Urethral Stricture — VA Disability Rating (DC 7518)

Diagnostic Code 7518 · 38 CFR §4.115b

What Is It?

A urethral stricture is a narrowing of the tube that carries urine out of the bladder, caused by scar tissue. In veterans the usual histories are straddle injuries and pelvic trauma, catheterization during a hospitalization or surgery, instrumentation after a urologic procedure, and infection, particularly gonorrhea or chlamydia that was treated late. The stream weakens, starting takes longer, the bladder never quite empties, infections recur, and eventually the bladder muscle itself thickens from pushing against the resistance. Treatment runs from periodic dilation to internal urethrotomy to formal urethroplasty, and recurrence is common. Under 38 CFR §4.115b, DC 7518 has no percentages. The entry is the instruction to rate as voiding dysfunction, and 38 CFR §4.115a opens that section by directing that the particular condition be rated as urine leakage, frequency, or obstructed voiding. For a stricture the obstructed voiding formula is usually the fit, and it is unusually specific: the 10 percent level requires marked obstructive symptomatology together with at least one of four named findings, and the 0 percent level is defined by needing dilatation one to two times a year. Those findings are objective tests, which means the difference between 0 and 10 percent is often a matter of whether anybody ordered the right study before your examination.

Rating Criteria

Evidence Needed

Three objective tests decide most of these claims, and each maps onto a named criterion. A post-void residual measurement, done by bladder ultrasound or catheter, establishes whether you retain more than 150 cc. Uroflowmetry gives the peak flow rate, where less than 10 cc/sec is the stated threshold. A retrograde urethrogram or cystoscopy documents the stricture itself with its location and length. Beyond the tests, the treatment interval is a criterion in its own right: dilatation every two to three months meets the 10 percent level while dilatation one to two times a year sits at 0 percent, so the dates of every dilation matter and should be listed. Add culture-positive urinary infections attributable to obstruction, the operative reports for any urethrotomy or urethroplasty, and, if incontinence followed surgery, a pad count.

C&P Exam Tips

Ask directly whether a post-void residual and uroflowmetry are being done as part of the examination. Those two numbers are written into the 10 percent criterion and a general examination often skips both, which leaves an obstructed veteran documented at 0 percent. Bring the dates of every dilation you have had, since periodic dilatation every 2 to 3 months is itself a qualifying finding. Describe the stream in the regulation's own words if they are true for you: hesitancy, slow or weak stream, decreased force of stream. Say how long it takes to start and to finish, whether you strain, whether you have to go again shortly after finishing, and whether you have had to be catheterized in an emergency room for retention. If surgery left you leaking, count your pads and say the number.

How to File

File on VA Form 21-526EZ naming urethral stricture under DC 7518 and ask for evaluation under the voiding dysfunction criteria of 38 CFR §4.115a, specifying that you want all three formulas considered. Attach the post-void residual, the uroflowmetry, the urethrogram or cystoscopy, a dated list of every dilation, culture results for infections, and any operative reports. If the stricture followed catheterization during service, a documented straddle or pelvic injury, or an infection treated in service, cite those records by date. If it followed treatment for an already service-connected condition, file it as secondary under 38 CFR §3.310. Claim recurrent infections, incontinence, and erectile dysfunction as separate issues.

Common Mistakes

The biggest mistake is walking into the examination without a post-void residual or a uroflowmetry result. Both are named findings in the 10 percent criterion, both are quick to perform, and neither happens automatically. The second is not tracking dilation dates, since the frequency of dilatation is itself a criterion and the difference between twice a year and every two to three months is the difference between 0 and 10 percent. The third is accepting the obstructed voiding formula when another one now pays more, which happens often after urethroplasty leaves incontinence — the leakage formula reaches 60 percent while obstruction stops at 30. The fourth is not claiming what the obstruction caused upstream, particularly recurrent infection and, in long-standing cases, kidney impairment.

Frequently Asked Questions

What are the four findings in the 10 percent criterion?

The obstructed voiding criteria require marked obstructive symptomatology — hesitancy, slow or weak stream, decreased force of stream — plus any one or combination of the following: post void residuals greater than 150 cc; uroflowmetry showing a markedly diminished peak flow rate of less than 10 cc/sec; recurrent urinary tract infections secondary to obstruction; or stricture disease requiring periodic dilatation every 2 to 3 months. You need only one of the four. Knowing that turns a vague symptom complaint into a specific evidentiary target.

Can a urethral stricture be rated higher than 30 percent?

Yes, through a different formula. Obstructed voiding is capped at 30 percent for urinary retention requiring intermittent or continuous catheterization. But DC 7518 says to rate as voiding dysfunction generally, and the leakage formula runs to 60 percent for an appliance or absorbent materials changed more than four times per day. Veterans who develop incontinence after urethroplasty or sphincter injury are frequently evaluated under the wrong formula, so if your problem has shifted from getting urine out to keeping it in, say so and ask for the leakage criteria.

How does dilation frequency affect the rating?

It is a criterion by itself. Requiring dilatation 1 to 2 times per year is the 0 percent level. Stricture disease requiring periodic dilatation every 2 to 3 months is one of the four findings that, with marked obstructive symptoms, meets 10 percent. Keep a list of every dilation with its date, and ask urology to record the planned interval in the chart, because a decision made on a chart that shows two dilations with no stated schedule tends to default to the lower level.

My stricture came from a catheter during a service hospitalization. Does that work?

Yes, and catheter-related stricture is a recognized mechanism. What you need is the record showing the catheterization and its duration, the current urologic documentation of the stricture and its location, and a medical opinion stating that it is at least as likely as not that the instrumentation caused the scarring. Bulbar strictures in particular are associated with catheterization and with straddle injury, and a urologist willing to say so with reasoning tied to your own history is what makes the opinion adequate.

Does surgery to fix the stricture end the claim?

No, and it often changes what should be claimed. Urethroplasty has a good success rate but strictures recur, and surgery in that area can leave incontinence, changed ejaculation, penile curvature, or erectile dysfunction. File for the residuals after surgery rather than assuming the condition is resolved, and if you are now leaking, ask for evaluation under the urine leakage criteria, which reach higher than the obstruction criteria you were probably rated under before.