Shortness of breath va rating. The higher your rating, the more disability insurance you. Shortness of breath va rating

 
 The higher your rating, the more disability insurance youShortness of breath va rating  08-38 252 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Reno, Nevada THE ISSUE Entitlement to service connection for recurrent symptoms of chest pain, shortness of breath and dyspnea including potential etiologies of underlying respiratory

VA declines to revise the evaluation criteria to incorporate symptoms of extreme fatigue, hypotension, shortness of breath. Coughing. 100%. Louis,A VA physician stated that the Veteran's spontaneous pneumothorax was secondary to his COPD. When people experience shortness of breath because of anxiety or panic, it can make them feel more anxious, which can worsen their breathing. Worsening of preexisting shortness of breath. To qualify for a 100 percent disability rating, your VA examiner will have to assess your COPD as completely and permanently disabling. 88 per monthUCSD Shortness of Breath Questionnaire. People experience and describe shortness of breath differently depending on the cause. IMPORTANT UPDATE: Chronic bronchitis VA. to ICD-9-CM. as well as shortness of breath. Carbon monoxide poisoning. Lung cancer can cause shortness of breath. A veteran with restrictive lung disease with pulmonary fibrosis will be rated under the General Rating Formula for Interstitial Lung Disease (diagnostic codes 6825 through 6833): A 10% rating is given if the FVC of 75 to 80 percent predicted, or; DLCO (SB) of 66 to 80 percent predicted. Other symptoms include cold or flu-like symptoms such as cough, runny nose, and shortness of breath. If. Less than 40% or a bunch of other issues are listed below. 02 may differ. Feeling huffy and puffy. This affects patients with large and progressive curves (over 70 degrees) that compress the lungs. #2: Secondary Service Connection for Allergic Rhinitis with a rating. Asthma is a common condition from Burn Pit Exposure. When a person gets older, their energy levels decrease and they have more and more ailments that bother than on an everyday basis, this is normal. 23 - Rating of Disabilities Aggravated by Active Service/Attitude of Rating Officers. shortness of breath; sweating;In addition, the Veteran has submitted a statement from his employer, which indicates that the Veteran experiences shortness of breath, which causes fatigue. Shortness of breath; Feeling weak; and more;. Ratings range from 0 percent to 100 percent. Symptoms of sand, dust and particulate exposure include irritation of the eyes, nose, throat, and skin. Ask your healthcare provider about medications to help decrease your shortness of breath. Dyspnea, commonly referred to as shortness of breath, is the subjective sensation of uncomfortable breathing comprised of various sensations of varying intensity. Shortness of Breath. There are two types of home health star ratings: Quality of Patient Care Star Ratings. 82 each month. Use a fan when you feel short of breath or “closed in” along with doing pursed-lips breathing can help. Lung nodules may be asymptomatic, but can lead to serious complications down the road. VA Disability Ratings for Respiratory Cancers. With METs based ratings, the higher level of exertion you are able to withstand prior to having those symptoms listed above, the higher your METs score. Problems breathing can come on suddenly or last for weeks or longer. Shortness of breath, or breathlessness, is described as the frightening sensation of being unable to breathe normally or feeling suffocated. If FEV-1 and FVC tests are not performed, then asthma can be rated based on the kind of medication that is used to treat the condition or the severity of the condition based on the number of ER visits. To qualify for a 100 percent disability rating, your VA examiner will have to assess your COPD as completely and permanently disabling. High fever, chills and cough. Circulation. Anxiety disorders are common and cause a wide range of mental and physical symptoms. The assessment included coronary artery disease, with fatigue, dizziness, and lightheadedness, relieved with eating, most likely hypoglycemia. Drawing of organs that may be involved in development of shortness of breath, including the central nervous system, airway, lungs, chest, and heart. A score of 0 means you have no shortness of breath at all. This makes it difficult to breathe and can cause coughing, wheezing, and chest tightness. 