Genitourinary System - (Caution, not complete)

The Genitourinary System

Topics:

Urinary Rating Systems

Urinary Conditions

Urinary Tract Infection

Renal Rating System

Renal (Kidney) Conditions

Hydronephrosis

The Penis and Testis

Cancer and Tumors of the Genitourinary System

Genitourinary Tuberculosis

Other Genitourinary Conditions

DBQs for Genitourinary Conditions

Principles that Apply

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

The genitourinary system is in charge of getting rid of unwanted liquid waste in the body.

This bodily system is comprised of two kidneys, two ureters, a bladder, a urethra, and any genitals directly relating to urination (although the male testes are also categorized under this system). The kidneys filter the blood and turn the waste into urine. The ureters then take the urine to the bladder where it is stored before traveling through the urethra to the genitals leading to the outside of the body.

the organs of the genitourinary system

For rating purposes, “renal” refers to the functioning of the kidneys and “urinary” refers to the functioning of the ureters, bladder and urethra.

Note: If a single condition causes problems with both urinary and renal functioning, then only the one that gives the highest rating is used. There cannot be two ratings for a single condition. However, if a single condition causes another defined condition, then the second condition can be rated separately as long as it has separate and distinct symptoms. The Pyramiding Principle still applies: a single symptom can only be rated once.

Double Note: There are a few times for these conditions that the VASRD uses vague terms like “severely decreased.” The exact definition of terms like that is up to the opinion of the people deciding the rating, so unfortunately, we can’t really give you a more concrete definition than this. It may mean one thing to one person and something entirely different to someone else. What they are supposed to be keeping in mind when deciding ratings, however, is how much that condition affects your overall health and ability to work. If that is severely affected, then the Rating Authorities should consider it a “severely decreased” condition. Hope that helps!

Urinary Rating Systems

Note: The word “void” means to urinate.

There are three different urinary rating systems.

Urinary Frequency: A condition is rated under this system if it causes the body to urinate more often than normal. If you have to urinate 5 or more times during the night, or if you have to urinate more than every hour during the day, it is rated 40%. If you have to urinate 3 or 4 times during the night, or if you have to urinate every 1 to 2 hours during the day, it is rated 20%. If you have to urinate 2 times during the night, or if you have to urinate every 2 to 3 hours during the day, it is rated 10%.

Obstructed Voiding: A condition is rated under this system if there is something that makes it hard to urinate.

If the condition requires the use of a catheter constantly or intermittently, then it is rated 30%.

If there are obvious symptoms (slow or weak stream, hesitancy to start urinating, etc.) and if there is one or more of the following: 1) more than 150 cc (cubic centimeters) of urine left over in your bladder after you urinate, 2) less than 10 cc of urine per second are passed through the ureter, 3) there are regular urinary tract infections because of the obstruction, or 4) the urethra becomes narrow because of an infection and requires regular dilatation (stretching) treatments every 2 to 3 months—then it is rated 10%.

If there are only obvious symptoms (slow or weak stream, hesitancy to start urinating, etc.) but none of the other 4 conditions listed above, then it is rated 0%. This 0% rating is still given even if there is narrowing of the urethra that requires regular dilatation (stretching) treatments only once or twice a year.

Voiding Dysfunction: All urinary conditions that cannot be rated as urinary frequency or obstructed voiding are rated by this system. If the condition requires the use of a catheter or other urinary assistive appliance to remove urine from the bladder, or if the condition requires the use of absorbent materials (like pads or Depends) that must be changed more than 4 times a day, then it is rated 60%. If it requires absorbent materials that must be changed 2 to 4 times a day, then it is rated 40%. If it requires absorbent materials that must be changed only once a day, then it is rated 20%.

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Urinary Conditions

The following conditions are all rated based on the urinary rating systems above. The system that most closely describes the condition and its symptoms is used.

Code 7512: Chronic Cystitis is the swelling of the bladder most often due to infections, but it can be caused by other things as well. If it is caused by a urinary tract infection, then it is rated as described for that condition. All other causes of this condition are rated under this code.

