[Federal Register Volume 62, Number 36 (Monday, February 24, 1997)]
[Proposed Rules]
[Pages 8204-8205]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-4415]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 4
RIN 2900-AI22
Intervertebral Disc Syndrome
AGENCY: Department of Veterans Affairs.
ACTION: Proposed rule.
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SUMMARY: This document proposes to amend the Department of Veterans
Affairs (VA) Schedule for Rating Disabilities by revising the
evaluation criteria for diagnostic code 5293, intervertebral disc
syndrome. The intended effect of this amendment is to clarify the
criteria to ensure that veterans diagnosed with this condition meet
uniform criteria and receive consistent evaluations.
DATES: Comments must be received by VA on or before April 25, 1997.
ADDRESSES: Mail or hand deliver written comments to: Director, Office
of Regulations Management (02D), Department of Veterans Affairs, 810
Vermont Ave., NW, Room 1154, Washington DC 20420. Comments should
indicate that they are in response to ``RIN 2900-AI22.'' All written
comments will be available for public inspection at the above address
in the Office of Regulations Management, Room 1158, between the hours
of 8:00 a.m. and 4:30 p.m., Monday through Friday (except holidays).
FOR FURTHER INFORMATION CONTACT: Caroll McBrine, M.D., Consultant,
Regulations Staff (213A), Compensation and Pension Service, Veterans
Benefits Administration, Department of Veterans Affairs, 810 Vermont
Ave., NW, Washington, DC 20420, (202) 273-7230.
SUPPLEMENTARY INFORMATION: The central portion of one or more
intervertebral discs, cartilages that separate the spinal vertebrae,
may protrude or rupture through the outer fibrous part of the disc and
compress or irritate the adjacent nerve root. Intervertebral disc
syndrome is a group of signs and symptoms due to nerve root irritation
that commonly includes back pain and sciatica (pain along the course of
the sciatic nerve) in the case of lumbar disc disease, and neck and arm
or hand pain in the case of cervical disc disease. It may also include
scoliosis, paravertebral muscle spasm, limitation of motion of the
spine, tenderness over the spine, limitation of straight leg raising,
and neurologic findings corresponding to the level of the disc. If the
disc compresses the cauda equina (the collection of nerve roots
extending from the lower end of the spinal cord), bowel or bladder
sphincter functions or sexual function may also be affected.
Intervertebral disc syndrome has a variable course and variable
manifestations. Many people have a series of relapses and remissions of
back pain and sciatica over a long period of time with no symptoms
during remission; other patients experience chronic signs and symptoms.
The current evaluation criteria for intervertebral disc syndrome
(DC 5293) include: a 60-percent evaluation for persistent sciatic
neuropathy or other neurologic findings, with little intermittent
relief; a 40-percent evaluation for severe recurring attacks; a 20-
percent evaluation for moderate recurring attacks; a 10-percent
evaluation if the condition is mild; and a zero-percent evaluation if
the condition is postoperative, cured. These criteria require rating
agencies to make a subjective determination as to whether the condition
is ``mild,'' ``moderate,'' or ``severe.'' In addition, they raise
questions as to whether any neurologic manifestation, regardless of
severity, warrants a 60-percent evaluation, or whether intervertebral
disc syndrome with neurologic manifestations may be evaluated higher or
lower than 60 percent.
In order to clarify the evaluation criteria, and thereby assure
more consistent evaluations, we propose to eliminate subjective terms
such as mild, moderate, and severe in favor of more objective criteria,
and to provide specific instructions for evaluating both the orthopedic
and neurologic manifestations of intervertebral disc syndrome. We also
propose that these criteria apply both pre-operatively and post-
operatively.
