38 C.F.R. § 4.114
Current through November 30, 2024
Do not combine ratings under diagnostic codes 7301 through 7329 inclusive, 7331, 7342, 7345 through 7350 inclusive, 7352, and 7355 through 7357 inclusive, with each other. Instead, when more than one rating is warranted under those diagnostic codes, assign a single evaluation under the diagnostic code that reflects the predominant disability picture, and elevate it to the next higher evaluation if warranted by the severity of the overall disability.
| Rating | |
| 7200 Soft tissue injury of the mouth, other than tongue or lips: | |
| Rate as for disfigurement (diagnostic codes 7800 and 7804) and impairment of mastication. | |
| 7201 Lips, injuries of: | |
| Rate as disfigurement (diagnostic codes 7800 and 7804). | |
| 7202 Tongue, loss of whole or part: | |
| Absent oral nutritional intake | 100 |
| Intact oral nutritional intake with permanently impaired swallowing function that requires prescribed dietary modification | 60 |
| Intact oral nutritional intake with permanently impaired swallowing function without prescribed dietary modification | 30 |
| Note (1): Rate the residuals of speech impairment as complete organic aphonia (DC 6519) or incomplete aphonia as laryngitis, chronic (DC 6516). | |
| Note (2): Dietary modifications due to this condition must be prescribed by a medical provider. | |
| 7203 Esophagus, stricture of: | |
| Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by § 4.112(a) and treatment with either surgical correction or percutaneous esophago-gastrointestinal tube (PEG tube) | 80 |
| Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following (1) dilatation 3 or more times per year, (2) dilatation using steroids at least one time per year, or (3) esophageal stent placement | 50 |
| Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year | 30 |
| Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic | 10 |
| Documented history without daily symptoms or requirement for daily medications | 0 |
| Note (1): Findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy. | |
| Note (2): Non-gastrointestinal complications of procedures should be rated under the appropriate system. | |
| Note (3): This diagnostic code applies, but is not limited to, esophagitis, mechanical or chemical; Mallory Weiss syndrome (bleeding at junction of esophagus and stomach due to tears) due to caustic ingestion of alkali or acid; drug-induced or infectious esophagitis due to Candida, virus, or other organism; idiopathic eosinophilic, or lymphocytic esophagitis; esophagitis due to radiation therapy; esophagitis due to peptic stricture; and any esophageal condition that requires treatment with sclerotherapy. | |
| Note (4): Recurrent esophageal stricture is defined as the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved. | |
| Note (5): Refractory esophageal stricture is defined as the inability to achieve target esophageal diameter despite receiving no fewer than 5 dilatation sessions performed at 2-week intervals. | |
| 7204 Esophageal motility disorder: | |
| Rate as esophagus, stricture of (DC 7203). | |
| Note: This diagnostic code applies, but is not limited to, achalasia (cardiospasm), diffuse esophageal spasm (DES), corkscrew esophagus, nutcracker esophagus, and other motor disorders of the esophagus; esophageal rings (including Schatzki rings), mucosal webs or folds, and impairment of the esophagus caused by systemic conditions such as myasthenia gravis, scleroderma, and other neurologic conditions. | |
| 7205 Esophagus, diverticulum of, acquired: | |
| Rate as esophagus, stricture of (DC 7203). | |
| Note: This diagnostic code, applies, but is not limited to, pharyngo- esophageal (Zenker's) diverticulum, mid-esophageal diverticulum, and epiphrenic (distal esophagus) diverticulum. | |
| 7206 Gastroesophageal reflux disease: | |
| Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by § 4.112(a) and treatment with either surgical correction of esophageal stricture(s) or percutaneous esophago-gastrointestinal tube (PEG tube) | 80 |
| Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following (1) dilatation 3 or more times per year, (2) dilatation using steroids at least one time per year, or (3) esophageal stent placement | 50 |
| Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year | 30 |
| Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic | 10 |
| Documented history without daily symptoms or requirement for daily medications | 0 |
| Note (1): Findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy. | |
| Note (2): Non-gastrointestinal complications of procedures should be rated under the appropriate system. | |
