M21-1 Manual / Part VIII, Subpart iv, Chapter 8, Section C

Convalescent Ratings Under 38 CFR 4.30

M21-1, Part VIII, Subpart iv, Chapter 8, Section C

Overview

In This Section

This section contains the following topics:

Topic	Topic Name
1	General Information on Convalescent Ratings
2	Evidentiary Considerations for Convalescent Ratings
3	Rating Considerations for Convalescent Benefits

1. General Information on Convalescent Ratings

Introduction

This topic contains general information on convalescent ratings under 38 CFR 4.30, including

convalescent ratings under 38 CFR 4.30
severe postoperative residuals for ratings under 38 CFR 4.30
when the provisions of 38 CFR 4.30 are not applicable
actions prompting convalescent ratings, and
disability evaluation associated with convalescent ratings.

Change Date

November 18, 2021

VIII.iv.8.C.1.a. Convalescent Ratings Under 38 CFR 4.30

38 CFR 4.30 provides for a temporary 100-percent evaluation without regard to other provisions of the rating schedule if treatment of a service-connected (SC) disability resulted in

surgery necessitating at least one month of convalescence
surgery with severe postoperative residuals, or
immobilization of at least one major joint by cast without surgery, including procedures performed at an outpatient clinic.

Note: The provision allowing assignment of a convalescent rating for outpatient surgery necessitating at least one month of convalescence became effective March 1, 1989.Reference: For more information on the statutory authority to assign a temporary disability rating based on convalescence, see 38 U.S.C. 1156(a)(1)(D).

VIII.iv.8.C.1.b. Severe Postoperative Residuals for Ratings Under 38 CFR 4.30

Under 38 CFR 4.30(a)(2), severe postoperative residuals include but are not limited to

incompletely healed surgical wounds
stumps of recent amputations
therapeutic immobilization of one major joint or more
application of a body cast
the necessity for house confinement, or
the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited).

VIII.iv.8.C.1.c. When the Provisions of 38 CFR 4.30 Are Not Applicable

The use of a convalescent rating is unnecessary if

a temporary total rating under 38 CFR 4.29 is in effect at the time of hospital discharge, and
the conditions requisite for extensions under 38 CFR 4.29 for an adequate convalescent period are present.

However, assign the temporary 100-percent convalescent rating under 38 CFR 4.30 from the date of hospital treatment

if the final hospital summary justifies an extension of the temporary 100-percent rating for periods beyond 6 months after discharge, and
upon approval by the Veterans Service Center Manager (VSCM).

VIII.iv.8.C.1.d. Actions Prompting Convalescent Ratings

A convalescent rating under the provisions of 38 CFR 4.30 can be prompted based on receipt of a specific claim from a Veteran or based on receipt of a Report of Hospitalization at a Department of Veterans Affairs (VA) facility.

A prescribed form is not required for the purpose of adjudicating entitlement to a convalescent rating when VA receives a Report of Hospitalization at a VA hospital. However, receipt of a Report of Hospitalization will result in a rating decision only when entitlement to a temporary rating is warranted.

If a Report of Hospitalization at a VA hospital is received, but entitlement to convalescent benefits is not warranted
do not formally deny entitlement by rating decision, and
follow the procedures in M21-1, Part X, Subpart iii, 1.A.2.b for disposition of the pending end product and annotation of the claims folder.
Note: When a Report of Hospitalization is reviewed in compliance with this procedure and entitlement to convalescence is shown, but the disability could also be assigned a temporary total schedular evaluation (such as for joint replacement, recurrence of active cancer, and other similar situations), take adjudicative action to favorably award benefits as within the scope of the convalescent rating. Reference: For more information on temporary total schedular evaluations for
definite periods, see M21-1, Part VIII, Subpart iv, 8.D.1 and 2, and
indefinite periods, see M21-1, Part VIII, Subpart iv, 8.D.3.