100%: Total occupational and social impairment due to symptoms, such as. Shortness of breath or difficulty breathing;. About Shortness of Breath. Definition: Evaluation of the patient for the presence or absence of dyspnea (shortness of breath) and its severity at the time of the palliative care initial encounter. Understanding the burn pit presumptive conditions is vital for veterans seeking VA disability benefits for burn pit presumptives. COVID-19 is a respiratory disease caused by the SARS-CoV-2 virus. COVID-19 (2019-nCoV) is a disease that causes flu-like symptoms such as shortness of breath, cough, fever, loss of sense of smell and/or taste, shaking chills, headache, and sore throat. Table 1. Veteran's branch of service is AIR FORCE for the period of Jun 13, 1979 to Aug 17, 1979 and ARMY for the period of Mar 22, 1982 to Jun 16, 1982 during Peacetime. Anemia, Primary. For this, a veteran should have: A single disability, like asthma, rated at a minimum of 60%, OR. Outside of these examples. To attain service connection, you must meet the 3 general requirements: Have a current medical diagnosis for sarcoidosis. 60% VA Rating. February 21, 2022. Emphysema involves damage to the tiny air sacs in the lungs as a result of long-term exposure to irritants such as smoke, chemical fumes and air pollution. High and/or low levels of prolonged exposure to ACM may cause cancer. shortness of breath; weight loss, and ; lung disorders; Conclusion. But, VA recognizes that it is a legitimate disability and so it borrows appropriate diagnostic codes from similar conditions. Patient Survey Star Ratings. Hold your lips together as if you are trying to whistle or. VA combined ratings. Shortness of breath; Feeling weak or tired with regularity; Chronic bronchitis or pneumonia; Sudden onset of wheezing;. These 27 PACT Act claims (sorted from A to Z) are now “presumed” to be service connected for veteran’s exposure to burn pits and other airborne hazards: Asthma, code 6602 (cannot have been diagnosed before discharge) Asthma, code 6602. Anxiety may cause you to feel : Restless. Ventilation is needed to be able to move oxygen in and move used air or carbon dioxide out. ” Nurses reported using the suggested words on the 0-10 scale to guide patients in their self-rating (none, mild, moderate, severe or unbearable) (Fig. These ratings are based on the level of social and occupational impairment a veteran experiences, and the severity of symptoms VA uses to. Many patients continue to have ongoing symptoms well after their initial SARS-CoV-2 infection. See if you can get a VA disability rating today. Shortness of breath is associated with a myriad of symptoms, depending on what brings it about. Chronic bronchitis, code 6600. Shortness of breath can be caused by many things, including: Asthma. If FEV-1 and FVC tests are not performed, then asthma can be rated based on the kind of medication that is used to treat the condition or the severity of the condition based on the number of ER visits. VA Rating : MET test causes symptoms (like shortness of breath, fatigue, chest pain, dizziness, heart palpitations, arrhythmia, or fainting) at 3. 49 per month. Acid reflux can cause shortness of breath when stomach acid reenters the esophagus. If your symptoms are severe enough that treatments and therapy are not slowing the disease, you could be eligible for a lung transplant. When we started seeing service members with unexplained shortness of breath, they had already had a number of noninvasive studies, chest X-rays, C. 4. 1000: Client was brought to the ED by her daughter due to increased shortness of breath this morning. A person with long COVID who has lung damage that causes shortness of breath, fatigue, and related effects is substantially limited in respiratory function, among other major life activities. 888. Swelling in ankles and feet. Ratings for asthma depend on the severity and the frequency of asthma attacks and can range from a 0% rating to a 100% disabled rating. A 100 percent disability rating is warranted where the evidence reveals chronic congestive heart failure, or a workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or there is left ventricular dysfunction with an ejection fraction of less than 30 percent. Disability ratings can also drop down to as low as 10%. Loss of height (stature). You can take in 40-55% of air in a deep breath. You can take in 56-70% of air in a deep. 97, DC 6600, a veteran must experience the following levels of pulmonary dysfunction to qualify for a chronic bronchitis disability rating: 10% ratings are assigned to veterans who demonstrate: FEV-1 of 71% to 80% predicted; or. Cardiovascular concerns. Although VA recognizes hiatal hernias as a disabling condition, proving the link between a hernia & military. But sometimes, aortic valve regurgitation occurs suddenly. July 2010, September 2010, and October 2010 VA treatment records noted no symptoms referable to the heart and noted that the Veteran's CAD was asymptomatic. 