| Note (3): This diagnostic code applies, but is not limited to, esophagitis, mechanical or chemical; Mallory Weiss syndrome (bleeding at junction of esophagus and stomach due to tears) due to caustic ingestion of alkali or acid; drug-induced or infectious esophagitis due to Candida, virus, or other organism; idiopathic eosinophilic, or lymphocytic esophagitis; esophagitis due to radiation therapy; esophagitis due to peptic stricture; and any esophageal condition that requires treatment with sclerotherapy. | |
| Note (4): Recurrent esophageal stricture is defined as the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved. | |
| Note (5): Refractory esophageal stricture is defined as the inability to achieve target esophageal diameter despite receiving no fewer than 5 dilatation sessions performed at 2-week intervals. | |
| 7207 Barrett's esophagus: | |
| With esophageal stricture: Rate as esophagus, stricture of (DC 7203). | |
| Without esophageal stricture: | |
| Documented by pathologic diagnosis with high-grade dysplasia | 30 |
| Documented by pathologic diagnosis with low-grade dysplasia | 10 |
| Note (1): If malignancy develops, rate as malignant neoplasms of the digestive system, exclusive of skin growths (DC 7343). | |
| Note (2): If the condition is resolved via surgery, radiofrequency ablation, or other treatment, rate residuals as esophagus, stricture of (DC 7203). | |
| 7301 Peritoneum, adhesions of, due to surgery, trauma, disease, or infection: | |
| Persistent partial bowel obstruction that is either inoperable and refractory to treatment, or requires total parenteral nutrition (TPN) for obstructive symptoms | 80 |
| Symptomatic peritoneal adhesions, persisting or recurring after surgery, trauma, inflammatory disease process such as chronic cholecystitis or Crohn's disease, or infection, as determined by a healthcare provider; and clinical evidence of recurrent obstruction requiring hospitalization at least once a year; and medically-directed dietary modification other than total parenteral nutrition (TPN); and at least one of the following: (1) abdominal pain, (2) nausea, (3) vomiting, (4) colic, (5) constipation, or (6) diarrhea | 50 |
| Symptomatic peritoneal adhesions, persisting or recurring after surgery, trauma, inflammatory disease process such as chronic cholecystitis or Crohn's disease, or infection, as determined by a healthcare provider; and medically-directed dietary modification other than total parenteral nutrition (TPN); and at least one of the following: (1) abdominal pain, (2) nausea, (3) vomiting, (4) colic, (5) constipation, or (6) diarrhea | 30 |
| Symptomatic peritoneal adhesions, persisting or recurring after surgery, trauma, inflammatory disease process such as chronic cholecystitis or Crohn's disease, or infection, as determined by a healthcare provider, and at least one of the following: (1) abdominal pain, (2) nausea, (3) vomiting, (4) colic, (5) constipation, or (6) diarrhea | 10 |
| History of peritoneal adhesions, currently asymptomatic | 0 |
| 7303 Chronic complications of upper gastrointestinal surgery: | |
| Requiring continuous total parenteral nutrition (TPN) or tube feeding for a period longer than 30 consecutive days in the last six months | 80 |
| Any one of the following symptoms with or without pain: (1) daily vomiting despite oral dietary modification or medication; (2) six or more watery bowel movements per day every day, or explosive bowel movements that are difficult to predict or control; (3) post-prandial (meal-induced) light-headedness (syncope) with sweating and the need for medications to specifically treat complications of upper gastrointestinal surgery such as dumping syndrome or delayed gastric emptying | 50 |
| With two or more of the following symptoms: (1) vomiting two or more times per week or vomiting despite medical treatment; (2) discomfort or pain within an hour of eating and requiring ongoing oral dietary modification; (3) three to five watery bowel movements per day every day | 30 |
| With either nausea or vomiting managed by ongoing medical treatment | 10 |
| Post-operative status, asymptomatic | 0 |
| Note (1): For resection of small intestine, use DC 7328. | |
| Note (2): If pancreatic surgery results in a vitamin or mineral deficiency (e.g., B12, iron, calcium, or fat-soluble vitamins), evaluate under the appropriate vitamin/mineral deficiency code and assign the higher rating. For example, evaluate Vitamin A, B, C or D deficiencies under DC 6313; ocular manifestations of vitamin deficiencies, such as night blindness, under DC 6313; keratitis or keratomalacia due to Vitamin A deficiency under DC 6001; Vitamin E deficiency under neuropathy; and Vitamin K deficiency under prolonged clotting (e.g., DC 7705). | |
| Note (3): This diagnostic code includes operations performed on the esophagus, stomach, pancreas, and small intestine, including bariatric surgery. | |
