VA Disability Ratings of the Genitourinary System
What is the Genitourinary System?
The genitourinary system consists of the organs of the reproductive system (i.e., the vagina, ovaries, uterus, fallopian tubes, external genitalia, and perineum in women, and the prostate gland, testicles, epididymis, and penis in men) and the urinary system (i.e., the kidneys, ureters, bladder, and urethra). They are grouped together because of their proximity to each other and their use of common pathways. The primary functions of the genitourinary system include the following:
- Excretion of liquid waste products
- Regulation of blood volume
- Electrolyte regulation
- Acid-base balance regulation
- Arterial blood pressure regulation
Disorders of the genitourinary system include a range of disorders from those that are asymptomatic to those that manifest an array of signs and symptoms. Causes for genitourinary disorders can include congenital factors, infectious diseases, trauma, or conditions that secondarily involve the urinary structure. However, many veterans experience conditions related to the genitourinary system as a result of service-related injuries or diseases. If veterans believe their genitourinary condition was caused or aggravated by their time in service, they should consider filing a claim for VA disability compensation.
Service Connection for Conditions of the Genitourinary System
To establish direct service connection for conditions of the genitourinary system, veterans must demonstrate that their condition is related to their time in service. Veterans can do so by showing evidence of the following:
- A current diagnosis of a genitourinary condition
- An in-service event, injury, or illness
- A medical nexus opinion linking the current, diagnosed genitourinary condition to the in-service event
After reviewing your claims file and the evidence you submitted, VA will make a decision on your claim. If VA concedes service connection for your genitourinary condition, it will then assign a disability rating based on severity.
How VA Rates Genitourinary Conditions
Genitourinary conditions are rated under 38 CFR § 4.115a, Ratings of the Genitourinary System – Dysfunctions. Conditions affecting kidney function are referred to as “renal,” while ureters, urethra, and bladder conditions are called “urinary”.
Urinary Rating System
There are three different urinary rating systems which we discuss below.
A condition is evaluated under urinary frequency if it causes the body to urinate more often than normal. The rating criteria are as follows:
- 40% - urinating more than every hour daily and five or more times during the night
- 20% – urinating every 1-2 hours daily and 3-4 times per night
- 10% – urinating every 2-3 hours daily and at least twice at night
The obstructed voiding rating system is reserved for conditions that make it hard to urinate. The following disability ratings may be assigned:
- 30% – a catheter is needed constantly or intermittently
- 10% – slow or weak stream, hesitancy to start urinating, and one or more of the following: (1) more than 150cc of urine left in the bladder after urinating; (2) less than 10cc of urine passing through ureter every second; (3) regular urinary tract infections due to obstruction; (4) narrow urethra requires dilatation treatments every 2-3 months
- 0% – slow or weak stream, hesitancy to start urinating, or narrowing of the urethra that require dilatation treatments only once or twice per year
All urinary conditions that cannot be rated as urinary frequency or obstructed voiding are rated by this system, as follows:
- 60% – the condition either constantly requires the use of a catheter to remove urine or if the condition requires the use of absorbent materials that need to be changed more than 4 times per day
- 40% – requiring absorbent materials that need to be changed 2-4 times per day
- 20% – requiring absorbent materials that need to be changed once per day
Renal Rating System
For all renal conditions, VA uses a general rating formula. The criteria are listed below:
- 100% – requires regular dialysis, the body cannot perform physical activity due to albuminuria or persistent edema, or a BUN (blood urea nitrogen) of more than 80mg/dL, or more than 9 mg/dL of creatinine in the blood, or severely decreased kidney operation
- 80% – there is a level of 4 to 8 mg/dL of creatinine in the blood, or albuminuria with a BUN of 40 to 80 mg/dL with persistent edema, or overall poor health symptomized by lethargy, anorexia, weight low, weakness, or the inability to exert much energy
- 60% – definite decrease in kidney function, or constant albuminuria with some edema, or hypertension with an average diastolic pressure above 120
- 30% – albumin is present in urine with either red blood cells or hyaline and granular casts, or slight edema, or hypertension with diastolic pressure averaging above 100 or systolic pressuring averaging above 160
- 0% – albumin and casts are present in the urine with a history of nephritis (inflammation of the kidneys) or hypertension is present with average diastolic pressure less than 100 or with average systolic pressure less than 160
Examples of renal conditions that are rated according to the general formula outlined above, include, but are not limited to, the following:
- Nephrectomy (Diagnostic Code 7500) – the removal of one kidney. This condition will automatically be rated at 30 percent. A higher rating may be warranted based on the working condition of the remaining kidney.
- Nephritis (Diagnostic Code 7502) – the swelling of the nephrons inside the kidney. This condition can only be rated if it is directly caused by an infectious disease and has continued despite appropriate treatment of the disease.
- Interstitial nephritis (Diagnostic Code 7537) – occurs when the spaces between the tubules in the kidney swell.
- Pyelonephritis (Diagnostic Code 7504) – form of nephritis where a urinary tract infection has spread up to the kidney. This condition can be rated on either the renal rating system or on the ratings for a urinary tract infection, whichever results in a higher rating.
- Kidney Disease (Diagnostic Code 7530) – any kidney disease that requires regular dialysis.
- Kidney Transplant (Diagnostic Code 7531) – rated 100 percent for one year following the transplant surgery. After the one-year period, the condition is re-evaluated and rated on any symptom under the renal rating system. The minimum rating is a 30 percent.
- Atherosclerotic renal disease (Code 7534) – also known as renal artery stenosis or atheroembolic renal disease. A condition where the artery to the kidney narrows and decreases the blood flow to the kidney.
- Toxic nephropathy (Diagnostic Code 7535) – any damage to the kidney that is caused by any kind of chemical or biological product that enters the blood stream.
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