Body system: Genitourinary SystemRegulation: 38 CFR § 4.115b
Chronic pyelonephritis is long-term, recurrent kidney infection that produces permanent scarring of the kidney tissue and progressive loss of function over time. It typically results from repeated or inadequately treated acute pyelonephritis, often with underlying structural urinary tract abnormalities or vesicoureteral reflux. The VA rates this condition under whichever rating ladder produces the higher evaluation when applied to the predominant disability: renal dysfunction (38 CFR § 4.115a) when kidney function loss dominates the picture (0/30/60/80/100%), or urinary tract infection (0/10/30%) when recurrent symptomatic infections dominate. The 30% and 0% tiers can be reached through either ladder; 60%, 80%, and 100% are renal-only.
Rating levels
- 100% — You qualify for 100% when the kidney damage from pyelonephritis is the predominant disability and has progressed to end-stage renal disease — GFR under 15 mL/min/1.73 m² sustained for at least 3 consecutive months in the past year, OR routine dialysis dependence, OR transplant eligibility. Any one of these qualifies.
- 80% — You qualify for 80% when kidney damage is predominant and has progressed to Stage 4 CKD — GFR 15-29 mL/min/1.73 m² sustained for 3+ consecutive months in the past year.
- 60% — You qualify for 60% when kidney damage is predominant and has progressed to Stage 3b CKD — GFR 30-44 mL/min/1.73 m² sustained for 3+ consecutive months in the past year.
- 30% — You qualify for 30% if EITHER (a) kidney damage is predominant with Stage 3a CKD — GFR 45-59 mL/min/1.73 m² sustained for 3+ consecutive months — OR (b) recurrent UTI symptoms predominate, requiring a urinary drainage device (ureteral stent or nephrostomy tube), more than 2 hospitalizations per year, or continuous intensive management. The VA picks whichever pathway applies; if both could apply, the predominant disability wins.
- 10% — You qualify for 10% if recurrent UTI symptoms predominate and require 1-2 hospitalizations per year, OR continuous suppressive antibiotic therapy for 6+ months. This tier only applies when UTI symptoms are the predominant disability — there is no equivalent renal-dysfunction criteria at 10%.
- 0% — You qualify for 0% if EITHER (a) you have Stage 2 CKD (GFR 60-89) plus one renal-dysfunction marker (urinary casts, structural abnormalities, or proteinuria ≥30 mg/g) sustained for 3+ consecutive months, OR (b) recurrent UTI symptoms predominate but have not required hospitalization, requiring suppressive antibiotic therapy for less than 6 months. The condition is recognized as service-connected but is not currently producing compensable disability.