| 7304 Peptic ulcer disease: | |
| Post-operative for perforation or hemorrhage, for three months | 100 |
| Continuous abdominal pain with intermittent vomiting, recurrent hematemesis (vomiting blood) or melena (tarry stools); and manifestations of anemia which require hospitalization at least once in the past 12 months | 60 |
| Episodes of abdominal pain, nausea, or vomiting, that: last for at least three consecutive days in duration; occur four or more times in the past 12 months; and are managed by daily prescribed medication | 40 |
| Episodes of abdominal pain, nausea, or vomiting, that: last for at least three consecutive days in duration; occur three times or less in the past 12 months; and are managed by daily prescribed medication | 20 |
| History of peptic ulcer disease documented by endoscopy or diagnostic imaging studies | 0 |
| Note: After three months at the 100% evaluation, rate on residuals as determined by mandatory VA medical examination. Apply the provisions of § 3.105(e) of this chapter to any change in evaluation based upon that or any subsequent examination. | |
| 7307 Gastritis, chronic: | |
| Rate as peptic ulcer disease (DC 7304). | |
| Note: This diagnostic code includes Helicobacter pylori infection, drug-induced gastritis, Zollinger-Ellison syndrome, and portal-hypertensive gastropathy with varix-related complications. | |
| 7308 Postgastrectomy syndrome: | |
| Rate residuals as chronic complications of upper gastrointestinal surgery (DC 7303). | |
| 7309 Stomach, stenosis of: | |
| Rate as chronic complications of upper gastrointestinal surgery (DC 7303) or peptic ulcer disease (DC 7304), depending on the predominant disability. | |
| 7310 Stomach, injury of, residuals: | |
| Pre-operative: Rate as adhesions of peritoneum due to surgery, trauma, disease, or infection (DC 7301). No adhesions are necessary when evaluating under DC 7301. | |
| Post-operative: Rate as chronic complications of upper gastrointestinal surgery (DC 7303). | |
| Rate as peritoneal adhesions. | |
| 7311 Residuals of injury of the liver: | |
| Depending on the specific residuals, separately evaluate as adhesions of peritoneum (diagnostic code 7301), cirrhosis of liver (diagnostic code 7312), and chronic liver disease without cirrhosis (diagnostic code 7345). | |
| 7312 Cirrhosis of the liver: | |
| Liver disease with Model for End-Stage Liver Disease score greater than or equal to 15; or with continuous daily debilitating symptoms, generalized weakness and at least one of the following: (1) ascites (fluid in the abdomen), or (2) a history of spontaneous bacterial peritonitis, or (3) hepatic encephalopathy, or (4) variceal hemorrhage, or (5) coagulopathy, or (6) portal gastropathy, or (7) hepatopulmonary or hepatorenal syndrome | 100 |
| Liver disease with Model for End-Stage Liver Disease score greater than 11 but less than 15; or with daily fatigue and at least one episode in the last year of either (1) variceal hemorrhage, or (2) portal gastropathy or hepatic encephalopathy | 60 |
| Liver disease with Model for End-Stage Liver Disease score of 10 or 11; or with signs of portal hypertension such as splenomegaly or ascites (fluid in the abdomen) and either weakness, anorexia, abdominal pain, or malaise | 30 |
| Liver disease with Model for End-Stage Liver Disease score greater than 6 but less than 10; or with evidence of either anorexia, weakness, abdominal pain or malaise | 10 |
| Asymptomatic, but with a history of liver disease | 0 |
| Note (1): Rate hepatocellular carcinoma occurring with cirrhosis under DC 7343 (Malignant neoplasms of the digestive system, exclusive of skin growths) in lieu of DC 7312. | |
| Note (2): Biochemical studies, imaging studies, or biopsy must confirm liver dysfunction (including hyponatremia, thrombocytopenia, and/or coagulopathy). | |
| Note (3): Rate condition based on symptomatology where the evidence does not contain a Model for End-Stage Liver Disease score. | |
| 7314 Chronic biliary tract disease: | |
| With three or more clinically documented attacks of right upper quadrant pain with nausea and vomiting during the past 12 months; or requiring dilatation of biliary tract strictures at least once during the past 12 months. | 30 |
| With one or two clinically documented attacks of right upper quadrant pain with nausea and vomiting in the past 12 months. | 10 |
| Asymptomatic, without history of a clinically documented attack of right upper quadrant pain with nausea and vomiting in the past 12 months. | 0 |
| Note: This diagnostic code includes cholangitis, biliary strictures, Sphincter of Oddi dysfunction, bile duct injury, and choledochal cyst. Rate primary sclerosing cholangitis under chronic liver disease without cirrhosis (DC 7345). | |
