DIABETES MELLITUS. Diabetes Mellitus is a disorder of carbohydrate metabolism of varying Any of the following are considered to be diagnostic of diabetes: …
D
DENGUE
Dengue, also called Dandy fever or breakbone fever It is an acute virus
disease caused by the bite of an infected mosquito It starts with sudden
onset of fever, pains in the joints, muscles, head, and eyes and a Roseola
rose colored skin eruption Usually there are 2 or 3 days of symptoms, a
few days remission and then 2 or 3 more days of symptoms Recovery may be
slow but the mortality rate is low
|Present |30 |
|Upon Recovery |0 |
DEVIATED SEPTUM
A deviated septum is an abnormal dividing wall in the nose, usually
congenital Disregard
DIABETES MELLITUS
Diabetes Mellitus is a disorder of carbohydrate metabolism of varying
etiologies, characterized by hyperglycemia
Any of the following are considered to be diagnostic of diabetes:
1 Classic symptoms weight loss, excessive thirst, etc of diabetes
combined with a non-fasting blood glucose level of 200 mg or more
and/or a
fasting level of 140 mg or more
2 A Fasting Blood Sugar on more than one occasion different days
equal to or greater than 140 mg
3 Fasting Glucose less than 140 mg but the 120 minute sample and one
other sample exceed 200 mg after a 75 gm glucose meal
Glycosylated Hemoglobin HbA1c and Fructosamine tests have not replaced
the Fasting Blood Sugar or Glucose Tolerance Test for making the diagnosis
of diabetes They are, however, useful for assessing the level of control
of the disease
Type I, or insulin dependent diabetes IDDM, requires insulin replacement
therapy for survival Low insulin levels and other factors may make these
individuals prone to complications and poor control
Type II, or noninsulin dependent diabetes NIDDM, is characterized by
abnormalities in insulin metabolism rather than the complete absence of
insulin production The hyperglycemia in these individuals may be
controlled by diet, but oral hypoglycemic agents or even supplemental
insulin therapy may be required In some instances weight loss may result
in return of glucose levels to the normal range
Diabetics are subject to premature
arteriosclerosis and the most common
cause of death is cardiovascular disease Stroke and renal failure are
also common Up to 50 of insulin dependent diabetics develop renal
disease, initially manifested by albuminuria Renal failure is likely to
follow the development of kidney disease in these individuals
Blindness, due to retinopathy, may also contribute to excess morbidity
Diabetic neuropathy with its combination of decreased sensation, increased
susceptibility to infection, and impaired circulation may lead to chronic
ulceration of the feet and in severe, cases, the need for amputation
The prognosis with regard to individuals with diabetes is dependent upon
their willingness to comply with their physicians instructions and to
educate themselves concerning the disease They must be willing to accept
the limitations of diet, medication and conduct which are prescribed
Underwriting Requirements
An APS VA Form 29-8158 is required
The basic rating table shows the debits to be used in the most favorable
cases Additional debits must be applied when all conditions are not
favorable
|Basic Rating |Less than |10-15
|15 Years and|
| |10 Years |Years |Over |
|Age 39 and under |150 |175 |225 |
|Age 40 - 59 |125 |125 |175 |
|Age 60 - 65 |100 |100 |200 |
Extra ratings are to be added to the basic rating given above as follows:
|1 Under control less than 1 year |100 |
|2 Overweight: Basic build rate 120 to 150 debits |50 |
|3 Overweight: Basic build rate over 150 debits |100 |
|4 Blood pressure table rate 40-50 debits |100 |
|5 Blood pressure table rate over 50 debits |200 |
|6 No 2 and No 4 above combined |300 |
|7 No 3 and No 4 above combined |300 |
|8 Occasional 1 to 3 glycosuria |50 |
|9 Acetone or diacetic |100 |
|10 Fasting blood sugar 180-200 mg or Postprandial |100 |
|180-250 mg | |
|11 Fasting blood sugar over 220 mg or Postprandial |200
|
|above 250 mg | |
|12 Albuminuria requiring a debit of 25 and up |100 |
|13 Insulin 71-85 units daily |25 |
|14 Insulin over 86 units daily |75 |
|15 Under medical control for over 20 years |50 |
|16 Two episodes of diabetic coma |100 |
|17 More than two episodes of diabetic coma |100 |
|18 Evidence of other vascular disease, ie, |200 |
|amputation | |
|19 Alcoholism, requiring debits of 30 and up |100 |
|20 Inadequate medical supervision |100 |