19, 1968 or in effect on Aug. I am asthmatic (with a history and meds) and I have a unchallenged FEV1 below 55%, and on the first step of a methcholine challenge my FEV1 drops way below 40%. Swelling in your legs or ankles. This is the highest possible rating and means that the veteran is Totally Disabled. Use of inhaled medication can improve ventilation and reduce your shortness of. You need to see the doc regularly for flare-ups. VA disability benefits are available for veterans with anemia that is service-connected. In their early stages, you get short of breath only when you exert yourself. 4 ° F ( 38. In many cases, the VA has rated Reactive Airway Disease under the diagnostic code for asthma (6602) in the Schedule for Rating Disabilities. #2: Secondary Service Connection for Hiatal Hernia. They may be done before and after you take certain. Pulmonary fibrosis. e. VA continues to investigate the best approaches to Veteran care and to conduct additional research into GWI and CMI. The Department of Veterans Affairs (VA) is issuing this interim final rule to amend its adjudication regulations to establish presumptive service connection for three. iStock-670532836. 19, 1968, based on the veteran’s effective date. In addition to shortness of breath, it can cause: Coughing; Tightness in the chest; Wheezing; To keep it under control, work with your doctor to create a treatment plan. 97, Schedule of Ratings – Respiratory System. Sudden onset of shortness. 60% Rating: Your asthma’s bad, but not the worst. 5 = very, very slight shortness of breath; 1 = very mild shortness of breath; 2 = mild shortness of breath; 3 = moderate shortness of breath or breathing difficulty; 4 = somewhat severe shortness of breath; 5 = strong or hard breathing; 6“I feel people usually get [i. The VA Schedule for Rating Disabilities is the instrument used for rating a veteran’s disability. Applying the newer rating criteria, a VA pulmonary function test in February 1997 measured FEV1 of 51 percent of predicted value, which is within the range of 40. Also, keep in mind that some infections only qualify veterans for a TEMPORARY 100% rating while the infection is active. WRIISC For more information, contact 800-248-8005 | War Related Illness and Injury Study Center +HDOWK2XWFRPHV0LOLWDU\([SRVXUHV, Patient Care If a veteran is not having an attack during a VA examination, there must be a history of attacks in the record for the VA to consider. Shortness of breath or difficulty breathing; Some individuals will experience these symptoms intermittently, having asthma attacks only after exercise or other triggers; other individuals can have symptoms at all times, regardless of their actions or environment. Collected For: PAL-03. They include asthma, allergies, heart disease, chronic obstructive pulmonary disease ( COPD ), and COVID-19. Shortness of breath that lasts weeks or months could be due to medical conditions including: Obesity. The "presumptive" illness(es) must have first appeared during active duty in the Southwest Asia theater of military operations or by December 31, 2021, and be at least 10 percent disabling. Fibromyalgia VA Ratings and Gulf War Vets. Call TTY if you have hearing loss 800-799-4889. will ease your shortness of breath. 97 (DC 6004) for COPD. To qualify for VA benefits, you’ll need to show that your condition is related to your military service. 2. Just fyi, I am working on my claim for VA disability for asthma, and I have a fully developed claim as yet un-submitted and I know the FEV1% chart to ratings. 60% Disability: Symptoms limit your ability to do the majority of your daily. This rating is given to a veteran's condition if there is one or more of the following: A score of 6 or 7 METS, and he is short of breath, fatigued, and experiences chest pain, dizziness, and/or fainting. Toll Free. Brain cancer, code 8002. The rate and depth of breathing normally increase during exercise and at high altitudes, but the increase seldom causes discomfort. 2 Breathlessness was the most common answer. Possible Medical Reasons for. In order to get a VA disability rating, your condition must be connected to your military service. "People who have anxiety can have a sensation of uncomfortable breathing. F. This is because the heart and lungs help carry oxygenated blood to tissues throughout. Treatments. Your breathing muscles get tired and trap air in your. 17438. Three. Compare Espiritu v. The rate and depth of breathing normally increase during exercise and at high altitudes, but the increase seldom causes discomfort. Respiratory disability rating scale. Shortness of breath — known medically as dyspnea — is often described as an intense tightening in the chest, air hunger or a feeling of suffocation. To receive a VA rating for your condition, you must provide medical evidence showing. A few months back I took one of those fast boat rides and couldn't breathe for shit. Swelling in ankles and feet. 38 