[Code of Federal Regulations]
[Title 38, Volume 1]
[Revised as of July 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 38CFR3.350]

[Page 250-257]
 
            TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF
 
                CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS
 
PART 3--ADJUDICATION--Table of Contents
 
     Subpart A--Pension, Compensation, and Dependency and Indemnity 
                              Compensation
 
Sec. 3.350  Special monthly compensation ratings.

    The rates of special monthly compensation stated in this section are 
those provided under 38 U.S.C. 1114.
    (a) Ratings under 38 U.S.C. 1114(k). Special monthly compensation 
under 38 U.S.C. 1114(k) is payable for each anatomical loss or loss of 
use of one hand, one foot, both buttocks, one or more creative organs, 
blindness of one eye having only light perception, deafness of both 
ears, having absence of air and bone conduction, complete organic 
aphonia with constant inability to communicate by speech or, in the case 
of a woman veteran, the anatomical loss of one or both breasts 
(including loss by mastectomy). This special compensation is payable in 
addition to the basic rate of compensation otherwise payable on the 
basis of degree of disability, provided that the combined rate of 
compensation does not exceed the monthly rate set forth in 38 U.S.C. 
1114(l) when authorized in conjunction with any of the provisions of 38 
U.S.C. 1114 (a) through (j) or (s). When there is entitlement under 38 
U.S.C. 1114 (l) through (n) or an intermediate rate under (p) such 
additional allowance is payable for each such anatomical loss or loss of 
use existing in addition to the requirements for the basic rates, 
provided the total does not exceed the monthly rate set forth in 38 
U.S.C. 1114(o). The limitations on the maximum compensation payable 
under this paragraph are independent of and do not preclude payment of 
additional compensation for dependents under 38 U.S.C. 1115, or the 
special allowance for aid and attendance provided by 38 U.S.C. 1114(r).
    (1) Creative organ. (i) Loss of a creative organ will be shown by 
acquired absence of one or both testicles (other than undescended 
testicles) or ovaries or other creative organ. Loss of use of one 
testicle will be established when examination by a board finds that:
    (a) The diameters of the affected testicle are reduced to one-third 
of the corresponding diameters of the paired normal testicle, or
    (b) The diameters of the affected testicle are reduced to one-half 
or less of

[[Page 251]]

the corresponding normal testicle and there is alteration of consistency 
so that the affected testicle is considerably harder or softer than the 
corresponding normal testicle; or
    (c) If neither of the conditions (a) or (b) is met, when a biopsy, 
recommended by a board including a genitourologist and accepted by the 
veteran, establishes the absence of spermatozoa.
    (ii) When loss or loss of use of a creative organ resulted from 
wounds or other trauma sustained in service, or resulted from operations 
in service for the relief of other conditions, the creative organ 
becoming incidentally involved, the benefit may be granted.
    (iii) Loss or loss of use traceable to an elective operation 
performed subsequent to service, will not establish entitlement to the 
benefit. If, however, the operation after discharge was required for the 
correction of a specific injury caused by a preceding operation in 
service, it will support authorization of the benefit. When the 
existence of disability is established meeting the above requirements 
for nonfunctioning testicle due to operation after service, resulting in 
loss of use, the benefit may be granted even though the operation is one 
of election. An operation is not considered to be one of election where 
it is advised on sound medical judgment for the relief of a pathological 
condition or to prevent possible future pathological consequences.
    (iv) Atrophy resulting from mumps followed by orchitis in service is 
service connected. Since atrophy is usually perceptible within 1 to 6 
months after infection subsides, an examination more than 6 months after 
the subsidence of orchitis demonstrating a normal genitourinary system 
will be considered in determining rebuttal of service incurrence of 
atrophy later demonstrated. Mumps not followed by orchitis in service 
will not suffice as the antecedent cause of subsequent atrophy for the 
purpose of authorizing the benefit.
    (2) Foot and hand. (i) Loss of use of a hand or a foot will be held 
to exist when no effective function remains other than that which would 
be equally well served by an amputation stump at the site of election 
below elbow or knee with use of a suitable prosthetic appliance. The 
determination will be made on the basis of the actual remaining 
function, whether the acts of grasping, manipulation, etc., in the case 
of the hand, or of balance, propulsion, etc., in the case of the foot, 
could be accomplished equally well by an amputation stump with 
prosthesis; for example:
    (a) Extremely unfavorable complete ankylosis of the knee, or 
complete ankylosis of two major joints of an extremity, or shortening of 
the lower extremity of 3\1/2\ inches or more, will constitute loss of 
use of the hand or foot involved.
    (b) Complete paralysis of the external popliteal nerve (common 
peroneal) and consequent footdrop, accompanied by characteristic organic 
changes including trophic and circulatory disturbances and other 
concomitants confirmatory of complete paralysis of this nerve, will be 
taken as loss of use of the foot.
    (3) Both buttocks. (i) Loss of use of both buttocks shall be deemed 
to exist when there is severe damage by disease or injury to muscle 
group XVII, bilateral, (diagnostic code 5317) and additional disability 
making it impossible for the disabled person, without assistance, to 
rise from a seated position and from a stooped position (fingers to toes 
position) and to maintain postural stability (the pelvis upon head of 
femur). The assistance may be done by the person's own hands or arms, 
and, in the matter of postural stability, by a special appliance.