VIII.iv.8.C.1.e. Disability Evaluation Associated With Convalescent Ratings

The issue of entitlement to a convalescent rating, whether prompted by receipt of a claim from a Veteran or a Report of Hospitalization from a VA medical facility, is not synonymous with a claim for increased evaluation.
If a claim for increase is received for an SC disability and the evidence shows entitlement to a convalescent rating for the same disability, award a temporary total evaluation under the provisions of 38 CFR 4.30 as within scope of the claim for increase.
A claim from a Veteran specifically for a convalescent rating or a review based on receipt of a Report of Hospitalization is not a claim for increased evaluation of the associated disability. However, when the evidence establishes entitlement to a convalescent rating, whether based on a claim from the Veteran or receipt of a Report of Hospitalization at a VA hospital, the assignment of a post-convalescence evaluation is a part of the process of rating the convalescence issue.
An increased evaluation may be warranted and awarded following the period of convalescence.
A reduced evaluation may be warranted by the evidence following the period of convalescence, and reduction action should be taken in compliance with 38 CFR 3.105(e), as warranted.
If the medical evidence does not establish that a change in the post-convalescence evaluation is warranted, assign the evaluation in effect prior to convalescence.
If the medical evidence suggests improvement may occur but such improvement is not definitively established, consider scheduling a routine future examination when otherwise warranted.
The assigned evaluation prior to the period of convalescence is not subject to review as a part of the convalescent rating.
When a claim for convalescence for an SC issue must be denied, do not routinely address the evaluation of the SC issue unless a separate claim for increase has been received.
Reference: For more information on determining the need for review examinations, see
38 CFR 3.327, and
M21-1, Part IV, Subpart ii, 1.A.

2. Evidentiary Considerations for Convalescent Ratings

Introduction

This topic contains information on evidentiary considerations for convalescent ratings under 38 CFR 4.30, including

evidentiary requirements for convalescent ratings, and
work excuses and convalescent ratings.

Change Date

July 29, 2021

VIII.iv.8.C.2.a. Evidentiary Requirements for Convalescent Ratings

Entitlement to a temporary total disability rating for convalescence requires that a report rendered at the time of a hospital discharge or an outpatient release indicate that a surgical procedure had been performed that would require at least one month of convalescence for the Veteran to return to a healthy state. Although a convalescent rating necessitates that surgical intervention must have occurred, there is no requirement that the surgical report be of record when other medical evidence establishes the date of admission, date of discharge, the type of procedure performed, and/or other information relevant to arriving at the convalescence determination. Reference: For more information on the evidentiary requirements for convalescent ratings, see Felden v. West, 11 Vet.App. 427 (1998).

VIII.iv.8.C.2.b. Work Excuses and Convalescent Ratings

Entitlement under 38 CFR 4.30 can be established solely by a work excuse from a medical provider if there is

a clear connection between the claimant's inability to return to previous employment and surgery or cast immobilization, and
no contrary evidence of record.

When there is contrary evidence of record, a work excuse will be weighed as one piece of evidence for consideration.

3. Rating Considerations for Convalescent Benefits

Introduction

This topic contains information on rating considerations for convalescent benefits under 38 CFR 4.30, including

determining the effective date of convalescent ratings
convalescence for disabilities with common secondary etiology
extension of convalescent ratings
requesting future examinations, and
post-convalescence evaluations and 38 CFR 3.105(e).

Change Date

January 21, 2022

VIII.iv.8.C.3.a. Determining the Effective Date of Convalescent Ratings

The temporary total evaluation is assigned effective from the date of hospital admission or outpatient treatment and will continue for a period of one, two, or three months (depending on what the facts support) from the first day of the month following such hospital discharge or outpatient release. Notes:

For prosthetic implants and resurfacing of the joints, rated under 38 CFR 4.71a, diagnostic codes (DCs) 5051-5056, the schedular 100-percent evaluation following implantation of the prosthesis or resurfacing does not commence until after initial award of a one-month convalescent rating under 38 CFR 4.30 following hospital discharge.
If a Veteran is hospitalized near the end of the month for a prosthetic implant or resurfacing of a joint or any other disability requiring convalescence and released on or after the beginning of the following month, the convalescent rating under 38 CFR 4.30 is effective beginning on the date of the hospital admission. However, the period of convalescence is extended from the first day of the month following the Veteran’s discharge. For a prosthetic implant or resurfacing of a joint, the 100-percent rating under the appropriate DC will commence on the first day of the month following the convalescence period.

