Department of Veterans Affairs § 4.115B

Department of Veterans Affairs § 4.115b

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Renal dysfunction: Long-term drug therapy, 1–2 hospitalizations per Requiring regular dialysis, or precluding more year and/or requiring intermittent intensive than sedentary activity from one of the fol- management ...... 10 lowing: persistent edema and albuminuria; or, BUN more than 80mg%; or, creatinine more than 8mg%; or, markedly decreased function [59 FR 2527, Jan. 18, 1994; 59 FR 10676, Mar. 7, of kidney or other organ systems, estpecially 1994] cardiovascular ...... 100 Persistent edema and albuminuria with BUN 40 § 4.115b Ratings of the genitourinary to 80mg%; or, creatinine 4 to 8mg%; or, gen- system—diagnoses. eralized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion ...... 80 Rat- Constant albuminuria with some edema; or, defi- ing nite decrease in kidney function; or, hypertension at least 40 percent disabling under di- Note: When evaluating any agnostic code 7101 ...... 60 claim involving loss or loss Albumin constant or recurring with hyaline and of use of one or more cre- granular casts or red blood cells; or, transient ative organs, refer to § 3.350 or slight edema or hypertension at least 10 percent disabling under diagnostic code 7101 30 of this chapter to determine Albumin and casts with history of acute nephritis; whether the veteran may be or, hypertension non-compensable under diag- entitled to special monthly nostic code 7101 ...... 0 compensation. Footnotes in Voiding dysfunction: the schedule indicate condi- Rate particular condition as urine leakage, fre- tions which potentially estab- quency, or obstructed voiding lish entitlement to special Continual Urine Leakage, Post Surgical Urinary monthly compensation; how- Diversion, Urinary Incontinence, or Stress In- ever, there are other condi- continence: tions in this section which Requiring the use of an appliance or the wearing under certain circumstances of absorbent materials which must be changed more than 4 times per day ...... 60 also establish entitlement to Requiring the wearing of absorbent materials special monthly compensa- which must be changed 2 to 4 times per day .. 40 tion. Requiring the wearing of absorbent materials 7500 Kidney, removal of one: which must be changed less than 2 times per day ...... 20 Minimum evaluation ...... 30 Urinary frequency: Or rate as renal dysfunction if Daytime voiding interval less than one hour, or; there is nephritis, infection, awakening to void five or more times per night 40 or pathology of the other. Daytime voiding interval between one and two 7501 Kidney, abscess of: hours, or; awakening to void three to four Rate as urinary tract infection ...... times per night ...... 20 Daytime voiding interval between two and three hours, or; awakening to void two times per night ...... 10 Obstructed voiding: Urinary retention requiring intermittent or continuous catheterization ...... 30 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 sec- ondary to obstruction. 4. Stricture disease requiring periodic dilatation every 2 to 3 months ...... 10 Obstructive symptomatology with or without stricture disease requiring dilatation 1 to 2 times per year ...... 0 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 management ...... 30