(Authority: 38 U.S.C. 1114(k))

    (ii) Special monthly compensation for loss or loss of use of both 
lower extremities (38 U.S.C. 1114(l) through (n)) will not preclude 
additional compensation under 38 U.S.C. 1114(k) for loss of use of both 
buttocks where appropriate tests clearly substantiate that there is such 
additional loss.
    (4) Eye. Loss of use or blindness of one eye, having only light 
perception, will be held to exist when there is inability to recognize 
test letters at 1 foot and when further examination of the eye reveals 
that perception of objects, hand movements, or counting fingers cannot 
be accomplished at 3

[[Page 252]]

feet. Lesser extents of vision, particularly perception of objects, hand 
movements, or counting fingers at distances less than 3 feet is 
considered of negligible utility.
    (5) Deafness. Deafness of both ears, having absence of air and bone 
conduction will be held to exist where examination in a Department of 
Veterans Affairs authorized audiology clinic under current testing 
criteria shows bilateral hearing loss is equal to or greater than the 
minimum bilateral hearing loss required for a maximum rating evaluation 
under the rating schedule.


(Authority: Pub. L. 88-20)

    (6) Aphonia. Complete organic aphonia will be held to exist where 
there is a disability of the organs of speech which constantly precludes 
communication by speech.


(Authority: Pub. L. 88-22)

    (7) Anatomical loss of a breast exists when there is complete 
surgical removal of breast tissue (or the equivalent loss of breast 
tissue due to injury). As defined in 38 CFR 4.116, radical mastectomy, 
modified radical mastectomy, and simple (or total) mastectomy result in 
anatomical loss of a breast, but wide local excision, with or without 
significant alteration of size or form, does not.


(Authority: 38 U.S.C. 501, 1114(k))

    (b) Ratings under 38 U.S.C. 1114(l). The special monthly 
compensation provided by 38 U.S.C. 1114(l) is payable for anatomical 
loss or loss of use of both feet, one hand and one foot, blindness in 
both eyes with visual acuity of 5/200 or less or being permanently 
bedridden or so helpless as to be in need of regular aid and attendance.
    (1) Extremities. The criteria for loss and loss of use of an 
extremity contained in paragraph (a)(2) of this section are applicable.
    (2) Eyes, bilateral. 5/200 visual acuity or less bilaterally 
qualifies for entitlement under 38 U.S.C. 1114(l). However, evaluation 
of 5/200 based on acuity in excess of that degree but less than 10/200 
(Sec. 4.83 of this chapter), does not qualify. Concentric contraction of 
the field of vision beyond 5 degrees in both eyes is the equivalent of 
5/200 visual acuity.
    (3) Need for aid and attendance. The criteria for determining that a 
veteran is so helpless as to be in need of regular aid and attendance 
are contained in Sec. 3.352(a).
    (4) Permanently bedridden. The criteria for rating are contained in 
Sec. 3.352(a). Where possible, determinations should be on the basis of 
permanently bedridden rather than for need of aid and attendance (except 
where 38 U.S.C. 1114(r) is involved) to avoid reduction during 
hospitalization where aid and attendance is provided in kind.
    (c) Ratings under 38 U.S.C. 1114(m). (1) The special monthly 
compensation provided by 38 U.S.C. 1114(m) is payable for any of the 
following conditions:
    (i) Anatomical loss or loss of use of both hands;
    (ii) Anatomical loss or loss of use of both legs at a level, or with 
complications, preventing natural knee action with prosthesis in place;
    (iii) Anatomical loss or loss of use of one arm at a level, or with 
complications, preventing natural elbow action with prosthesis in place 
with anatomical loss or loss of use of one leg at a level, or with 
complications, preventing natural knee action with prosthesis in place;
    (iv) Blindness in both eyes having only light perception;
    (v) Blindness in both eyes leaving the veteran so helpless as to be 
in need of regular aid and attendance.
    (2) Natural elbow or knee action. In determining whether there is 
natural elbow or knee action with prosthesis in place, consideration 
will be based on whether use of the proper prosthetic appliance requires 
natural use of the joint, or whether necessary motion is otherwise 
controlled, so that the muscles affecting joint motion, if not already 
atrophied, will become so. If there is no movement in the joint, as in 
ankylosis or complete paralysis, use of prosthesis is not to be 
expected, and the determination will be as though there were one in 
place.
    (3) Eyes, bilateral. With visual acuity 5/200 or less or the vision 
field reduced to 5 degree concentric contraction in both eyes, 
entitlement on account of

