VA Disability Rating for Bladder Fistula (DC 7516)
Diagnostic Code 7516 · 38 CFR §4.115b
What Is It?
DC 7516 covers bladder fistula — an abnormal connection between the urinary bladder and another organ or the skin surface. These openings allow urine to leak into areas where it does not belong, such as the intestines, vagina, or through the abdominal wall. In veterans, fistulas may develop from combat injuries, surgical complications, radiation treatment, or chronic infections. The condition often causes persistent urinary leakage, infections, and significant quality of life impacts. Treatment may involve surgical repair, though some fistulas recur or cannot be fully corrected. 38 CFR 4.115b prints the code as "Bladder, fistula of" with one instruction, "Rate as voiding dysfunction or urinary tract infection, whichever is predominant," and one percentage of its own: 100 percent for "Postoperative, suprapubic cystotomy." Otherwise the claim goes to 38 CFR 4.115a, where voiding dysfunction is rated as urine leakage, frequency, or obstructed voiding, and only the predominant area of dysfunction is considered. Leakage reaches 60 percent, frequency 40 and obstructed voiding 30. The urinary tract infection formula stops at 30 percent, except that where infection has caused poor renal function, 4.115a says to rate it as renal dysfunction, whose rows run from 0 to 100 percent by kidney filtration (GFR).
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | Postoperative, suprapubic cystotomy. Or, urinary tract infection with poor renal function, rated as renal dysfunction: chronic kidney disease with GFR less than 15 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months; or requiring regular routine dialysis; or eligible kidney transplant recipient. |
| 80% | Urinary tract infection with poor renal function, rated as renal dysfunction: chronic kidney disease with GFR from 15 to 29 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. |
| 60% | Continual urine leakage, post surgical urinary diversion, urinary incontinence, or stress incontinence: requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day. Or, urinary tract infection with poor renal function, rated as renal dysfunction: chronic kidney disease with GFR from 30 to 44 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. |
| 40% | Urine leakage: requiring the wearing of absorbent materials which must be changed 2 to 4 times per day. Or, urinary frequency: daytime voiding interval less than one hour, or awakening to void five or more times per night. |
| 30% | Obstructed voiding: urinary retention requiring intermittent or continuous catheterization. Or, urinary tract infection: recurrent symptomatic infection requiring drainage by stent or nephrostomy tube, or requiring greater than 2 hospitalizations per year, or requiring continuous intensive management. Or, urinary tract infection with poor renal function, rated as renal dysfunction: chronic kidney disease with GFR from 45 to 59 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. |
| 20% | Urine leakage: requiring the wearing of absorbent materials which must be changed less than 2 times per day. Or, urinary frequency: daytime voiding interval between one and two hours, or awakening to void three to four times per night. |
| 10% | Urinary frequency: daytime voiding interval between two and three hours, or awakening to void two times per night. Or, obstructed voiding: 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 (less than 10 cc/sec), recurrent urinary tract infections secondary to obstruction, or stricture disease requiring periodic dilatation every 2 to 3 months. Or, urinary tract infection: recurrent symptomatic infection requiring 1-2 hospitalizations per year or suppressive drug therapy lasting six months or longer. |
| 0% | Obstructed voiding: obstructive symptomatology with or without stricture disease requiring dilatation 1 to 2 times per year. Or, urinary tract infection: recurrent symptomatic infection not requiring hospitalization, but requiring suppressive drug therapy for less than 6 months. Or, urinary tract infection with poor renal function, rated as renal dysfunction: GFR from 60 to 89 mL/min/1.73 m2 together with recurrent red blood cell, white blood cell or granular casts, structural kidney abnormalities (cystic, obstructive, or glomerular), or an albumin/creatinine ratio of 30 mg/g or more, for at least 3 consecutive months during the past 12 months. |
Evidence Needed
- Imaging or cystoscopy reports confirming the presence and location of the fistula
- Surgical records if repair has been attempted, including any operative report for a suprapubic cystotomy
- Documentation of urinary leakage frequency and absorbent material usage
- A voiding diary of daytime voiding intervals and night-time awakenings if frequency is the main problem
- Records of recurrent infections attributable to the fistula, with hospitalizations, drainage procedures and the length of any suppressive drug therapy
- GFR results over time if infection has affected kidney function
- Medical records connecting the fistula to an in-service event or condition
C&P Exam Tips
- Be specific about the amount and frequency of urinary leakage
- Document how many absorbent pads or materials you use and how often they are changed
- Say whether you need catheterization or an appliance, since those are named in the rating rows
- Describe any odor, skin irritation, or social limitations caused by the leakage
- Bring records of any surgical repair attempts and their outcomes
- Mention all infections that have resulted from the fistula
How to File
File under DC 7516 with imaging confirming the fistula, treatment records, and documentation of daily leakage patterns. If the fistula resulted from combat injury or military medical treatment, include those service records. A personal statement describing the daily impact is particularly important for this condition.
Common Mistakes
- Not documenting the daily volume and frequency of urinary leakage.
- Failing to track absorbent material usage with specificity.
- Not claiming skin conditions caused by chronic urine exposure separately.
- Overlooking the mental health impact of living with a bladder fistula.
Frequently Asked Questions
What types of bladder fistulas does the VA recognize?
38 CFR 4.115b prints DC 7516 simply as "Bladder, fistula of," without listing types. Common types include vesicovaginal (bladder to vagina), vesicointestinal (bladder to bowel), and vesicocutaneous (bladder to skin surface). Apart from the 100 percent row for postoperative suprapubic cystotomy, the rating follows the predominant dysfunction, voiding dysfunction or urinary tract infection, rather than the fistula type.
Can a fistula be fully repaired?
Some fistulas can be surgically repaired successfully, while others may recur or resist closure. If your fistula was repaired but you still have residual leakage, urinary frequency, obstructed voiding or recurrent infections, you may still qualify for a compensable rating. 38 CFR 4.115b says to rate DC 7516 as voiding dysfunction or urinary tract infection, whichever is predominant, and it prints no row for scarring; 38 CFR 4.118 is the schedule that rates scars.
How do I prove the daily impact of a bladder fistula?
Keep a daily log of leakage episodes, pad changes, and infections. Take photos of the supplies you use. Buddy statements from family members who can attest to the impact on your daily life are also valuable evidence for your claim.