Code 7515: A Calculus in the Bladder is a stone (like a kidney stone, but in the bladder) that can interfere with the ability to urinate.

Code 7516: A Fistula in the Bladder is an abnormal passageway that connects the bladder to other areas of the body that do not normally connect. It can cause problems urinating and urinary tract infections. This condition should be rated on whatever symptom is worse. So if rating it as a urinary tract infection would result in a higher rating than the other urinary rating systems, then that rating should be used.

Also rated under this code is a Suprapubic Cystotomy. This is a surgery that creates a new passageway from the bladder to the skin that allows urination when the normal urinary tract is blocked. This condition is rated 100%.

Code 7517: Any Injury of the Bladder is rated under this code.

Code 7518: A Stricture of the Urethra occurs when the pathway through the urethra becomes narrowed.

Code 7519: A Fistula in the Urethra is an abnormal passageway from the urethra to other areas of the body that do not normally connect. If there are multiple passageways leading from the urethra to the outside of the body, then it is rated 100%.

Code 7542: A Neurogenic Bladder occurs when a person loses control over urination because of damage to the nerves or the brain.

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Urinary Tract Infection

A urinary tract infection is a bacterial infection that can affect the upper urinary tract (these can be called a kidney infection) or the lower urinary tract (a bladder infection). These infections are normally treated and cured with no disability. However, if a condition results in multiple urinary tracts infections it can be rated based on the severity and frequency of the infections.

The ratings: A 30% rating is given if the condition causes regular infections that require hospitalization 3 or more times a year, or if it requires serious continuous treatment. A 10% rating is given if the condition requires regular drug therapy, 1 or 2 hospitalizations a year, or if it requires serious continuous treatment.

If any of these conditions that are rated as urinary tract infections also cause renal problems, then only one or the other can be rated. If the renal problems are more severe, then the condition should be rated under the renal rating system.

The following conditions are rated as urinary tract infections:

Code 7501: Abscess of the Kidney is a puss-filled pocket in the kidney.

Code 7525: Chronic Epididymo-orchitis is pain in the epididymis. If the pain is caused by tuberculosis, it is rated as nonpulmonary tuberculosis.

Code 7527: Prostate Gland conditions (any) are either rated as urinary tract infections or by the urinary rating system, whichever better defines the symptoms of the condition.

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Renal Rating System

A 100% rating is given if at least one of the following is present:

– The condition requires regular dialysis.

– The body cannot perform any physical activity because of persistent edema or because of albuminuria.

– A BUN of more than 80 mg/dL.

– A creatinine level of 9 mg/dL or more in the blood.

– A severely decreased functioning of the kidneys or other organs due to kidney dysfunction.

An 80% rating is given if one or more of the following is present:

– Persistent edema and albuminuria with a BUN of 40 to 80 mg/dL.

– A creatinine level of 4 to 8 mg/dL in the blood.

– Overall poor health with symptoms like lethargy, weakness, anorexia, weight loss, or the inability to exert much energy.

A 60% rating is given if one or more of the following is present:

– Constant albuminuria with some edema.

– A definite decrease in kidney function.

– Hypertension with the average diastolic pressure (the smaller number on the bottom in the blood pressure reading) of 120 or more.

A 30% rating is given if one or more of the following is present:

– Occasional or slight edema.

– Hypertension with the average diastolic pressure (the smaller number on the bottom) of 100 or more, or with the average systolic pressure (the larger number on top) of 160 or more.

– Albumin is present in the urine with either hyaline and granular casts or red blood cells.

A 0% rating is given if:

– Hypertension with the average diastolic pressure of less than 100, or with the average systolic pressure of less than 160.

– Albumin and casts are present in the urine with a history of nephritis.

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Renal (Kidney) Conditions

The following conditions are all rated based on the renal rating system above.

Code 7500: A Nephrectomy is the removal of one kidney. The minimum rating for this condition is 30%. A higher rating can be given based on the renal rating system if the remaining kidney shows symptoms of disease or infection. The rating for the removal of one kidney, however, cannot be combined with a rating for symptoms in the remaining kidney. Only one rating for both kidneys under this code is allowed.

