BASIC RATING PRINCIPLES 38 CFR Part 4 Subpart A and B.
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Transcript of BASIC RATING PRINCIPLES 38 CFR Part 4 Subpart A and B.
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BASIC RATING PRINCIPLES
38 CFR Part 4
Subpart A and B
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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%
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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ASSIGNING THE CORRECT EVALUATION
38 CFR Part 4
Subpart B – Disability Ratings
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EVALUATION
• Description of the Diagnosis
• Identification of the Proper Diagnostic Code
• Criteria “in-between” levels of disability
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EVALUATION
• Importance of Pain (DeLuca)
• Importance of Functional Loss
• Consistency in Evaluative Judgment
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BODY SYSTEMS
38 CFR Part 4
Subpart B
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BODY SYSTEMS
• 15 Specific Systems
• Organized Chaos -- working knowledge of diagnostic codes very beneficial
• Specific “rating rules” contained in footnotes