We propose to evaluate intervertebral disc syndromes that are
primarily disabling because of periods of acute symptoms that require
bed rest according to the cumulative amount of time over the course of
a year that the patient is incapacitated, i.e., requires bed rest and
treatment by a physician. Incapacitating episodes of at least six weeks
total duration per year would be evaluated at 60 percent;
incapacitating episodes of at least four but less than six weeks total
duration per year at 40 percent; incapacitating episodes of at least
two but less than four weeks total duration per year at 20 percent; and
incapacitating episodes of at least one but less than two weeks total
duration per year at 10 percent. Evaluating the condition in this
manner will assure more consistent evaluations when the disc disease is
episodic because percentage evaluations will be assigned based on an
objective standard--yearly cumulative duration of incapacitating
episodes--rather than a subjective assessment of whether the condition
is mild, moderate, or severe.
We propose to evaluate intervertebral disc syndromes that are
disabling primarily because of chronic orthopedic manifestations (e.g.,
painful muscle spasm or limitation of motion), chronic neurologic
manifestations (e.g., footdrop, muscle atrophy, or sensory loss), or a
combination of both, by assigning separate evaluations for the
orthopedic and neurologic manifestations, using DC 5293 hyphenated with
the appropriate orthopedic or neurologic code. Assigning separate
evaluations for the orthopedic and neurologic manifestations will
assure that evaluations accurately reflect the actual disabling effects
of the condition, and that neurologic manifestations in particular will
not be over-or under-evaluated by being considered categorically rather
than individually.
When an intervertebral disc syndrome is disabling both because of
incapacitating episodes and persistent orthopedic or neurologic
manifestations, we propose that the rating agency use whichever
alternative method of evaluation results in a higher evaluation.
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 (RFA), 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),
[[Page 8205]]
this amendment is exempt from the initial and final regulatory
flexibility analysis requirements of sections 603 and 604.
This regulatory amendment has been reviewed by the Office of
Management and Budget under the provisions of Executive Order 12866,
Regulatory Planning and Review, dated September 30, 1993.
The Catalog of Federal Domestic Assistance program numbers are
64.104 and 64.109.
List of Subjects in 38 CFR Part 4
Disability benefits, Individuals with disabilities, Pensions,
Veterans.
Approved: November 5, 1996.
Jesse Brown,
Secretary of Veterans Affairs.
For the reasons set out in the preamble, 38 CFR part 4, subpart B,
is proposed to be amended as set forth below:
PART 4--SCHEDULE FOR RATING DISABILITIES
1. The authority citation for part 4 continues to read as follows:
Authority: 38 U.S.C. 1155.
2. Section 4.71a is amended by revising diagnostic code 5293 and
adding an authority citation at the end of the section to read as
follows:
Sec. 4.71a Schedule of ratings--musculoskeletal system.
The Spine
* * * * *
5293 Intervertebral disc syndrome:
Evaluate intervertebral disc syndrome (preoperatively or
postoperatively) based on either its chronic manifestations or on the
annual duration of incapacitating episodes, whichever results in a
higher evaluation.
With incapacitating episodes having a total duration of at least
six weeks per year...................................................60
With incapacitating episodes having a total duration of at least
four weeks but less than six weeks per year..........................40
With incapacitating episodes having a total duration of at least
two weeks but less than four weeks per year..........................20
With incapacitating episodes having a total duration of at least
one week but less than two weeks per year............................10
Note (1): An incapacitating episode of intervertebral disc syndrome
means a period of acute symptoms (orthopedic, neurologic, or both),
requiring bed rest and treatment by a physician.
Note (2): When evaluating on the basis of chronic manifestations,
evaluate orthopedic manifestations, such as limitation of motion of
lumbar or cervical spine, paravertebral muscle spasm, or scoliosis of
the spine, under DC 5293, using evaluation criteria for an appropriate
diagnostic code; evaluate neurologic manifestations, such as footdrop,
muscle atrophy, sensory loss, or neurogenic bladder separately under DC
5293, using evaluation criteria for an appropriate diagnostic code.
* * * * *
(Authority: 38 U.S.C. 1155.)
[FR Doc. 97-4415 Filed 2-21-97; 8:45 am]
BILLING CODE 8320-01-P