| 7315 Cholelithiasis, chronic: | |
| Rate as chronic biliary tract disease (DC 7314). | |
| 7317 Gallbladder, injury of: | |
| Rate as adhesions of the peritoneum due to surgery, trauma, disease, or infection (DC 7301); or chronic gallbladder and biliary tract disease (DC 7314), or cholecystectomy (gallbladder removal), complications of (such as strictures and biliary leaks) (DC 7318), depending on the predominant disability. | |
| Note: When rating gallbladder injuries analogous to DC 7301, a finding of adhesions is not necessary. | |
| 7318 Cholecystectomy (gallbladder removal), complications of (such as strictures and biliary leaks): | |
| With recurrent abdominal pain (post-prandial or nocturnal); and chronic diarrhea characterized by three or more watery bowel movements per day | 30 |
| With intermittent abdominal pain; and diarrhea characterized by one to two watery bowel movements per day | 10 |
| Asymptomatic | 0 |
| 7319 Irritable bowel syndrome (IBS): | |
| Abdominal pain related to defecation at least one day per week during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension | 30 |
| Abdominal pain related to defecation for at least three days per month during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension | 20 |
| Abdominal pain related to defecation at least once during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension | 10 |
| Note: This diagnostic code may include functional digestive disorders (see § 3.317 of this chapter), such as dyspepsia, functional bloating and constipation, and diarrhea. Evaluate other symptoms of a functional digestive disorder not encompassed by this diagnostic code under the appropriate diagnostic code, to include gastrointestinal dysmotility syndrome (DC 7356), following the general principles of § 4.14 and this section. | |
| 7323 Colitis, ulcerative: | |
| Rate as Crohn's disease or undifferentiated form of inflammatory bowel disease (DC 7326). | |
| 7325 Enteritis, chronic: | |
| Rate as Irritable Bowel Syndrome (DC 7319) or Crohn's disease or undifferentiated form of inflammatory bowel disease (DC 7326), depending on the predominant disability. | |
| 7326 Crohn's disease or undifferentiated form of inflammatory bowel disease: | |
| Severe inflammatory bowel disease that is unresponsive to treatment; and requires hospitalization at least once per year; and results in either an inability to work or is characterized by recurrent abdominal pain associated with at least two of the following: (1) six or more episodes per day of diarrhea, (2) six or more episodes per day of rectal bleeding, (3) recurrent episodes of rectal incontinence, or (4) recurrent abdominal distension | 100 |
| Moderate inflammatory bowel disease that is managed on an outpatient basis with immunosuppressants or other biologic agents; and is characterized by recurrent abdominal pain, four to five daily episodes of diarrhea; and intermittent signs of toxicity such as fever, tachycardia, or anemia | 60 |
| Mild to moderate inflammatory bowel disease that is managed with oral and topical agents (other than immunosuppressants or other biologic agents); and is characterized by recurrent abdominal pain with three or less daily episodes of diarrhea and minimal signs of toxicity such as fever, tachycardia, or anemia | 30 |
| Minimal to mild symptomatic inflammatory bowel disease that is managed with oral or topical agents (other than immunosuppressants or other biologic agents); and is characterized by recurrent abdominal pain with three or less daily episodes of diarrhea and no signs of systemic toxicity | 10 |
| Note (1): Following colectomy/colostomy with persistent or recurrent symptoms, rate either under DC 7326 or DC 7329 (Intestine, large, resection of), whichever provides the highest rating. | |
| Note (2): VA requires diagnoses under DC 7326 to be confirmed by endoscopy or radiologic studies. | |
| Note (3): Inflammation may involve small bowel (ileitis), large bowel (colitis), or inflammation of any component of the gastrointestinal tract from the mouth to the anus. | |
| 7327 Diverticulitis and diverticulosis: | |
| Diverticular disease requiring hospitalization for abdominal distress, fever, and leukocytosis (elevated white blood cells) one or more times in the past 12 months; and with at least one of the following complications: (1) hemorrhage, (2) obstruction, (3) abscess, (4) peritonitis, or (5) perforation | 30 |
| Diverticular disease requiring hospitalization for abdominal distress, fever, and leukocytosis (elevated white blood cells) one or more times in the past 12 months; and without associated (1) hemorrhage, (2) obstruction, (3) abscess, (4) peritonitis, or (5) perforation | 20 |