[[Page 253]]

need for regular aid and attendance will be determined on the facts in 
the individual case.
    (d) Ratings under 38 U.S.C. 1114(n). The special monthly 
compensation provided by 38 U.S.C. 1114(n) is payable for any of the 
conditions which follow: Amputation is a prerequisite except for loss of 
use of both arms and blindness without light perception in both eyes. If 
a prosthesis cannot be worn at the present level of amputation but could 
be applied if there were a reamputation at a higher level, the 
requirements of this paragraph are not met; instead, consideration will 
be given to loss of natural elbow or knee action.
    (1) Anatomical loss or loss of use of both arms at a level or with 
complications, preventing natural elbow action with prosthesis in place;
    (2) Anatomical loss of both legs so near the hip as to prevent use 
of a prosthetic appliance;
    (3) Anatomical loss of one arm so near the shoulder as to prevent 
use of a prosthetic appliance with anatomical loss of one leg so near 
the hip as to prevent use of a prosthetic appliance;
    (4) Anatomical loss of both eyes or blindness without light 
perception in both eyes.
    (e) Ratings under 38 U.S.C. 1114 (o). (1) The special monthly 
compensation provided by 38 U.S.C. 1114(o) is payable for any of the 
following conditions:
    (i) Anatomical loss of both arms so near the shoulder as to prevent 
use of a prosthetic appliance;
    (ii) Conditions entitling to two or more of the rates (no condition 
being considered twice) provided in 38 U.S.C. 1114(l) through (n);
    (iii) Bilateral deafness rated at 60 percent or more disabling (and 
the hearing impairment in either one or both ears is service connected) 
in combination with service-connected blindness with bilateral visual 
acuity 5/200 or less.
    (iv) Service-connected total deafness in one ear or bilateral 
deafness rated at 40 percent or more disabling (and the hearing 
impairment in either one of both ears is service-connected) in 
combination with service-connected blindness of both eyes having only 
light perception or less.
    (2) Paraplegia. Paralysis of both lower extremities together with 
loss of anal and bladder sphincter control will entitle to the maximum 
rate under 38 U.S.C. 1114(o), through the combination of loss of use of 
both legs and helplessness. The requirement of loss of anal and bladder 
sphincter control is met even though incontinence has been overcome 
under a strict regimen of rehabilitation of bowel and bladder training 
and other auxiliary measures.
    (3) Combinations. Determinations must be based upon separate and 
distinct disabilities. This requires, for example, that where a veteran 
who had suffered the loss or loss of use of two extremities is being 
considered for the maximum rate on account of helplessness requiring 
regular aid and attendance, the latter must be based on need resulting 
from pathology other than that of the extremities. If the loss or loss 
of use of two extremities or being permanently bedridden leaves the 
person helpless, increase is not in order on account of this 
helplessness. Under no circumstances will the combination of ``being 
permanently bedridden'' and ``being so helpless as to require regular 
aid and attendance'' without separate and distinct anatomical loss, or 
loss of use, of two extremities, or blindness, be taken as entitling to 
the maximum benefit. The fact, however, that two separate and distinct 
entitling disabilities, such as anatomical loss, or loss of use of both 
hands and both feet, result from a common etiological agent, for 
example, one injury or rheumatoid arthritis, will not preclude maximum 
entitlement.
    (4) Helplessness. The maximum rate, as a result of including 
helplessness as one of the entitling multiple disabilities, is intended 
to cover, in addition to obvious losses and blindness, conditions such 
as the loss of use of two extremities with absolute deafness and nearly 
total blindness or with severe multiple injuries producing total 
disability outside the useless extremities, these conditions being 
construed as loss of use of two extremities and helplessness.
    (f) Intermediate or next higher rate. An intermediate rate 
authorized by this paragraph shall be established at the

[[Page 254]]

arithmetic mean, rounded to the nearest dollar, between the two rates 
concerned.


