[Federal Register Volume 67, Number 209 (Tuesday, October 29, 2002)]
[Proposed Rules]
[Pages 65915-65916]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-27408]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 4

RIN 2900-AL32


Schedule for Rating Disabilities; Evaluation of Multiple Scars

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: This document proposes to amend that portion of the Department 
of Veterans Affairs (VA) Schedule for Rating Disabilities that 
addresses the Skin in order to clarify how to evaluate multiple 
superficial or deep scars in a uniform and consistent manner.

DATES: Comments must be received by VA on or before December 30, 2002.

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; or fax comments to 
(202) 273-9289; or e-mail comments to [email protected]. 
Comments should indicate that they are submitted in response to ``RIN 
2900-AL32.'' All comments received will be available for public 
inspection in the Office of Regulations Management, Room 1158, between 
the hours of 8 a.m. and 4:30 p.m., Monday through Friday (except 
holidays).

FOR FURTHER INFORMATION CONTACT: Caroll McBrine, M.D., Consultant, 
Regulations Staff (211A), Compensation and Pension Service, Veterans 
Benefits Administration, Department of Veterans Affairs, 810 Vermont 
Ave., NW., Washington, DC 20420, (202) 273-7230.

SUPPLEMENTARY INFORMATION: This document proposes to amend the 
Department of Veterans Affairs (VA) Schedule for Rating Disabilities 
(38 CFR part 4) by revising Sec.  4.118, that portion of the Schedule 
that addresses scars. It would clarify the method of evaluating 
multiple superficial and deep scars and provide directions that promote 
consistent evaluations.
    A current note under diagnostic codes 7801 (scars, other than head, 
face, or neck, that are deep or that cause limited motion) and 7802 
(scars, other than head, face, or neck, that are superficial and that 
do not cause limited motion) in Sec.  4.118 of VA's Schedule for Rating 
Disabilities (38 CFR part 4) directs that scars in widely separated 
areas, as on two or more extremities or on anterior and posterior 
surfaces of extremities or trunk, be separately rated and combined in 
accordance with 38 CFR 4.25 (Combined ratings table).
    The current rating schedule provides an evaluation level of 10 
percent under diagnostic code 7803 for superficial unstable scars and 
under diagnostic code 7804 for superficial painful scars. However, it 
provides no guidance on whether or not each painful or unstable scar, 
no matter how small or close together, should be separately evaluated. 
Examples where this might be an issue are multiple scars stemming from 
a grenade explosion or from certain surgical procedures, such as 
numerous ligations of varicose veins on a single leg. This lack of 
guidance has led to inconsistent evaluations because raters are unsure 
whether each unstable or painful scar calls for a separate evaluation. 
Therefore, we propose to revise the rating schedule to clarify how 
multiple superficial unstable or painful scars are to be evaluated.
    The provision concerning the evaluation of multiple scars under 
diagnostic codes 7801 and 7802 has been in effect for many years. 
Diagnostic codes 7803 and 7804 both address superficial scars, which 
are, by virtue of the lesser extent of tissue damage, inherently less 
seriously disabling than deep scars, which are evaluated under 
diagnostic code 7801. It would, therefore, be neither appropriate nor 
internally consistent to assign a separate evaluation for each painful 
or unstable superficial scar, while assigning only a single evaluation 
for multiple deep scars, unless they are in widely separated areas. 
Disproportionately high evaluations for superficial scars would result 
if that were done. Therefore, we propose to evaluate multiple 
superficial scars under diagnostic codes 7803 and 7804 in the same 
manner that multiple deep and superficial scars are evaluated under 
diagnostic codes 7801 and 7802. The issues related to evaluation are 
similar, and evaluating multiple scars of all four types in the same 
manner would promote fair and consistent handling of multiple scars, 
result in equitable evaluations, and remove any ambiguity about their 
evaluation. We propose to provide three notes at the beginning of Sec.  
4.118 providing directions for evaluating multiple scars evaluated 
under diagnostic codes 7801, 7802, 7803, and 7804.
    The first note would explain that scars located in two or more of 
the following locations are considered to be in widely separated areas 
of the body: the anterior surface of the left upper extremity, the 
anterior surface of the right upper extremity, the posterior surface of 
the left upper extremity, the posterior surface of the right upper 
extremity, the anterior surface of the left lower extremity, the 
anterior surface of the right lower extremity, the posterior surface of 
the left lower extremity, the posterior surface of the right lower 
extremity, the anterior surface of the trunk, the posterior surface of 
the trunk, and the head, face, and neck. This represents a rewording of 
part of the current note under diagnostic codes 7801 and 7802.
    The second note would direct raters to assign a single evaluation 
for all superficial scars in each widely separated area of the body. 
This is also a rewording of part of the current note under diagnostic 
codes 7801 and 7802, and would apply to diagnostic codes 7802, 7803, 
and 7804, the three codes under which superficial scars are evaluated. 
Since there is the possibility that one or more multiple superficial 
scars might have characteristics that would allow evaluation under more 
than one of the diagnostic codes from 7802 to 7804, the note also 
directs raters to increase the evaluation for scar(s) in each widely 
separated area of the body by 10 percent if any of the scars in a given 
area meet the criteria for evaluation under at least two diagnostic 
codes (among 7802, 7803, or 7804).
    The third note would apply to deep scars and directs raters to 
assign a single evaluation for all deep scars in each widely separated 
area of the body. This is not a substantive change from the current 
direction.
    We propose an additional change under diagnostic code 7801 in order 
to eliminate possible confusion about scars that fall between the sizes 
indicated at various percentage levels. Ten percent would be assigned 
for area or areas of at least 6 square inches (39 sq. cm.) but less 
than 12 square inches (77 sq. cm.), 20 percent for area or areas of at 
least 12 square inches (77 sq. cm.) but less than 72 square inches (465 
sq. cm.), 30 percent for area or areas of at least 72 square inches 
(465 sq. cm.) but less than

