Book C, Supplement No. 28

Custom Federal Regulations Service™

This is supplemental material

for Book C of your set of

Federal Regulations

Title 38, Part 4

Schedule for Rating Disabilities

Veterans Benefits Administration

Supplement No. 28

Covering period of Federal Register issues

from June 25, 2001, through February 24, 2002

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GENERAL INSTRUCTIONS

Custom Federal Regulations Service™

Supplemental Materials for Book C

Code of Federal Regulations

Title 38, Part 4

Schedule for Rating Disabilities

Veterans Benefits Administration

Supplement No. 28

25 February 2002

Covering the period of Federal Register issues

from June 25, 2001, through February 24, 2002

When Book C was originally prepared, it was current through final regulations published in the Federal Register of 24 March 1992. These supplemental materials are designed to keep your regulations up to date. You should file the attached pages immediately, and record the fact that you did so on the Supplement Filing Record which is at page C-8 of Book C, Schedule for Rating Disabilities.

To ensure accuracy and timeliness of your materials,

it is important that you follow these simple procedures:

1. Always file your supplemental materials immediately upon receipt.

2. Before filing, always check the Supplement Filing Record (page C-8) to be sure that all prior supplements have been filed. If you are missing any supplements, contact the Veterans Benefits Administration at the address listed on page C-2.

3. After filing, enter the relevant information on the Supplement Filing Record sheet (page C-8)—the date filed, name/initials of filer, and date through which the Federal Register is covered.

4. If as a result of a failure to file, or an undelivered supplement, you have more than one supplement to file at a time, be certain to file them in chronological order, lower number first.

5. Always retain the filing instructions (simply insert them at the back of the book) as a backup record of filing and for reference in case of a filing error.

6. Be certain that you permanently discard any pages indicated for removal in the filing instructions in order to avoid confusion later.

To execute the filing instructions, simply remove and throw away the pages listed under Remove These Old Pages, and replace them in each case with the corresponding pages from this supplement listed under Add These New Pages. Occasionally new pages will be added without removal of any old material (reflecting new regulations), and occasionally old pages will be removed without addition of any new material (reflecting rescinded regulations)—in these cases the word None will appear in the appropriate column.

FILING INSTRUCTIONS

Book C, Supplement No. 28

February 25, 2002

Remove theseAdd theseSection(s)

old pagesnew pagesAffected

Do not file this supplement until you confirm that

all prior supplements have been filed

4.116-1 to 4.116-44.116-1 to 4.116-4§4.116

Be sure to complete the

Supplement Filing Record (page C-8)

when you have finished filing this material.

HIGHLIGHTS

Book C, Supplement No. 28

February 25, 2002

Supplement Highlights references: Where substantive changes are made in the text of regulations, the paragraphs of Highlights sections are cited at the end of the relevant section of text. Thus, if you are reading §3.263, you will see a note at the end of that section which reads: “Supplement Highlights references—6(2).” This means that paragraph 2 of the Highlights section in Supplement No. 6 contains information about the changes made in §3.263. By keeping and filing the Highlights sections, you will have a reference source explaining all substantive changes in the text of the regulations.

Supplement frequency: This Book C (Schedule for Rating Disabilities) was originally supplemented four times a year, in February, May, August, and November. Beginning 1 August 1995, supplements will be issued every month during which a final rule addition or modification is made to the parts of Title 38 covered by this book. Supplements will be numbered consecutively as issued.

Modifications in this supplement include the following:

1. On 14 February 2002, the VA published a final rule, effective 18 March 2002, to amend the adjudication regulations to provide for payment of special monthly compensation for a woman veteran who loses one or both breasts as a result of service-connected disability. Change in this Book C:

• In §4.116, revised Note 2 at the beginning of the section, and added footnote references in diagnostic code 7626 indicating ratings that are to be reviewed for entitlement to special monthly compensation under §3.350.

• See also new §3.350(a)(7) in Book B (Adjudication).

C28-1

4.116-1§4.116—Schedule of ratings–gynecological conditions and disorders of the breast 4.116-1

Gynecological Conditions and Disorders of the Breast

4.116Schedule of ratings–gynecological conditions and disorders of the breast...... 4.116-1

§4.116 Schedule of ratings—gynecological conditions and disorders of the breast.

Note 1: Natural menopause, primary amenorrhea, and pregnancy and childbirth are not disabilities for rating purposes. Chronic residuals of medical or surgical complications of pregnancy may be disabilities for rating purposes.