|21 Coronary artery disease |500 |
|22 Family history |See Family |
| |History |
|23 Retinitis |50 |
|24 Neuropathy |50 |
|25 Phlebitis - unilateral - no previous attack |50 |
|26
Bilateral or recurrent attack |100 |
DIAPHRAGMATIC HERNIA
Diaphragmatic hernias are protrusions of abdominal contents through the
diaphragm into the chest About 50 percent exist from birth Small
congenital diaphragmatic hernias discovered accidentally by x-ray taken for
other reasons may be disregarded if they are not causing symptoms
Diaphragmatic hernias caused by injury traumatic may require surgical
correction
Underwriting Requirements
An APS VA Form 29-8158 is required
|Present | |
| Small, symptomless, no other GI |0 |
|complaints | |
| Small with symptoms |20 |
|Cured by operation | |
| Within 1 year |10 |
| After 1 year |0 |
|Others | |
| Depending upon size, symptoms and |Refer to
Section Chief |
|degree of disability | |
DIARRHEA-DYSENTERY
Diarrhea is an abnormal frequent bowel movement of fluid fecal bowel
waste matter It is usually caused by contaminated food or minor
infections of the intestinal tract usually referred to as acute
enteritis, gastroenteritis, or intestinal grippe It may result from
numerous other causes, ie liver and pancreatic disorders, parasite
infections, emotional upset and virus infection
Dysentery is a term similar in meaning to diarrhea but is a much more
severe and prolonged condition It is characterized by pain in the abdomen,
diarrhea and cramps Blood or mucous may appear in the stools The two
specific varieties are amebic and bacillary
Bacillary dysentery is an acute infection of the bowel usually caused by
bacteria Prognosis is good if treatment is prompt and adequate
Amebic dysentery, also called amebiasis, is an infectious disease
caused by the invasion of the intestinal tract by ameba Typical symptoms
include frequent stools accompanied by cramps, blood and ulceration in
the
bowel Recurrences are common If recognized in the early stages and
thoroughly treated, early recovery can be expected If chronic or
neglected, complications of the liver or colon may develop When symptoms
cease and repeated stool examinations are found to be negative, the risk
may be regarded as cured, Diagnosis is by examination of the stool in which
may be found the specific ameba amoeba histolytica
Salmonella - There are many serological types of this infection which
usually occur in otherwise healthy subjects following the ingestion of
contaminated food or drink, Following an incubation period of from 8 to 48
hours there is a sudden onset of colicky, abdominal pain and loose watery
diarrhea Symptoms usually subside within 2 to 5 days and recovery is
uneventful Sometimes symptoms last 10 to 14 days It may occur as a focal
infection of various organs, may complicate malaria, relapsing fever,
sickle cell anemia, bartonellosis Carrions disease liver and neoplastic
diseases An individuals resistance to this disease may be reduced
following major gastric surgery, use of corticosteroids, alkylating
agents,
or irradiation Diagnosis depends upon a history of exposure or ingestion,
and isolation of causative organism Fatalities are rare and are usually
limited to infants and debilitated individuals The carrier state usually
will spontaneously cease in l to 3 months
Underwriting Requirements
An APS VA Form 29-8158 is required
|Diarrhea | |
| Uncomplicated - upon recovery |0 |
| Others |RFC |
| | |
|Bacillary Dysentery | |
| Present |40 |
| Within 6 months after recovery |0 |
|Amebic Dysentery | |
| One attack, duration less than 2 | |
|months | |
| Presently under treatment |50 |
| Within 1 year after recovery |20 |
|
After 1 year |0 |
| One attack of 2 or more months, or | |
|recurrent attacks | |
| Presently under treatment |100 |
| Within 1 year after recovery |75 |
| Within 2 years |30 |
| After 2 years |0 |
| | |
|Salmonella | |
| Uncomplicated |0 |
| Complications |Rate for abscess of organ |
| |or accompanied disease |
DIPHTHERIA
Diphtheria is an acute infectious disease characterized by the formation of
a grayish membrane in the pharynx and nasal passages It sometimes shuts
off the windpipe completely Persons affected may appear to have a mild
sore throat but usually fever is high and exhaustion is extreme In
extreme
cases it can cause paralysis of the palate and pharynx Myocarditis is
always a hazard
Underwriting Requirements
An APS VA Form 29-8158 is required
|Present |200 |
