[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
