Kidneys & Urinary — VA Disability Ratings

How Kidneys & Urinary conditions are rated

The genitourinary schedule is built differently from most of the rating system. Instead of giving each diagnosis its own table, many codes in 38 CFR §4.115b send the rater to shared formulas in §4.115a, with lines such as "Rate as renal dysfunction," "Rate as voiding dysfunction," or "whichever is predominant." Most of this schedule comes down to those formulas.

§4.115a describes three areas of dysfunction: renal dysfunction, voiding dysfunction, and urinary tract infection. Voiding dysfunction carries the instruction to "rate particular condition as urine leakage, frequency, or obstructed voiding." Where a code refers the rater to these areas, "only the predominant area of dysfunction shall be considered for rating purposes." Distinct disabilities may still be evaluated separately, pursuant to §4.14, "if the symptoms do not overlap," and because the areas do not cover every symptom, some diagnoses carry criteria of their own.

Renal dysfunction is rated on glomerular filtration rate (GFR), in mL/min/1.73 m2. Chronic kidney disease with GFR from 45 to 59 is rated 30%, from 30 to 44 is 60%, and from 15 to 29 is 80%, each "for at least 3 consecutive months during the past 12 months." 100% applies to GFR below 15 over that period, to regular routine dialysis, or to an "eligible kidney transplant recipient." A 0% level covers GFR from 60 to 89 with recurrent casts, structural kidney abnormalities, or an albumin/creatinine ratio of 30 mg/g or more. A note accepts estimated GFR and creatinine-based approximations when "determined to be appropriate and calculated by a medical professional." Because the GFR levels need three consecutive months, a run of dated lab results can matter more than a single reading.

The other formulas turn on things that can be counted. Leakage and incontinence are rated by absorbent materials: 20% when changed less than 2 times a day, 40% at 2 to 4 times, and 60% at more than 4 times or when an appliance is required. Urinary frequency is rated by the daytime voiding interval or nighttime awakenings to void, from 10% (an interval between two and three hours, or two awakenings) to 40% (less than one hour, or five or more). Obstructed voiding reaches 30% for retention requiring catheterization. Urinary tract infection is rated 0%, 10% or 30% on hospitalizations, drainage, and suppressive drug therapy; where renal function is poor, it is rated as renal dysfunction instead.

§4.115 adds a rule about the heart. 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." Two exceptions are printed: when absence of a kidney is the sole renal disability, and when chronic renal disease requires regular dialysis, any hypertension or heart disease is rated separately.

A few codes set floors or timed ratings of their own. Removal of one kidney carries a 30% minimum under DC 7500. Malignant neoplasms (DC 7528) are rated 100%, with a mandatory VA examination six months after treatment ends and any change subject to §3.105(e). A kidney transplant (DC 7531) is rated 100% from hospital admission, with an examination one year after discharge and a 30% minimum thereafter. And a note at the top of §4.115b directs the rater to §3.350 on special monthly compensation whenever a claim involves "loss or loss of use of one or more creative organs."