Code 7502: Nephritis is the swelling of the nephrons inside the kidney. The nephrons do the actual work of filtering the blood. Nephritis can only be rated if it is directly caused by an infectious disease and has continued despite appropriate treatment of the disease.

Nephritis is often closely related to heart diseases. If nephritis is present and a heart disease is present and both are caused by the same general condition, then only one rating can be given even though there are two organs affected by the condition. Only the condition that rates the highest is used. The heart disease can, however, be rated separately if one kidney was removed because of nephritis but the remaining kidney is healthy. Then the heart disease warrants a rating and the removed kidney can also be rated under code 7500. The heart disease could also be rated separately if the nephritis is severe enough to need regular dialysis.

Code 7537: Interstitial nephritis occurs when the spaces between the tubules in the kidney swell. This reduces the ability of the kidneys to filter blood.

Code 7504: Pyelonephritis is a 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 the higher rating.

Code 7507: Nephrosclerosis is a disease where the kidney is damaged because of high blood pressure. This condition is rated on the worst symptoms. So, if the kidney damage causes the worst symptoms, then it is rated under the renal rating system.

It could also be rated under high blood pressure or heart disease if the symptoms support it. If it is rated under one of these cardiovascular conditions, then the next highest rating is given. So, if the symptoms for high blood pressure would result in a 40% rating, then it would be raised to the next highest rating, 60% in this case. This extra bonus is not given if it is rated under the renal rating system.

Only one rating can be given for this condition. A rating for high blood pressure, heart disease, and nephrosclerosis is not allowed. Only the one that gives the highest rating is used.

Code 7530: Any kidney disease that requires regular dialysis is rated under the renal rating system. Only conditions that cannot be coded under another renal code is assigned this code.

Code 7531: A kidney transplant is rated 100% for one year following the transplant surgery. After the one-year mark, the condition is reevaluated and rated on any symptoms under the renal rating system. The minimum rating for this condition is 30%.

Code 7532: Any renal tubular condition is rated under this code. The renal tubules are the tubes in the kidney that carry the urine through the filtering process. The minimum rating for a condition that has obvious symptoms is 20%.

Code 7533: Any cystic disease of the kidney is rated under this code. A cyst is a sac most often containing fluid that can grow anywhere in the body. Many do not cause problems, but some can seriously affect the functioning of the organs.

Code 7534: Atherosclerotic renal disease (also known as renal artery stenosis or atheroembolic renal disease) is a condition where the artery to the kidney narrows and decreases the blood flow to the kidney.

Code 7535: Toxic nephropathy is any damage to the kidney that is caused by any kind of chemical or biological product that enters the blood stream. These could include antibiotics, radiocontract agents, some medicines, heavy metals, and more.

Code 7536: Glomerulonephritis is a condition where the small blood vessels (glomeruli) in the kidney swell and are damaged. This results in poor filtering of the blood.

Code 7538: Papillary necrosis is a disorder where the papillae die. This can lead to kidney dysfunction or renal failure.

Code 7539: Renal amyloid disease is caused by the buildup of protein in the kidney, which may result in the kidney not being able to filter blood.

Code 7540: Disseminated intravascular coagulation with renal cortical necrosis, while it has an overwhelming name, is a pretty simple condition. Basically the kidney fails because of blood clots.

Code 7541: Renal Involvement in other conditions. So, if the kidneys are affected by conditions like sickle cell anemia, lupus, or diabetes, it can be rated separately from those conditions.

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Hydronephrosis

Code 7509: Hydronephrosis is a condition where the kidney swells because the exit for the urine is blocked. If the condition does not require a catheter to drain the fluid, then it is rated 10%. If there are regular attacks of renal colic and the use of a catheter is required, then it is rated 20%. If there are regular attacks of colic and an infection that affects the functioning of the kidney, then it is rated 30%. Any condition more severe than this is rated under the renal rating system.

The following conditions are rated as hydronephrosis unless otherwise specified. If they are rated on hydronephrosis, their final code will be an analogous code, and will look like this: 7510-7509. The first four-digit code defines the condition and the second four-digit code tells how it is rated.