Example 1: A Veteran enters the hospital on March 10 for a total knee replacement and is discharged on March 13. The convalescent rating will commence on March 10. The convalescent rating is continued for one month beginning April 1, the first day of the month after the date of discharge, and is followed by the 100-percent rating under 38 CFR 4.71a, DC 5055 beginning May 1, which will continue for four months. Example 2: A Veteran enters the hospital on March 30 for a total knee replacement and is discharged on April 2. The convalescent rating will commence on March 30. The convalescent rating is continued for one month beginning May 1, the first day of the month after the date of discharge, and is followed by the 100-percent rating under 38 CFR 4.71a, DC 5055 beginning June 1, which will continue for four months.Important: Convalescent ratings should be extended only for the period of documented convalescence. When the duration of the convalescence period is not known, do not establish an open-ended rating. In such a case,
grant a temporary 100-percent rating for the known period of convalescence, and
advise the Veteran to submit evidence documenting continuation and duration of the limitations warranting extension of convalescence.
Reference: For more information on effective date of convalescent ratings, see 38 CFR 3.401(h)(2).

VIII.iv.8.C.3.b. Convalescence for Disabilities With Common Secondary Etiology

Assign a convalescent rating for the predominant disability requiring surgical or other treatment necessitating convalescence.

When secondary disabilities associated with the primary disability exist, the evaluation for the secondary disabilities will not be routinely discontinued or reduced during the period of convalescence established for the primary disability unless the evidence of record factually supports a reduced evaluation.
Evaluations for secondary disabilities may be considered when determining entitlement to special monthly compensation (SMC). When evaluating the post-convalescence impairment, consider whether a change in evaluation for the primary and all secondary disabilities is warranted based on the evidence of record.
When a reduction in the evaluation of a secondary disability is factually supported, apply 38 CFR 3.105(e), as warranted by the facts of the case.

Example: A Veteran undergoes surgery for an SC neck condition. Service connection was previously established for bilateral radiculopathy associated with the neck condition. The evidence supports assignment of a convalescent rating. Further, the additional disabilities (not including the neck but including the radiculopathies) combine for an additional 60-percent evaluation. Outcome: Assign the convalescent rating for the SC neck condition. Continue the evaluations for the radiculopathies. Grant SMC (s) based on statutory housebound status during the period of convalescence. When the convalescent rating is reduced, consider whether the pre-convalescence evaluation for the neck and/or radiculopathies warrants adjustment based on the medical evidence.

VIII.iv.8.C.3.c. Extension of Convalescent Ratings

Extensions of temporary total awards are authorized under 38 CFR 4.30(b) when justified by the facts. A temporary total evaluation awarded for any of the criteria in 38 CFR 4.30(a)(1), (2), or (3) can be extended to a total duration of six months (in incremental amounts of one, two, or three months). Further extensions of one to six months beyond the initial six-month period may be made with the following limitations:

entitlement must have been established under 38 CFR 4.30(a)(2) or (3) (surgery with severe postoperative residuals or immobilization of one or more major joint), and
approval of the VSCM is required.

VIII.iv.8.C.3.d. Requesting Future Examinations

Generally, unless required by the diagnostic code, reexamination is not required following a period in which a temporary total rating was assigned under 38 CFR 4.30. The rating activity must review the evidence of record and assign a new post-convalescence evaluation based on the residual disability following the convalescence period. Only request a VA examination before the end of the total disability period when the evidence is inadequate to determine the residual disability and assign a schedular evaluation after the convalescence period. Do not create an open-ended convalescent rating pending receipt of the results of the review examination. If the examination cannot be conducted before the end of the period of convalescence, evaluate the disability based on the evidence available and request an at-once examination.

VIII.iv.8.C.3.e. Post-Convalescence Evaluations and 38 CFR 3.105(e)

Assignment of an evaluation lower than 100-percent after the temporary 38 CFR 4.30 convalescence period does not, itself, implicate 38 CFR 3.105(e). The award of a temporary total evaluation with an appropriate schedular evaluation equal to or greater than the pre-convalescence running award rate taking effect thereafter does not create a reduction or discontinuance in compensation payments currently being made. 38 CFR 4.30 states: “The termination of these total ratings will not be subject to §3.105(e) of this chapter.” Exception: If the residual disability is less disabling than the rating in effect prior to the assignment of temporary total disability under 38 CFR 4.30 so that assigning the appropriate post-convalescence evaluation would result in a reduction or discontinuance in compensation payments made under the running award:

assign the temporary 100-percent convalescent rating as provided in M21-1, Part VIII, Subpart iv, 8.C.1.e
assign the evaluation in effect prior to hospitalization effective immediately thereafter, and
propose reduction in accordance with 38 CFR 3.105(e) to the lower rate supported by the evidence.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part VIII, Subpart iv, Chapter 8, Section C (U.S. government work, reproduced for reference). Browse all sections →