Note 2: When evaluating any claim involving loss or loss of use of one or more creative organs or anatomical loss of one or both breasts, refer to §3.350 of this chapter to determine whether the veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, almost any condition in this section might, under certain circumstances, establish entitlement to special monthly compensation.

Rating

7610Vulva, disease or injury of (including vulvovaginitis).

7611Vagina, disease or injury of.

7612Cervix, disease or injury of.

7613Uterus, disease, injury, or adhesions of.

7614Fallopian tube, disease, injury, or adhesions of (including pelvic inflammatory disease (PID)).

7615Ovary, disease, injury, or adhesions of.

General Rating Formula for Disease, Injury, or Adhesions of Female Reproductive Organs (diagnostic codes 7610 through 7615):

Symptoms not controlled by continuous treatment...... 30

Symptoms that require continuous treatment...... 10

Symptoms that do not require continuous treatment...... 0

7617Uterus and both ovaries, removal of, complete:

For three months after removal...... 1001

Thereafter501

7618Uterus, removal of, including corpus:

For three months after removal...... 1001

Thereafter………………………………………………………………………………..301

7619Ovary, removal of:

For three months after removal...... 1001

Thereafter:

Complete removal of both ovaries...... 301

Removal of one with or without partial removal of the other...... 01

7620Ovaries, atrophy of both, complete...... 201

7621Uterus, prolapse:

Complete, through vagina and introitus...... 50

Incomplete 30

7622Uterus, displacement of:

With marked displacement and frequent or continuous

menstrual disturbances...... 30

With adhesions and irregular menstruation...... 10

7623Pregnancy, surgical complications of:

With rectocele or cystocele...... 50

With relaxation of perineum ...... 10

7624Fistula, rectovaginal:

Vaginal fecal leakage at least once a day requiring wearing of pad...... 100

Vaginal fecal leakage four or more times per week, but less than

daily, requiring wearing of pad...... 60

Vaginal fecal leakage one to three times per week requiring

wearing of pad...... 30

Vaginal fecal leakage less than once a week...... 10

Without leakage...... 0

7625Fistula, urethrovaginal:

Multiple urethrovaginal fistulae...... 100

Requiring the use of an appliance or the wearing of absorbent

materials which must be changed more than four times per day...... 60

Requiring the wearing of absorbent materials which must be

changed two to four times per day...... 40

Requiring the wearing of absorbent materials which must be

changed less than two times per day...... 20

7626Breast, surgery of:

Following radical mastectomy:

Both...... 801

One...... 501

Following modified radical mastectomy:

Both...... 601

One...... 401

Following simple mastectomy or wide local excision

with significant alteration of size or form:

Both...... 501

One...... 301

Following wide local excision without significant

alteration of size or form:

Both or one...... 0

Note: For VA purposes:

(1) Radical mastectomy means removal of the entire breast, underlying pectoral muscles, and regional lymph nodes up to the coracoclavicular ligament.

(2) Modified radical mastectomy means removal of the entire breast and axillary lymph nodes (in continuity with the breast). Pectoral muscles are left intact.

(3) Simple (or total) mastectomy means removal of all of the breast tissue, nipple, and a small portion of the overlying skin, but lymph nodes and muscles are left intact.

(4) Wide local excision (including partial mastectomy, lumpectomy, tylectomy, segmentectomy, and quadrantectomy) means removal of a portion of the breast tissue.

7627Malignant neoplasms of gynecological system or breast...... 100

Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.

7628Benign neoplasms of the gynecological system or breast. Rate according to impairment in function of the urinary or gynecological systems, or skin.

7629Endometriosis:

Lesions involving bowel or bladder confirmed by laparoscopy, pelvic

pain or heavy or irregular bleeding not controlled by treatment,

and bowel or bladder symptoms...... 50

Pelvic pain or heavy or irregular bleeding not controlled

by treatment...... 30

Pelvic pain or heavy or irregular bleeding requiring

continuous treatment for control...... 10

Note: Diagnosis of endometriosis must be substantiated by laparoscopy.

1Review for entitlement to special monthly compensation under §3.350 of this chapter.

[29 FR 6718, May 22, 1964, as amended at 41 FR 11301, Mar. 18, 1976; 41 FR 34258, Aug. 13, 1976; redesignated and revised, 60 FR 19855, Apr. 21, 1995; 67 FR 6874, Feb. 14, 2002]

Supplement Highlights references: 12(1), 28(1).

(No. 28 2/25/02)