[[Page 65916]]

144 square inches (929 sq. cm.), and 40 percent for area or areas of 
144 square inches (929 sq. cm.) or greater.

Unfunded Mandates

    The Unfunded Mandates Reform Act requires, at 2 U.S.C. 1532, that 
agencies prepare an assessment of anticipated costs and benefits before 
developing any rule that may result in an expenditure by State, local, 
or tribal governments, in the aggregate, or by the private sector of 
$100 million or more in any given year. This rule would have no 
consequential effect on State, local, or tribal governments.

Paperwork Reduction Act

    This document contains no provisions constituting a collection of 
information under the Paperwork Reduction Act (44 U.S.C. 3501-3520).

Executive Order 12866

    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.

Regulatory Flexibility Act

    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 these 
amendments would not directly affect any small entities. Only VA 
beneficiaries could be directly affected. Therefore, pursuant to 5 
U.S.C. 605(b), these amendments are exempt from the initial and final 
regulatory flexibility analysis requirements of sections 603 and 604.

(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: October 3, 2002.
Anthony J. Principi,
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, unless otherwise noted.

    2. Section 4.118 is amended by:
    A. Adding three Notes immediately before diagnostic code 7800.
    B. Revising diagnostic codes 7801 and 7802.
    The addition and revision read as follows:


Sec.  4.118  Schedule of ratings--skin.

    Notes to the Schedule of Ratings for Skin: (1) For purposes of 
evaluating scars, scars located in two or more of the following 
locations are considered to be in widely separated areas of the 
body:
    (a) The anterior surface of the left upper extremity.
    (b) The anterior surface of the right upper extremity.
    (c) The posterior surface of the left upper extremity.
    (d) The posterior surface of the right upper extremity.
    (e) The anterior surface of the left lower extremity.
    (f) The anterior surface of the right lower extremity.
    (g) The posterior surface of the left lower extremity.
    (h) The posterior surface of the right lower extremity.
    (i) The anterior surface of the trunk.
    (j) The posterior surface of the trunk.
    (k) The head, face, and neck.
    (2) Assign a single evaluation for all superficial scars in each 
widely separated area of the body. Increase the evaluation for 
scar(s) in each widely separated area of the body by 10 percent if 
any of the scars in a given area meet the criteria for evaluation 
under at least two diagnostic codes (among 7802, 7803, or 7804).
    (3) Assign a single evaluation for all deep scars in each widely 
separated area of the body.
* * * * *
7801 Scars, other than head, face, or neck, that are deep or that 
cause limited motion:
    Area or areas of 144 square inches (929 sq. cm.) or greater--40
    Area or areas of at least 72 square inches (465 sq. cm.) but 
less than 144 square inches (929 sq. cm.)--30
    Area or areas of at least 12 square inches (77 sq. cm.) but less 
than 72 square inches (465 sq. cm.)--20
    Area or areas of at least 6 square inches (39 sq. cm.) but less 
than 12 square inches (77 sq. cm.)--10

    Note: A deep scar is one associated with underlying soft tissue 
damage.


7802 Scars, other than head, face, or neck, that are superficial and 
that do not cause limited motion:
    Area or areas of 144 square inches (929 sq. cm.) or greater--10

    Note: A superficial scar is one not associated with underlying 
soft tissue damage.

* * * * *

[FR Doc. 02-27408 Filed 10-28-02; 8:45 am]
BILLING CODE 8320-01-P