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 4.25 Combined ratings table
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 4.27 Use of diagnostic codes
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% 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 4.31 Zero percent evaluations
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 4.41 History of injury
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 4.44 The bones 4.45 The joints
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 4.62 Circulatory disturbances
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 4.67 Pelvic bones
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 4.69 Dominant hand
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