Rating Table for Heart and Lung Disability Symptoms

Rating

Of the pelvis, vertebrae, or extending into major joints, or with multiple localization or with long history of intractability and debility, anemia, amyloid liver changes, or other continuous constitutional symptoms

100

Frequent episodes, with constitutional symptoms

60

With definite involucrum or sequestrum, with or without discharging sinus

30

With discharging sinus or other evidence of active infection within the past 5 years

20

Inactive, following repeated episodes, without evidence of active infection in past 5 years

10

Note (1): A rating of 10 percent, as an exception to the amputation rule, is to be assigned in any case of active osteomyelitis where the amputation rating for the affected part is no percent. This 10 percent rating and the other partial ratings of 30 percent or less are to be combined with ratings for ankylosis, limited motion, nonunion or malunion, shortening, etc., subject, of course, to the amputation rule. The 60 percent rating, as it is based on constitutional symptoms, is not subject to the amputation rule. A rating for osteomyelitis will not be applied following cure by removal or radical resection of the affected bone.

Note (2): The 20 percent rating on the basis of activity within the past 5 years is not assignable following the initial infection of active osteomyelitis with no subsequent reactivation. The prerequisite for this historical rating is an established recurrent osteomyelitis. To qualify for the 10 percent rating, 2 or more episodes following the initial infection are required. This 20 percent rating or the 10 percent rating, when applicable, will be assigned once only to cover disability at all sites of previously active infection with a future ending date in the case of the 20 percent rating.

With constitutional manifestations associated with active joint involvement, totally incapacitating

100

Less than criteria for 100% but with weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring 4 or more times a year or a lesser number over prolonged periods

60

Symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year

40

One or two exacerbations a year in a well-established diagnosis

20

For chronic residuals:

For residuals such as limitation of motion or ankylosis, favorable or unfavorable, rate under the appropriate diagnostic codes for the specific joints involved. Where, however, the limitation of motion of the specific joint or joints involved is noncompensable under the codes a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5002. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.

Note: The ratings for the active process will not be combined with the residual ratings for limitation of motion or ankylosis. Assign the higher evaluation.

Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 pct is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as below:

With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations

20

With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups

10

Note (1): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion.

Note (2): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be utilized in rating conditions listed under diagnostic codes 5013 to 5024, inclusive.

With widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud’s-like symptoms:

That are constant, or nearly so, and refractory to therapy

40

That are episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time

20

That require continuous medication for control

10

Note: Widespread pain means pain in both the left and right sides of the body, that is both above and below the waist, and that affects both the axial skeleton ( i.e. , cervical spine, anterior chest, thoracic spine, or low back) and the extremities.

Rating

Major

Minor

Prosthetic replacement of the shoulder joint:

For 1 year following implantation of prosthesis

100

100

With chronic residuals consisting of severe, painful motion or weakness in the affected extremity

60

50

With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic codes 5200 and 5203.

Minimum rating

30

20

Prosthetic replacement of the elbow joint:

For 1 year following implantation of prosthesis

100

100

With chronic residuals consisting of severe painful motion or weakness in the affected extremity

50

40

With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5205 through 5208.

Minimum evaluation

30

20

Prosthetic replacement of wrist joint:

For 1 year following implantation of prosthesis

100

100

With chronic residuals consisting of severe, painful motion or weakness in the affected extremity

40

30

With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic code 5214.

Minimum rating

20

20

Note: The 100 pct rating for 1 year following implantation of prosthesis will commence after initial grant of the 1-month total rating assigned under §4.30 following hospital discharge.

Prosthetic replacement of the head of the femur or of the acetabulum:

For 1 year following implantation of prosthesis

100

Following implantation of prosthesis with painful motion or weakness such as to require the use of crutches

¹90

Markedly severe residual weakness, pain or limitation of motion following implantation of prosthesis

70

Moderately severe residuals of weakness, pain or limitation of motion

50

Minimum rating

30

Prosthetic replacement of knee joint:

For 1 year following implantation of prosthesis

100

With chronic residuals consisting of severe painful motion or weakness in the affected extremity

60

With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5256, 5261, or 5262.

Minimum rating

30

Prosthetic replacement of ankle joint:

For 1 year following implantation of prosthesis

100

With chronic residuals consisting of severe painful motion or weakness

40

With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to 5270 or 5271.

Minimum rating

20

Rating

Major

Minor

Note: The scapula and humerus move as one piece.

Unfavorable, abduction limited to 25° from side

50

40

Intermediate between favorable and unfavorable

40

30

Favorable, abduction to 60°, can reach mouth and head

30

20

To 25° from side

40

30

Midway between side and shoulder level

30

20

At shoulder level

20

20

Loss of head of (flail shoulder)

80

70

Nonunion of (false flail joint)

60

50

Fibrous union of

50

40

Recurrent dislocation of at scapulohumeral joint.

