VA Proposes Changes to Digestive System Ratings Schedule (by Danielle Alush and Jennifer Morrell, Widener University Delaware Law School)

The Department of Veterans Affairs (VA) has proposed to amend the section of the Schedule for Rating Disabilities that addresses the digestive system—38 C.F.R. § 4.110-4.114. The changes include the addition of new medical conditions and new diagnostic codes (DCs), revision and clarification of rating criteria, and--according to VA--updating terminology to reflect the most up-to-date medical knowledge and clinical practice of the gastroenterology and hepatology specialties.

According to VA, the update reflects recommendations from the 2007 report of the National Academy of Sciences, Institute of Medicine. VA also relied on the Rome Foundation, a non-profit organization that created a classification system for the various forms of gastrointestinal dysfunction, known as Rome IV.

The following are some of the proposed changes:

· Ulcers—According to VA, advancements in medicine indicate that most peptic ulcers are caused by infection (Helicobacter pylori) or the use of pharmaceuticals such as aspirin or other non-steroidal anti-inflammatory drugs and not caused by location. The VA proposes to eliminate outdated instructions such as Section 4.110 and DCs 7304-06, all of which classify ulcers by location.

· Dumping syndrome—VA proposes to rate dumping syndrome under the new DC 7303, "Chronic complications of upper gastrointestinal surgery," which covers surgeries on the esophagus, stomach, pancreas, and small intestine, including bariatric surgery. In addition, VA proposes to eliminate Section 4.11, as the material in it becomes superfluous once the new DC takes effect.

· Weight Loss—In the current ratings schedule, weight loss requirements vary across numerous different conditions. VA proposes to rename section 4.112 “Weight loss and nutrition” and substantially revise the definitions contained therein to achieve greater uniformity in decision-making. The updated section includes four main definitions: Weight loss, baseline weight, undernutrition, and nutritional support. Finally, the new section would allow the use of either the Hamwi formula for ideal body weight (IBW) or the Body Mass Index (BMI) table in assessing “baseline weight.”

· GERD—VA currently rates GERD analogous to hiatal hernia under diagnostic code 7346. In the proposed changes, VA would assign GERD its own diagnostic code (7206), but VA would continue rating the condition by analogy, this time using the diagnostic code for esophageal stricture, DC 7203.

· Other new diagnostic codes—A number of new codes proposed in this comment are intended to provide more specificity and possibly a more gainful rating to claimants, according to VA. The new codes include gastroesophageal reflux disease (DC 7206—mentioned above), Barrett's esophagus (DC 7207), chronic complications of upper gastrointestinal surgery (DC 7303), liver abscess (DC 7350), pancreas transplant (DC 7352), celiac disease (DC 7355), gastrointestinal dysmotility syndrome (DC 7356), and post pancreatectomy syndrome (DC 7357).

VA’s proposed changes can be found here. Comments are due by March 14, 2022.