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] Sec. 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 100
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 cardiovascular....................
Persistent edema and albuminuria with BUN 40 to 80mg%; or, 80
creatinine 4 to 8mg%; or, generalized poor health
characterized by lethargy, weakness, anorexia, weight loss,
or limitation of exertion....................................
Constant albuminuria with some edema; or, definite decrease in 60
kidney function; or, hypertension at least 40 percent
disabling under diagnostic code 7101.........................
Albumin constant or recurring with hyaline and granular casts 30
or red blood cells; or, transient or slight edema or
hypertension at least 10 percent disabling under diagnostic
code 7101....................................................
Albumin and casts with history of acute nephritis; or, 0
hypertension non-compensable under diagnostic code 7101......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 60
materials which must be changed more than 4 times per day....
Requiring the wearing of absorbent materials which must be 40
changed 2 to 4 times per day.................................
Requiring the wearing of absorbent materials which must be 20
changed less than 2 times per day............................Urinary frequency:
Daytime voiding interval less than one hour, or; awakening to 40
void five or more times per night............................
Daytime voiding interval between one and two hours, or; 20
awakening to void three to four times per night..............
Daytime voiding interval between two and three hours, or; 10
awakening to void two times per night........................Obstructed voiding:
Urinary retention requiring intermittent or continuous 30
catheterization..............................................
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 10
to 3 months................................................
Obstructive symptomatology with or without stricture disease 0
requiring dilatation 1 to 2 times per year...................Urninary tract infection:
Poor renal function: Rate as renal dysfunction.
Recurrent symptomatic infection requiring drainage/frequent 30
hospitalization (greater than two times/year), and/or
requiring continuous intensive management....................
Long-term drug therapy, 1-2 hospitalizations per year and/or 10
requiring intermittent intensive management..................------------------------------------------------------------------------ [59 FR 2527, Jan. 18, 1994; 59 FR 10676, Mar. 7, 1994] Sec. 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 Sec. 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 evaluation........................................ 30
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 Sec. Sec. 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 30
times/year.............................................7509 Hydronephrosis:
Severe; Rate as renal dysfunction.
Frequent attacks of colic with infection (pyonephrosis), 30
kidney function impaired...................................
Frequent attacks of colic, requiring catheter drainage...... 20
Only an occasional attack of colic, not infected and not 10
requiring catheter drainage................................
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 30
times/year.............................................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 30
times/year.............................................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 dysfunction7516 Bladder, fistula of:
Rate as voiding dysfunction or urinary tract infection,
whichever is predominant.
Postoperative, suprapubic cystotomy....................... 1007517 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 fistulae......................... 1007520 Penis, removal of half or more............................. 30
Or rate as voiding dysfunction.7521 Penis removal of glans..................................... 20
Or rate as voiding dysfunction.7522 Penis, deformity, with loss of erectile power--20 \1\......7523 Testis, atrophy complete:..................................
Both--20 \1\
One--0 \1\7524 Testis, removal:...........................................
Both--30 \1\
One--0 \1\
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 Sec.
Sec. 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 system............ 100
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 Sec. 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 surgery.............................. 100
Thereafter: Rate on residuals as renal dysfunction, 30
minimum rating...........................................
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 Sec. 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 condition.................. 20
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.------------------------------------------------------------------------\1\ Review for entitlement to special monthly compensation under Sec.
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]
Gynecological Conditions and Disorders of the Breast