|After recovery | |
| Without complications |0 |
| With complications |Rate for complication or |
| |residual impairments |
DISLOCATIONS
A dislocation is the displacement of the bones that form a joint Loss of
use of the joint occurs and continues until the dislocation is corrected
Injury to ligaments and soft tissue in and about the joint is common
Recurrent dislocations of the shoulder, elbow, and knee trick knee often
require surgical repair to stabilize the joint
The ratings below are for dislocations only If accompanied by ankylosis or
fracture, consider under appropriate rules
Underwriting Requirements
An APS VA Form 29-8158 is required
|Recurrent dislocation of hip | |
| Present
|15 |
| Corrected by surgery |0 |
|Congenital dislocation of hip | |
| Present | |
| One side with or without aids |15 |
| Both sides with or without aids |30 |
| Corrected by surgery |0 |
|Recurrent dislocation of elbow, shoulder, or knee | |
| Present |10 |
| Corrected by surgery |0 |
|Other dislocations | |
| Singe - after recovery |0 |
| Recurrent |15 |
DIVERTICULUM-DIVERTICULOSIS-DIVERTICULITIS
A diverticulum is a closed pouch or saccular opening extending out from a
hollow organ
Diverticulosis is the presence of multiple pouches or sacs usually found in
the large sigmoid or descending intestine colon This condition can
exist
without showing any signs and in this state is of no underwriting
consequence It does exist in a large percentage of persons over 45 and
they are not even aware of its presence Usually it is found on routine x-
ray taken for some other reason
Diverticulitis is the inflammation of one or more diverticulum This
inflammation is usually the first evidence that diverticulosis is present
The inflammation may subside within a few days or may spread and cause
abscess, spasm or swelling edema These complications may lead to
peritonitis, fistula formation with the urinary bladder or erosion into an
artery or vein, etc; surgical correction is often required
Meckels diverticulum is a congenital pouch or sac located near the
appendix Usually it creates no symptoms When it does surgery is normally
required Following a successful operation it becomes a standard risk
Underwriting Requirements
An APS VA Form 29-8158 is required
|Diverticulum of duodenum - rate for size | |
| Present |35 |
| Corrected by surgery | |
|
Within 1 year |10 |
| After 1 year |0 |
| | |
|Diverticulum of esophagus |See Esophagus |
| | |
|Meckels Diverticulum | |
| Without symptoms |0 |
| With symptoms |35 |
| Operated - upon recovery |0 |
| | |
|Diverticulosis | |
| Present - no history of diverticulitis | |
| Unoperated or single operation, |0 |
|asymptomatic | |
| Others |15 |
| | |
|Diverticulitis | |
|
Unoperated, one or more attacks | |
| Within 1 year of last attack |20 |
| 2nd year |10 |
| After 2 years |0 |
| Operated | |
| Within 1 year of operation |20 |
| 2nd year |10 |
| After 2 years |0 |
DIVERTICULUM OF BLADDER
Diverticulum of the bladder results from a congenital deformity of the
bladder wall; they may be singular or multiple, with or without symptoms
and large or small They are frequently the cause of recurrent infection
See Diverticulosis
Underwriting Requirements
An APS VA Form 29-8158 is required
|Present - Urine normal | |
| Small to medium |25 |
| Others |50 |
|With abnormal urine, add debits under urine
| |
| | |
|Operated - Urine normal | |
| Within 1 year |20 |
| Within 2 years |10 |
| After 2 years |0 |
|With abnormal urine, add debits under urine | |
DRUG ADDICTION
Amphetamines Benzedrine, Dexedrine, Methedrine, etc are also known as
pep pills, bennies, dexies, speed, ice, etc They are used medically for
weight reduction, narcolepsy, depression and some behavioral disorders
They are a stimulant and can result in restlessness, dryness of mouth,
tachycardia and tremor Abuse, particularly by injections, can produce a
psychosis or even death
Barbiturates Phenobarbital, Luminal, Amytal, Nembutal, Seconal, etc are
also known as goofballs, blue heavens, yellow jackets, red devils,
phennies, etc They are used medically to sedate or calm patients and to
induce sleep They are depressants acting in much the same way as
alcohol
and, in combination with alcohol, may produce death They are habit
forming and may produce a physical dependence Abrupt withdrawal after
heavy use often causes convulsions and even death
Cocaine coke, crack, powder is widely available in many forms from powder
