Title 38

SECTION 4.115a

4.115a Ratings of the genitourinary system - dysfunctions.

§ 4.115a Ratings of the genitourinary system - dysfunctions.

Diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these. The following section provides descriptions of various levels of disability in each of these symptom areas. Where diagnostic codes refer the decisionmaker to these specific areas dysfunction, only the predominant area of dysfunction shall be considered for rating purposes. Since the areas of dysfunction described below do not cover all symptoms resulting from genitourinary diseases, specific diagnoses may include a description of symptoms assigned to that diagnosis.

Renal dysfunction:
Requiring regular dialysis, or precluding more than sedentary activity from one of the following: persistent edema and albuminuria; or, BUN more than 80mg%; or, creatinine more than 8mg%; or, markedly decreased function of kidney or other organ systems, estpecially cardiovascular 100
Persistent edema and albuminuria with BUN 40 to 80mg%; or, creatinine 4 to 8mg%; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion 80
Constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under diagnostic code 7101 60
Albumin constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema or hypertension at least 10 percent disabling under diagnostic code 7101 30
Albumin and casts with history of acute nephritis; or, hypertension non-compensable under diagnostic code 7101 0
Voiding dysfunction:
Rate particular condition as urine leakage, frequency, or obstructed voiding
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 60
Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day 40
Requiring the wearing of absorbent materials which must be changed less than 2 times per day 20
Urinary frequency:
Daytime voiding interval less than one hour, or; awakening to void five or more times per night 40
Daytime voiding interval between one and two hours, or; awakening to void three to four 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 secondary 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
Urinary 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
Long-term drug therapy, 1-2 hospitalizations per year and/or requiring intermittent intensive management 10
[59 FR 2527, Jan. 18, 1994; 59 FR 10676, Mar. 7, 1994]