Current through Register Vol. 49, No. 13, September 23, 2024
Subpart
1.
General.
This part provides the percentage of disability of the whole
body for permanent partial impairment of the gastrointestinal tract. For
evaluative purposes, the gastrointestinal tract has been divided into:
A. the upper digestive tract including the
esophagus, stomach, duodenum, small intestine, and pancreas;
B. the colon and rectum;
C. the anus;
D. the liver;
E. the biliary tract;
F. enterocutaneous fistulas.
The ratings determined under subparts
2 to
7 may be combined as
described in part
5223.0300, subpart
3, item E.
Subp. 2.
Upper digestive
tract.
Esophagus, stomach, duodenum, small intestine, and
pancreas.
A. Class 1, two percent.
Signs or symptoms of organic upper digestive tract disorder are present; there
is anatomic loss or alteration, but treatment is not required; and weight can
be maintained at the desirable level, as defined in part
5223.0310, subpart 20, by oral
diet.
B. Class 2, 15 percent. Signs
or symptoms of organic upper digestive tract disorder are present; there is
anatomic loss or alteration; treatment with dietary restriction and drugs is
required for control of symptoms, signs, or nutritional deficiency; and there
is loss of weight below the desirable weight which does not exceed ten percent
on oral diet.
C. Class 3, 35
percent:
(1) signs or symptoms of organic
upper digestive tract disorder are present; there is anatomic loss or
alteration; treatment with dietary restrictions and drugs does not completely
control symptoms, signs, or nutritional state; and there is loss of weight
below the desirable weight which is greater than ten percent but does not
exceed 20 percent on oral diet; or
(2) signs or symptoms of organic upper
digestive tract disorder are present; there is anatomic loss or alteration;
intravenous hyperalimentation is required for therapy; and weight loss does not
exceed 20 percent of the desirable weight.
D. Class 4, 65 percent. Signs or symptoms of
organic upper digestive tract disorder are present; there is anatomic loss or
alteration; continuous treatment with dietary restrictions and drugs does not
completely control symptoms, signs, or nutritional state; and there is loss of
weight below the desirable weight which is greater than 20 percent regardless
of whether on oral diet or intravenous hyperalimentation.
E. Surgical removal or alteration of all or
part of the esophagus, stomach, duodenum, small intestine, or pancreas, not
otherwise ratable under this subpart or subpart
7 or part
5223.0620, zero percent.
Subp. 3.
Colon and
rectum.
Fiber supplements are not to be considered a special diet or
a restriction of diet.
A. Class 1, two
percent. Signs or symptoms of organic colonic or rectal disorder are
infrequent; limitation of activities, special diet, or medication is not
required; no systemic manifestations are present; and weight can be maintained
at the desirable level, as defined in part
5223.0310, subpart 20.
B. Class 2, 15 percent. Signs or symptoms of
organic colonic or rectal disorder are frequent; there is anatomic loss or
alteration; there is intermittent disturbance of bowel function, accompanied by
periodic or continual pain; no continuous restriction of diet or symptomatic
therapy is necessary; and weight can be maintained at desirable
weight.
C. Class 3, 30 percent.
Signs or symptoms of organic colonic or rectal disorder are very frequent;
there is anatomic loss or alteration; there are moderate to severe
exacerbations of disturbance of bowel function, accompanied by periodic or
continual pain; treatment with restriction of activity, special diet, and drugs
is required during episodes of symptoms; and there is loss of weight below the
desirable weight or anemia due to blood loss.
D. Class 4, 50 percent. Signs or symptoms of
organic colonic and rectal disorder are continuous; there is anatomic loss or
alteration; there are persistent disturbances of bowel function with severe
persistent pain; treatment with complete limitation of activity, restriction of
diet, and medication is required and does not entirely control the symptoms;
and there is loss of weight below the desirable weight or anemia due to blood
loss.
E. Surgical removal or
alteration of all or part of the colon and rectum, not otherwise ratable under
this subpart or subpart
7, zero percent.