CFR § 4. These statements were reiterated during the Veteran's hearing before a Veteran's Law Judge in October 2007. Most people who get COVID-19 will experience mild to moderate. R. • Cancer. Shortness of breath . ♦ Labored breathing. com. R06. VA automatically assigns a 100 percent disability rating to veterans with a service-connected active cancer, including any type of respiratory cancer. Learn more from the Department of Defense. when you breathe out and shortness of breath” (Mayo linic). Shortness of breath after only slight activity or while at rest. Abnormal weight loss. Winston Tan, associate professor of medicine with the Mayo Clinic division of hematology/oncology in Florida, at least one of these two symptoms occurs in 60% to 90% of patients. It is a prevalent symptom impacting millions of people. Costochondritis is a condition that is not specifically coded in VA ratings so it doesn’t have its own diagnostic code. Heart attack. To be service. The journey for veterans to secure an appropriate VA disability rating that accurately represents their health challenges, especially when it comes to complex interconnected conditions. Key Points. Your health care provider typically writes this nexus letter to present to the VA. If your blood pressure reading is 140/90 or above, you most likely have high blood pressure. You can take in. Lean forward slightly, resting your upper body on your forearms. Key Points. 40%-55% or max oxygen consumption of 15-20 ml/kg/min. The Report of Medical History does show that the Veteran did. See August 2016 Board Hearing Transcript. ) A severe allergic reaction (anaphylaxis),. At a. However, there are high blood pressure VA disability benefits available. 97, Diagnostic Code (DC) 6602. A bronchitis VA rating ranges from 10% to 100% based on the severity of your condition, including: How long it takes you to breath. Shortness of breath when lying down. The most common symptoms of Long Covid include shortness of breath, fatigue, and sleep disorders, but researchers have identified over 200 possible symptoms. This test is used to diagnose COPD, bronchitis, asthma, and even lung cancer. It can be acute (sudden dyspnea) or chronic (long-lasting dyspnea). At a. People experience and describe shortness of breath differently depending on the cause. This is the virus that causes COVID-19. The private physician indicated that the Veteran was hospitalized for a week for total spontaneous pneumothorax and since has been experienced shortness of breath. F. Or elevate the head of the bed with pillows and blanket under the mattress, between the mattress and box springs, or by placing blocks under the headboard. VA proposes the following changes to the criteria of DC 6817: (1) Removing “primary pulmonary hypertension” from the 100 percent evaluation criteria, because it will be rated under new DC 6849, (2) removing references to cor pulmonale, which can be adequately evaluated under the proposed General Rating Formula, (3) recharacterizing. 97, diagnostic code 6602. You can take in 40-55% of air in a deep breath. com. But, VA recognizes that it is a legitimate disability and so it borrows appropriate diagnostic codes from similar conditions. App. Anxiety disorders are rated under the schedule of ratings for. Lack of good lung ventilation in COPD makes you short of breath. I kept prodding Drs. The rate and depth of breathing normally increase during exercise and at high altitudes, but the increase seldom causes discomfort. VA Medical Center, Houston, TX (B. The Veteran denied chest pain, palpitations, shortness of breath, or dizziness. If so, you could be like hundreds of other veterans that suffer from exercise induced asthma. Shortness of breath on exposure to allergens or provoking agents. Bronchiectasis. Bacterial lung infections can be service-connected conditions in the VASRD. To determine a veteran’s ratings, the VA relies a great deal on pulmonary function tests (PFTs). Sleep Apnea. FEV–1 of 56- to 70-percent predicted, or; FEV–1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication. Another way to get a 30% VA rating for a heart condition is with a stress test. - VHL HealthSheet #40217_VA; Chronic Lung Disease, Helping with Treatment: for Caregivers. Ischemic Heart Disease VA Rating. Inhaling steam. VA uses METs to rate heart disabilities at any level – 100%, 60%, 30% or 10%. 100% VA Rating for Heart Disease. The Quality of Patient Care (QoPC) Star Rating is based on OASIS assessments and Medicare claims data. As of December 1st, 2023 the VA disability rate benefit amounts are as follows: 0 percent disability rating: $0. 