With frequent episodes and guarding of all arm movements

30

20

With infrequent episodes, and guarding of movement only at shoulder level

20

20

Malunion of:

Marked deformity

30

20

Moderate deformity

20

20

Dislocation of

20

20

Nonunion of:

With loose movement

20

20

Without loose movement

10

10

Malunion of

10

10

Or rate on impairment of function of contiguous joint.

Rating

Major

Minor

Unfavorable, at an angle of less than 50° or with complete loss of supination or pronation

60

50

Intermediate, at an angle of more than 90°, or between 70° and 50°

50

40

Favorable, at an angle between 90° and 70°

40

30

Flexion limited to 45°

50

40

Flexion limited to 55°

40

30

Flexion limited to 70°

30

20

Flexion limited to 90°

20

20

Flexion limited to 100°

10

10

Flexion limited to 110°

0

  0

Extension limited to 110°

50

40

Extension limited to 100°

40

30

Extension limited to 90°

30

20

Extension limited to 75°

20

20

Extension limited to 60°

10

10

Extension limited to 45°

10

10

20

20

60

50

Joint fracture, with marked cubitus varus or cubitus valgus deformity or with ununited fracture of head of radius

20

20

50

40

Nonunion in upper half, with false movement:

With loss of bone substance (1 inch (2.5 cms.) or more) and marked deformity

40

30

Without loss of bone substance or deformity

30

20

Nonunion in lower half

20

20

Malunion of, with bad alignment

10

10

Nonunion in lower half, with false movement:

With loss of bone substance (1 inch (2.5 cms.) or more) and marked deformity

40

30

Without loss of bone substance or deformity

30

20

Nonunion in upper half

20

20

Malunion of, with bad alignment

10

10

Loss of (bone fusion):

The hand fixed in supination or hyperpronation

40

30

The hand fixed in full pronation

30

20

The hand fixed near the middle of the arc or moderate pronation

20

20

Limitation of pronation:

Motion lost beyond middle of arc

30

20

Motion lost beyond last quarter of arc, the hand does not approach full pronation

20

20

Limitation of supination:

To 30° or less

10

10

Note: In all the forearm and wrist injuries, codes 5205 through 5213, multiple impaired finger movements due to tendon tie-up, muscle or nerve injury, are to be separately rated and combined not to exceed rating for loss of use of hand.

Rating

Major

Minor

Unfavorable, in any degree of palmar flexion, or with ulnar or radial deviation

50

40

Any other position, except favorable

40

30

Favorable in 20° to 30° dorsiflexion

30

20

Note: Extremely unfavorable ankylosis will be rated as loss of use of hands under diagnostic code 5125.

Dorsiflexion less than 15°

10

10

Palmar flexion limited in line with forearm

10

10

IV. Limitation of Motion of Individual Digits

With a gap of more than two inches (5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers

20

20

With a gap of one to two inches (2.5 to 5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers

10

10

With a gap of less than one inch (2.5 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers

0

0

With a gap of one inch (2.5 cm.) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees

10

10

With a gap of less than one inch (2.5 cm.) between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, and; extension is limited by no more than 30 degrees

0

0

Any limitation of motion

0

0

Rating

General Rating Formula for Diseases and Injuries of the Spine

(For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes):

With or without symptoms such as pain (whther or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease

Unfavorable ankylosis of the entire spine

100

Unfavorable ankylosis of the entire thoracolumbar spine

50

Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine

40

Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine

30

Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis

20

Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height

10

Note (1):
Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

Note (2):
(See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.

Note (3):
In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted.

Note (4):
Round each range of motion measurement to the nearest five degrees.

Note (5):
For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months

60

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months

40

With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months

20

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months

10

Note(1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.

Note(2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.

Unfavorable, extremely unfavorable ankylosis, the foot not reaching ground, crutches necessitated

390

Intermediate

70

Favorable, in flexion at an angle between 20° and 40°, and slight adduction or abduction

60

Extension limited to 5°

10

Flexion limited to 10°

40

Flexion limited to 20°

30

Flexion limited to 30°

20

Flexion limited to 45°

10

Limitation of abduction of, motion lost beyond 10°

20

Limitation of adduction of, cannot cross legs

10

Limitation of rotation of, cannot toe-out more than 15°, affected leg

10

80

Fracture of shaft or anatomical neck of:

With nonunion, with loose motion (spiral or oblique fracture)

80

With nonunion, without loose motion, weightbearing preserved with aid of brace

60

Fracture of surgical neck of, with false joint

60

Malunion of:

