Body system: Genitourinary SystemRegulation: 38 CFR § 4.115b
A bladder fistula is an abnormal channel connecting the bladder to another structure — most commonly the bowel (vesicocolic), vagina (vesicovaginal), skin (vesicocutaneous), or uterus. Causes include prior pelvic surgery, radiation, malignancy, inflammatory bowel disease, prolonged obstructed labor, or trauma. Symptoms range from continuous urine leakage to recurrent UTIs to pneumaturia. The VA assigns a 100% rating during the postoperative period following suprapubic cystotomy. Otherwise, 38 CFR § 4.115a directs raters to evaluate the condition under whichever ladder best fits the predominant residual symptom: voiding dysfunction (3 sub-formulas at 0-60%) or urinary tract infection (0/10/30%).
Rating levels
- 100% — You qualify for 100% during the postoperative period following a suprapubic cystotomy (surgical creation of an opening through the lower abdominal wall directly into the bladder for urinary drainage). This procedure is typically done to manage a bladder fistula or chronic obstruction. The 100% rating covers the immediate post-op recovery period; after recovery, the rating transitions to whichever ladder (voiding dysfunction or UTI) best matches the residual predominant symptom.
- 60% — You qualify for 60% under the urine leakage sub-formula if your bladder fistula causes leakage requiring a urinary collection appliance OR absorbent materials changed more than 4 times per day.
- 40% — You qualify for 40% under the urine leakage sub-formula if you wear absorbent materials and change them 2 to 4 times per day.
- 40% — You qualify for 40% under the frequency sub-formula if you urinate more than once per hour during the day, OR wake 5+ times per night.
- 30% — You qualify for 30% under the obstructed voiding sub-formula if the fistula causes urinary retention requiring intermittent self-catheterization or continuous indwelling catheter.
- 30% — You qualify for 30% under the UTI sub-formula if recurrent infection from the fistula requires a urinary drainage device, more than 2 hospitalizations per year, or continuous intensive management. Any one pathway qualifies.
- 20% — You qualify for 20% under the urine leakage sub-formula if absorbent material changes are fewer than 2 per day.
- 20% — You qualify for 20% under the frequency sub-formula with daytime intervals of 1-2 hours OR 3-4 nocturnal voids.
- 10% — You qualify for 10% under the frequency sub-formula with daytime intervals of 2-3 hours OR exactly 2 nocturnal voids.
- 10% — You qualify for 10% under the obstructed voiding sub-formula if marked obstructive symptoms are accompanied by any objective finding (PVR > 150 cc, peak flow < 10 cc/sec, recurrent UTIs from obstruction, or strictures requiring dilation every 2-3 months).
- 10% — You qualify for 10% under the UTI sub-formula with 1-2 hospitalizations per year for UTI, OR continuous suppressive antibiotic therapy for 6+ months.
- 0% — You qualify for 0% under the obstructed voiding sub-formula if obstructive symptoms only require dilation 1-2 times per year or no dilation. Recognized as service-connected but not currently producing compensable disability.
- 0% — You qualify for 0% under the UTI sub-formula if recurrent infections do not require hospitalization but do require suppressive antibiotic therapy for less than 6 months. Recognized as service-connected but not currently producing compensable disability.