[Federal Register Volume 59, Number 11 (Tuesday, January 18, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-1046]


[[Page Unknown]]

[Federal Register: January 18, 1994]


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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 4

RIN 2900-AF41

 

Schedule for Rating Disabilities; Dental and Oral Conditions

AGENCY: Department of Veterans Affairs.

ACTION: Final regulation.

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SUMMARY: The Department of Veterans Affairs (VA) has amended that 
portion of its Schedule for Rating Disabilities which deals with dental 
and oral conditions. This amendment is based on a General Accounting 
Office study noting that there has been no comprehensive review of the 
rating schedule since 1945, and recommending that such a review be 
conducted. The effect of this action is to update this portion of the 
rating schedule to ensure that it uses current medical terminology, 
unambiguous criteria, and that it reflects medical advances which have 
occurred since the last review.

DATES: This amendment is effective February 17, 1994.

FOR FURTHER INFORMATION CONTACT: Bob Seavey, Consultant, Regulations 
Staff, Compensation and Pension Service, Veterans Benefits 
Administration, Department of Veterans Affairs, 810 Vermont Avenue NW., 
Washington, DC 20420, (202) 233-3005.

SUPPLEMENTARY INFORMATION: In December 1988, the General Accounting 
Office recommended that VA prepare a plan for a comprehensive review of 
the rating schedule and, based on the results, revise the medical 
criteria accordingly. As part of the process to implement these 
recommendations, VA published a proposal to amend 38 CFR 4.150 in the 
Federal Register of January 19, 1993 (58 FR 4961-2). Interested persons 
were invited to submit written comments, suggestions or objections on 
or before March 22, 1993. We received one comment from the Veterans of 
Foreign Wars.
    For limited motion of the temporomandibular joint under diagnostic 
code 9905, we proposed evaluation criteria containing precise ranges of 
limited inter-incisal motion and lateral excursion. For a 10 percent 
evaluation under limited inter-incisal movement, we proposed a range of 
31 to 40 millimeters. The commenter suggested that we replace this 
criterion with the phrase ``any limitation of motion interfering with 
mastication or speech,'' which was essentially the same requirement for 
a 10 percent evaluation under diagnostic code 9905 in the 1945 Rating 
Schedule.
    We do not concur with the suggested change. One of our goals in 
reviewing the rating schedule is to eliminate ambiguous rating 
criteria. One means of accomplishing this is to make the criteria as 
objective as possible. Inter-incisal measurements are a commonly 
accepted standard for objectively assessing movement of the 
temporomandibular joint, and their use will ensure that comparable 
medical conditions are assigned comparable evaluations. Since the 
maximum inter-incisal opening is between 40 and 60 millimeters, 31 to 
40 millimeters represents the lowest range of limitation which might 
interfere with mastication or speech while preserving an objective 
standard. For these reasons, we do not believe any change in the 
proposed criteria is warranted.
    VA appreciates the comment submitted in response to the proposed 
rule, which is now adopted without amendment.
    The Secretary hereby certifies that this regulatory amendment will 
not have a significant economic impact on a substantial number of small 
entities as they are defined in the Regulatory Flexibility Act, 5 
U.S.C. 601-612. The reason for this certification is that this 
amendment would not directly affect any small entities. Only VA 
beneficiaries could be directly affected. Therefore, pursuant to 5 
U.S.C. 605(b), this amendment is exempt from the initial and final 
regulatory flexibility analysis requirements of sections 603 and 604.
    In accordance with Executive Order 12291, Federal Regulation, the 
Secretary has determined that this regulatory amendment is non-major 
for the following reasons:
    (1) It will not have an annual impact on the economy of $100 
million or more.
    (2) It will not cause a major increase in costs or prices.
    (3) It will not have significant adverse effects on competition, 
employment, investment, productivity, innovation, or on the ability of 
United States-based enterprises to compete with foreign-based 
enterprises in domestic or export markets.
    The Catalog of Federal Domestic Assistance numbers are 64.104 and 
64.109.

List of Subjects in 38 CFR Part 4

    Handicapped, Pensions, Veterans.

    Approved: August 19, 1993.
Jesse Brown,
Secretary of Veterans Affairs.
    For the reasons set out in the preamble, 38 CFR part 4, subpart B, 
is amended as set forth below:

PART 4--SCHEDULE FOR RATING DISABILITIES

Subpart B--Disability Ratings

    1. The authority citation for part 4 continues to read as follows:

    Authority: 72 Stat. 1125; 38 U.S.C. 1155.