Code 7508: Nephrolithiasis (also known as kidney stones) is the presence of stones in the kidney or ureter. These stones block the flow of urine through the tubes. This condition is rated as hydronephrosis unless stones are repeatedly formed and it requires either drug therapy, diet therapy, or removal surgeries or procedures 3 or more times each year. If this is the case, it is rated 30%. Otherwise, rate as hydronephrosis.

Code 7510: Ureterolithiasis is the presence of stones in the ureter. These stones can block the flow of urine through the tubes. This condition is rated as hydronephrosis unless stones are repeatedly formed and it requires either drug therapy, diet therapy, or removal surgeries or procedures 3 or more times each year. If this is the case, it is rated 30%. Otherwise, rate as hydronephrosis.

Code 7511: A ureteral stricture is the narrowing of the ureters that blocks the flow of urine through these tubes to the bladder. This condition is rated as hydronephrosis.

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The Penis and Testes

Additional compensation is given by the VA for the loss of or loss of use of reproductive organs. See the Special Monthly Compensation to see if your condition qualifies.

Code 7520: If half or more of the penis is removed, then it is rated 30%. This condition can also be rated under the urinary rating system if that can result in a higher rating than 30%.

Code 7521: If the glans is removed, it is rated 20%. This condition can also be rated under the urinary rating system if that can result in a higher rating than 20%.

Code 7522: If the penis is deformed and cannot erect, then it is rated 20%.

Code 7523: Atrophy of the testicles is when they shrink and become nonfunctional. If one testicle is atrophied, then it is rated 0%. If both testicles are atrophied, then it is rated 20%.

Code 7524: If both testicles are removed, it is rated 30%. If only one testicle is removed, it is rated 0%. There are a few conditions for this code. If the testicle was removed because it was not fully developed or did not descend, then it is not ratable since this is a pre-existing condition and not directly related to military service. If the testicle had to be removed because of an injury or condition that is related to military service, and the remaining testicle is not functioning (whether or not it is related to service), it is rated 30%.

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Cancer and Tumors of the Genitourinary System

Cancer is the growth of abnormal cells. These cells can be benign—they do not destroy the good cells around them—or they can be malignant—they destroy the cells around them.

Code 7529: Benign tumors affecting the genitourinary system are rated based on how they affect the systems around them. For example, if the condition interferes with renal functioning, then it would be rated under the renal rating system.

Code 7528: Malignant cancer is rated 100% while it is active. This 100% rating will continue for the first 6 months after the last treatment. The condition will then be reevaluated. If it is no longer active, then it is rated on any lasting symptoms like a benign condition.

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Genitourinary Tuberculosis

Code 7505: Tuberculosis of the kidney is rated 100% while it is active. This 100% rating will continue for 1 year, after which the condition will be reexamined and rated based on the lasting symptoms or complications. These lasting symptoms are rated based on the renal rating system.

Code 7525: A tuberculosis infection causing epididymo-orchitis is rated 100% while the infection is active. This 100% rating will continue for 1 year, after which the condition will be reexamined and rated based on the lasting symptoms or complications. These lasting symptoms are rated based on the ratings for a urinary tract infection.

For more information on tuberculosis, please see the Tuberculosis page.

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Other Genitourinary Conditions

All other genitourinary system conditions will be rated analogously (see the Analogous and Equivalent Codes page) with the above ratings. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

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DBQs for Genitourinary Conditions

Here are the Disability Benefits Questionnaires (DBQs) used for genitourinary conditions: Kidney Conditions DBQ, Male Reproductive DBQ, Prostate Cancer DBQ, and Urinary Tract DBQ.

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Principles that Apply

Special Monthly Compensation: The loss of or loss of use of a reproductive organ may qualify for the VA’s Special Monthly Compensation.

Pyramiding: A single condition can only be rated once! However, if another condition exists that is additional to the genitourinary system condition (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the VASRD Principles page for further guidance.

For conditions of the cardiovascular system, please see The Heart, The Arteries and Veins, and The Blood pages.

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