(Authority: 38 U.S.C. 1114 (p))

    (1) Extremities. (i) Anatomical loss or loss of use of one foot with 
anatomical loss or loss of use of one leg at a level, or with 
complications preventing natural knee action with prosthesis in place, 
shall entitle to the rate between 38 U.S.C. 1114(l) and (m).
    (ii) Anatomical loss or loss of use of one foot with anatomical loss 
of one leg so near the hip as to prevent use of prosthetic appliance 
shall entitle to the rate under 38 U.S.C. 1114(m).
    (iii) Anatomical loss or loss of use of one foot with anatomical 
loss or loss of use of one arm at a level, or with complications, 
preventing natural elbow action with prosthesis in place, shall entitle 
to the rate between 38 U.S.C. 1114(l) and (m).
    (iv) Anatomical loss or loss of use of one foot with anatomical loss 
or loss of use of one arm so near the shoulder as to prevent use of a 
prosthetic appliance shall entitle to the rate under 38 U.S.C. 1114(m).
    (v) Anatomical loss or loss of use of one leg at a level, or with 
complications, preventing natural knee action with prosthesis in place 
with anatomical loss of one leg so near the hip as to prevent use of a 
prosthetic appliance, shall entitle to the rate between 38 U.S.C. 
1114(m) and (n).
    (vi) Anatomical loss or loss of use of one leg at a level, or with 
complications, preventing natural knee action with prosthesis in place 
with anatomical loss or loss of use of one hand, shall entitle to the 
rate between 38 U.S.C. 1114 (l) and (m).
    (vii) Anatomical loss or loss of use of one leg at a level, or with 
complications, preventing natural knee action with prosthesis in place 
with anatomical loss of one arm so near the shoulder as to prevent use 
of a prosthetic appliance, shall entitle to the rate between 38 U.S.C. 
1114 (m) and (n).
    (viii) Anatomical loss of one leg so near the hip as to prevent use 
of a prosthetic appliance with anatomical loss or loss of use of one 
hand shall entitle to the rate under 38 U.S.C. 1114(m).
    (ix) Anatomical loss of one leg so near the hip as to prevent use of 
a prosthetic appliance with anatomical loss or loss of use of one arm at 
a level, or with complications, preventing natural elbow action with 
prosthesis in place, shall entitle to the rate between 38 U.S.C. 1114 
(m) and (n).
    (x) Anatomical loss or loss of use of one hand with anatomical loss 
or loss of use of one arm at a level, or with complications, preventing 
natural elbow action with prosthesis in place, shall entitle to the rate 
between 38 U.S.C. 1114 (m) and (n).
    (xi) Anatomical loss or loss of use of one hand with anatomical loss 
of one arm so near the shoulder as to prevent use of a prosthetic 
appliance shall entitle to the rate under 38 U.S.C. 1114(n).
    (xii) Anatomical loss or loss of use of one arm at a level, or with 
complications, preventing natural elbow action with prosthesis in place 
with anatomical loss of one arm so near the shoulder as to prevent use 
of a prosthetic appliance, shall entitle to the rate between 38 U.S.C. 
1114 (n) and (o).
    (2) Eyes, bilateral, and blindness in connection with deafness and/
or loss or loss of use of a hand or foot.
    (i) Blindness of one eye with 5/200 visual acuity or less and 
blindness of the other eye having only light perception will entitle to 
the rate between 38 U.S.C. 1114 (l) and (m).
    (ii) Blindness of one eye with 5/200 visual acuity or less and 
anatomical loss of, or blindness having no light

perception in the other eye, will entitle to a rate equal to 38 U.S.C. 
1114(m).
    (iii) Blindness of one eye having only light perception and 
anatomical loss of, or blindness having no light perception in the other 
eye, will entitle to a rate between 38 U.S.C. 1114 (m) and (n).
    (iv) Blindness in both eyes with visual acuity of 5/200 or less, or 
blindness in both eyes rated under subparagraph (2) (i) or (ii) of this 
paragraph, when accompanied by service-connected total deafness in one 
ear, will afford entitlement to the next higher intermediate rate of if 
the veteran is already entitled to an intermediate rate, to the next 
higher statutory rate under 38 U.S.C. 1114, but in no event higher than 
the rate for (o).

