3 Resolution of reasonable doubt– Broad interpretation, consistent with the facts in each

case. See 38 CFR 3.102

• 4.6 Evaluation of evidence– Assigning weight to evidence and balancing evidence for

equitable and just decision

• 4.7 Higher of two evaluations– Assign higher evaluation if more nearly approximating

disability criteria

GENERAL POLICY

• 4.9 Congenital or developmental defects– Defects such as refractive error, personality disorder,

mental deficiency, etc. are not subject to SC

• 4.10 Functional Impairment– Examiner must describe full effect of disability on

ordinary activity

• 4.13 Effect of change of diagnosis– No change unless actual change occurs as opposed to

difference in thoroughness or use of descriptive terms

GENERAL POLICY

• 4.14 Avoidance of pyramiding– Evaluating same disability under various diagnoses

• 4.15 Total disability ratings– The ability to overcome handicap (disability) is based

on average impairment in earning capacity upon the economic or industrial handicap to be overcome rather than individual success

• 4.16 Total disability ratings for compensation based on unemployability of the individual– Schedular criteria and etiology of disability

GENERAL POLICY

• 4.17 Total disability ratings for pension based on unemployability and age– Same percentage requirements as 4.16 resulting

in inability to secure and follow gainful employment

• 4.17a Misconduct etiology– Coexistence of misconduct disability does not

preclude P&T rating under 4.15, 4.16 and 4.17

GENERAL POLICY

• 4.18 Unemployability– Unemployed versus unemployable

• 4.19 Age in service-connected claims– Age is not a factor in SC claims or an excuse in TDIU

claims. Age will only be considered in NSC pension claims

• 4.20 Analogous ratings– Unlisted condition rated based on closely related

condition. Conjectural analogies will be avoided

GENERAL POLICY

• 4.21 Application of rating schedule– RS does not cover all findings of a disability.

Residuals and impairment of function will be considered

• 4.22 Rating of disabilities aggravated by active service– Degree of disability over and above level at entry

• 4.23 Attitude of rating officers– READ THIS OFTEN AND REMIND THEM

GENERAL POLICY

• 4.24 Correspondence– All interpretations of the schedule , advisory

opinions, lack of clarity or application directed to Director, C&P

• 4.25 Combined ratings table– Average man 100% healthy and how each

disability impacts him/her

GENERAL POLICY

• 4.26 Bilateral Factor– Paired Extremities

– Paired Skeletal Muscles

– Partial disability

– Extra 10% added to combined total

• 4.27 Use of diagnostic codes– Arbitrary numbers to show basis of evaluation assigned

and for statistical purposes

– ICD-9

GENERAL POLICY

• 4.28 Prestabilization rating from date of discharge from service– Unstabilized, unhealed or incompletely healed

– 50% or 100% --- 6 months or one year

• 4.29 Ratings for service-connected disabilities requiring hospital treatment or observation– In excess of 21 days of treatment for SCD

– Consideration of authorized absences

GENERAL POLICY

• 4.30 Convalescent ratings– Surgery for SCD, immobilization by cast

without surgery– Extensions beyond 3 months are possible– Convalescence greater than 30 days

• 4.31 Zero percent evaluations– Absent the requirements for a 10%

GENERAL POLICY

• 4.40 Functional Loss– Inability, due to damage or infection, to perform normal

working movements of the body; Evidence of disuse (atrophy)?

• 4.41 History of injury– Determinations regarding trauma, congenital or

developmental, or healed disease

• 4.42 Complete medical examination of injury cases– General examinations and all specialist examinations

when possible

GENERAL POLICY

• 4.43 Osteomyelitis– Once clinically identified, it must be viewed as a

continuously disabling process

• 4.44 The bones– Misalignment due to stress and malunion must be

described

• 4.45 The joints– Limited or loose motion, weakness, fatigue, pain and

incoordination– Major and Minor joints for rating purposes

GENERAL POLICY

• 4.46 Accurate measurement– Length of stumps, location of scars, degree of muscle

atrophy, use of goniometer to measure limitation of motion, unretouched pictures?

• 4.55 Principles of combined ratings for muscle injuries– 23 muscle groups in 5 anatomical regions; muscle

injury versus peripheral nerve; ankylosed joints; same and different anatomical regions

GENERAL POLICY

• 4.56 Evaluation of muscle disabilities– 4 classifications of muscle injuries– Nature of each wound– Objective description of each wound– Through-and-Through wounds– Compound comminuted fracture with muscle or

tendon damage

GENERAL POLICY

• 4.57 Static foot deformities– Bilateral flatfoot (pes planus) as a congenital condition

or as an acquired condition

• 4.58 Arthritis due to strain– Extremity amputation or shortening causes strain on

associated parts. These traumatic events are causative factors in developing arthritis

• 4.59 Painful motion– Productive of disability, sciatic neuritis with spinal

arthritis, entitlement to minimum compensable rating based on pain or instability or malalignment

GENERAL POLICY

• 4.61 Examination– Except for trauma, all examinations for arthritis

should cover all major joints with special reference to Heberden’s or Haygarth’s nodes

• 4.62 Circulatory disturbances– Circulatory disturbances of the lower extremity

following injury to popliteal space is rated as phlebitis

GENERAL POLICY

• 4.63 Loss of use of hand or foot– No effective remaining function held to exist other than

equally served by amputation

– Extremely unfavorable complete ankylosis of knee or 2 joints of an extremity or shortening of 3 ½ inches or more

• 4.64 Loss of use of both buttocks– Severe muscle damage to MG XVII Bilateral with

inability to rise or maintain postural stability

GENERAL POLICY

• 4.66 Sacroiliac joint– Lumbosacral and sacroiliac joints considered as one

anatomical segment– Arthritis most common disability– X-rays vital– Careful consideration of strain and pain or paralysis

affecting discs

• 4.67 Pelvic bones– Variability of residuals following fractures -- faulty

posture, LOM, muscle injury, painful motion, spasm, neuritis, peripheral nerve injury and LOM hip

GENERAL POLICY

• 4.68 Amputation rule– Limited by elective amputation site– Painful neuroma of a stump shall be assigned

evaluation for elective reamputation

• 4.69 Dominant hand– Right or left determined by evidence of record

or testing on VAE– Only one hand is dominant

GENERAL POLICY

• 4.70 Inadequate examination– If insufficient, request supplemental report with

details as to limitation of ordinary activities, prognosis of return to and continuation of useful work

• 4.71 Measurement of ankylosis and joint motion– Rating specialists must consider the normal

motion described in Plates 1,2 and 3

ASSIGNING THE CORRECT EVALUATION

38 CFR Part 4

Subpart B – Disability Ratings

EVALUATION

• Description of the Diagnosis

• Identification of the Proper Diagnostic Code

• Criteria “in-between” levels of disability

EVALUATION

• Importance of Pain (DeLuca)

• Importance of Functional Loss

• Consistency in Evaluative Judgment

BODY SYSTEMS

38 CFR Part 4

Subpart B

BODY SYSTEMS

• 15 Specific Systems

• Organized Chaos -- working knowledge of diagnostic codes very beneficial

• Specific “rating rules” contained in footnotes