[Federal Register Volume 86, Number 214 (Tuesday, November 9, 2021)]
[Rules and Regulations]
[Pages 62095-62096]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-24419]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 4

RIN 2900-AQ67


Schedule for Rating Disabilities: The Cardiovascular System

AGENCY: Department of Veterans Affairs.

ACTION: Final rule; correction.

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SUMMARY: On September 30, 2021, the Department of Veterans Affairs (VA) 
published in the Federal Register a final rule that amended the portion 
of the VA Schedule for Rating Disabilities (``VASRD'' or ``rating 
schedule'') that addresses the cardiovascular system. This correction 
addresses the instructions for evaluating peripheral arterial disease 
in the published final rule and corrects another minor technical error.

DATES: This correction is effective November 14, 2021.

FOR FURTHER INFORMATION CONTACT:  Gary Reynolds, M.D., VASRD Program 
Management Office (210), Compensation Service, Veterans Benefits 
Administration, Department of Veterans Affairs, 810 Vermont Avenue NW, 
Washington, DC 20420, (202) 461-9700. (This is not a toll-free 
telephone number.)

SUPPLEMENTARY INFORMATION: VA is correcting its final rule, ``RIN 2900-
AQ67, Schedule for Rating Disabilities: The Cardiovascular System'', 
that was published on September 30, 2021, in the Federal Register at 86 
FR 54089. The error is with new Note (2) for diagnostic code (DC) 7114 
peripheral arterial disease which fails to identify which of the four 
tests are necessary before an evaluation can be assigned. In the 
proposed rule, VA identified two major shortcomings in the rating 
criteria for DC 7114 that were addressed by creating evaluation 
criteria that use the ankle/brachial index (ABI), ankle pressure (AP), 
toe pressure (TP) and transcutaneous oximetry 
(TcPO2) to describe four different levels of 
impairment. See 84 FR 37594, 37599 (Aug. 1, 2019). New Note (2) 
instructed raters to select the highest impairment value of ABI, AP, 
TP, or TcPO2 for evaluation when rating a 
condition under DC 7114. Upon further consideration, we believe the 
note could be misconstrued as requiring medical examiners to conduct 
all four tests. This is inconsistent with our intent, which was to 
provide examiners with multiple options in the event that ABI was 
unreliable due to non-compressible arteries. To address this issue, we 
are correcting new Note (2) to read, ``If AP, TP, and 
TcPO2 testing are not of record, evaluate based 
on ABI unless the examiner states that an AP, TP, or 
TcPO2 test is needed in a particular case because 
ABI does not sufficiently reflect the severity of the veteran's 
peripheral arterial disease. In all other cases, evaluate based on the 
test that provides the highest impairment value.'' This correction 
serves two purposes: (1) It reflects VA's intent that although ABI 
should be the primary testing by which conditions should be rated under 
DC 7114, raters should request AP, TP, or TcPO2 
testing when the record reflects that an examiner believes ABI testing 
does not sufficiently reflect a veteran's level of impairment, and (2) 
when multiple tests are of record, it allows the rater to select the 
test result that would grant the veteran the highest evaluation.
    Additionally, VA is fixing a technical error with the section 
heading for 38 CFR 4.100 to ensure that it is applicable to all 
diagnostic codes that could use the general rating formula for diseases 
of the heart in its evaluation criteria, such as DCs 7009 and 7110.

Correction

    In FR Rule Doc. No. 2021-19998, published September 30, 2021, at 86 
FR 54089, make the following corrections:


Sec.  4.100  [Corrected]

0
1. On page 54093, at the top of the third column, remove the section 
heading ``Sec.  4.100 Application of the evaluation criteria for 
diagnostic codes 7000-7007, 7011, and 7015-7020.'' and add in its place 
``Sec.  4.100 Application of the general rating formula for diseases of 
the heart.''

0
2. On page 54095, in Sec.  4.104, correct Note (2) in the entry for 
diagnostic code 7114 ``Peripheral arterial disease'' to read as 
follows:

[[Page 62096]]

Sec.  4.104  Schedule of ratings--cardiovascular system.

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                          Diseases of the Heart
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                                                              Rating
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                              * * * * * * *
7114 Peripheral arterial disease:
 
                              * * * * * * *
Note (2): If AP, TP, and TcPO2 testing are not of
 record, evaluate based on ABI unless the examiner
 states that an AP, TP, or TcPO2 test is needed in a
 particular case because ABI does not sufficiently
 reflect the severity of the veteran's peripheral
 arterial disease. In all other cases, evaluate based on
 the test that provides the highest impairment value....
 
                              * * * * * * *
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Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of 
the Secretary, Department of Veterans Affairs.
[FR Doc. 2021-24419 Filed 11-8-21; 8:45 am]
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