Subp. 4.
Anus.
A. Class 1, two percent:
(1) signs of organic anal disorder are
present and there is anatomic loss or alteration, or there is an objectively
demonstrated neurological lesion known to interfere with anal function and
there is mild incontinence involving gas or liquid stool;
(2) signs of organic anal disorder are
present, and there is anatomic loss or alteration, and anal symptoms are mild,
intermittent, and controlled by treatment.
B. Class 2, 12 percent:
(1) signs of organic anal disorder are
present and there is anatomic loss or alteration, or there is an objectively
demonstrated neurological lesion known to interfere with anal function, and
moderate but partial fecal incontinence is present, and treatment is
required;
(2) signs of organic anal
disorder are present, there is anatomic loss or alteration, and continual anal
symptoms are present and incompletely controlled by treatment.
C. Class 3, 22 percent:
(1) signs of organic anal disorder are
present and there is anatomic loss or alteration, or there is an objectively
demonstrated neurological lesion known to interfere with anal function and
complete fecal incontinence is present in spite of continuous
treatment;
(2) signs of organic
anal disorder are present, there is anatomic loss or alteration, and continued
anal symptoms are present and completely unresponsive or not amenable to
therapy.
Subp.
5.
Liver.
A. Class
1, five percent:
(1) there is objective
evidence of persistent liver disorder even though no symptoms of liver disorder
are present; there is no history of ascites, jaundice, or bleeding esophageal
varices within five years; weight can be maintained at the desirable level, as
defined in part
5223.0310, subpart 20; and
biochemical studies, that is, SGOT or SGPT, are less than four times the upper
limit of normal;
(2) primary
disorders of bilirubin metabolism are present.
B. Class 2, 20 percent. There is objective
evidence of persistent liver disorder even though no symptoms of liver disease
are present; there is no history of ascites, jaundice, or bleeding esophageal
varices within five years; weight can be maintained at the desirable level; and
biochemical studies, that is, SGOT or SGPT, are more than four times the upper
limit of normal.
C. Class 3, 40
percent. There is objective evidence of persistent liver disorder; there is a
history of jaundice, ascites, or bleeding esophageal or gastric varices within
the past year; and there are intermittent symptoms of portosystemic
encephalopathy.
D. Class 4, 75
percent. There is objective evidence of persistent liver disorder; there is
persistent ascites, jaundice, or bleeding esophageal or gastric varices; there
are central nervous system manifestations of hepatic insufficiency; and there
is loss of lean body weight below the desirable weight which is greater than
ten percent.
E. Surgical removal or
alteration of part of the liver, not otherwise ratable under this subpart or
subpart
7, zero percent.
Subp. 6.
Biliary
tract.
A. Class 1, five percent. There
are less than four episodes in a 12-month period of biliary tract
dysfunction.
B. Class 2, 20
percent. There are more than four episodes in a 12-month period of biliary
tract dysfunction, and symptoms are unresponsive or unamenable to
treatment.
C. Class 3, 40 percent.
There is irreparable persisting obstruction of the bile tract with recurrent
cholangitis.
D. Class 4, 75
percent. There is persistent jaundice and liver disorder due to obstruction of
the common bile duct, and the liver disease is as described in subpart
5,
item D.
E. Surgical removal or
alteration of all or part of the biliary tract or gallbladder, not otherwise
ratable under this subpart or subpart
7, zero percent.
Subp. 7.
Enterocutaneous
fistulas.
A. Esophagostomy, as defined
in part
5223.0310, subpart 24, ten
percent.
B. Gastrostomy, as defined
in part
5223.0310, subpart 31, ten
percent.
C. Jejunostomy, as defined
in part
5223.0310, subpart 34, 15
percent.
D. Ileostomy, as defined
in part
5223.0310, subpart 33, 15
percent.
E. Colostomy, as defined
in part
5223.0310, subpart 15, five
percent.
Statutory Authority: MS s
176.105