[[Page 255]]

    (v) Blindness in both eyes having only light perception or less, or 
rated under subparagraph (2)(iii) of this paragraph, when accompanied by 
bilateral deafness (and the hearing impairment in either one or both 
ears is service-connected) rated at 10 or 20 percent disabling, will 
afford entitlement to the next higher intermediate rate, or if the 
veteran is already entitled to an intermediate rate, to the next higher 
statutory rate under 38 U.S.C. 1114, but in no event higher than the 
rate for (o).


(Authority: Sec. 112, Pub. L. 98-223)

    (vi) Blindness in both eyes rated under 38 U.S.C. 1114 (l), (m) or 
(n), or rated under subparagraphs (2)(i), (ii) or (iii) of this 
paragraph, when accompanied by bilaterial deafness rated at no less than 
30 percent, and the hearing impairment in one or both ears is service-
connected, will afford entitlement to the next higher statutory rate 
under 38 U.S.C. 1114, or if the veteran is already entitled to an 
intermediate rate, to the next higher intermediate rate, but in no event 
higher than the rate for (o).


(Authority: 38 U.S.C. 1114(p))

    (vii) Blindness in both eyes rated under 38 U.S.C. 1114 (l), (m), or 
(n), or under the intermediate or next higher rate provisions of this 
subparagraph, when accompanied by:
    (A) Service-connected loss or loss of use of one hand, will afford 
entitlement to the next higher statutory rate under 38 U.S.C. 1114 or, 
if the veteran is already entitled to an intermediate rate, to the next 
higher intermediate rate, but in no event higher than the rate for (o); 
or
    (B) Service-connected loss or loss of use of one foot which by 
itself or in combination with another compensable disability would be 
ratable at 50 percent or more, will afford entitlement to the next 
higher statutory rate under 38 U.S.C. 1114 or, if the veteran is already 
entitled to an intermediate rate, to the next higher intermediate rate, 
but in no event higher than the rate for (o); or
    (C) Service-connected loss or loss of use of one foot which is 
ratable at less than 50 percent and which is the only compensable 
disability other than bilateral blindness, will afford entitlement to 
the next higher intermediate rate or, if the veteran is already entitled 
to an intermediate rate, to the next higher statutory rate under 38 
U.S.C. 1114, but in no event higher than the rate for (o).


(Authority: 38 U.S.C. 1114(p))

    (3) Additional independent 50 percent disabilities. In addition to 
the statutory rates payable under 38 U.S.C. 1114 (l) through (n) and the 
intermediate or next higher rate provisions outlined above, additional 
single permanent disability or combinations of permanent disabilities 
independently ratable at 50 percent or more will afford entitlement to 
the next higher intermediate rate or if already entitled to an 
intermediate rate to the next higher statutory rate under 38 U.S.C. 
1114, but not above the (o) rate. In the application of this 
subparagraph the disability or disabilities independently ratable at 50 
percent or more must be separate and distinct and involve different 
anatomical segments or bodily systems from the conditions establishing 
entitlement under 38 U.S.C. 1114 (l) through (n) or the intermediate 
rate provisions outlined above. The graduated ratings for arrested 
tuberculosis will not be utilized in this connection, but the permanent 
residuals of tuberculosis may be utilized.
    (4) Additional independent 100 percent ratings. In addition to the 
statutory rates payable under 38 U.S.C. 1114 (l) through (n) and the 
intermediate or next higher rate provisions outlined above additional 
single permanent disability independently ratable at 100 percent apart 
from any consideration of individual unemployability will afford 
entitlement to the next higher statutory rate under 38 U.S.C. 1114 or if 
already entitled to an intermediate rate to the next higher intermediate 
rate, but in no event higher than the rate for (o). In the application 
of this subparagraph the single permanent disability independently 
ratable at 100 percent must be separate and distinct and involve 
different anatomical segments or bodily systems from the conditions 
establishing entitlement under 38 U.S.C. 1114 (l) through (n) or the 
intermediate rate provisions outlined above.