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7502 Nephritis, chronic: 7512 Cystitis, chronic, includes interstitial Rate as renal dysfunction. and all etiologies, infectious and non-in- 7504 Pyelonephritis, chronic: fectious: Rate as renal dysfunction or Rate as voiding dysfunction. urinary tract infection, which- 7515 Bladder, calculus in, with symptoms ever is predominant. interfering with function: 7505 Kidney, tuberculosis of: Rate as voiding dysfunction Rate in accordance with 7516 Bladder, fistula of: §§ 4.88b or 4.89, whichever Rate as voiding dysfunction or is appropriate. urinary tract infection, which- 7507 Nephrosclerosis, arteriolar: ever is predominant. Rate according to predominant Postoperative, suprapubic symptoms as renal dysfunc- cystotomy ...... 100 tion, hypertension or heart 7517 Bladder, injury of: disease. If rated under the Rate as voiding dysfunction. cardiovascular schedule, 7518 Urethra, stricture of: however, the percentage rat- Rate as voiding dysfunction. ing which would otherwise 7519 Urethra, fistual of: be assigned will be elevated Rate as voiding dysfunction. to the next higher evaluation. Multiple urethroperineal fistulae 100 7508 Nephrolithiasis: 7520 Penis, removal of half or more ...... 30 Rate as hydronephrosis, ex- Or rate as voiding dysfunction. cept for recurrent stone for- 7521 Penis removal of glans ...... 20 mation requiring one or more Or rate as voiding dysfunction. of the following: 7522 Penis, deformity, with loss of erectile 1. diet therapy power—20 1. 2. drug therapy 7523 Testis, atrophy complete:. 3. invasive or non-invasive Both—20 1 procedures more than One—0 1 two times/year ...... 30 7524 Testis, removal:. 7509 Hydronephrosis: Both—30 1 Severe; Rate as renal dysfunc- 1 tion. One—0 Frequent attacks of colic with infec- Note: In cases of the removal tion (pyonephrosis), kidney func- of one testis as the result of tion impaired ...... 30 a service-incurred injury or Frequent attacks of colic, requiring disease, other than an catheter drainage ...... 20 undescended or congenitally Only an occasional attack of colic, undeveloped testis, with the not infected and not requiring absence or nonfunctioning of catheter drainage ...... 10 the other testis unrelated to 7510 Ureterolithiasis: service, an evaluation of 30 Rate as hydronephrosis, ex- percent will be assigned for cept for recurrent stone for- the service-connected testic- mation requiring one or more ular loss. Testis, of the following: underscended, or congeni- 1. diet therapy tally undeveloped is not a 2. drug therapy ratable disability. 3. invasive or non-invasive 7525 Epididymo-orchitis, chronic only: procedures more than Rate as urinary tract infection. two times/year ...... 30 For tubercular infections: Rate 7511 Ureter, stricture of: in accordance with §§ 4.88b Rate as hydronephrosis, ex- or 4.89, whichever is appro- cept for recurrent stone for- priate. mation requiring one or more 7527 Prostate gland injuries, infections, hy- of the following: pertrophy, postoperative residuals: 1. diet therapy Rate as voiding dysfunction or 2. drug therapy urinary tract infection, which- 3. invasive or non-invasive ever is predominant. procedures more than 7528 Malignant neoplasms of the genito- two times/year ...... 30 urinary system ...... 100

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Note—Following the cessation Or rate as renal dysfunction. of surgical, X-ray, 7533 Cystic diseases of the kidneys (poly- antineoplastic chemotherapy cystic disease, uremic medullary cystic or other therapeutic proce- disease, Medullary sponge kidney, and dure, the rating of 100 per- similar conditions): cent shall continue with a Rate as renal dysfunction. mandatory VA examination 7534 Atherosclerotic renal disease (renal at the expiration of six artery stenosis or atheroembolic renal dis- months. Any change in eval- ease): uation based upon that or Rate as renal dysfunction. any subsequent examination 7535 Toxic nephropathy (antibotics, shall be subject to the provi- radiocontrast agents, nonsteroidal anti-in- sions of § 3.105(e) of this flammatory agents, heavy metals, and chapter. If there has been no similar agents): local reoccurrence or metas- tasis, rate on residuals as Rate as renal dysfunction. voiding dysfunction or renal 7536 Glomerulonephritis: dysfunction, whichever is Rate as renal dysfunction. predominant. 7537 Interstitial nephritis: 7529 Benign neoplasms of the genito- Rate as renal dysfunction. urinary system: 7538 Papillary necrosis: Rate as voiding dysfunction or Rate as renal dysfunction. renal dysfunction, whichever 7539 Renal amyloid disease: is predominant. Rate as renal dysfunction. 7530 Chronic renal disease requiring reg- 7540 Disseminated intravascular coagula- ular dialysis: tion with renal cortical necrosis: Rate as renal dysfunction. Rate as renal dysfunction. 7531 Kidney transplant: 7541 Renal involvement in diabetes Following transplant surgery .... 100 mellitus, sickle cell anemia, systemic Thereafter: Rate on residuals lupus erythematosus, vasculitis, or other as renal dysfunction, min- systemic disease processes. imum rating ...... 30 Rate as renal dysfunction. Note—The 100 percent eval- 7542 Neurogenic bladder: uation shall be assigned as Rate as voiding dysfunction. of the date of hospital ad- mission for transplant sur- 1 Review for entitlement to special monthly com- gery and shall continue with pensation under § 3.350 of this chapter. a mandatory VA examination one year following hospital [59 FR 2527, Jan. 18, 1994; 59 FR 14567, Mar. 29, discharge. Any change in 1994, as amended at 59 FR 46339, Sept. 8, 1994] 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 condition ...... 20

