[Federal Register Volume 77, Number 26 (Wednesday, February 8, 2012)]
[Rules and Regulations]
[Pages 6466-6467]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-2883]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 4

RIN 2900-AN75


Schedule for Rating Disabilities; AL Amyloidosis (Primary 
Amyloidosis)

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: The Department of Veterans Affairs (VA) is amending its 
Schedule for Rating Disabilities by updating the schedule of ratings 
for the hemic and lymphatic systems to include AL amyloidosis. This 
regulatory action is necessary to add AL amyloidosis as one of the 
disease conditions and establish criteria for disability evaluation to 
fully implement the decision by the Secretary of Veterans Affairs to 
grant presumptive service connection based on herbicide exposure for 
this disease. The intended effects are to provide consistency in 
disability ratings and to ease tracking of AL amyloidosis for 
statistical analysis.

DATES: Effective Date: This final rule is effective March 9, 2012.
    Applicability Date: This final rule applies to an application for 
benefits that:
     Is received by VA on or after March 9, 2012;
     Was received by VA before March 9, 2012 but has not been 
decided by a VA regional office as of that date;
     Is appealed to the Board of Veterans' Appeals on or after 
March 9, 2012;
     Was appealed to the Board before March 9, 2012 but has not 
been decided by the Board as of that date; or
     Is pending before VA on or after March 9, 2012 because the 
Court of Appeals for Veterans Claims vacated a Board decision on the 
application and remanded it for readjudication.

FOR FURTHER INFORMATION CONTACT: Thomas J. Kniffen, Chief, Regulations 
Staff (211D), 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 number.)

SUPPLEMENTARY INFORMATION: On October 22, 2010, VA published in the 
Federal Register (75 FR 65279) a proposed rule that would add AL 
amyloidosis to VA's Schedule for Rating Disabilities to update the 
schedule of ratings for the hemic and lymphatic systems, 38 CFR 4.117, 
by creating diagnostic code 7717. The schedule previously did not 
contain a diagnostic code for AL amyloidosis. As an unlisted condition, 
it has been rated by analogy to non-Hodgkin's lymphoma using the 
``built-up'' diagnostic code 7799-7715. However, AL amyloidosis 
requires a set of evaluation criteria with a unique diagnostic code, to 
serve as a basis for disability rating, because the condition is not 
part of the group of diseases under the non-Hodgkin's lymphoma 
classification, but, rather, a disorder of the bone marrow 
characterized by the accumulation and deposition of abnormal, insoluble 
proteins called light chain amyloid proteins in any organ of the body, 
interfering with the structure and function of the organ. Additionally, 
adding the diagnostic code would establish criteria for disability 
evaluation to fully implement the decision by the Secretary of Veterans 
Affairs to grant presumptive service connection based on herbicide 
exposure for this disease. A final rule regarding that decision was 
published in the Federal Register at 74 FR 21258, which amended 38 CFR 
3.309(e) by adding AL amyloidosis to the list of diseases associated 
with exposure to certain herbicide agents. For these reasons, VA 
proposed a regulation that would amend VA's Schedule of Rating 
Disabilities by adding rating guidance and a diagnostic code 
specifically for AL amyloidosis.
    VA proposed diagnostic code 7717 for AL amyloidosis because it was 
the first available diagnostic code in the Hemic and Lymphatic Systems 
listed in Sec.  4.117. VA proposed to assign a 100 percent rating 
because the disease is incurable and progressive, generally causing 
death in a few years. Providing a 100-percent evaluation in all cases 
would obviate the need to repeatedly reassess and reevaluate veterans 
with AL amyloidosis over a short period of time. Because of the poor 
prognosis, no follow-up examination will be required for re-evaluation 
of this disability rating. VA also proposed to refer to AL amyloidosis 
in diagnostic code 7717 as ``primary amyloidosis,'' which is another 
common name for the same disease. VA also proposed to amend 38 CFR Part 
4, Appendices A, B, and C to reflect the proposed addition of 
diagnostic code 7717 for AL amyloidosis to the rating schedule.

Comment in Response to Proposed Rule

    A 60-day comment period ended December 21, 2010, and we received 
one comment from a member of the general public. The comment expressed 
support for the rule. We are not making any changes in the final rule 
based on this supportive comment.
    As no further comments were received, we thus are making no changes 
to the proposed rule. Therefore, based on the rationale set forth in 
the proposed rule and this document, we are adopting the provisions of 
the proposed rule as a final rule with no changes.

Unfunded Mandates

    The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 
1532, that agencies prepare an assessment of anticipated costs and 
benefits before issuing any rule that may result in an expenditure by 
State, local, and tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any given year. This rule will have no such effect on 
State, local, and tribal governments, or on the private sector.

