BLADDER DISEASE OF

Summary

The Veteran, a Veteran who served from July 1965 to July 1968 and again from February 1991 to September 1991, including service in Vietnam, was granted a 60 percent rating for residuals of prostate cancer with bladder dysfunction. The appeal concerned the period from December 1, 2013, to February 11, 2021, following a reduction in his disability rating. The Board found that the Veteran's claim for an increased rating was supported by his credible testimony in an October 2013 correspondence, which indicated he required absorbent materials changed more than four times daily. This testimony was corroborated by subsequent VA treatment records from February and August 2015, which also noted his endorsement of voiding dysfunction and prescription of absorbent materials. The Board concluded that this evidence warranted a 60 percent rating for bladder dysfunction, applying the benefit of the doubt in the Veteran's favor. The decision specifically addressed the period prior to February 11, 2021, as the higher rating from that date forward was not contested. The Board noted that the Veteran's prostate cancer residuals were rated based on bladder dysfunction under Diagnostic Code 7542, with the 60 percent rating reflecting the need for absorbent materials changed more than four times daily.

Rationale

Credible testimony corroborated by subsequent VA treatment records; Benefit of the doubt applied; 60 percent rating warranted for bladder dysfunction

Full Decision Text

Citation Nr: 26001459
Decision Date: 01/30/26	Archive Date: 01/30/26

DOCKET NO. 16-17 493
DATE: January 30, 2026

ORDER

Entitlement to a 60 percent rating for residuals of prostate cancer from December 1, 2013, to February 11, 2021, is granted.  

FINDING OF FACT

Granting the Veteran the benefit of the doubt, he was shown to have required the use of absorbent materials that needed changing more than four times per day for the entirety of the period from December 1, 2013, to February 11, 2021.

CONCLUSION OF LAW

The criteria for an initial 60 percent rating for prostate cancer residuals manifested by bladder dysfunction from December 1, 2013, to February 11, 2021, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.115a, 4.115b, Diagnostic Code 7542.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from July 1965 to July 1968, and from February 1991 to September 1991, to include service in the Republic of Vietnam during the Vietnam War era.  He died March 2024, and the appellant is his surviving spouse, who has been properly substituted in his stead to continue those extant claims still before VA at the time of his passing; this of course includes the current appeal. 

The matter of entitlement to an increased rating for prostate cancer residuals was previously before the Board in December 2023, whereupon the Board denied entitlement to a rating in excess of 10 percent for the condition prior to February 11, 2021, and in excess of 60 percent thereafter.  After the Veteran's passing and the confirmation of the appellant's substitution, she appealed the matter to the United States Court of Appeals for Veterans Claims (Court).  In a September 2025 Joint Motion for Partial Remand, the Court vacated only the denial of a rating in excess of 10 percent for the prostate cancer residuals prior to February 11, 2021.  Specifically, the Court found fault with the Board's failure to consider evidence potentially suggesting that the Veteran's symptoms were more severe than what is encompassed by the 10 percent rating in effect prior to February 11, 2021.  

Of note, the Court explicitly did not address the issue of entitlement to a rating in excess of 60 percent for prostate cancer residuals from February 11, 2021, as the appellant did not contest this portion of the December 2023 decision.  To that end, the Court did not address the potential entitlement to benefits ancillary to the increased rating claim, to specifically include any question of entitlement to a total disability rating based on individual unemployability as due to service connected disabilities (TDIU).  As such, the Board will restrict its analysis in the current decision solely to the question of entitlement to a rating in excess of 10 percent for the prostate cancer residual condition for the period prior to February 11, 2021.  

The Veteran was service connected for bladder dysfunction at the time of his death, as a residual of his prostate cancer.  

Initially, the Veteran was assigned a 100 percent rating for the condition pursuant to 38 C.F.R. § 4.115a, Diagnostic Code 7528, which allows for a total rating for malignant neoplasms of the genitourinary system.  Following cessation of surgical, x-ray, antineoplastic chemotherapy, or other therapeutic procedure, the 100 percent rating shall continue with a mandatory VA examination at the expiration of six months.  Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 C.F.R. § 3.105(e) of this chapter.  If there has been no local recurrence or metastasis, the disorder should be rated based on the residuals as voiding dysfunction or renal dysfunction, whichever is predominant.  38 C.F.R. § 4.115(b), Diagnostic Code 7528.  Only the predominant area of dysfunction shall be considered for rating purposes.  Because 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.  38 C.F.R. § 4.115a.

With this in mind, the Board highlights that in a September 2013 rating decision, the regional office reduced the rating for prostate cancer residuals from a total rating to 10 percent, effective December 1,
 recurrence or metastasis, the disorder should be rated based on the residuals as voiding dysfunction or renal dysfunction, whichever is predominant.  38 C.F.R. § 4.115(b), Diagnostic Code 7528.  Only the predominant area of dysfunction shall be considered for rating purposes.  Because 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.  38 C.F.R. § 4.115a.

With this in mind, the Board highlights that in a September 2013 rating decision, the regional office reduced the rating for prostate cancer residuals from a total rating to 10 percent, effective December 1, 2013.  The Veteran previously appealed this reduction, and it was affirmed in a final April 2019 Board decision.  As such, the propriety of the cessation of the total rating assigned for the prostate cancer residuals is not before the Board.  Thus, the only remaining question is whether he was entitled to a rating in excess of that 10 percent for the period from December 1, 2013, to February 11, 2021, when the rating was increased to 60 percent.  

