Voiding Dysfunction — How the VA Rates Urinary Conditions

The VA rates many urinary conditions under the voiding dysfunction criteria in 38 CFR 4.115a. This includes conditions affecting the bladder, prostate, and urinary tract. Section 4.115a rates voiding dysfunction as urine leakage, urinary frequency, or obstructed voiding, and it says that only the predominant area of dysfunction shall be considered for rating purposes.

Urinary leakage (incontinence) ratings: requiring the wearing of absorbent materials that must be changed less than 2 times per day warrants 20%; requiring the wearing of absorbent materials that must be changed 2 to 4 times per day warrants 40%; requiring the use of an appliance or the wearing of absorbent materials that must be changed more than 4 times per day warrants 60%.

Urinary frequency ratings: daytime voiding interval between 2 and 3 hours, or awakening to void 2 times per night warrants 10%; daytime voiding interval between 1 and 2 hours, or awakening to void 3 to 4 times per night warrants 20%; daytime voiding interval less than 1 hour, or awakening to void 5 or more times per night warrants 40%.

Obstructed voiding ratings: obstructive symptomatology with or without stricture disease requiring dilatation 1 to 2 times per year warrants 0%; marked obstructive symptomatology (hesitancy, slow or weak stream, decreased force of stream) with any one or combination of post-void residuals greater than 150 cc, a markedly diminished peak flow rate on uroflowmetry (less than 10 cc/sec), recurrent urinary tract infections secondary to obstruction, or stricture disease requiring periodic dilatation every 2 to 3 months warrants 10%; urinary retention requiring intermittent or continuous catheterization warrants 30%.

Many veterans develop urinary conditions secondary to service-connected diabetes, prostate conditions, spinal cord conditions, or medications taken for other service-connected disabilities. When filing, clearly identify which service-connected condition causes the urinary symptoms and obtain a nexus opinion if the connection is not already documented.