| Asymptomatic; or a symptomatic diverticulitis or diverticulosis that is managed by diet and medication | 0 |
| Note: For colectomy or colostomy, use DC 7327 or DC 7329 (Intestine, large, resection of), whichever results in a higher evaluation. | |
| 7328 Intestine, small, resection of: | |
| Status post intestinal resection with undernutrition and anemia; and requiring total parenteral nutrition (TPN) | 80 |
| Status post intestinal resection with undernutrition and anemia; and requiring prescribed oral dietary supplementation, continuous medication and intermittent total parenteral nutrition (TPN) | 60 |
| Status post intestinal resection with four or more episodes of diarrhea per day resulting in undernutrition and anemia; and requiring prescribed oral dietary supplementation and continuous medication | 40 |
| Status post intestinal resection with four or more episodes of diarrhea per day | 20 |
| Status post intestinal resection, asymptomatic | 0 |
| Note: This diagnostic code includes short bowel syndrome, mesenteric ischemic thrombosis, and post-bariatric surgery complications. Where short bowel syndrome results in high-output syndrome, to include high-output stoma, consider assigning a higher evaluation under DC 7329 (Intestine, large, resection of). | |
| 7329 Intestine, large, resection of: | |
| Total colectomy with formation of ileostomy, high-output syndrome, and more than two episodes of dehydration requiring intravenous hydration in the past 12 months | 100 |
| Total colectomy with or without permanent colostomy or ileostomy without high-output syndrome | 60 |
| Partial colectomy with permanent colostomy or ileostomy without high-output syndrome | 40 |
| Partial colectomy with reanastomosis (reconnection of the intestinal tube) with loss of ileocecal valve and recurrent episodes of diarrhea more than 3 times per day | 20 |
| Partial colectomy with reanastomosis (reconnection of the intestinal tube) | 10 |
| 7330 Intestinal fistulous disease, external: | |
| Requiring total parenteral nutrition (TPN); or enteral nutritional support along with at least one of the following: (1) daily discharge equivalent to four or more ostomy bags (sized 130 cc), (2) requiring ten or more pad changes per day, or (3) a Body Mass Index (BMI) less than 16 and persistent drainage (any amount) for more than 1 month during the past 12 months | 100 |
| Requiring enteral nutritional support along with at least one of the following: (1) daily discharge equivalent to three or less ostomy bags (sized 130 cc), (2) requiring fewer than ten pad changes per day, or (3) a Body Mass Index (BMI) of 16 to 18 inclusive and persistent drainage (any amount) for more than 2 months in the past 12 months | 60 |
| Intermittent fecal discharge with persistent drainage for more than 3 months in the past 12 months | 30 |
| Note: This code applies to external fistulas that have developed as a consequence of abdominal trauma, surgery, radiation, malignancy, infection, or ischemia. | |
| 7331 Peritonitis, tuberculous, active or inactive: | |
| Active | 100 |
| Inactive: See §§ 4.88b and 4.89 . | |
| 7332 Rectum and anus, impairment of sphincter control: | |
| Complete loss of sphincter control characterized by incontinence or retention that is not responsive to a physician-prescribed bowel program and requires either surgery or digital stimulation, medication (beyond laxative use), and special diet; or incontinence to solids and/or liquids two or more times per day, which requires changing a pad two or more times per day | 100 |
| Complete or partial loss of sphincter control characterized by incontinence or retention that is partially responsive to a physician-prescribed bowel program and requires either surgery or digital stimulation, medication (beyond laxative use), and special diet; or incontinence to solids and/or liquids two or more times per week, which requires wearing a pad two or more times per week | 60 |
| Complete or partial loss of sphincter control characterized by incontinence or retention that is fully responsive to a physician-prescribed bowel program and requires digital stimulation, medication (beyond laxative use), and special diet; or incontinence to solids and/or liquids two or more times per month, which requires wearing a pad two or more times per month | 30 |
| Complete or partial loss of sphincter control characterized by incontinence or retention that is fully responsive to a physician-prescribed bowel program and requires medication or special diet; or incontinence to solids and/or liquids at least once every six months, which requires wearing a pad at least once every six months | 10 |
| History of loss of sphincter control, currently asymptomatic | 0 |
