PART 4—SCHEDULE FOR RATING DISABILITIES
§ 4.1 Essentials of evaluative rating.
§ 4.2 Interpretation of examination reports.
§ 4.3 Resolution of reasonable doubt.
§ 4.6 Evaluation of evidence.
§ 4.7 Higher of two evaluations.
§ 4.9 Congenital or developmental defects.
§ 4.10 Functional impairment.
§ 4.13 Effect of change of diagnosis.
§ 4.14 Avoidance of pyramiding.
§ 4.15 Total disability ratings.
§ 4.16 Total disability ratings for compensation based on unemployability of the individual.
§ 4.17 Total disability ratings for pension based on unemployability and age of the individual.
§ 4.17a Misconduct etiology.
§ 4.18 Unemployability.
§ 4.19 Age in service-connected claims.
§ 4.20 Analogous ratings.
§ 4.21 Application of rating schedule.
§ 4.22 Rating of disabilities aggravated by active service.
§ 4.23 Attitude of rating officers.
§ 4.24 Correspondence.
§ 4.25 Combined ratings table.
§ 4.26 Bilateral factor.
§ 4.27 Use of diagnostic code numbers.
§ 4.28 Prestabilization rating from date of discharge from service.
§ 4.29 Ratings for service-connected disabilities requiring hospital treatment or observation.
§ 4.30 Convalescent ratings.
§ 4.31 Zero percent evaluations.
The Musculoskeletal System
§ 4.40 Functional loss.
§ 4.41 History of injury.
§ 4.42 Complete medical examination of injury cases.
§ 4.43 Osteomyelitis.
§ 4.44 The bones.
§ 4.45 The joints.
§ 4.46 Accurate measurement.
§§ 4.47-4.54 [Reserved]
§ 4.55 Principles of combined ratings for muscle injuries.
§ 4.56 Evaluation of muscle disabilities.
§ 4.57 Static foot deformities.
§ 4.58 Arthritis due to strain.
§ 4.59 Painful motion.
§ 4.60 [Reserved]
§ 4.61 Examination.
§ 4.62 Circulatory disturbances.
§ 4.63 Loss of use of hand or foot.
§ 4.64 Loss of use of both buttocks.
§ 4.65 [Reserved]
§ 4.66 Sacroiliac joint.
§ 4.67 Pelvic bones.
§ 4.68 Amputation rule.
§ 4.69 Dominant hand.
§ 4.70 Inadequate examinations.
§ 4.71 Measurement of ankylosis and joint motion.
§ 4.71a Schedule of ratings—musculoskeletal system.
§ 4.72 [Reserved]
§ 4.73 Schedule of ratings—muscle injuries.
The Organs of Special Sense
§ 4.75 General considerations for evaluating visual impairment.
§ 4.76 Visual acuity.
§ 4.76a Computation of average concentric contraction of visual fields.
§ 4.77 Visual fields.
§ 4.78 Muscle function.
§ 4.79 Schedule of ratings—eye.
§§ 4.80-4.84 [Reserved]
Impairment of Auditory Acuity
§ 4.85 Evaluation of hearing impairment.
§ 4.86 Exceptional patterns of hearing impairment.
§ 4.87 Schedule of ratings—ear.
§ 4.87a Schedule of ratings—other sense organs.
Infectious Diseases, Immune Disorders and Nutritional Deficiencies
§ 4.88 [Reserved]
§ 4.88a Chronic fatigue syndrome.
§ 4.88b Schedule of ratings—infectious diseases, immune disorders and nutritional deficiencies.
§ 4.88c Ratings for inactive nonpulmonary tuberculosis initially entitled after August 19, 1968.
§ 4.89 Ratings for inactive nonpulmonary tuberculosis in effect on August 19, 1968.
The Respiratory System
§ 4.96 Special provisions regarding evaluation of respiratory conditions.
§ 4.97 Schedule of ratings—respiratory system.
The Cardiovascular System
§ 4.100 Application of the evaluation criteria for diagnostic codes 7000–7007, 7011, and 7015–7020.
§§ 4.101-4.103 [Reserved]
§ 4.104 Schedule of ratings—cardiovascular system.
The Digestive System
§ 4.110 Ulcers.
§ 4.111 Postgastrectomy syndromes.
§ 4.112 Weight loss.
§ 4.113 Coexisting abdominal conditions.
§ 4.114 Schedule of ratings—digestive system.
The Genitourinary System
§ 4.115 Nephritis.
§ 4.115a Ratings of the genitourinary system—dysfunctions.
§ 4.115b Ratings of the genitourinary system—diagnoses.
Gynecological Conditions and Disorders of the Breast
§ 4.116 Schedule of ratings—gynecological conditions and disorders of the breast.
The Hemic and Lymphatic Systems
§ 4.117 Schedule of ratings—hemic and lymphatic systems.
§ 4.118 Schedule of ratings—skin.
The Endocrine System
§ 4.119 Schedule of ratings—endocrine system.
Neurological Conditions and Convulsive Disorders
§ 4.120 Evaluations by comparison.
§ 4.121 Identification of epilepsy.
§ 4.122 Psychomotor epilepsy.
§ 4.123 Neuritis, cranial or peripheral.
§ 4.124 Neuralgia, cranial or peripheral.
§ 4.124a Schedule of ratings—neurological conditions and convulsive disorders.
§ 4.125 Diagnosis of mental disorders.
§ 4.126 Evaluation of disability from mental disorders.
§ 4.127 Mental retardation and personality disorders.
§ 4.128 Convalescence ratings following extended hospitalization.
§ 4.129 Mental disorders due to traumatic stress.
§ 4.130 Schedule of ratings—mental disorders.
Dental and Oral Conditions
§ 4.149 [Reserved]
§ 4.150 Schedule of ratings—dental and oral conditions.
Appendix A to Part 4—Table of Amendments and Effective Dates Since 1946
Appendix B to Part 4—Numerical Index of Disabilities
Appendix C to Part 4—Alphabetical Index of Disabilities
Authority: 38 U.S.C. 1155, unless otherwise noted.
Subpart A—General Policy in Ratingtop
§ 4.1 Essentials of evaluative rating.top
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]
§ 4.2 Interpretation of examination reports.top
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.
[41 FR 11292, Mar. 18, 1976]
§ 4.3 Resolution of reasonable doubt.top
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 §3.102 of this chapter.
[40 FR 42535, Sept. 15, 1975]
§ 4.6 Evaluation of evidence.top
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.
§ 4.7 Higher of two evaluations.top
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.
§ 4.9 Congenital or developmental defects.top
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]
§ 4.10 Functional impairment.top
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.
[41 FR 11292, Mar. 18, 1976]
§ 4.13 Effect of change of diagnosis.top
The repercussion upon a current rating of service connection when change 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 §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 §4.7.
[29 FR 6718, May 22, 1964, as amended at 61 FR 52700, Oct. 8, 1996]
§ 4.14 Avoidance of pyramiding.top
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.
§ 4.15 Total disability ratings.top
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.
§ 4.16 Total disability ratings for compensation based on unemployability of the individual.top
(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.
(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]
§ 4.17 Total disability ratings for pension based on unemployability and age of the individual.top
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 §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 Veterans Service Center Manager or the Pension Management Center Manager under §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; 71 FR 28586, May 17, 2006; 74 FR 26959, June 5, 2009]
§ 4.17a Misconduct etiology.top
A permanent and total disability rating under the provisions of §§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 §§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]
§ 4.18 Unemployability.top
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, §4.16 is for consideration.
[40 FR 42536, Sept. 15, 1975, as amended at 43 FR 45349, Oct. 2, 1978