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Electronic Code of Federal Regulations

e-CFR Data is current as of July 22, 2014

Title 38: Pensions, Bonuses, and Veterans' Relief
PART 4—SCHEDULE FOR RATING DISABILITIES
Subpart B—Disability Ratings


The Genitourinary System

§4.115   Nephritis.

Albuminuria alone is not nephritis, nor will the presence of transient albumin and casts following acute febrile illness be taken as nephritis. The glomerular type of nephritis is usually preceded by or associated with severe infectious disease; the onset is sudden, and the course marked by red blood cells, salt retention, and edema; it may clear up entirely or progress to a chronic condition. The nephrosclerotic type, originating in hypertension or arteriosclerosis, develops slowly, with minimum laboratory findings, and is associated with natural progress. Separate ratings are not to be assigned for disability from disease of the heart and any form of nephritis, on account of the close interrelationships of cardiovascular disabilities. If, however, absence of a kidney is the sole renal disability, even if removal was required because of nephritis, the absent kidney and any hypertension or heart disease will be separately rated. Also, in the event that chronic renal disease has progressed to the point where regular dialysis is required, any coexisting hypertension or heart disease will be separately rated.

[41 FR 34258, Aug. 13, 1976, as amended at 59 FR 2527, Jan. 18, 1994]

§4.115a   Ratings of the genitourinary system—dysfunctions.

Diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these. The following section provides descriptions of various levels of disability in each of these symptom areas. Where diagnostic codes refer the decisionmaker to these specific areas dysfunction, only the predominant area of dysfunction shall be considered for rating purposes. Since the areas of dysfunction described below do not cover all symptoms resulting from genitourinary diseases, specific diagnoses may include a description of symptoms assigned to that diagnosis.

   Rating
Renal dysfunction:
Requiring regular dialysis, or precluding more than sedentary activity from one of the following: persistent edema and albuminuria; or, BUN more than 80mg%; or, creatinine more than 8mg%; or, markedly decreased function of kidney or other organ systems, estpecially cardiovascular100
Persistent edema and albuminuria with BUN 40 to 80mg%; or, creatinine 4 to 8mg%; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion80
Constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under diagnostic code 710160
Albumin constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema or hypertension at least 10 percent disabling under diagnostic code 710130
Albumin and casts with history of acute nephritis; or, hypertension non-compensable under diagnostic code 71010
Voiding dysfunction:
Rate particular condition as urine leakage, frequency, or obstructed voiding   
Continual Urine Leakage, Post Surgical Urinary Diversion, Urinary Incontinence, or Stress Incontinence:
Requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day60
Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day40
Requiring the wearing of absorbent materials which must be changed less than 2 times per day20
Urinary frequency:
Daytime voiding interval less than one hour, or; awakening to void five or more times per night40
Daytime voiding interval between one and two hours, or; awakening to void three to four times per night20
Daytime voiding interval between two and three hours, or; awakening to void two times per night10
Obstructed voiding:
Urinary retention requiring intermittent or continuous catheterization30
Marked obstructive symptomatology (hesitancy, slow or weak stream, decreased force of stream) with any one or combination of the following:
1. Post void residuals greater than 150 cc.
2. Uroflowmetry; markedly diminished peak flow rate (less than 10 cc/sec).
3. Recurrent urinary tract infections secondary to obstruction.
4. Stricture disease requiring periodic dilatation every 2 to 3 months10
Obstructive symptomatology with or without stricture disease requiring dilatation 1 to 2 times per year0
Urninary tract infection:
Poor renal function: Rate as renal dysfunction.
Recurrent symptomatic infection requiring drainage/frequent hospitalization (greater than two times/year), and/or requiring continuous intensive management30
Long-term drug therapy, 1-2 hospitalizations per year and/or requiring intermittent intensive management10

[59 FR 2527, Jan. 18, 1994; 59 FR 10676, Mar. 7, 1994]

§4.115b   Ratings of the genitourinary system—diagnoses.