| Note: Complete or partial loss of sphincter control refers to the inability to retain or expel stool at an appropriate time and place. | |
| 7333 Rectum and anus, stricture of: | |
| Inability to open the anus with inability to expel solid feces | 100 |
| Reduction of the lumen 50% or more, with pain and straining during defecation | 60 |
| Reduction of the lumen by less than 50%, with straining during defecation | 30 |
| Luminal narrowing with or without straining, managed by dietary intervention | 10 |
| Note (1): Conditions rated under this code include dyssynergic defecation (levator ani) and anismus (functional constipation). | |
| Note (2): Evaluate an ostomy as Intestine, large, resection of (DC 7329). | |
| 7334 Rectum, prolapse of: | |
| Persistent irreducible prolapse, repairable or unrepairable | 100 |
| Manually reducible prolapse that is not repairable and occurs at times other than bowel movements, exertion, or while performing the Valsalva maneuver | 50 |
| Manually reducible prolapse that is not repairable and occurs only after bowel movements, exertion, or while performing the Valsalva maneuver | 30 |
| Spontaneously reducible prolapse that is not repairable | 10 |
| Note (1): For repairable prolapse of the rectum, continue the 100% evaluation for two months following repair. Thereafter, determine the appropriate evaluation based on residuals by mandatory VA examination. Apply the provisions of § 3.105(e) of this chapter to any change in evaluation based upon that or any subsequent examination. | |
| Note (2): Where impairment of sphincter control constitutes the predominant disability, rate under diagnostic code 7332 (Rectum and anus, impairment of sphincter control). | |
| 7335 Ano, fistula in, including anorectal fistula and anorectal abscess: | |
| More than two constant or near-constant fistulas with abscesses, drainage, and pain, which are refractory to medical and surgical treatment | 60 |
| One or two simultaneous fistulas, with abscess, drainage, and pain | 40 |
| Two or more simultaneous fistulas with drainage and pain, but without abscesses | 20 |
| One fistula with drainage and pain, but without abscess | 10 |
| 7336 Hemorrhoids, external or internal: | |
| Internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis | 20 |
| Prolapsed internal hemorrhoids with two or less episodes per year of thrombosis; or external hemorrhoids with three or more episodes per year of thrombosis | 10 |
| 7337 Pruritus ani (anal itching): | |
| With bleeding or excoriation | 10 |
| Without bleeding or excoriation | 0 |
| 7338 Hernia, including femoral, inguinal, umbilical, ventral, incisional, and other (but not including hiatal). | |
| Irreparable hernia (new or recurrent) present for 12 months or more; with both of the following present for 12 months or more: | |
| 1. Size equal to 15 cm or greater in one dimension; and | |
| 2. Pain when performing at least three of the following activities: (1) bending over, (2) activities of daily living (ADLs), (3) walking, and (4) climbing stairs | 100 |
| Irreparable hernia (new or recurrent) present for 12 months or more; with both of the following present for 12 months or more: | |
| 1. Size equal to 15 cm or greater in one dimension; and | |
| 2. Pain when performing two of the following activities: (1) bending over, (2) activities of daily living (ADLs), (3) walking, and (4) climbing stairs | 60 |
| Irreparable hernia (new or recurrent) present for 12 months or more; with both of the following present for 12 months or more: | |
| 1. Size equal to 3 cm or greater but less than 15 cm in one dimension; and | |
| 2. Pain when performing at least two of the following activities: (1) bending over, (2) activities of daily living (ADLs), (3) walking, and (4) climbing stairs | 30 |
| Irreparable hernia (new or recurrent) present for 12 months or more; with both of the following present for 12 months or more: | |
| 1. Size equal to 3 cm or greater but less than 15 cm in one dimension; and | |
| 2. Pain when performing one of the following activities: (1) bending over, (2) activities of daily living (ADLs), (3) walking, and (4) climbing stairs | 20 |
| Irreparable hernia (new or recurrent) present for 12 months or more; with hernia size smaller than 3 cm | 10 |
| Asymptomatic hernia; present and repairable, or repaired | 0 |
| Note (1): With two compensable inguinal hernias, evaluate the more severely disabling hernia first, and then add 10% to that rating to account for the second compensable hernia. Do not add 10% to that rating if the more severely disabling hernia is rated at 100%. | |
| Note (2): Any one of the following activities of daily living are sufficient for evaluation: bathing, dressing, hygiene, and/or transfers. | |
