(a) When assessing a mental disorder, the credit rating agency shall take into account the frequency, severity and duration of psychiatric symptoms, the duration of remissions and the veteran`s ability to adapt during the remission phases. The credit rating agency shall issue an assessment on the basis of all evidence relating to occupational and social impairments and not only on the basis of the auditor`s assessment of the degree of disability at the time of the audit. Current TDs 6510 to 6514 all refer to different types of chronic sinusitis assessed using the general sinusitis assessment formula under CD 6514. VA proposes to rename these codes to DC 6222 and 6226 respectively in accordance with § 4.87; In addition, VA suggests renaming each code to reflect current medical terminology. VA proposes to rename the renamed DC 6222 to “Rhinosinusitis, Pansinusitis”. VA proposes to rename the renamed DC 6223 to “Rhinosinusitis, ethmoid”. VA proposes to rename the renamed DC 6224 to “rhinosinusitis, frontal”. VA proposes to rename the renamed DC 6225 to “Rhinosinusitis, maxilla”. VA proposes to rename the renamed DC 6226 to “rhinosinusitis, sphenoid”. VA also suggests reflecting current medical terminology by renaming the General Assessment Formula for sinusitis to the General Assessment Formula for chronic rhinosinusitis and recurrent acute rhinosinusitis. VA will place this renamed evaluation formula immediately prior to the renamed CD 6222.

VA also proposes to adjust the values for the maximum oxygen consumption, which has a fixed relationship with the MET (each 3.5 ml of oxygen consumed corresponds to 1 MET). This change will ensure fairness with values already used in other body systems that use MET to assess disability (particularly the cardiovascular system). Finally, VA suggests continuing to use FEV-1/FVC as a PFT that can be used for evaluation purposes, although it is not included in the “Pulmonary Dysfunction” table. VA proposes to add a new DC 6848 for “lung transplantation”. Lung transplantation involves a single treatment that is not addressed in the current assessment plan. This procedure for a service-related lung disease results in significant disability that is not sufficiently accounted for in the current assessment scheme. On the one hand, recovery with lung function tests usually takes about 12 months. However, the result studies show significant differences in the return to working hours. This can be explained by looking at the two main populations that get lungs Start Printed page 8479 transplants.

There is one population that receives a lung transplant because of hereditary or genetic diseases that would completely exclude military service (e.g., cystic fibrosis), and another population that receives a lung transplant because of acquired diseases (e.g., chronic obstructive pulmonary disease). VA believes that due to the acquired conditions, the lung transplant population is a better characterization of the population of veterans who could receive this procedure and therefore be entitled to compensation. Based on this, VA intends to grant a 100% assessment for lung transplants and for one year after discharge from the hospital for such surgery. Subsequently, in accordance with other respiratory diseases, VA will base the assessment on residues according to the proposed general assessment formula, but with a minimum score of 30%. See Lisa Cicutto et al., “Factors Affecting Attainment of Paid Employment After Lung Transplantation,” 23 J. Heart-Lung Transplantation 481-86 (2004); see also Dmitry Tumin et al., “Attained Functional Status Moderate Functional Outcomes of Return to Work After Lung Transplantation,” 194 Lung 437-45 (2016). Diseases of the genitourinary system usually lead to disabilities associated with kidney or emptying disorders, infections or a combination of these. The following section provides descriptions of the different degrees of disability in each of these symptom domains. If the diagnostic codes refer the decision-maker to these specific areas of dysfunction, only the predominant area of dysfunction should be taken into account for evaluation purposes. Different disabilities may be assessed separately in accordance with § 4.14 in accordance with § 4.14 if the symptoms do not overlap.

Since the areas of dysfunction described below do not cover all symptoms resulting from genitourinary disease, specific diagnoses may include a description of the symptoms associated with that diagnosis. Specifically, VA suggests assigning a 0% rating if sleep apnea syndrome is asymptomatic, with or without treatment. VA would give a score of 10% if treatment results in “incomplete relief”. VA would assess ratings greater than 10% (e.g., 50 and 100 percent) only if the treatment is ineffective or if the Veteran is unable to use the prescribed treatment due to comorbidities. VA would only give a 100% rating if there was also damage to the final organs. VA proposes to include an information note that defines eligible comorbidities and provides examples, i.e., conditions that, in the opinion of a qualified medical service provider, directly impede or impede the application or implementation of a recognized form of therapeutic intervention that is normally effective. Recognition of tinnitus for evaluation purposes dates back to at least 1925, when evaluators were ordered to “add 15 [percent] to hearing loss as a combined assessment.” “The Schedule for Rating of Disability Ratings,” U.S. Veterans` Bureau, Table II, p. 59 (ed. 1925). As a result, tinnitus was assessed in conjunction with hearing loss and not as a disease in itself. In a final rule published in 1976, the VA endpoints recognized tinnitus for assessment purposes when it “[p]ersistt as a symptom of head injuries, concussions, or acoustic trauma.” 41 FR 11291, 11298 (18 March 1976).

In a final rule published in 1999, motivated in part by efforts to standardize tinnitus assessments beyond these three specific violations, the regulation was amended to give a single 10% rating without mentioning the underlying condition that leads to tinnitus. 64 FR 25202, 25206 (11 May 1999). Although not provided for by VA, this regulation has given the impression that tinnitus is an independent condition and not a symptom associated with an underlying condition. VA`s intention with the currently proposed revision is to accurately restore the medically substantiated relationship between tinnitus and an underlying pathology in accordance with current medical practice. In der Rechtssache Doucette v. Shulkin, 28 Vet. App. 366, 373 (2017), the U.S. Court of Appeals for Veterans Claims emphasized the potential value if VA “provides additional guidance on the symptoms that the assessment criteria [for hearing loss] consider.” Doucette participated in a veteran who advocated extra-gay consideration under 38 CFR 3,321(b)(1) because her hearing loss caused difficulty distinguishing sounds in an overcrowded environment, locating the source of sounds, understanding conventional speech, hearing television, and using the telephone. Id.

at p. 371. The Court held that such functional effects of decreased hearing and difficulty understanding speech in a daily environment were taken into account by the schedule assessment criteria, id. at 369, 371-72, although one dissenting judge held that the “criteria are not sufficient to account for a veteran`s functional impact and the overall picture of disability.” Id. at p. 374 (Schoelen, J., deviant). Home Print Page 8481 All correspondence relating to the interpretation of the disability assessment schedule, requests for expert advice, questions of ambiguity or application to individual cases of unusual difficulties will be directed to the Director, Compensation Services. A clear statement is made on the point(s) to which the information is requested, and the complete file is simultaneously transmitted to the registered office. Credit rating agencies will ensure that the latest physical examination report gives an adequate picture of the applicant`s condition. Allegations for which schedule assessments are considered insufficient or excessive and errors in the schedule are also brought to the attention.

First of all, VA proposes to rename this code to DC 6235 in accordance with § 4.87. Second, VA suggests renaming this code to “rhinosinusitis, autoimmune, granulomatous, or other causes” to update the terminology.