With marked knee or hip disability

30

With moderate knee or hip disability

20

With slight knee or hip disability

10

Extremely unfavorable, in flexion at an angle of 45° or more

60

In flexion between 20° and 45°

50

In flexion between 10° and 20°

40

Favorable angle in full extension, or in slight flexion between 0° and 10°

30

Recurrent subluxation or lateral instability:

Severe

30

Moderate

20

Slight

10

20

10

Flexion limited to 15°

30

Flexion limited to 30°

20

Flexion limited to 45°

10

Flexion limited to 60°

0

Extension limited to 45°

50

Extension limited to 30°

40

Extension limited to 20°

30

Extension limited to 15°

20

Extension limited to 10°

10

Extension limited to 5°

0

Nonunion of, with loose motion, requiring brace

40

Malunion of:

With marked knee or ankle disability

30

With moderate knee or ankle disability

20

With slight knee or ankle disability

10

10

Rating

In plantar flexion at more than 40°, or in dorsiflexion at more than 10° or with abduction, adduction, inversion or eversion deformity

40

In plantar flexion, between 30° and 40°, or in dorsiflexion, between 0° and 10°

30

In plantar flexion, less than 30°

20

Marked

20

Moderate

10

In poor weight-bearing position

20

In good weight-bearing position

10

Marked deformity

20

Moderate deformity

10

20

Rating

Over 4 inches (10.2 cms.)

³60

3 1/2 to 4 inches (8.9 cms. to 10.2 cms.)

³50

3 to 3 1/2 inches (7.6 cms. to 8.9 cms.)

40

2 1/2 to 3 inches (6.4 cms. to 7.6 cms.)

30

2 to 2 1/2 inches (5.1 cms. to 6.4 cms.)

20

1 1/4 to 2 inches (3.2 cms. to 5.1 cms.)

10

Note: Measure both lower extremities from anterior superior spine of the ilium to the internal malleolus of the tibia. Not to be combined with other ratings for fracture or faulty union in the same extremity.

Rating

Pronounced; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances

Bilateral

50

Unilateral

30

Severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities:

Bilateral

30

Unilateral

20

Moderate; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral

10

Mild; symptoms relieved by built-up shoe or arch support

0

A symptomatic condition secondary to many constitutional conditions, characterized by atrophy of the musculature, disturbed circulation, and weakness:

Rate the underlying condition, minimum rating

10

Marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, marked varus deformity:

Bilateral

50

Unilateral

30

All toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads:

Bilateral

30

Unilateral

20

Great toe dorsiflexed, some limitation of dorsiflexion at ankle, definite tenderness under metatarsal heads:

Bilateral

10

Unilateral

10

Slight

0

10

Operated with resection of metatarsal head

10

Severe, if equivalent to amputation of great toe

10

Rate as hallux valgus, severe.

  Note: Not to be combined with claw foot ratings.

All toes, unilateral without claw foot

10

Single toes

0

Severe

30

Moderately severe

20

Moderate

10

Note: With actual loss of use of the foot, rate 40 percent.

Severe

30

Moderately severe

20

Moderate

10

Note: With actual loss of use of the foot, rate 40 percent.

Rating

Dominant

Nondominant

Severe

40

30

Moderately Severe

30

20

Moderate

10

10

Slight

0

0

Severe

40

30

Moderately Severe

30

20

Moderate

20

20

Slight

0

0

Severe

40

30

Moderately Severe

30

20

Moderate

20

20

Slight

0

0

Severe

30

20

Moderately Severe

20

20

Moderate

10

10

Slight

0

0

Severe

40

30

Moderately Severe

30

20

Moderate

10

10

Slight

0

0

Severe

40

30

Moderately Severe

30

20

Moderate

10

10

Slight

0

0

Rating

Dominant

Nondominant

Severe

40

30

Moderately Severe

30

20

Moderate

10

10

Slight

0

0

Severe

30

20

Moderately Severe

20

20

Moderate

10

10

Slight

0

0

Note: The hand is so compact a structure that isolated muscle injuries are rare, being nearly always complicated with injuries of bones, joints, tendons, etc. Rate on limitation of motion, minimum 10 percent.

Rating

Severe

30

Moderately Severe

20

Moderate

10

Slight

0

Dorsal:
(1) Extensor hallucis brevis; (2) extensor digitorum brevis. Other important dorsal structures: cruciate, crural, deltoid, and other ligaments; tendons of long extensors of toes and peronei muscles

Severe

20

Moderately Severe

10

Moderate

10

Slight

0

Note: Minimum rating for through-and-through wounds of the foot—10.

Severe

30

Moderately Severe

20

Moderate

10

Slight

0

Severe

30

Moderately Severe

20

Moderate

10

Slight

0