| 7342 Visceroptosis, symptomatic, marked | 10 |
| 7343 Malignant neoplasms of the digestive system, exclusive of skin growths | 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. | |
| 7344 Benign neoplasms, exclusive of skin growths: | |
| Evaluate under a diagnostic code appropriate to the predominant disability or the specific residuals after treatment. | |
| Note: This diagnostic code includes lipoma, leiomyoma, colon polyps, or villous adenoma. | |
| 7345 Chronic liver disease without cirrhosis: | |
| Progressive chronic liver disease requiring use of both parenteral antiviral therapy (direct antiviral agents), and parenteral immunomodulatory therapy (interferon and other); and for six months following discontinuance of treatment | 100 |
| Progressive chronic liver disease requiring continuous medication and causing substantial weight loss and at least two of the following: (1) daily fatigue, (2) malaise, (3) anorexia, (4) hepatomegaly, (5) pruritus, and (6) arthralgia | 60 |
| Progressive chronic liver disease requiring continuous medication and causing minor weight loss and at least two of the following: (1) daily fatigue, (2) malaise, (3) anorexia, (4) hepatomegaly, (5) pruritus, and (6) arthralgia | 40 |
| Chronic liver disease with at least one of the following: (1) intermittent fatigue, (2) malaise, (3) anorexia, (4) hepatomegaly, or (5) pruritus | 20 |
| Previous history of liver disease, currently asymptomatic | 0 |
| Note (1): 100% evaluation shall continue for six months following discontinuance of parenteral antiviral therapy and administration of parenteral immunomodulatory drugs. Six months after discontinuance of parenteral antiviral therapy and parenteral immunomodulatory drugs, determine the appropriate disability rating by mandatory VA exam. Apply the provisions of § 3.105(e) of this chapter to any change in evaluation based upon that or any subsequent examination. | |
| Note (2): For individuals for whom physicians recommend both parenteral antiviral therapy and parenteral immunomodulatory drugs, but for whom treatment is medically contraindicated, rate according to DC 7312 (Cirrhosis of the liver). | |
| Note (3): This diagnostic code includes Hepatitis B (confirmed by serologic testing), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune liver disease, Wilson's disease, Alpha-1-antitrypsin deficiency, hemochromatosis, drug-induced hepatitis, and non-alcoholic steatohepatitis (NASH). Track Hepatitis C (or non-A, non-B hepatitis) under DC 7354 but evaluate it using the criteria in this entry. | |
| Note (4): Evaluate sequelae, such as cirrhosis or malignancy of the liver, under an appropriate diagnostic code, but do not use the same signs and symptoms as the basis for evaluation under DC 7354 and under a diagnostic code for sequelae. (See § 4.14 ) | |
| 7346 Hiatal hernia and paraesophageal hernia: | |
| Rate as esophagus, stricture of (DC 7203). | |
| 7347 Pancreatitis, chronic: | |
| Daily episodes of abdominal or mid-back pain that require three or more hospitalizations per year; and pain management by a physician; and maldigestion and malabsorption requiring dietary restriction and pancreatic enzyme supplementation | 100 |
| Three or more episodes of abdominal or mid-back pain per year and at least one episode per year requiring hospitalization for management either of complications related to abdominal pain or complications of tube enteral feeding | 60 |
| At least one episode per year of abdominal or mid-back pain that requires ongoing outpatient medical treatment for pain, digestive problems, or management of related complications including but not limited to cyst, pseudocyst, intestinal obstruction, or ascites | 30 |
| Note (1): Appropriate diagnostic studies must confirm that abdominal pain in this condition results from pancreatitis. | |
| Note (2): Separately rate endocrine dysfunction resulting in diabetes due to pancreatic insufficiency under DC 7913 (Diabetes mellitus). | |
| 7348 Vagotomy with pyloroplasty or gastroenterostomy: | |
| Following confirmation of postoperative complications of stricture or continuing gastric retention | 40 |
| With symptoms and confirmed diagnosis of alkaline gastritis, or with confirmed persisting diarrhea | 30 |
| With incomplete vagotomy | 20 |
| Note: Rate recurrent ulcer following complete vagotomy under DC 7304 (Peptic ulcer disease), with a minimum rating of 20%; and rate post-operative residuals not addressed by this diagnostic code under DC 7303 (Chronic complications of upper gastrointestinal surgery). | |
| 7350 Liver abscess: | |