[[Page 256]]

    (i) Where the multiple loss or loss of use entitlement to a 
statutory or intermediate rate between 38 U.S.C. 1114 (l) and (o) is 
caused by the same etiological disease or injury, that disease or injury 
may not serve as the basis for the independent 50 percent or 100 percent 
unless it is so rated without regard to the loss or loss of use.
    (ii) The graduated ratings for arrested tuberculosis will not be 
utilized in this connection, but the permanent residuals of tuberculosis 
may be utilized.
    (5) Three extremities. Anatomical loss or loss of use, or a 
combination of anatomical loss and loss of use, of three extremities 
shall entitle a veteran to the next higher rate without regard to 
whether that rate is a statutory rate or an intermediate rate. The 
maximum monthly payment under this provision may not exceed the amount 
stated in 38 U.S.C. 1114(p).
    (g) Inactive tuberculosis (complete arrest). The rating criteria for 
determining inactivity of tuberculosis are set out in Sec. 3.375.
    (1) For a veteran who was receiving or entitled to receive 
compensation for tuberculosis on August 19, 1968, the minimum monthly 
rate is $67. This minimum special monthly compensation is not to be 
combined with or added to any other disability compensation.
    (2) For a veteran who was not receiving or entitled to receive 
compensation for tuberculosis on August 19, 1968, the special monthly 
compensation authorized by paragraph (g)(1) of this section is not 
payable.
    (h) Special aid and attendance benefit; 38 U.S.C. 1114(r)--(1) 
Maximum compensation cases. A veteran receiving the maximum rate under 
38 U.S.C. 1114 (o) or (p) who is in need of regular aid and attendance 
or a higher level of care is entitled to an additional allowance during 
periods he or she is not hospitalized at United States Government 
expense. (See Sec. 3.552(b)(2) as to continuance following admission for 
hospitalization.) Determination of this need is subject to the criteria 
of Sec. 3.352. The regular or higher level aid and attendance allowance 
is payable whether or not the need for regular aid and attendance or a 
higher level of care was a partial basis for entitlement to the maximum 
rate under 38 U.S.C. 1114 (o) or (p), or was based on an independent 
factual determination.
    (2) Entitlement to compensation at the intermediate rate between 38 
U.S.C. 1114 (n) and (o) plus special monthly compensation under 38 
U.S.C. 1114(k). A veteran receiving compensation at the intermediate 
rate between 38 U.S.C. 1114 (n) and (o) plus special monthly 
compensation under 38 U.S.C. 1114(k) who establishes a factual need for 
regular aid and attendance or a higher level of care, is also entitled 
to an additional allowance during periods he or she is not hospitalized 
at United States Government expense. (See Sec. 3.552(b)(2) as to 
continuance following admission for hospitalization.) Determination of 
the factual need for aid and attendance is subject to the criteria of 
Sec. 3.352:
    (3) Amount of the allowance. The amount of the additional allowance 
payable to a veteran in need of regular aid and attendance is specified 
in 38 U.S.C. 1114(r)(1). The amount of the additional allowance payable 
to a veteran in need of a higher level of care is specified in 38 U.S.C. 
1114(r)(2). The higher level aid and attendance allowance authorized by 
38 U.S.C. 1114(r)(2) is payable in lieu of the regular aid and 
attendance allowance authorized by 38 U.S.C. 1114(r)(1).
    (i) Total plus 60 percent, or housebound; 38 U.S.C. 1114(s). The 
special monthly compensation provided by 38 U.S.C. 1114(s) is payable 
where the veteran has a single service-connected disability rated as 100 
percent and,
    (1) Has additional service-connected disability or disabilities 
independently ratable at 60 percent, separate and distinct from the 100 
percent service-connected disability and involving different anatomical 
segments or bodily systems, or
    (2) Is permanently housebound by reason of service-connected 
disability or disabilities. This requirement is met when the veteran is 
substantially confined as a direct result of service-connected 
disabilities to his or her dwelling and the immediate premises or, if 
institutionalized, to the ward or clinical areas, and it is reasonably 
certain that the disability or disabilities and

[[Page 257]]

resultant confinement will continue throughout his or her lifetime.

[26 FR 1587, Feb. 24, 1961, as amended at 27 FR 4739, May 18, 1962; 28 
FR 1587, Feb. 20, 1963; 28 FR 5671, June 11, 1963; 40 FR 54245, Nov. 21, 
1975; 45 FR 25392, Apr. 15, 1980; 46 FR 47541, Sept. 29, 1981; 48 FR 
41161, Sept. 14, 1983; 49 FR 47003, Nov. 30, 1984; 54 FR 34981, Aug. 23, 
1989; 60 FR 12886, Mar. 9, 1995; 67 FR 6873, Feb. 14, 2002]