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity.  Individual disabilities are assigned separate diagnostic codes.  See 38 U.S.C. § 1155; 38 C.F.R. § 4.1.  In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple ("staged") ratings may be assigned for different periods of time during the pendency of the appeal.  See generally Fenderson v. West, 12 Vet. App. 119 (1999).  Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings.  See Francisco v. Brown, 7 Vet. App. 55 (1994); 38 C.F.R. § 4.2.  Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings.

The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim.  See generally Hart v. Mansfield, 21 Vet. App. 505 (2007).  Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned.  See 38 C.F.R. § 4.7.

Effective December 1, 2013, the prostate cancer residuals are rated based on bladder dysfunction pursuant to 38 C.F.R. § 4.115a, Diagnostic Code 7542, which provides that voiding dysfunction is to be rated as urine leakage, frequency, or obstructed voiding.  Where diagnostic codes refer the decisionmaker to these specific areas of dysfunction, only the predominant area of dysfunction shall be considered for rating purposes.  Id. 

Urine leakage requiring the wearing of absorbent materials that must be changed less than 2 times per day warrants a 20 percent rating.  A 40 percent rating is warranted when the wearing of absorbent materials which must be changed 2 to 4 times per day is required.  A 60 percent rating is warranted where the use of an appliance or the wearing of absorbent materials that must be changed more than 4 times per day is required.  38 C.F.R. § 4.115a.

Urinary frequency involving a daytime voiding interval between two and three hours, or; awakening to void two times per night, warrants a 10 percent rating. Urinary frequency involving a daytime voiding interval between one and two hours, or; awakening to void three to four times per night, warrants a 20 percent rating.  A daytime voiding interval less than one hour, or; awakening to void five or more times per night, warrants a 40 percent rating.  Id.

For a rating based on obstructed voiding, a 0 percent rating requires obstructive symptomatology with or without stricture disease requiring periodic dilatation 1 to 2 times per year. A 10 percent rating requires 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 
inary frequency involving a daytime voiding interval between one and two hours, or; awakening to void three to four times per night, warrants a 20 percent rating.  A daytime voiding interval less than one hour, or; awakening to void five or more times per night, warrants a 40 percent rating.  Id.

For a rating based on obstructed voiding, a 0 percent rating requires obstructive symptomatology with or without stricture disease requiring periodic dilatation 1 to 2 times per year. A 10 percent rating requires 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 flow rate (less than 10 cc/second); (3) Recurrent urinary tract infections secondary to obstruction; (4) stricture disease requiring period dilation every two to three months. Urinary retention requiring intermittent or continuous catheterization warrants a 30 percent rating.  Id.

A review of available VA medical records confirm that the Veteran was diagnosed with prostate cancer via a biopsy performed in July 2011 at his local VA medical center.  Following radiotherapy and additional treatment, a June 2012 outpatient note shows that he was found to be cancer free.  

In a September 2012 VA examination, it was noted that the Veteran experienced voiding dysfunction as a direct result of treatment for his prostate cancer.  That being said, the examiner found no evidence that the voiding dysfunction caused urine leakage or required the use of an appliance.  The examiner did endorse symptoms of daytime voiding interval between 2 and 3 hours as well as nighttime awakening to void 2 times; additionally, the examiner found hesitancy as well as decreased force of stream that was markedly decreased. 

The Veteran was afforded a new VA examination in March 2013, wherein it was confirmed that the Veteran experienced voiding dysfunction as a residual of the prostate cancer.  Once more, however, the examiner found no evidence that the voiding dysfunction caused urine leakage or required the use of an appliance.  The examiner did endorse symptoms of daytime voiding interval between 2 and 3 hours as well as nighttime awakening to void 2 times; additionally, the examiner found that the Veteran exhibited hesitancy as well as decreased force of stream that was markedly decreased. 

On the basis of the two VA examinations, the regional office effectuated the reduction from 100 percent to 10 percent, pertaining to a daytime voiding interval between two and three hours as well as awakening to void two times per night, as reflected on both of the examinations.  However, the Board highlights that in an October 2013 correspondence, the Veteran asserted that he had to wear absorbent material which must be changed five times or more a day.  Thereafter, urology consultations at his local VA medical center dated in February 2015 and in August 2015 indicate that he endorsed experiencing voiding dysfunction and was prescribed the use of absorbent materials to avoid urine leakage.  

Given the Veteran's credible testimony in the October 2013 correspondence, which is corroborated by subsequent treatment records available in the claims file, the Board concludes that a 60 percent rating is warranted for prostate cancer residuals manifested by bladder dysfunction for the entirety of the period following the cessation of the total disability rating effective December 1, 2013.  Specifically, there is no indication from the record that the Veteran's bladder dysfunction was less severe at any point from December 1, 2013, and there is copious evidence showing that he required the use of absorbent materials for urinary incontinence throughout the appeal period. Therefore, granting the appellant the benefit of the doubt, the Board assigns a 60 percent rating for bladder dysfunction as a residual of prostate cancer for the entirety of the period from December 1, 2013, to February 11, 2021. This is considered a complete grant, as the appellant has never alleged renal dysfunction or fistula, the only bases for a higher evaluation, as due to this disability, and likewise the absence of a Brief on Appeal in this case is not prejudicial to the appellant.

 

A. C. MACKENZIE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Christopher M. Collins, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.