to crack cocaine It can be ingested in numerous ways from inhaling to
injections Thus hepatitis, AIDS, and other infections are possibilities
resulting from unsterile needles
LSD is a hallucinogenic drug with unpredictable results The most common
effects are delusions, depression, anxiety and confusion Even a single
bad trip may produce a psychiatric disorder, and hallucinations may
continue to recur even without further use LSD is commonly called acid,
sugar, big D, or cubes
Marijuana is also known as pot, grass, tea, weed, Mary Jane, and when
rolled may be referred to as reefers, sticks, joints, good-butts, etc
Legally it is an opiate and narcotic Its strength varies considerably,
with a very potent form being known as hashish In modest doses, the
effects are often similar to that of alcohol Use of hashish or strong
heavy doses or
extensive use of marijuana may produce hallucinations or
psychotic reactions
Narcotics are opium and opium derivatives such as morphine, codeine, heroin
and paregoric Demerol and Dolophine are also narcotics Many compounds
of opium are widely used in medicine as pain killers Heroin is the
principal illicit drug and is known as big H, horse, junk, smack and scrag
As is true of cocaine, it may be sniffed, injected beneath the skin skin
or joy popper or injected intraveneously mainliners On a long term
basis, a high tolerance develops and there is a psychic and physical
dependence Heroin addicts can be spotted by their pinpoint pupils, needle
marks, nodding and slow pulse rate
Underwriting Requirements
An APS VA Form 29-8158 is required
|Any drug of abuse | |
| Positive findings in urine, no |R |
|admissions, no history | |
| | |
|Amphetamines, cocaine | |
| Information from the proposed insured |125
|
|or attending physician confirming | |
|intermittent use as a temporary stimulant, | |
|no evidence of a ratable behavioral problem| |
| Suspicion of abuse by injection, | |
|behavioral problems | |
| Within 2 years |R |
| 3rd - 5th year | |
| If reverting to abuse |100 |
|improbable | |
| Otherwise |R |
| After 5 years |0 |
| | |
|Barbiturates | |
| Evidence of physical dependence | |
| Within 2 years |R |
| Thereafter - consider associated |Rate accordingly but not|
|problems and permanence of reform |less
than Amphetamine |
| |schedule above |
| | |
|LSD | |
| Use within 3 years |R |
| After 3 years | |
| Single trip only, no evidence |0 |
|of psychiatric problems or maladjustment, | |
|good student or employment record | |
| Others | |
| Within 5 years |R |
| 6th - 10th year |175 |
| After 10 years |0 |
| | |
|Marijuana and hashish | |
| Occasional use or discontinued 1 year |0 |
|or more | |
| Weekend or regular use
|55 |
| | |
|Opium and its derivatives, Demerol, | |
|Dolophine, including those that receive | |
|Methadone treatment | |
| Within 2 years |R |
| 3rd - 5th year |150 |
| 6th - 10th year |55 |
| After 10 years |0 |
| | |
|Other drugs | |
| Mescaline and peyote |Rate same as Hashish |
| Miscellaneous |Classify under one of |
| |the above guides |
| |according to its effect |
| |on the individual |
DUODENITIS
The duodenum is the first division of the small intestine, it
is about 11
inches or 12 finger breadths long duodeni means 12 - hence the name It
may become inflamed and produce symptoms of diarrhea alternating with
constipation, rumbling in the high abdomen and may produce a little
jaundice
The diagnosis is made in patients who have stomach trouble of the ulcer
type when x-rays produce no definite ulcer cavity The duodenal cap fills
and empties rapidly and appears irritable and fuzzy in outline
Underwriting Requirements
An APS VA Form 29-8158 is required
|Mild or moderate - infrequent brief episodes not |0 |
|requiring medical attention or prescription medication | |
|Severe - more frequent or prolonged, requiring medical |30 |
|attention, prescription medication and requiring | |
|diagnostic tests | |
DYSPLASTIC NEVUS SYNDROME
Dyplastic nevi or atypical moles are larger and more irregular than typical
benign moles They are both a precursor or melanoma and a marker for an
increased risk of melanoma arising from normal skin
Underwriting Requirements
An APS VA Form
29-8158 is required
|History of Dyplastic Nevi, no personal or family|0 |
|history of melanoma | |
|History of Dyplastic Nevi, plus family history |55 |
|of melanoma | |
|History of Dyplastic Nevi, plus personal history|Add 55 to Melanoma|
|of melanoma |schedule |
Source:warms.vba.va.gov
