NOTE (1): A rating of 10 percent, as an excep-
tion to the amputation rule, is to be assigned
in any case of active osteomyelitis where the
amputation rating for the affected part is no
percent. This 10 percent rating and the other
partial ratings of 30 percent or less are to be
combined with ratings for ankylosis, limited
motion, nonunion or malunion, shortening,
etc., subject, of course, to the amputation
rule. The 60 percent rating, as it is based on
constitutional symptoms, is not subject to the
amputation rule. A rating for osteomyelitis will
not be applied following cure by removal or
radical resection of the affected bone.
NOTE (2): The 20 percent rating on the basis of
activity within the past 5 years is not assigna-
ble following the initial infection of active
osteomyelitis with no subsequent reactivation.
The prerequisite for this historical rating is an
established recurrent osteomyelitis. To qualify
for the 10 percent rating, 2 or more episodes
following the initial infection are required. This
20 percent rating or the 10 percent rating,
when applicable, will be assigned once only
to cover disability at all sites of previously
active infection with a future ending date in
the case of the 20 percent rating.

5001 Bones and joints, tuberculosis of, active or inactive:

Active.....

Inactive: See §§ 4.88b and 4.89..

5002 Arthritis rheumatoid (atrophic) As an active process:

With constitutional manifestations associated
with active joint involvement, totally incapaci-
tating..

Less than criteria for 100% but with weight loss
and anemia productive of severe impairment
of health or severely incapacitating exacerba-
tions occurring 4 or more times a year or a
lesser number over prolonged periods.
Symptom combinations productive of definite
impairment of health objectively supported by
examination findings or incapacitating exacer-
bations occurring 3 or more times a year.
One or two exacerbations a year in a well-
established diagnosis

For chronic residuals:

For residuals such as limitation of motion or ankylosis, favorable or unfavorable, rate under the appropriate diagnostic codes for the specific joints involved. Where, however, the limitation of motion of the specific joint or joints involved is noncompensable under the codes a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5002. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.

NOTE: The ratings for the active process will not be combined with the residual ratings for limitation of motion or ankylosis. Assign the higher evaluation.

5003 Arthritis, degenerative (hypertrophic or osteoarthritis):

Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 pct is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as below: With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations

With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups

NOTE (1): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion. NOTE (2): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be utilized in rating conditions listed under diagnostic codes 5013 to 5024, inclusive. Arthritis, gonorrheal. 5005 Arthritis, pneumococcic.

100

5004

5006 Arthritis, typhoid.

5007 Arthritis, syphilitic.

5008 Arthritis, streptococcic.

5009 Arthritis, other types (specify).

With the types of arthritis, diagnostic codes 5004 through 5009, rate the disability as rheumatoid arthritis.

5010 Arthritis, due to trauma, substantiated by Xray findings: Rate as arthritis, degenerative.

5011

Bones, caisson disease of: Rate as arthritis, cord involvement, or deafness, depending on the severity of disabling manifestations. 5012 Bones, new growths of, malignant

NOTE: The 100 percent rating will be continued
for 1 year following the cessation of surgical,
X-ray, antineoplastic chemotherapy or other
therapeutic procedure. At this point, if there
has been no local recurrence or metastases,
the rating will be made on residuals.

5013 Osteoporosis, with joint manifestations.
5014 Osteomalacia.
5015 Bones, new growths of, benign.
5016 Osteitis deformans.
5017 Gout.

5018 Hydrarthrosis, intermittent.
5019 Bursitis.

5020 Synovitis.

5021 Myositis.

5022 Periostitis.

5023 Myositis ossificans. 5024 Tenosynovitis.

20

20

5051 Shoulder replacement (prosthesis). Prosthetic replacement of the shoulder joint:

For 1 year following implantation of prosthesis.

With chronic residuals consisting of severe, painful motion or weakness in the affected extremity........ With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic codes 5200 and 5203. Minimum rating..

5052 Elbow replacement (prosthesis). Prosthetic replacement of the elbow joint:

For 1 year following implantation of prosthesis....

With chronic residuals consisting of severe painful motion or weakness in the affected extremity... With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5205 through 5208.

Minimum evaluation..

5053 Wrist replacement (prosthesis). Prosthetic replacement of wrist joint: For 1 year following implantation of prosthesis..

With chronic residuals consisting of severe, painful motion or weakness in the affected extremity. With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic code 5214.

Minimum rating....

NOTE: The 100 pct rating for 1 year following implantation of prosthesis will commence after initial grant of the 1-month total rating assigned under §4.30 following hospital discharge.

5054 Hip replacement (prosthesis). Prosthetic replacement of the head of the femur or of the acetabulum: For 1 year following implantation of prosthesis..

20

20

50

30

50

100

60

60

30

100

40

40

20

20

30

30

20

20

of use below knee.
Anatomical loss or loss
of use above elbow
(preventing use of
prosthesis).

Anatomical loss or loss
of use above knee

(preventing use of
prosthesis).

Anatomical loss near

shoulder (preventing

use of prosthesis).
Anatomical loss near hip
(preventing use of
prosthesis).

NOTE.-Need for aid attendance or permanently bedridden qualifies for subpar. L. Code L-1 h, i (38 CFR 3.350(b)). Paraplegia with loss of use of both lower extremities and loss of anal and bladder sphincter control qualifies for subpar. O. Code O-2 (38 CFR 3.350(e)(2)). Where there are additional disabilities rated 50% or 100%, or anatomical or loss of use of a third extremity see 38 CFR 3.350(f) (3), (4) or (5).

(d) Amputation or resection of metacarpal bones (more than one-half the bone lost) in multiple fingers injuries will require a rating of 10 percent added to (not combined with) the ratings, multiple finger amputations, subject to the amputation rule applied to the forearm.

(e) Combinations of finger amputations at various levels, or finger amputations with ankylosis or limitation of motion of the fingers will be rated on the basis of the grade of disability; i.e., amputation, unfavorable ankylosis, most representative of the levels or combinations. With an even number of fingers involved, and adjacent grades of disability, select the higher of the two grades.

(f) Loss of use of the hand will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump with a suitable prosthetic applicance.

At

40

30

50

40

50

40

50

40

50

40

30

30

40

30

30

20

20

20

5150 Middle and little.
5151

(a) The ratings for multiple finger ampu-
tations apply to amputations at the
proximal interphalangeal joints or
through proximal phalanges.
(b) Amputation through middle pha-

langes will be rated as prescribed for unfavorable ankylosis of the fingers..... (c) Amputations at distal joints, or through distal phalanges, other than negligible losses, will be rated as prescribed for favorable ankylosis of the fingers....

At distal joint or through distal phalanx.... 5153 Index finger, amputation of

With metacarpal resection (more than one-half the bone lost)..

Without metacarpal resection, at proximal interphalangeal joint or proximal thereto.

Through middle phalanx or at distal joint

5154 Middle finger, amputation of:

With metacarpal resection (more than one-half the bone lost)..

Without metacarpal resection, at proximal interphalangeal joint or proximal thereto

5155 Ring finger, amputation of: With metacarpal resection (more than one-half the bone lost)..

Without metacarpal resection, at proximal interphalangeal joint or proximal thereto.

5156 Little finger, amputation of:

With metacarpal resection (more than
one-half the bone lost)..

Without metacarpal resection, at proxi-
mal interphalangeal joint or proximal
thereto.
NOTE: The single finger amputation rat-
ings are the only applicable ratings
for amputations of whole or part of
single fingers.