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Federal Register / Vol. 86, No. 187 / Thursday, September 30, 2021 / Rules and Regulations
syncope hypotension, breathlessness, dizziness, and angina chest pain. VA
points to the instruction concerning DCs 7009, 7010, 7011, and 7015, which only allow for a single evaluation for all four DCs based on the one that reflects the pre-dominant disability picture.
DC 7011, Ventricular Arrhythmias Sustained:
One commenter recommended VA
include discharge from inpatient cardiac rehabilitation as another event before waiting six months to conduct the mandatory reexamination for a sustained arrhythmia or ventricular aneurysmectomy. This recommendation was made to ensure VA claims processors do not disallow the application of the provisions of 4.29 in cases where the veteran is receiving cardiac rehabilitation, which the commenter believed to be a mistake.
The 100-percent evaluation under DC
7011, which is assigned for sustained ventricular arrhythmias following discharge from inpatient hospitalization, already contemplates activities the veteran may be subject to after sustained arrhythmia or ventricular aneurysmectomy, such as cardiac rehabilitation. In addition, a 100-percent evaluation under DC 7011 is assigned for an indefinite period and can remain even after the initial six-month mandatory reexamination, if the findings of the VA examination contemplated in the Note to DC 7011
warrant such a determination. Finally, VA confirms that it is appropriate to not apply the provisions of 4.29 in cases where the veteran is currently receiving a temporary total rating for a disability for which hospitalization was required.
Therefore, inpatient cardiac rehabilitation that occurs at any point during the indefinite assignment of a 100-percent rating under this DC cannot also qualify for benefits under the provisions of 4.29, which provide a temporary total disability rating for a service-connected disability requiring hospital treatment in a VA or VAapproved hospital for a period in excess of 21 days. Therefore, VA makes no changes based on this comment. VA
does, however, take this opportunity to clarify that the hospitalization referenced in DC 7011 is intended to only apply to inpatient cardiac hospitalization.
DC 7015, Atrioventricular Block:
One commenter asked if a block can be reclassified between benign or nonbenign. The commenter mischaracterizes how an evaluation changes from benign to non-benign, so VA would like to clarify how a veteran receives an evaluation for an atrioventricular block and how that
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evaluation changes. An evaluation occurs whenever a veteran submits an electrocardiogram ECG with either benign or non-benign atrioventricular block findings. Instead of reclassification, it is during a follow-up examination when the ECG conversion to a non-benign atrioventricular block is identified. It is the submission of that second non-benign ECG that changes the evaluation from VA raters. VA
makes no changes based on this comment.
DC 7019, Cardiac Transplantation:
One commenter sought clarification about the one-year time periods for rating and the mandatory evaluation.
The commenter went on further to assert it did not make sense for VA to stipulate that the 100 percent evaluation under this DC only last for one year starting from the hospital admission but mandate reexamination one year after discharge. VA reiterates that it proposed to replace the phrase for an indefinite period concerning the length of the 100
percent evaluation with the phrase for a minimum of one year. This means that the 100 percent evaluation can exceed one year depending on the circumstances of the case, including the date of discharge as well as the date of the reexamination. VA makes no changes based on this comment.
DC 7110, Aortic Aneurysm:
Two commenters provided input for this DC. One commenter felt the evaluation criteria were confusing, particularly the criteria for the zeropercent evaluation. The other commenter asked if veterans previously receiving a 60-percent evaluation with an aortic aneurysm that precluded exertion would be evaluated under the proposed 100-percent evaluation.
First, VA clarifies that a veteran previously receiving a 60-percent evaluation with an aortic aneurysm that precluded exertion will now be entitled to a 100-percent evaluation. Second, VA
originally proposed to provide a 100percent evaluation under this DC when the aneurysm size is five centimeters or larger or when the aneurysm is symptomatic e.g., precludes exertion and surgical correction was recommended. A zero-percent evaluation would have been assignable if surgery was not recommended and the aneurysm was smaller than five centimeters. Based on the comment, and to provide additional clarity, VA revises the evaluation criteria to specify that a 100-percent evaluation applies when 1
the aneurysm is five centimeters or larger in diameter; 2 the aneurysm is symptomatic; or 3 surgical correction is required. The current note addressing the circumstances triggering mandatory
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VA examination will be edited for clarity and will indicate that the 100percent evaluation period begins on the date the physician recommends surgical correction, as described in the proposed rule.
DC 7120, Varicose Veins:
One commenter noted the proposed criteria under DC 7120 states evaluate under diagnostic code 7121; however, DC 7121 was not listed in the proposed rating schedule. VA thanks the commenter for this comment. DC 7121
was not listed in the proposed rule because there is no change to the criteria that currently exists under that DC.
Technical Corrections:
Several technical corrections were made for ease of reading or parity in rating schedule language to the following DCs: 7009, 7010, 7011, 7110, and 7124. These corrections were minor and non-substantive in nature and did not change the meaning or substance of the criteria or notes.
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. 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 no small entities or businesses assign evaluations for disability claims. 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.

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