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BASIC RATING PRINCIPLES

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

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BASIC RATING PRINCIPLES

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  1. BASIC RATING PRINCIPLES 38 CFR Part 4 Subpart A and B

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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%

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. ASSIGNING THE CORRECT EVALUATION 38 CFR Part 4 Subpart B – Disability Ratings

  25. EVALUATION • Description of the Diagnosis • Identification of the Proper Diagnostic Code • Criteria “in-between” levels of disability

  26. EVALUATION • Importance of Pain (DeLuca) • Importance of Functional Loss • Consistency in Evaluative Judgment

  27. BODY SYSTEMS 38 CFR Part 4 Subpart B

  28. BODY SYSTEMS • 15 Specific Systems • Organized Chaos -- working knowledge of diagnostic codes very beneficial • Specific “rating rules” contained in footnotes

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