0 METs or less. Jackhammer esophagus, or hypercontractile peristalsis, is an esophageal motility disorder that is characterized by esophageal spasms that involve all or most of the muscles of the esophagus. Shortness of breath accompanied by. While some people have no symptoms, others may experience chest pain, cold hands and feet, dizziness or lightheadedness, headaches, irregular heartbeat, shortness of breath, and yellow or pale skin. No. B. Ratings range from 0 percent to 100 percent. Other Chronic Respiratory Disorders. When looking at symptoms of ischemic heart disease, VA specifically looks for the following when assigning a rating: shortness of breath, fatigue, chest pain,. A feeling of smothering, tightness, drowning, or suffocation. Usually, this will mean your rating ends up being too low. The treatment of your shortness of breath will depend on the cause, but the most important first step is to make sure you are getting enough air to supply your tissues with the oxygen they need. Asthma Ratings. Shortness of breath that wakes you up at night or requires you to sleep propped up to breathe. 10% VA Rating: Your FEV-1 is between 71 and 80 percent. Call 800-273-8255 and press 1. R. When you are becoming short of breath, do the following: Sit, relaxing your arms and shoulders. Typically, the higher the percentages for these kinds of respiratory disorders, the lower your disability rating will be. This is a behavioral response," Dr. The spasms are so intense and tend to last for a long time, making the name of the disorder, jackhammer esophagus, an adequate. Get plenty of rest. Shortness of breath (medically known as “dyspnea”) is the sensation of not being able to get enough air. If you are visiting r/veterans for the first time please read the rules. As with all VA ratings, the rating for each disease will vary from person to person depending on how far the disease has progressed and how much it affects each veteran’s day-to-day life. 80 percent disability rating: $1,778. Shortness of breath and chest pain are the most common presenting symptoms at diagnosis of malignant pleural mesothelioma (MPM). Start a confidential chat. Shortness of breath. The scale can help you realize how short of breath you are with specific activities. Shortness of breath — known medically as dyspnea — is often described as an intense tightening in the chest, air hunger or a feeling of suffocation. Shortness of breath—what doctors call dyspnea—is the unpleasant sensation of having difficulty breathing. Symptoms start with shortness of breath, cough, and chest pain and can take anywhere from 20-50. Key Points. In the modified version, patients are asked about the frequency of dyspnea when performing 21 different activities on a six-point rating scale . S. Many veterans suffering from burn pit exposure may not even know it because the symptoms can appear years after the. For asthma, the VA rates it based on findings during the veteran’s C&P exam, history of asthma attacks, and clinical tests such as FEV-1 and FCV, which measure lung capacity, as well as ER visits and medications needed. Pleuritis. 3d 1163 (2004). • Involves Cardiology, Surgery. In this case, the physician must clearly record a thorough history of asthma attacks. Palpitations: Irregular heartbeats or a sensation of “fluttering”. 4. Passed into law in August of 2022, the Honoring our PACT Act piece of VA legislation added hypertension to its list of diagnoses presumed to be caused by exposure to the tactical herbicide known as Agent Orange (AO), making eligibility for disability benefits much easier. about one-third of Veterans who . In this case, the physician must clearly record a thorough history of asthma attacks. In many cases, treatment/stabilization may actually precede establishing a final diagnosis. To receive a VA rating for lung nodules, they must be accompanied by or have symptoms similar to a respiratory condition for which the VA can give a disability rating. Veterans with these symptoms would be eligible to receive VA. The meaning of SHORTNESS OF BREATH is difficulty breathing. In addition to this kind of anxiety that we might expect living with a chronic illness, people living with COPD often experience shortness of breath. Dyspnea can happen due to overexertion, spending time at high altitudes, or as a symptom of several conditions. And while a fleeting bout of difficulty. scans, pulmonary function tests, exercise tests. VA rating for constrictive bronchiolitis Getting VA disability benefits for constrictive bronchiolitis Benefits of contacting Woods and Woods What is constrictive. The VA gives ratings on a percentage ranging from 10% to 100%, with 100% being full. So I have so sort of condition that I have shortness of breath usually during high winds like when outside. People experience and describe shortness of breath differently depending on the cause. Breathe in slowly through your nose while counting to 2. Human factors including age, health status, existing medical conditions, and genetics. Chest pain is one of the main symptoms of a heart attack. Your ratings on the scale can help you pace your activity. It can be acute (sudden dyspnea) or chronic (long-lasting dyspnea). Shortness of breath; A tight feeling in the chest;. How physicians evaluate patients with dementia who present with shortness of breath. 