    2. Section 4.149 is added under the undesignated center heading `` 
Dental and Oral Conditions'' to read as follows:


Sec. 4.149  Rating diseases of the teeth and gums.

    Treatable carious teeth, replaceable missing teeth, dental or 
alveolar abscesses, periodontal disease (pyorrhea), and Vincent's 
stomatitis are not disabling conditions, and may be considered service-
connected solely for the purpose of determining entitlement to dental 
examinations or outpatient dental treatment under the provisions of 
Secs. 17.120 or 17.123 of this chapter.
    3. Section 4.150 is revised to read as follows:


Sec. 4.150  Schedule of ratings--dental and oral conditions. 

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                                                                  Rating
                                                                        
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9900Maxilla or mandible, chronic osteomyelitis or                       
 osteoradionecrosis of:                                                 
    Rate as osteomyelitis, chronic under diagnostic code 5000...        
9901Mandible, loss of, complete, between angles.................     100
9902Mandible, loss of approximately one-half:                           
    Involving temporomandibular articulation....................      50
    Not involving temporomandibular articulation................      30
9903Mandible, nonunion of:                                              
    Severe......................................................      30
    Moderate....................................................      10
    Note--Dependent upon degree of motion and relative loss of          
     masticatory function.......................................        
9904Mandible, malunion of:                                              
    Severe displacement.........................................      20
    Moderate displacement.......................................      10
    Slight displacement.........................................       0
    Note--Dependent upon degree of motion and relative loss of          
     masticatory function.......................................        
9905Temporomandibular articulation, limited motion of:                  
    Inter-incisal range:                                                
        0 to 10 mm..............................................      40
        11 to 20 mm.............................................      30
        21 to 30 mm.............................................      20
        31 to 40 mm.............................................      10
    Range of lateral excursion:                                         
        0 to 4 mm...............................................      10
    Note--Ratings for limited inter-incisal movement shall not          
     be combined with ratings for limited lateral excursion.....        
9906Ramus, loss of whole or part of:                                    
    Involving loss of temporomandibular articulation                    
        Bilateral...............................................      50
        Unilateral..............................................      30
    Not involving loss of temporomandibular articulation                
        Bilateral...............................................      30
        Unilateral..............................................      20
9907Ramus, loss of less than one-half the substance of, not             
 involving loss of continuity:                                          
    Bilateral...................................................      20
    Unilateral..................................................      10
9908Condyloid process, loss of, one or both sides...............      30
9909Coronoid process, loss of:                                          
    Bilateral...................................................      20
    Unilateral..................................................      10
9911Hard palate, loss of half or more:                                  
    Not replaceable by prosthesis...............................      30
    Replaceable by prosthesis...................................      10
9912Hard palate, loss of less than half of:                             
    Not replaceable by prosthesis...............................      20
    Replaceable by prosthesis...................................       0
9913Teeth, loss of, due to loss of substance of body of maxilla         
 or mandible without loss of continuity:                                
    Where the lost masticatory surface cannot be restored by            
     suitable prosthesis:                                               
        Loss of all teeth.......................................      40
        Loss of all upper teeth.................................      30
        Loss of all lower teeth.................................      30
        All upper and lower posterior teeth missing.............      20
        All upper and lower anterior teeth missing..............      20
        All upper anterior teeth missing........................      10
        All lower anterior teeth missing........................      10
        All upper and lower teeth on one side missing...........      10
    Where the loss of masticatory surface can be restored by            
     suitable prosthesis........................................       0
    Note--These ratings apply only to bone loss through trauma          
     or disease such as osteomyelitis, and not to the loss of           
     the alveolar process as a result of periodontal disease,           
     since such loss is not considered disabling................        
9914Maxilla, loss of more than half:                                    
    Not replaceable by prosthesis...............................     100
    Replaceable by prosthesis...................................      50
9915Maxilla, loss of half or less:                                      
    Loss of 25 to 50 percent:                                           
        Not replaceable by prosthesis...........................      40
        Replaceable by prosthesis...............................      30
    Loss of less than 25 percent:                                       
        Not replaceable by prosthesis...........................      20
        Replaceable by prosthesis...............................       0
9916Maxilla, malunion or nonunion of:                                   
    Severe displacement.........................................      30
    Moderate displacement.......................................      10
    Slight displacement.........................................      0 
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[FR Doc. 94-1046 Filed 1-14-94; 8:45 am]
BILLING CODE 8320-01-P