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GYNECOLOGICAL CONDITIONS AND Rating DISORDERS OF THE BREAST Vaginal fecal leakage one to three times per week requiring wearing of pad ...... 30 § 4.116 Schedule of ratings—gyneco- Vaginal fecal leakage less than once a logical conditions and disorders of week ...... 10 the breast. Without leakage ...... 0 7625 Fistula, urethrovaginal: Rating Multiple urethrovaginal fistulae ...... 100 Note 1: Natural menopause, primary Requiring the use of an appliance or the amenorrhea, and pregnancy and child- wearing of absorbent materials which birth are not disabilities for rating pur- must be changed more than four times poses. Chronic residuals of medical or per day ...... 60 surgical complications of pregnancy may Requiring the wearing of absorbent mate- be disabilities for rating purposes. rials which must be changed two to four Note 2: When evaluating any claim involv- times per day ...... 40 ing loss or loss of use of one or more Requiring the wearing of absorbent mate- creative organs or anatomical loss of rials which must be changed less than one or both breasts, refer to § 3.350 of two times per day ...... 20 this chapter to determine whether the 7626 Breast, surgery of: veteran may be entitled to special Following radical mastectomy: monthly compensation. Footnotes in the Both ...... 180 schedule indicate conditions which po- One ...... 150 tentially establish entitlement to special Following modified radical mastectomy: monthly compensation; however, almost 1 any condition in this section might, under Both ...... 60 certain circumstances, establish entitle- One ...... 140 ment to special monthly compensation. Following simple mastectomy or wide local 7610 Vulva, disease or injury of (including excision with significant alteration of size vulvovaginitis). or form: 7611 Vagina, disease or injury of. Both ...... 150 7612 Cervix, disease or injury of. One ...... 130 7613 Uterus, disease, injury, or adhesions of. Following wide local excision without sig- 7614 Fallopian tube, disease, injury, or adhesions nificant alteration of size or form: of (including pelvic inflammatory disease (PID)). Both or one ...... 0 7615 Ovary, disease, injury, or adhesions of. General Rating Formula for Disease, Injury, or Ad- Note: For VA purposes: hesions of Female Reproductive Organs (diag- (1) Radical mastectomy means nostic codes 7610 through 7615): removal of the entire breast, un- Symptoms not controlled by continuous derlying pectoral muscles, and treatment ...... 30 regional lymph nodes up to the Symptoms that require continuous treat- coracoclavicular ligament.. ment ...... 10 (2) Modified radical mastectomy Symptoms that do not require continuous means removal of the entire treatment ...... 0 breast and axillary lymph nodes 7617 Uterus and both ovaries, removal of, com- (in continuity with the breast). plete: Pectoral muscles are left intact.. For three months after removal ...... 1 100 (3) Simple (or total) mastectomy Thereafter ...... 1 50 means removal of all of the 7618 Uterus, removal of, including corpus: breast tissue, nipple, and a For three months after removal ...... 1 100 small portion of the overlying Thereafter ...... 1 30 skin, but lymph nodes and mus- 7619 Ovary, removal of: cles are left intact.. For three months after removal ...... 1 100 (4) Wide local excision (including Thereafter: partial mastectomy, Complete removal of both ovaries 1 30 lumpectomy, tylectomy, Removal of one with or without segmentectomy, and partial removal of the other ...... 1 0 quadrantectomy) means re- 7620 Ovaries, atrophy of both, complete ...... 1 20 moval of a portion of the breast 7621 Uterus, prolapse: tissue.. Complete, through vagina and introitus ...... 50 7627 Malignant neoplasms of gynecological sys- Incomplete ...... 30 tem or breast ...... 100 7622 Uterus, displacement of: With marked displacement and frequent or continuous menstrual disturbances ...... 30 With adhesions and irregular menstruation 10 7623 Pregnancy, surgical complications of: With rectocele or cystocele ...... 50 With relaxation of perineum ...... 10 7624 Fistula, rectovaginal: Vaginal fecal leakage at least once a day requiring wearing of pad ...... 100 Vaginal fecal leakage four or more times per week, but less than daily, requiring wearing of pad ...... 60

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