| Assign a rating of 100% for 6 months from the date of initial diagnosis. Six months following initial diagnosis, determine the appropriate disability rating by mandatory VA examination. Thereafter, rate the condition based on chronic residuals under the appropriate body system. Apply the provisions of § 3.105(e) of this chapter to any reduction in evaluation. | |
| Note: This diagnostic code includes abscesses caused by bacterial, viral, amebic (e.g., E. hystolytica), fungal (e.g., C. albicans), and other agents. | |
| 7351 Liver transplant: | |
| For an indefinite period from the date of hospital admission for transplant surgery | 100 |
| Eligible and awaiting transplant surgery, minimum rating | 60 |
| Following transplant surgery, minimum rating | 30 |
| Note: Assign a rating of 100% as of the date of hospital admission for transplant surgery. One year following discharge, determine the appropriate disability rating by mandatory VA examination. Apply the provisions of § 3.105(e) of this chapter to any change in evaluation based upon that or any subsequent examination. Rate residuals of any recurrent underlying liver disease under the appropriate diagnostic code and, when appropriate, combine with other post-transplant residuals under the appropriate body system(s), subject to the provisions of § 4.14 and this section. | |
| 7352 Pancreas transplant: | |
| For an indefinite period from the date of hospital admission for transplant surgery | 100 |
| Minimum rating | 30 |
| Note: Assign a rating of 100% as of the date of hospital admission for transplant surgery. One year following discharge, determine the appropriate disability rating by mandatory VA examination. Apply the provisions of § 3.105(e) of this chapter to any change in evaluation based upon that or any subsequent examination. | |
| 7354 Hepatitis C (or non-A, non-B hepatitis): | |
| Rate under DC 7345 (Chronic liver disease without cirrhosis). | |
| 7355 Celiac disease: | |
| Malabsorption syndrome with weakness which interferes with activities of daily living; and weight loss resulting in wasting and nutritional deficiencies; and with systemic manifestations including but not limited to, weakness and fatigue, dermatitis, lymph node enlargement, hypocalcemia, low vitamin levels; and anemia related to malabsorption; and episodes of abdominal pain and diarrhea due to lactase deficiency or pancreatic insufficiency | 80 |
| Malabsorption syndrome with chronic diarrhea managed by medically-prescribed dietary intervention such as prescribed gluten-free diet, with nutritional deficiencies due to lactase and pancreatic insufficiency; and with systemic manifestations including, but not limited to, weakness and fatigue, dermatitis, lymph node enlargement, hypocalcemia, low vitamin levels, or atrophy of the inner intestinal lining shown on biopsy | 50 |
| Malabsorption syndrome with chronic diarrhea managed by medically-prescribed dietary intervention such as prescribed gluten-free diet; and without nutritional deficiencies | 30 |
| Note (1): An appropriate serum antibody test or endoscopy with biopsy must confirm the diagnosis. | |
| Note (2): For evaluation of celiac disease with the predominant disability of malabsorption, use the greater evaluation between DC 7328 or celiac disease under DC 7355. | |
| 7356 Gastrointestinal dysmotility syndrome: | |
| Requiring complete dependence on total parenteral nutrition (TPN) or continuous tube feeding for nutritional support | 80 |
| Requiring intermittent tube feeding for nutritional support; with recurrent emergency treatment for episodes of intestinal obstruction or regurgitation due to poor gastric emptying, abdominal pain, recurrent nausea, or recurrent vomiting | 50 |
| With symptoms of chronic intestinal pseudo-obstruction (CIPO) or symptoms of intestinal motility disorder, including but not limited to, abdominal pain, bloating, feeling of epigastric fullness, dyspepsia, nausea and vomiting, regurgitation, constipation, and diarrhea, managed by ambulatory care; and requiring prescribed dietary management or manipulation | 30 |
| Intermittent abdominal pain with epigastric fullness associated with bloating; and without evidence of a structural gastrointestinal disease | 10 |
| Note: Use this diagnostic code for illnesses associated with § 3.317(a)(2)(i)(B) (3) of this chapter, other than those which can be evaluated under DC 7319. | |
| 7357 Post pancreatectomy syndrome: | |
| Following total or partial pancreatectomy, evaluate under Pancreatitis, chronic (DC 7347), Chronic complications of upper gastrointestinal surgery (DC 7303), or based on residuals such as malabsorption (Intestine, small, resection of, DC 7328), diarrhea (Irritable bowel syndrome, DC 7319, or Crohn's disease or undifferentiated form of inflammatory bowel disease, DC 7326), or diabetes (DC 7913), whichever provides the highest evaluation | |
38 C.F.R. §4.114
Authority: 38 U.S.C. 1155