   Rating
Note: When evaluating any claim involving loss or loss of use of one or more creative organs, refer to §3.350 of this chapter to determine whether the veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.
7500   Kidney, removal of one:
Minimum evaluation30
Or rate as renal dysfunction if there is nephritis, infection, or pathology of the other.
7501   Kidney, abscess of:
Rate as urinary tract infection
7502   Nephritis, chronic:
Rate as renal dysfunction.
7504   Pyelonephritis, chronic:
Rate as renal dysfunction or urinary tract infection, whichever is predominant.
7505   Kidney, tuberculosis of:
Rate in accordance with §§4.88b or 4.89, whichever is appropriate.
7507   Nephrosclerosis, arteriolar:
Rate according to predominant symptoms as renal dysfunction, hypertension or heart disease. If rated under the cardiovascular schedule, however, the percentage rating which would otherwise be assigned will be elevated to the next higher evaluation.
7508   Nephrolithiasis:
Rate as hydronephrosis, except for recurrent stone formation requiring one or more of the following:
1. diet therapy
2. drug therapy
3. invasive or non-invasive procedures more than two times/year30
7509   Hydronephrosis:
Severe; Rate as renal dysfunction.
Frequent attacks of colic with infection (pyonephrosis), kidney function impaired30
Frequent attacks of colic, requiring catheter drainage20
Only an occasional attack of colic, not infected and not requiring catheter drainage10
7510   Ureterolithiasis:
Rate as hydronephrosis, except for recurrent stone formation requiring one or more of the following:
1. diet therapy
2. drug therapy
3. invasive or non-invasive procedures more than two times/year30
7511   Ureter, stricture of:
Rate as hydronephrosis, except for recurrent stone formation requiring one or more of the following:
1. diet therapy
2. drug therapy
3. invasive or non-invasive procedures more than two times/year30
7512   Cystitis, chronic, includes interstitial and all etiologies, infectious and non-infectious:
Rate as voiding dysfunction.
7515   Bladder, calculus in, with symptoms interfering with function:
Rate as voiding dysfunction
7516   Bladder, fistula of:
Rate as voiding dysfunction or urinary tract infection, whichever is predominant.
Postoperative, suprapubic cystotomy100
7517   Bladder, injury of:
Rate as voiding dysfunction.
7518   Urethra, stricture of:
Rate as voiding dysfunction.
7519   Urethra, fistual of:
Rate as voiding dysfunction.
Multiple urethroperineal fistulae100
7520   Penis, removal of half or more30
Or rate as voiding dysfunction.
7521   Penis removal of glans20
Or rate as voiding dysfunction.
7522   Penis, deformity, with loss of erectile power—201
7523   Testis, atrophy complete:
Both—201
One—01
7524   Testis, removal:
Both—301
One—01
Note: In cases of the removal of one testis as the result of a service-incurred injury or disease, other than an undescended or congenitally undeveloped testis, with the absence or nonfunctioning of the other testis unrelated to service, an evaluation of 30 percent will be assigned for the service-connected testicular loss. Testis, underscended, or congenitally undeveloped is not a ratable disability.
7525   Epididymo-orchitis, chronic only:
Rate as urinary tract infection.
For tubercular infections: Rate in accordance with §§4.88b or 4.89, whichever is appropriate.
7527   Prostate gland injuries, infections, hypertrophy, postoperative residuals:
Rate as voiding dysfunction or urinary tract infection, whichever is predominant.
7528   Malignant neoplasms of the genitourinary system100
Note—Following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. If there has been no local reoccurrence or metastasis, rate on residuals as voiding dysfunction or renal dysfunction, whichever is predominant.
7529   Benign neoplasms of the genitourinary system:
Rate as voiding dysfunction or renal dysfunction, whichever is predominant.
7530   Chronic renal disease requiring regular dialysis:
Rate as renal dysfunction.
7531   Kidney transplant:
Following transplant surgery100
Thereafter: Rate on residuals as renal dysfunction, minimum rating30
Note—The 100 percent evaluation shall be assigned as of the date of hospital admission for transplant surgery and shall continue with a mandatory VA examination one year following hospital discharge. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.
7532   Renal tubular disorders (such as renal glycosurias, aminoacidurias, renal tubular acidosis, Fanconi's syndrome, Bartter's syndrome, related disorders of Henle's loop and proximal or distal nephron function, etc.):
Minimum rating for symptomatic condition20
Or rate as renal dysfunction.
7533   Cystic diseases of the kidneys (polycystic disease, uremic medullary cystic disease, Medullary sponge kidney, and similar conditions):
Rate as renal dysfunction.
7534   Atherosclerotic renal disease (renal artery stenosis or atheroembolic renal disease):
Rate as renal dysfunction.
7535   Toxic nephropathy (antibotics, radiocontrast agents, nonsteroidal anti-inflammatory agents, heavy metals, and similar agents):
Rate as renal dysfunction.
7536   Glomerulonephritis:
Rate as renal dysfunction.
7537   Interstitial nephritis:
Rate as renal dysfunction.
7538   Papillary necrosis:
Rate as renal dysfunction.
7539   Renal amyloid disease:
Rate as renal dysfunction.
7540   Disseminated intravascular coagulation with renal cortical necrosis:
Rate as renal dysfunction.
7541   Renal involvement in diabetes mellitus, sickle cell anemia, systemic lupus erythematosus, vasculitis, or other systemic disease processes.
Rate as renal dysfunction.
7542   Neurogenic bladder:
Rate as voiding dysfunction.

1Review for entitlement to special monthly compensation under §3.350 of this chapter.

[59 FR 2527, Jan. 18, 1994; 59 FR 14567, Mar. 29, 1994, as amended at 59 FR 46339, Sept. 8, 1994]



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