Executive Orders 12866 and 13563

    Executive Orders 12866 and 13563 direct agencies to assess the 
costs and benefits of available regulatory alternatives and, when 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, and other advantages; distributive impacts; 
and equity). Executive Order 13563 (Improving Regulation and Regulatory 
Review) emphasizes the importance of quantifying both costs and 
benefits, reducing costs, harmonizing rules, and promoting flexibility. 
Executive Order 12866 (Regulatory Planning and Review) defines a 
``significant regulatory action,'' which requires review by the Office 
of Management and Budget (OMB), as ``any regulatory action that is 
likely to result in a rule that may: (1) Have an annual effect on the 
economy of $100 million or more or adversely affect in a material way 
the economy, a sector of the economy, productivity, competition, jobs, 
the environment, public health or safety, or State, local, or tribal 
governments or communities; (2) Create a serious inconsistency or 
otherwise interfere with an action taken or planned by another agency; 
(3) Materially alter the budgetary impact of entitlements, grants, user 
fees, or loan programs or the rights and obligations of recipients 
thereof; or (4) Raise novel legal or policy issues arising out of legal 
mandates, the President's priorities, or the principles set forth in 
this Executive Order.''

[[Page 6467]]

    The economic, interagency, budgetary, legal, and policy 
implications of this regulatory action have been examined and it has 
been determined not to be a significant regulatory action under 
Executive Order 12866.

Paperwork Reduction Act

    This document contains no provisions constituting a collection of 
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3521).

Regulatory Flexibility Act

    The Secretary hereby certifies that this final rule 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 rule could affect only VA beneficiaries and will not directly 
affect small entities. Therefore, pursuant to 5 U.S.C. 605(b), this 
rule is exempt from the initial and final regulatory flexibility 
analyses requirements of sections 603 and 604.

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance program numbers and 
titles for this rule are as follows: 64.109, Veterans Compensation for 
Service-Connected Disability; and 64.110, Veterans Dependency and 
Indemnity Compensation for Service-Connected Death.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. John R. 
Gingrich, Chief of Staff, Department of Veterans Affairs, approved this 
document on February 2, 2012, for publication.

List of Subjects in 38 CFR Part 4

    Disability benefits, Pensions, Veterans.

    Dated: February 3, 2012.
Robert C. McFetridge,
Director of Regulation Policy and Management, Office of the General 
Counsel, Department of Veterans Affairs.

    For the reasons set out in the preamble, 38 CFR part 4 is amended 
as set forth below:

PART 4--SCHEDULE FOR RATING DISABILITIES

0
1. The authority citation for part 4 continues to read as follows:

    Authority: 38 U.S.C. 1155, unless otherwise noted.

Subpart B--Disability Ratings


Sec.  4.117  [Amended]

0
2. In Sec.  4.117, add diagnostic code 7717, immediately following the 
note at the end of diagnostic code 7716, to read as follows:


Sec.  4.117  Schedule of ratings--hemic and lymphatic systems.

------------------------------------------------------------------------
                                                                 Rating
------------------------------------------------------------------------
 
                                * * * * *
7717 AL amyloidosis (primary amyloidosis)....................        100
------------------------------------------------------------------------


0
3. In Appendix A to part 4, under Sec. 4.117, add diagnostic code 7717 
in numerical order (following diagnostic code number 7716) to the table 
to read as follows:

Appendix A to Part 4--Table of Amendments and Effective Dates Since 
1946


------------------------------------------------------------------------
                            Diagnostic
           Sec.              Code No.
------------------------------------------------------------------------
 
                                * * * * *
4.117....................
 
                                * * * * *
                                  7717  Added 3/9/2012.
 
                                * * * * *
------------------------------------------------------------------------


0
4. In Appendix B to part 4 add diagnostic code 7717 to the table in 
numerical order (following the entry for diagnostic code number 7716) 
and its disability entry ``AL amyloidosis (primary amyloidosis)'' to 
read as follows:

Appendix B to Part 4--Numerical Index of Disabilities

------------------------------------------------------------------------
            Diagnostic Code No.
------------------------------------------------------------------------
THE HEMIC AND LYMPHATIC SYSTEMS
------------------------------------------------------------------------
 
                                * * * * *
7717......................................  AL amyloidosis (primary
                                             amyloidosis).
 
                                * * * * *
------------------------------------------------------------------------


0
5. Appendix C to part 4 is amended by adding in alphabetical order 
(following ``Agranulocytosis'') a new entry ``AL amyloidosis'' and its 
diagnostic code number ``7717'' to read as follows:

Appendix C to Part 4--Alphabetical Index of Disabilities


------------------------------------------------------------------------
                                                         Diagnostic Code
                                                               No.
------------------------------------------------------------------------
 
                                * * * * *
AL amyloidosis........................................              7717
 
                                * * * * *
------------------------------------------------------------------------


[FR Doc. 2012-2883 Filed 2-7-12; 8:45 am]
BILLING CODE 8320-01-P