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Federal Register / Vol. 86, No. 187 / Thursday, September 30, 2021 / Rules and Regulations The same commenter stated that physicians at VA medical centers do not know and have no reasonable means to ascertain information related to the disability rating criteria associated with immersion foot injuries and related kidney dysfunction, in order to properly treat disabled veterans. Furthermore, the commenter discussed in detail his medical conditions and claims adjudication process. VA appreciates these comments; however, the comments relate to diagnosis and treatment of cardiovascular and renal conditions rather than disability evaluations in the rating schedule.
Therefore, these issues are not within the scope of this rulemaking. VA makes no changes based on these comments.

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VII. Proposed Changes to 4.115
In its proposed rule, VA deemed the first three sentences of 4.115
unnecessary and proposed to remove them. However, during its internal review and additional considerations of such removal, VA realized that further study of this action is warranted to account for complex relationships between cardiovascular and genitourinary disabilities.
Currently, VA does not assign separate evaluations for heart disease and any form of nephritis due to its close interrelationship with cardiovascular disabilities. However, VA can separately evaluate nonnephritis renal disease and cardiovascular disease e.g., diabetic nephropathy and coronary artery disease when complications do not overlap.
VA proposed new terminology for 4.115, but did not clearly define renal disease and its relationship with cardiovascular conditions. Thus, if the proposed changes were to be made effective, they might be interpreted as precluding separate evaluations for nonnephritis renal disease and cardiovascular disabilities. This was not an intended consequence of this rulemaking, and would be disadvantageous to veterans who suffer from service-connected renal and cardiovascular conditions.
Therefore, VA withdraws its proposal to revise 4.115. VA will review and update 4.115 during its next revision of the VA Rating Schedule for Disabilities.
VII. Technical Correction In the proposed rule, VA updated its general rating formula for renal dysfunction by replacing subjective criteria with specific, objective laboratory findings, such as the GFR and ACR. Upon further review, VA realized
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that it inadvertently omitted a reference to the period of evaluation for the GFR
and ACR values. VA makes a clarifying change in the text for the 100, 80, 60, 30, and 0 percent disability evaluations by adding the reference during the past 12 months to Chronic kidney disease with GFR . . . for at least 3 consecutive months. This change to the language does not result to any substantive changes to the criteria in the general rating formula for renal dysfunction.

Paperwork Reduction Act This final rule contains no provisions constituting a collection of information under the Paperwork Reduction Act of 1995 44 U.S.C. 35013521.

Executive Orders 12866 and 13563

Catalog of Federal Domestic Assistance The Catalog of Federal Domestic Assistance program numbers and titles affected by this document are 64.009, Veterans Medical Care Benefits; 64.104, Pension for Non-Service-Connected Disability for Veterans; 64.109, Veterans Compensation for Service-Connected Disability.

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. The Office of Information and Regulatory Affairs has determined that this rule is a significant regulatory action under Executive Order 12866. The Regulatory Impact Analysis associated with this rulemaking can be found as a supporting document at www.regulations.gov.
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. 601612. The certification is based on the fact that small entities or businesses are not affected by revisions to the VASRD. Therefore, pursuant to 5
U.S.C. 605b, the initial and final regulatory flexibility analysis requirements of 5 U.S.C. 603 and 604 do not apply.
Unfunded Mandates
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List of Subjects in 38 CFR Part 4
Disability benefits, Pensions, Veterans.
Signing Authority Denis McDonough, Secretary of Veterans Affairs, approved this document on June 22, 2021, 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.
Jeffrey M. Martin, Assistant Director, Office of Regulation Policy & Management, Office of the Secretary, Department of Veterans Affairs.

For the reasons set out in the preamble of this rule and the proposed rule, the Department of Veterans Affairs amends 38 CFR part 4 as follows:
PART 4SCHEDULE FOR RATING
DISABILITIES
1. The authority citation for part 4
continues to read as follows:

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

Subpart BDisability Ratings 2. Amend 4.115a by revising the introductory text and the table entries for Renal dysfunction and Urinary tract infection to read as follows:

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 the 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 one year. This final rule will have no such effect on State, local, and tribal governments, or on the private sector.

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Congressional Review Act Pursuant to the Congressional Review Act 5 U.S.C. 801 et seq., the Office of Information and Regulatory Affairs designated this rule as not a major rule, as defined by 5 U.S.C. 8042.

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4.115a Ratings of the genitourinary systemdysfunctions.

Diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these.
The following section provides descriptions of various levels of disability in each of these symptom
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