20% of times 70% gives us 14%; add 14% to 30% to get 44% then round the 44% down to 40% for the final combined rating. The key to controlling panic is to break the cycle before it starts. Modern medical advances and knowledge would be employed to compensate Veterans more accurately under the changes. 100 percent disability rating: $3,332. (83 KB, PDF)Both are chronic and usually worsen over time. ORD Home » Topics » Respiratory Health. Fainting. Fatigue. If the VA has sufficient evidence to make its decision on some of the claims, but not all, a deferred rating will be applied. For Chronic Bronchitis you can be rated 10%, 30%,. Start a confidential chat. Feeling of suffocation. Discomfort or pain in 1 or both arms, radiating to jaw or neck. The VA disability rating for pleuritis can be: 10%. The Schedule of Ratings calls for pleurisy to be rated under Ratings for inactive nonpulmonary tuberculosis either initially entitled after Aug. 43 per month. Shortness of breath and cough: Shortness of breath and a cough indicate a variety of conditions ranging from mild to severe, including panic attacks, acute bronchitis,. VA Study; 2010/viewarticle/979747. 18 - Misconduct Etiology/Unemployability. Your rating is heavily based on breathing tests that measure several different components. 60%. 11-25 369 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in North Litt100% VA Rating: you are qualified to receive individual unemployability benefits. Shortness of Breath. For example, the VA. Pulmonary Hypertension (PH) Pulmonary hypertension is high blood pressure in your pulmonary arteries, which carry oxygen-poor blood from your heart to your lungs. VA disability ratings for emphysema. Difficulty inhaling or exhaling. Those symptoms include dizziness, fainting, chest pain, shortness of breath, and fatigue. It often coincides with rapid breathing, hyperventilation, rapid heart rate, chest pain/chest tightness, dizziness,. Advanced testing of the heart and lungs may reveal why some people who have recovered from COVID-19 still have shortness of breath. Feeling anxious can surface emotions like apprehension, worry, and fear. During the other VA examination in March 1992 (of the trachea and bronchi), it was noted that the veteran had shortness of breath on even a moderate amount of exertion and that, reportedly, about one year earlier, he had to give up a job because of this problem. The PACT Act is one of the largest health care and benefits expansions in VA history. The conditions covered in. A VA rating for asthma depends on frequency and severity of your symptoms. When the airways become inflamed and narrow, some people may cough, wheeze, or experience shortness of breath. SSD causes significant impairment in occupational, social, and personal functioning due to excessive thoughts and behaviors related to physical symptoms. 2022 Jan;70 (1):119-125. 4. 31 per month; 60 percent disability rating: $1,361. Lean forward slightly, resting your upper body on your forearms. For example, if you receive a disability rating of 10%, you receive $165. Shortness of breath. Shortness of breath 6. Doctors often recommend relaxation techniques. An April 2011 VA examination report indicated that the estimated METs level was 5-7. Shortness of breath on exposure to allergens or provoking agents. You look okay, but you feel like crap. Shortness of Breath. Veteran Crisis Hotline Dial 988 Press 1 Call or Text or ChatResting while sitting can help relax your body and make breathing easier. R. The others are: pain in the jaw, neck, or back; lightheadedness or. Difficulty inhaling or exhaling. See moreWhen the airways become inflamed and narrow, some people may cough, wheeze, or experience shortness of breath. 30%. Long COVID-19 affects virtually any organ in the body. Find a Treatment Center. Here is a brief look at the VA rating schedule for heart disease: 100 percent rating. The dollar amount of benefits is determined by the degree of your disability. Today, we’re taking a look at how the VA rates lung nodules, as well. In one’s lifetime, one may experience rare episodes of shortness of breath as part of high levels of activity like exhaustive exertion, or during environmental. Dyspnea on exertion. These are non-invasive tests that measure lung volume, capacity, rates of flow, and gas exchange. People experience and describe shortness of breath differently depending on the cause. This is the American ICD-10-CM version of R06. VA Disability Ratings for Costochondritis.